The Sacrotuberous Ligament

The sacrotuberous ligament is an essential bridge between the upper and lower body

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.

 sacrotuberous ligament connects the upper and lower bodysacrobutberous ligament and multiifidus are connected through the htoracolumbar fasciasacrotuberous ligament and hamstring

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.


The Deltoid Muscle of the Shoulder
William Broad is a Liability (In Yoga)
  1. Hello again!
    This ligaments are diffucult to fully understand. And they can surly trigger primitive reflexes, that you havent had a problem with since before. I ended up with major problems in hands, neck, head.
    And a even bigger problem accured during the treatment of this ligament with injections that chocked the whole system. It froze the psoas and the diafragm, caused a inbalance in the vagus nerve and the autonom nervous system. Things that I still work with, to get the body back on track again. I have much more to learn about this matter. 🙂

  2. When I was 12 (22 years ago) I went to my first track and field practice. We did sprints and ran up and down a set of concrete bleachers. I had a good time and went home. Early the next morning I woke up with pain. Thought it was a Charlie horse in my left glute and tried to stretch it and go back to sleep. Later ended up trying to crawl using only one leg and weeping with the pain. Ended up in the hospital for a few days and on crutches for a month. The eventual diagnosis was viral sacroiliitis. Fast forward a few years and I went to the doctor for a short left leg. Could feel it walking and it did indeed measure shorter. Doctor couldn’t suggest anything. My leg was just shorter. Tried a few heel lifts and just ended up messing up my feet. A few years later I ended up at a chiropractor with a diagnosis of mild scoliosis. It wasn’t until two years ago that I discovered the psoas. If I could stay on my back constantly in a psoas release I could be balanced. But even with weekly psoas releases it just kept tightening down. Took a side trip into osteopathy with some improvement. Learned about the link between an underactive glute (which I have on the left side as well) and a tight psoas and was working on activating the glute in the hopes of getting the psoas to release. Also got a tight calf on the left side. Been working to keep that loose as well. While pregnant a few months ago has great success with the Webster technique which focuses on subtle alignments of the pelvic bones. I’m even trying pelvic floor therapy now.

    But reading this post really resonates with me. I’m thinking now that this sacrotuberous ligament may have been damaged when I was 12 and the inflammation impinged on the nerves running through the sacroiliac joint leading to pain only when I engaged the muscles of my leg (the doctors could move my leg all around with no pain). And possibly subtly destabilized my hips leading to this chronic one-sided tension that years of expensive physical therapy and dedicated yoga practice have been unable to unseat.

    I believe this imbalance also led to a repetitive stress injury in my right forearm that left me unable to write, brush my hair, or many other things with my right hand for several years.

    Thank you for this post. I continue to learn and hope one day to posture and stretch and strengthen my way out of this old injury.

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