Lumbar and SIJ Flashcards
Observation - The
Buttgripper
(SIJ)
PASSIVE: Over activity deep external rotators of the hip joint uni or bilaterally
ACTIVE
*One leg stance
*Pelvic control [trunk control; abductor
*Hip control [overactive piriformis; glut med/min
Control of pelvis/hip
*
Control of the pelvis/hip
*One leg stance: Recruitment of trunk muscles
If force closure is not in place
ant sagital rot of tested sides’s ilium CN ipsilat SIJ + longitudinal pelvic rot towards lifted leg + caudal pubic symphysis displacement
* One leg stance: Recruitment of hip muscles
If force closure is not in place –> anterior displacement/rot of femur
LX / SIJ palpation
*Position of bony landmarks,
mostly for symmetry
*Iliac crests, PSIS’s, ASIS’s, greater
trochanters i.r.t pelvis
Standing Forward
Flexion test (StFT)
Gillet, Stork, Standing kinetic test
establish innominate asymmetry [‘torsion’]: Try to find a pattern
*Iliac crests R L; PSIS R L; ASIS R L; PSIS ASIS R L;
Greater trochanters pelvis
*Palpate PSIS movement with trunk and leg movement
*Forward Flexion Test; Gillet Test
*Hip rotations
Posterior Pelvic Pain Provocation test [P4] /Thigh thrust
*The test is performed supine and the
patient’s hip flexed to an angle of 90
degrees on the side to be examined:
*Light manual pressure is applied to
the patient’s flexed knee along the
longitudinal axis of the femur while
the pelvis is stabilized by the
examiner’s other hand resting on the
patients contralateral ASIS
*The test is positive when the patient
feels a familiar well localized pain
deep in the gluteal area on the
provoked side
Gaenslen’s test
The patient, lying supine, flexes the hip/knee and draws it towards the chest by clasping the flexed knee with both hands. The opposite leg extends over the edge while the other leg remains flexed. The examiner uses this manoeuvre to gently stress both sacroiliac joints simultaneously.
Anterior ligament stress
- Legs slightly bend on pillows
- Transvers opening force on ASIS
- Comfortable contact
- Take up soft tissue slack
- Strong small ‘overpressure’
Posterior ligament stress
- Push down vertically
- Comfortable contact – careful avoiding ‘glut minimus pinch’
Sacral thrust
P-a sacrum
Nutation & counternutation of the sacrum
EROM P-a-p differentiation
SIJ vs lumbo-sacral pain
provocation
Stabilise sacrum in p-a direction, do a-p pressure on ASIS
EROM Longitudinal
movement SIJ vs LS
pain provocation
Stabilise sacrum in longit-ceph direction, do longit-caud
pressure innominate
Stabilise sacrum in longit-caud direction, do longit-ceph
pressure on ischial tub
ASLR (MC test)
*Assessing pelvic control strategy: Just lift 10 cm and
observe
*Lumbopelvic stabilization lacking = compensation
*rib cage draws in = EO
*Lower ribs flare out = IO
*Thoracic extension = ES
*Abdomen bulge = breath holding
*Repeat with pelvic belt. Improvement = positive test
*+ test = a need for rehab of Force Closure
ASLR (original test)
*The patient is asked to score any feeling of impairment
[‘how much effort?’] (on both sides separately) on a 6
point scale: not difficult at all = 0; minimally difficult = 1;
somewhat difficult = 2; fairly difficult = 3; very difficult =
4; unable to do = 5 Mens et al 2001 ; EBCG 2008]
*Feel under WB heel which one pushes down the
hardest to lift the other leg
*Repeat with pelvic belt. Improvement = positive test
*+ test = a need for rehab of Force Closure
SIJ *Pain Provocation tests - best evidence base
*P4 , Ant gapping, Gaenslen FABER [3 out of 4 +]
*Post gapping; EROM sagittal rotation innominate in sidelying
*PAM in prone [ EndROM tests]
SIJ - Movement/Biomechanical tests very weak evidence base
*Asymmetry/Torsion of innominates
-Multi test score of positional observation, Gillet , hip rotations etc
*Joint mobility and acute pain
-NZT tests for hyper/ hypomobility [Confirm a joint lock’?]
SIJ - Motor Control tests medium to strong evidence base
*One leg standing
*ASLR
SIJ RX - SIJ movement treatment
Pain - sidelying
- Physiological movement’ of the SIJ
= Sagittal rotation of the
innominate [Mid ROM in sidelying] - Both legs bend – mid-ROM
- Do PSR and ASR movement
SIJ RX - maitlands
- Any of the physical examination movements
- P-a, a-p movements of the Sx, ASIS or PSIS
- Sacral nutation and counternutation
- Innominate rotation
SIJ RX - Rocabado
- Concept of restoring joint position with muscle
energy techniques - Use muscle energy to change bony position
*Muscle pulling one articular surface
*Muscles stabilising the other - Sub-max muscle contraction
- Hold 6 secs
- Repeat 6x
- 6x per day
SIJ RX - Mulligan: MWM: Pain with Lx extension
- Stabilise sacrum in p-a direction and apply a-p pressure of
innom: test LxE - Stabilise Sacrum in p-a direction and push PSIS lateral-& pa:
test LxE
SIJ RX - Passive joint mobilisation in hypo- or normal mobility
and/ or momentory pain
- Gr IV – IV+ movements: Sagital movement [P-a on sacrum, a-p on ilium]
- Transverse movement of ASIS [Ant gapping]
- Longitudinal movement caudad or cephalad
- EROM Rotation of the ilium/hemipelvis [ant or posterior]
SIJ RX - * Passive joint mobilisation for ++pain and after injury
- Supine: NZTT movements
- Sidelying: MidROM pelvic sagital rotations
