Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics

doi:10.1016/0268-0033(89)90003-X

Clinical Biomechanics

Volume 4, Issue 4, November 1989, Pages 204-209

https://doi.org/10.1016/0268-0033(89)90003-X Get rights and content

Abstract

In the embalmed human pelvis, the connections between sacrum and fifth lumbar vertebra were spared together with most of the ligaments. The effect of load application to the sacrotuberous ligament was studied on rotation in the sacroiliac joint. It was shown that load application along the direction of hamstring and gluteus maximus muscles significantly diminished ventral rotation of the sacrum. The results imply that loading the sacrotuberous ligament restricts nutation of the sacrum. Consequently, muscles which attach to the sacrotuberous ligaments, such as the gluteus maximus, and in certain individuals the long head of the biceps, can dynamically influence movement and stability of the sacroiliac joints. The importance of sacrotuberous ligaments and sacroiliac joints as parts of the kinematic chain is emphasized.

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There are more references available in the full text version of this article.

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Prospective studies have described evidence about the risk of developing pregnancy-related pelvic girdle pain (PPGP) such as, parity, previous history of low back and pelvic girdle pain. No previous studies have prospectively associated PPGP with postural control.
This study aimed to identify postural control predictors of PPGP during pregnancy.
Forty-six pregnant women were surveyed throughout their pregnancy for the presence of PPGP. At baseline, participants were evaluated for muscle latencies, mediolateral centre-of-pressure (COP) displacement and velocity during single-leg lift performed with eyes open and closed. PPGP was considered if they presented with one positive clinical assessment as well as pain within the pelvic area.
Eighteen (45%) of the participants developed PPGP. This group presented with PPGP around a mean 29th week (SD = 5.7), with mean pelvic pain intensity of 4 mm VAS (SD = 2) on a (0–10 cm VAS) and mean PPGP questionnaire score of 21.5 points (SD = 10.6) out of a possible 100 points with 0 indicating no functional disability. The two factors that were significantly associated with PPGP were the right and left biceps femoris (BF) muscle. For every 50 ms of difference of BF muscles latency between eyes open and closed, the risk of PPGP increases by 20% (right BF) and 30% (left BF) to develop PPGP.
This study shows that BF muscle delay during single-leg lift presented at baseline was a significant predictor for the development of PPGP in late pregnancy.
The sacroiliac joint – Victim or culprit
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Citation Excerpt :
Sacral nutation results in an increase in the compressive forces across the SIJs as the posterior parts of the ilia approximate and an increase in the tension of the majority of the SIJ ligaments including the interosseous, short dorsal, sacrotuberous and sacroiliac ligaments [13]. In contrast to the sacrotuberous ligament, which increases in tension and therefore limits nutation [14,15], the long dorsal sacroiliac ligament increases in tension and limits counternutation [16]. It is theorised that tension in the long dorsal SI ligament also increases with tensioning of the ipsilateral sacrotuberous ligament and contraction of the erector spinae and muscles.
It is estimated that 10–30% of all low back pain is attributed to the sacroiliac joints. There are many challenges to diagnosing and treating the sacroiliac joints. Central to this challenge is determining whether the sacroiliac joint is the primary source of pain or dysfunction. This paper considers the complexities of diagnosis and management of sacroiliac joint dysfunction by providing a best evidence informed overview of the mechanics of the sacroiliac joint, the aetiology of sacroiliac joint dysfunction and the most current diagnostic strategies and management options for dysfunctions of these joints from a biopsychosocial perspective. This comprehensive chapter aims to shed light on the challenges of managing sport and exercise-related sacroiliac joint pain, and in so doing highlight the paucity of high quality research investigation of the joint, and the clinical uncertainty that is an unavoidable feature of addressing dysfunction of this joint.
The Ligaments of the Lumbar Spine
2019, Surgical Anatomy of the Lateral Transpsoas Approach to the Lumbar Spine
As with the other regions of the spine, the lumbar vertebrae rely on a robust collection of soft tissues to maintain their structural integrity during load bearing and movement. Of these soft tissues, the lumbar vertebral ligaments play a very important role. These highly specialized structures allow for extremes of movement while maintaining alignment of the spinal canal, intervertebral foramina, and intervertebral disks. Therefore, disruption of these structures can lead to significant neurological compromise. Spine surgeons need a detailed understanding of the anatomy of the lumbar spine ligaments.
Lumbar axial rotation kinematics in men with non-specific chronic low back pain
2019, Clinical Biomechanics
Lumbar flexion, coupled with rotation, is a dominant factor in the etiology and exacerbation of low back pain. Yet, no study has examined its kinematics in patients with non-specific chronic low back pain (NSCLBP). The aim of the study was to evaluate the lumbar rotation kinematics in neutral standing and with full flexion in men with NSCLBP.
ROM, average velocity, maximum velocity and maximal acceleration of lumbar rotation in neutral standing and with full flexion were measured using an industrial lumbar motion monitor in 50 men (25 with NSCLBP and 25 controls). VAS and Rolland Morris questionnaire were also included.
