Lumbar Pelvic SIJ

Question 1

Pelvic girdle/SIJ pain illness script

Answer 1

• Females affected more than males
• Pregnancy & childbirth
• MOI: recent fall onto buttock or knee
• Early: hurts with everything
• Later: inconsistent onset vs specific motions
• Presents as sharp pain at SIJ/PSIS region, guarded gait, any pelvic motion, any lifting of LE, sleeping difficult, any rolling/supine-sit aggravates
• PT: belting to stabilize in symptom modulation phase

Question 2

SIJ treatment options

Answer 2

• Stabilization (belt)
• SIJ manual therapy: manipulation, mobs, STM
• Pelvic girdle MET
• Movement control

Question 3

SIJ stabilization CPR (Hicks)

Answer 3

• Age <40
• Average SLR >91º
• Positive prone instability test (PIT)
• Aberrant movement present: instability catch, painful arc, thigh climb)

Question 4

Describe the prone instability test (PIT)

Answer 4

• Locate painful segment with PA (then hands off)
• Patient lifts B feet off floor
• PT re-applies PA to painful segment
• POS = Significant pain reduction
• More useful as part of the 2005 Hicks stabilization CPR than alone

Question 5

LQ algorithm CPR for pelvic girdle

Answer 5

• Motion testing: march/Gillet & forward bending tests
• Positional testing: ant/post illia, inflare/outflare
• Ligamentous palpation provocation testing: long & short SI, Sacrospinous, & Sacrotuberous ligaments

Question 6

SIJ CPR/provocation test cluster

Answer 6

• Distraction
• Compression
• Thigh thrust
• Ganslen’s (pelvic torsion)
• Sacral thrust (Laslett’s cluster): substitute Patrick’s test/FABER for Van der Wurff CPR

Question 7

Describe pelvic gridle postion testing

Answer 7

• Illial anterior/posterior rotation
• Upslip/downslip (sagittal): look sat ASIS
• Inflare/outflare (transverse): look at ASIS

Question 8

Van der Wurff’s Cluster / CPR

Answer 8

• Distraction
• Compression
• Thigh Thrust
• Ganslen’s
• Patrick’s test (FABER)

Question 9

Describe the active SLR test (AKA Mens test)

Answer 9

• Stabilize the pelvis & repeat active SLR
• Positive = pain abolished with stabilization

Question 10

Describe a supine to long sit test treatment guidance

Answer 10

• It test for Pelvic Torsion (Ilia Rotation) vs. Leg Length Discrepancy
• Supine Bridge 1st, then assess supine malleoli position, then long sit
• Short to long leg = Posterior Ilial rotation
• Long to Short leg = Anterior Ilial rotation
• Short leg with no change = Leg Length Discrepancy