The Sacroiliac Joint Conundrum: Are Two Degrees Truly Significant?

2025-12-19

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Stop me if you’ve heard this one before: "The patient’s PSIS is 2 degrees higher on the right, so their pelvis is rotated and that’s why their back hurts."In this episode of Untold Physio Stories, we’re diving into the weeds of the Sacroiliac Joint. We’ve all been taught the intricate palpation models, but when we look at the actual kinematics, we’re often talking about movements so small they’re nearly impossible to reliably detect with human hands.In this episode, we discuss:

Stop me if you’ve heard this one before: "The patient’s PSIS is 2 degrees higher on the right, so their pelvis is rotated and that’s why their back hurts."

In this episode of Untold Physio Stories, we’re diving into the weeds of the Sacroiliac Joint. We’ve all been taught the intricate palpation models, but when we look at the actual kinematics, we’re often talking about movements so small they’re nearly impossible to reliably detect with human hands.

In this episode, we discuss:

The "Two-Degree" Threshold: Is a 2-degree shift a clinical "aha!" moment or just measurement error (or normal human asymmetry)?
Reliability vs. Reality: Why our obsession with "alignment" might be distracting us from what actually gets the patient moving.
The Untold Story: A real-world case where focusing on the "degrees" led a clinician down a rabbit hole, and how shifting to a multi-modal, loading-based approach changed the outcome.

The bottom line: If your treatment plan changes based on a 2-degree palpation finding, you might be treating the map, not the territory. It’s time to stop over-complicating the SIJ and start focusing on what the evidence actually tells us.

Don’t let a minor deviation in a "test" dictate a major shift in your "treatment." Sensitivity matters, but clinical relevance matters more.

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