LECTURE 4B Flashcards
SI joint pain is divided into what 3 categories
- pregnancy
- pathology
- non specific
SI joint dysfunction has symptoms below the knee true or false
false
2+ joints away = nerve
most people with acute LBP present with at least ___ red flag
80% of people with 1 RED FLAG
*need consistent patterns of pathology
provocation or stress tests are statistically good or poor?
the best!
over alignment/positional or mobility/functional tests
What are 6 stress tests for SI?
- FABER
- Distraction
- compression
- thigh thrust
- Gaenslen’s
- sacral thrust
what are 4 positional tests for SI?
- iliac crest heights
- ASIS heights
- PSIS heights
- isch tub heights
What are 4 mobility/functional tests for SI?
- Standing flexion
- seated flexion
- stork/marching/gillet
- supine to long sit test
What are 4 main forms of SI joint hypomobility?
- downslip
- upslip
- innominate rotation
- pubic lesion
TX for Si joint HYPOMOBILITY
manual + core ex
If I have pain in posterior sacrum (or groin),
radiating pain into thigh
increased pain with transitional movements
-pain with lumbar extension
-+ SI stress tests
+ compression test with SI belt
WHAT IS DX
sacroilitis!
SI joint arthritis
*treat with NSAIDs, ice, core and LE exercises
If I have a form closure problem (pelvic girdle instability), my ____ stability is not working
passive stability = form closure
*LIGAMENT/JOINT PROB
-bad friction coefficient/loose ligaments
If I have a lack of stability due to muscles not working well around my SI joint, I have a
force closure active stability problem
-TREAT WITH CORE STABILITY
which 4 muscles are providing external ACTIVE stability to SI joint?
erector spinae
glute max
lats
biceps femoris
which 4 muscles are providing INTERNAL active stability to SI joint? (force closure)
- TA
- sacral multifidi
- pelvic floor
- hip ER
____ fascia + muscle contractions have a ballooning effect to force close the SI joint
thoracolumbar fascia
If I have:
1. pain (persistent, severe) in LBP, sacrum, butt, hip, post thigh and/or popliteal space
- pain with touching pirformis, sulcus, or GT
- pain with sitting or squating
- persistent HIP ER on affected side
- can’t lie down or stand comfortably
- LE paresthesias
PIRFORMIS SYNDROME
If there is a side with pain + hypermobility, and other side has hypomobility, what should you treat first
HYPOMOBILITY side always first
*treat dysfunction, not side of pain
What imaging is best at catching SI joint changes?
MRI scans
*disc
*cancer/infection
are bone scans appropriate for SI joint?
NO
radiographs (acute, osteoporosis/stress fx or trauma)
OR
MRI (best!)
If the pelvis/pubic bone fx, will there be another fx?
YES (closed loop)
joint with decreased mobility should be treated with:
HVLAT
mobilizations
METs
ROM exercises
joint with excessive mobility/instability should be treated using
stabilization ex
NM control ex
external bracing (compression)
joint with excessive compression signs should be treated based on…
the cause of compression!
1. joint fibrosis–> MOBILIZATION
2. excessive mm tone–> MET, STM, biofeedback
What are side effects of spinal manipulation?
minor: soreness 1-2 days
major: ischemia, cauda equina