All examined kinematical parameters were significantly lower in men with NSCLBP compared with controls (↓ROM = 29%–45%; ↓AV = 40%–68%; ↓MV = 25%–50%; ↓MA = 20%–37%). Left rotation manifested smaller kinematic values (except for MA) than right rotation (Δ ROM = 35%; Δ AV = 66%; Δ MV = 19%) in NSCLBP. Most kinematical parameters significantly decreased from neutral standing to standing with flexion (right rotation: ↓ROM = 43%–45%, ↓AV = 38%–45%, ↓MV = 24%–27%, ↓MA for the NSCLBP group = 21%; left rotation: ↓ROM = 25%–38%, ↓AV in the control group: =34%, ↓MV in the control group: =23%, ↓MA in the control group = 25%). No correlations were found between all measured kinematical parameters, VAS and RMQ total score in the NSCLBP group.
The kinematic parameters of lumbar rotation were reduced in men with NSCLBP compared with controls both in neutral standing and with fully forward bending.
Most lumbar rotation kinematics decreased from neutral standing to standing with flexion.
The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis
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Citation Excerpt :
Such objective was formulated since previous studies using similar methodology (e.g. Jacob and Kissling, 1995; Smidt et al., 1995; Sturesson et al., 2000a, 2000b; Agarwal et al., 2014) did not address this issue. Moreover, for quite a long time extension of the innominate (SIJ nutation) has been regarded as the ‘position of stability’ (or close-packed position) protected by larger ligamentous guard, as opposed to flexion of the innominate (SIJ counternutation) limited only by the thin anterior ligamentous complex and long dorsal sacroiliac ligament (Vleeming et al., 1989a, 1989b, 1996). Findings of this study can be of importance in the debate whether local muscles indeed have a stabilizing function in contrast to other muscles of the trunk.
The role of so-called local muscle system in motor control of the lower back and pelvis is a subject of ongoing debate. Prevailing beliefs in stabilizing function of this system were recently challenged. This study investigated the impact of in vitro simulated force of transversely oriented fibres of the transversus abdominis muscle (a part of the local system) on flexibility of the sacroiliac joint during asymmetric moment application to the pelvis.
In 8 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixed contralateral innominate. Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion Capture System. Load–deformation curves were plotted and flexibility of the sacroiliac joint was calculated separately for anterior and posterior rotations of the innominate, with and without simulated muscle force.
Flexibility of the sacroiliac joint was significantly bigger during anterior rotation of the innominate, as compared to posterior rotation (Anova P < 0.05). After application of simulated force of transversus abdominis, flexibility of the joint did not change both during anterior and posterior rotations of the innominate.
A lack of a stiffening effect of simulated transversus abdominis force on the sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening influence of this muscle on the pelvis cannot be confirmed. Consistent with previous findings smaller flexibility of the joint recorded during posterior rotation of the innominate may be of clinical importance for physio- and manual therapists. However, major limitations of the study should be acknowledged: in vitro conditions and simulation of only solitary muscle force.
Hamstring Elongation Quantified Using Ultrasonography During the Straight Leg Raise Test in Individuals With Low Back Pain
2015, PM and R
Citation Excerpt :
Second, the ST is only a component of the hamstring muscle group, and as such, it may not reflect whole hamstring muscle group function [32]. For example, it is known that from the 3 hamstring muscles, it is the long head of the biceps femoris maintains proximal attachments with the low back and sacroiliac joint via the sacrotuberus ligament [33]. The particular muscle was selected because it can be easily and reliably identified with ultrasound [32].
Although the straight leg raise (SLR) test frequently is used to assess hamstring extensibility in individuals with low back pain (LBP), evidence relating LBP, SLR, and hamstring extensibility remains unclear. The SLR measures the angle between the lifted leg and the horizontal, however, and, as such, it is not a direct measure of the elongation capacity of the hamstrings.
To examine the differences in hamstring elongation (quantified via ultrasonography) and SLR score between individuals with LBP and asymptomatic controls and to determine the relationship between hamstring elongation, SLR, and functional disability scores.
Cross-sectional study.
University laboratory.
Forty men and women with chronic LBP (mean ± SD, age 43.51 ± 3.71 years and 40 control subjects (age 45.11 ± 4.01 years) participated in this study.
Passive SLR, elongation assessed via ultrasonography, and functional disability.
SLR score, elongation of tendinous tissue within the semitendinosus muscle, and Oswestry Disability Index.
Two-way analysis of variance tests indicated a significantly lower SLR score and a greater Oswestry score in LBP group compared with control subjects (P < .05). In contrast, there were no significant group differences in hamstring elongation (P > .05). Gender did not have an effect on all dependent measures (P > .05). Hamstring elongation showed a low correlation with SLR score and a minimal correlation with Oswestry score.
These results indicate that the SLR score is not determined by hamstring elongation (quantified via ultrasonography).

