The sacrotuberous ligament is an essential bridge between the upper and lower body. I know that I probably abuse the category of “most important part of the body”, but the sacrotuberous ligament is worthy of inclusion in the club. It is majorly involved in standing, walking, running and possibly involved in a whole host of pain scenarios.
The sacrotuberous ligament connects the spine (sacro) to the pelvis (ischial tuberosities) and in most people the bottom of the ligament connects into the tendon of the biceps femoris, one of the hamstring muscles.
A very cool argument can be made that these ligaments indirectly connect the muscles of the entire back of the body. The bottom of the sacrotuberous ligament connects into the hamstrings via the biceps femoris. The top of the sacrotuberous ligament connects into thoracolumbar fascia that connects into the multifidus and erector spinea. The hamstrings extend down, the multifidus and erector spinea extend up and the ligaments connect them together.
The sacrotuberous ligament runs on either side of the body and plays an important role in our ability to stand and move. As part of the complex of ligaments that make up the sacroiliac joints the sacrotuberous ligament stabilizes the sacrum within the pelvis helping to bear weight when we are upright. Issues with hypermobility often involve laxity in these ligaments.
The stabilizing action of the sacrotuberous ligament plays a role in walking and running, aiding in the support required for transferring weight from foot to foot. When fully functional they also stabilize the pelvis against excessive anterior tilt, hip hiking and pelvic twisting.
These incredibly important ligaments can also play a role in all sorts of back, pelvic and leg pain. The sacrotuberous ligament connects to the coccyx (tail bone) so it will likely involved with coccyx pain . The nerves that innervate the peroneal muscles pass through or next to the sacrotuberous ligament so peroneal pain might be related as well.
Let’s not leave out one of my main interests—incontinence—as the muscles and fascia of the pelvic floor all connect into the sacrotuberous ligament.
There is also an interesting connection to be made between the sacrotuberous ligament and the twin issues of sciatica and piriformis syndrome. It is possible that dysfunction in one or both of the sacrotuberous ligaments play a role in causing these two problematic issues.
And if all of this isn’t enough I haven’t mentioned the misery of one sacrotuberous ligament being shorter or tighter than the other which brings leg length discrepancy, scoliosis and other twisted spine and pelvic issues into play.
So what do you think? Does the sacrotuberous ligament strike you as a ridiculously important piece of our anatomy? And if I had to guess I didn’t cover everything. But I will leave it there and if anyone has anything to add please weigh in.