Meet The Experts - Vol. 4

Meet the Expert-Vol.4

Dr. Jeni Saunders

Sports and Exercise Physician, Adjunct Associate Professor, University of Notre Dame, AUS

Dr. Jeni Saunders has published an e-book for patients, providing an insightful guide on the sacroiliac joint functional anatomy and treatment strategies.



The book explains that 80% of patients with sacroiliac joint insufficiency can improve through the first stage of treatment, which involves wearing a pelvic belt, manual therapy and muscle re-education alone. The second stage, prolotherapy or PRP in injected into the posterior sacroiliac ligaments. The final stage focuses on muscle strength, specifically re-educating the muscles for optimal function.

In the first stage, coordination of the trunk muscle stabilisers is emphasized. This includes a delicate use of the primary stabilisers in the first layer: the transversus abdominis, multifidus, pelvic floor muscles, and diaphragm. Once this coordination is achieved, the second and final layers can be addressed. The book outlines muscle strengthening grades, starting with very light loads. This approach is similar to methods taught at the Spine and Joint Centre in Rotterdam (directed by Jan-Paul van Wingerden, PhD) emphasizing muscle activation and coordination exercises without resorting to excessive exercise initially.

The book’s standout feature is its consistent focus on the relationship with the sacroiliac joint, even when explaining muscle functions. For patients with sacroiliac joint problems, exercises that put excessive shearing forces on the joint, like bridging, are not suitable. It advises against exercises in postures not encountered in daily life. Activities like stationary cycling, rowing, and aquatic walking are recommended for activating stabilizing muscles, though sitting might be challenging for some patients with sacroiliac joint issues. Thus, walking in the water is often suggested over cycling or rowing.

The book further discusses the 20% of patients who do not recover with muscle re-education alone. Detailed PRP treatment program is provided. After injections, it recommends using a sacroiliac brace and maintaining rest for two weeks, avoiding strenuous activities, and engaging in gentle activities like aquatic walking.

The final section, "Other Conditions Associated with SIJ Incompetence," clearly explains related issues, such as pudendal nerve impingement. The structural relationships between the sacroiliac joint, hip joint, pubic symphysis, and pelvic ring are also described. I like the description that does not neglect the relation to sacroiliac joint when explaining the surrounding muscle abnormalities and nerve entrapment.

This book advocates for a thorough, step-by-step approach to treating sacroiliac joint problems, aiming to reduce the need for injections and potentially avoid sacroiliac joint fusion surgery. I believe that even post-surgery, these steps will help patients return to daily life with optimal muscle function. Emphasizing muscle coordination as a first step, rather than jumping directly into strengthening exercises, is a critical point.

For both patients and health care professionals, I recommend this book.


Daisuke Kurosawa