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Clinical Biomechanics

Abstract

References (14)

The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint

Clin Biomech

Rupture of the intervertebral disc with involvement of the spinal canal

New Engl J Med

Die wirbelsäulenleiden and ihre Differential diagnose

An approach to the functional anatomy of the sacroiliac joints in vivo

Anat Clin

Stabilization of the pelvis with the Hoffman frame

Acta Orthop Scand

Mobility of the pubic symphysis. In vivo measurements with an electromechanic method and a roentgen stereophotogrammetric method

Clin Orthop Rel Res

Mobility in the SI joints at high age; a kinematic and roentgenologic study

Spine

Cited by (87)

A multivariate model for predicting PPGP considering postural adjustment parameters

The sacroiliac joint – Victim or culprit

The Ligaments of the Lumbar Spine

Lumbar axial rotation kinematics in men with non-specific chronic low back pain

The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis

Hamstring Elongation Quantified Using Ultrasonography During the Straight Leg Raise Test in Individuals With Low Back Pain

Original articleLoad application to the sacrotuberous ligament; influences on sacroiliac joint mechanics

Abstract

Clin Biomech

Rupture of the intervertebral disc with involvement of the spinal canal

New Engl J Med

Die wirbelsäulenleiden and ihre Differential diagnose

An approach to the functional anatomy of the sacroiliac joints in vivo

Anat Clin

Stabilization of the pelvis with the Hoffman frame

Acta Orthop Scand

Mobility of the pubic symphysis. In vivo measurements with an electromechanic method and a roentgen stereophotogrammetric method

Clin Orthop Rel Res

Mobility in the SI joints at high age; a kinematic and roentgenologic study

Spine

Original article
Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics