5. Manipulative Conditions Of The Pelvis

Question 1

How is the diagnosis of SI syndrome made?

Answer 1

There is no gold standard test. Diagnosis made after exclusion of other pathology

Question 2

What are the three theories of pathophysiology of SI syndrome?

Answer 2

• joint subluxation due to response to adjustment
• joint dysfunction with abnormal mobility (prominent theory)
• chronic low grade inflammation (conflicting study evidence)

Question 3

What are the etiologies of SI syndrome?

Answer 3

• acute trauma
• repetitive stress injury
• static overstrain
• post-traumatic complications of sprains or strains
• osteoarthrosis
• gender

Question 4

The SI joint is more susceptible to axial compression and torsion that the lumbar motion segments. What are some activities that can cause this?

Answer 4

• forward bending, twisting and lifting
• fall on the buttocks
• unexpected step, or a step from a miscalculated height
• uncoordinated movement, minor trivial event

Question 5

What is the most common cause of SI syndrome?

Answer 5

Repetitive stress injury

Question 6

What are examples of repetitive stress injuries that can cause SI syndrome?

Answer 6

• repetitive lifting and twisting (nurses, package handlers)

- athletic training (figure skaters)

Question 7

What is an example of static overstrain leading to SI syndrome?

Answer 7

Postural from prolonged slouching while sitting or from a bad chair

Question 8

A high percentage of older males have DJD but it doesn’t necessarily
correlate with symptoms or dysfunction. When does DJD/osteoarthrosis correlate with joint dysfunction?

Answer 8

In cases of premature degeneration and DJD ins spinal facets

Question 9

How does pregnancy play a role in the etiology of SI syndrome?

Answer 9

Ligamentous laxity and large belly in the 3rd trimester causes increased lumbar lordosis, anterior pelvic tilt which causes increased stress to the SI joints

Question 10

How does childbirth play a role in the etiology of SI syndrome?

Answer 10

Stress of birth process to SI joints may lead to postpartum laxity, etc. with corresponding stress to joints

Question 11

What is the estimated prevalence of SI syndrome in adults?

Answer 11

Estimates range from 23% to 50-70% from various studies with limited objective diagnostic criteria

Question 12

What is the estimated prevalence of SI syndrome in children?

Answer 12

Studies indicate that it is not uncommon (23% had LBP and 28% had hypomobile SI joints) and most common in 12-17 years olds

Question 13

Si syndrome is a clinical diagnosis and is not established by the presence or absence of any singular symptom or finding. Some of the symptoms and physical findings that may be present include:

Answer 13

• Deep aching pain of SI, usually unilateral, with episodes of sharp pain
• referred pain to buttock and possibly all the way to dorsum of foot
• hypersthesia in buttock or leg
• aggravating factors are activities that increase the focus of weight in the joint
• alleviating factors including rest, NSAIDS, stretching, ice and massage

Question 14

The pain pattern of SI syndrome can help differentiate from other low back syndromes. How would facet syndrome referred pain be different?

Answer 14

The lumbar pain is often bilateral and is accompanied by scleratogenous pain referral to hip, buttock and sometimes leg (above knee)

Question 15

What is the referred (scleratogenous) pain of SI syndrome.

Answer 15

common referral to buttocks, posterior
thigh, groin
occasionally to lateral calf, ankle and/or
dorsum of foot

Question 16

The pain pattern of SI syndrome can help differentiate from other low back syndromes. How would disc herniation referred pain be different?

Answer 16

Disc herniations would present with lumbar pain and referred (radicular pain into the buttock and leg, often extending into the calf and foot

Question 17

What activities typically aggravate SI syndrome?

Answer 17

Anything that increases focus of weight in the joint
Ex: sitting to standing, climbing stairs, etc.
Also activities that cause extreme motion to SI or sustained postures, such as prolonged sitting

Question 18

What are activities/treatments that alleviate SI syndrome pain?

Answer 18

mild walking
rest (variable)
direct pressure/massage stretching
ice
heat
anti-inflammatory agents, analgesics

Question 19

What are some postural findings that could be present with SI syndrome?

Answer 19

• normal to antalgic posture
• unleveling of crests, PSIS’s, gluteal folds or contours
• lumbar scoliosis

Question 20

What are some possible gait findings with SI syndrome?

Answer 20

• normal to protective gait that may include decreased stance phase on affected side to reduce painful weight bearing

Question 21

What are some possible GROM findings for SI syndrome?

Answer 21

• normal to painful and restricted GROM

- altered lumbopelvic rhythm

Question 22

What are some possible bony static palpatory findings in SI syndrome?

Answer 22

• Tenderness over the sacral sulcus, PSIS
• asymmetry of PSIS’s, iliac crest, depth of sacral base
• leg length inequality
• PI ilium
• AS ilium

Question 23

Why can a PI ilium cause medial knee pain?

Answer 23

The PI ilium will pull on sartorial due to flexed position which irritates the insertion

Question 24

A PI ilium would result in a functional ____ (short/long) leg that _____ (shortens/lengthens) during the sit up test.

Answer 24

Short, lengthen

Question 25

An AS ilium would result in a functional ____ (short/long) leg that _____ (shortens/lengthens) during the sit up test.

Answer 25

Long, shortens

Question 26

What are the soft tissue static palpations that can be found with SI syndrome?

Answer 26

Tenderness over the SI joint and periarticular soft tissue

Question 27

Si syndrome could present with _____ during joint play

Answer 27

Pain on springing

Question 28

Segmental motion in SI syndrome may be:

Answer 28

Painful, restricted or aberrant in flexion or extension

Question 29

In SI syndrome, when doing percussion, what might be a finding?

Answer 29

Pain over involved joint which might differentiate an inflamed or infected SI joint

Question 30

What orthopedic tests can be used to evaluated SI syndrome?

Answer 30

• SI stretch test or HIbbs test to evaluate pain with traction
• iliac compression test, thigh thrust or sacral trust to evaluate pain with compression and/or shearing

Question 31

What kind of muscle testing can be done in the evaluation of SI syndrome?

Answer 31

There are no muscles crossing the joint. However, imbalance or injury to hip flexors, extensors or rotators may initiate, exacerbate, predispose or complicate this condition.

Question 32

Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI dysfunction results from SI joint restriction and/or ilium/sacrum malposition has what treatment options?

Answer 32

• manipulation
• mobilization
• exercises
• orthotics
• leg length inequality treatment

Question 33

Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI dysfunction results from instability/hypermobility has what treatment options?

Answer 33

• belts
• exercises (stabilization)
• proliferant injections
• fusion

Question 34

Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI discomfort caused mainly by inflammation in the joint has what treatment options?

Answer 34

• ice
• oral or injected anti-inflammatory medications
• PT modalities
• rest