Clinical pearls and other info :)

Question 1

What are the SINSS? Describe them.

Answer 1

Author: Maitland

• Severity -
• Irritability - How quickly/easily do symptoms come on and how quickly/easily do they go away?
• Nature
• Stage
• Stability

Question 2

Why is back pain difficult to heal?

Answer 2

The spine is never able to rest, so it can’t be unloaded.

Question 3

SI joint stability details

Answer 3

The SI joint stability occurs through force and form closure.
Form closure=bony stability (articular stability)
Force closure=dynamic stability (myofascial stability)

Attachments/actions: sacrotuberous ligament (nutation of the sacrum), biceps femoris attachment ischial tuberosity; long dorsal sacroiliac ligament; action of latissimus dorsi through its attachment via thoracolumbar fascia

Question 4

Biomechanics of the SI joint

Answer 4

Nutation of the sacrum (anterior motion relative to the iliac) is restrained by the sacrotuberous ligament.
- Further enhanced by action of biceps femurs attachment to ischial tuberosity

Counternutation of the sacrum (posterior motion relative to the iliac) is restrained by the long dorsal sacroiliac ligament
- Further enhanced by action of latissimus dorsi through its attachment via thoracolumbar fascia

Question 5

What muscles help create force closure at the SI joint?

Answer 5

• Core muscles (diaphragm, multifidus, transversus abdominus, sacrum, pelvic floor & muscles)
• Anterior oblique system (internal and external obliques, abdominal fascia, and adductors)
• Deep longitudinal system (erector spine, fascia, sacrotuberous ligament, biceps femoris, semimembranosus and semitendinosus)
• Posterior oblique system (latissimus dorsi, thoracolumbar fascia, gluteus maximus)
• Lateral system (gluteus medius, gluteus minimus, adductors)

Question 6

How should form closure be treated?

Answer 6

With an SI belt to stabilize the innominate and sacrum.