L8 Special Considerations Flashcards
Key Exam Findings for SI joint dysfunction
- does not centralize with repeated lumbar movements
- need 2/4 positive tests of the SI joint tests
- positive active SLR test
Interventions for SI Joint Dysfunction
- lumbosacral regional manip
- MET
- stabilization, belt, tapping
- stabilization exercise
Sacrum Joint Overview
- sacrum and two innominates
- large stable joint due to convoluted surface and very strong anterior and posterior ligamentous structures
- 35 muscles attaching on the sacrum and innominates
Incidence and Prevalence of SI Joint Disorders
very wide range
.4% to 98% depending on diagnostic criteria
more widely accepted to be 10-22% of idiopathic back and butt pain
RF for SI Joint Dysfunction
- post operative lumbar fusions (depends on # of fused vertebrae)
- pregnancy due to increased laxity and altered COM
- hypermobility
- high energy trauma such as fall or MVA
- previous hx of BP
maybe related to leg length discrepancy, scoliosis, hip OA
Possible causes of dysfunction
- rotation of innominate
- torsion
- nutation/counternutation
- upslip/downslip
- inflare/outflare
Posterior Rotation might present as
- decreased hip extension during long stride gait
- apparent leg length shorter on that side
- LBP during squat
Anterior Rotation might present as
- decreased gluteal activation on that side
- tight spasmed parapspinals
- limited hup flexion during squat
- adaptively shortened hip flexors and rectus femoris if chronic
SIJ Dysfunction Common things seen in exam
- pain is reported inferomedial to PSIS
- alterations in gait
- should observe squatting, lateral step down, SLS, hopping
- loss of sagittal and frontal plane motion with pain
- overpressure may be provocative
SIJ Provocation Tests
- Thigh Thrust = 3-4 downward thrusts
- Distraction = forces on ASIS
- Compression = greater trochanter for 10s
- Sacral Thrust = 3-4 thrust on post sacrum
- Gaenslen’s = maxxing hip flex and hip ext
SIJ Management
- manual therapy - joint mob, manip, MET, manual stretching, STM
- gait training
- postural re-ed
- strengthening
- taping to support correction
Anteriorly Rotated on the Right SIJ MET
right glues push and L hip flexors pull 3-5 seconds for 3-5 sets
need extensors to pull pelvis back
Posteriorly Rotated on the Right SIJ MET
right hip flexors pull and R glutes push 3-5s for 3-5 sets
need flexors to pull pelvis forward
Shotgun Technique
- using the abd/add to reset SIJ and pubic symphysis
- pt is supine hooklying
- abduct into PT’s hands 5 seconds at multiple progressive angles
- PT forearm placed between knees and pt adducts into 5s
- reassess for symptoms and impairments
Lumbar fusions
rates continue to go up, especially post-traumatic and elderly populations
good for spondylolisthesis and scoliosis, not great for DDD or DJD
Indications for Lumbar Fusions
progressive, neurologic symptoms and/or severe instability
failed conserative care
Types of surgical approaches for lumbar fusions
PLIF = decompression of lateral foramen
TLIF = complete removal of facet joint
ALIF = anterior approach for revision after failure
Post-Operative Complications for Lumbar Fusions
LOTS of complications
Myocardial infarcation
pulmonary embolus
CSF leaking
vertebral fractures
Post Fusion Rehab
- preferably pt had PT before surgery
- watching for numerous complications
- protect incision and surgical site until anatomic fusion occurs
- focus on ADLs initially
- most likely won’t be totally pain-free
Stabilization Clinical Findings
- younger age <40
- 3+ prior episodes
- increasing frequency of episodes
- aberrant movement patterns
- SLR > 91°
- pos prone instability test
- general hypermobility
Interventions for Stabilization
local activation of deep core
general strengthening
postural awareness
Aberrant movement patterns
gower’s sign
altered lumbopelvic rhythm
deviation from sagittal plane
painful arc of motion
instability catch or judder
Indictors of Failure with stabilization program
neg prone instability
hypomobility to spring test
aberrant motion absent
FABQ score <9
Sorenson’s test predictive values
LBP <176s
no LBP >198s
3x more likely to have LBP <58s
Grade 5 prone plank
120s or more
Grade 4 prone plank
<90 seconds
Grade 3 Prone Plank
can assume but can’t hold it
Grade 2 Prone Plank
on knees instead of toes
Normal timing for side plank test
94s males
72s females
Motor Control Exercises for Sagittal
promoting flexion
activities like bridges, bird/dog
watching for anterior/poterior pelvic tilt error
Motor Control Exercise for Frontal Plane
Abduction/Adduction motion
fire hydrant, walking with kettle bells in each hand
watching for lateral ean error
deadlift clinical progression
- Assessment for adequate mobility and stability
- Hip hinge with dowel
- Hip hinge with dowel press
- Wall touch
- Banded pull through
- Banded pull up
- Banded extension
- Elevated deadlift
Squat Teaching Progression
- Watch in all three planes with body weight
- Assess for adequate mobility and stability
- Squat sit to stand with dowel
- Wall sit to assisted squat to chair/box squat
- goblet squat to back squat to front squat to overhead squat
