Lumbopelvic spine interventions: SIJ (Lecture 6)

Question 1

KNOW: The SIJ joint moves but only slightly
* But it can be a pain generator
* Pregnancy can make it hypermobile - or any kind of hypermobility disorder (elhers danlos / downsyndrome)
*

Question 2

SIJ Sprain: Expected findings:
* Direct or indirect trauma may have caused this
* Signs / symptoms include pain and inflammation well localized over SI joint
* Ipsilatearl muscle guarding of thracolumbar erector spinae (same side as pain - these muscles might be very visibly taut)
* Positive pain provocation tests

SIJ Hypermobility: Expected findings
* Related to repetitive minor trauma, childbirth strains, or history of trauma
* Typical signs/symdptomes: dull ache on assuming a fixed posture (think sitting for a long time) with **occasional radiation to posterior thigh (rarely goes past the posterior thigh) **
* Positive pain provocation tests
* May have positive active straight leg raise

SI Joint Displacement: Expected findings
* Thought to be related to a hypermobile SIJ - Since one side is hypermobile the other is most likely hypomobile - so we can do joint assesment to the hypomobile side
* “Lowered” iliac crest; anteriorly/posteriorly rotated ilium, “upslip” / “Downslip” inflare / outflare - usually this is due to muscle imbalance not because of joint displacement
* Resistricted passive motion
* Positive pain provocation tests

Most common upslip is related to quadratus lumborium tightness (pulls it up)

inflare / outflare = wings of ilum rotated in for inflare and out for outflare
* not well demonstrated in literature (same w/ anterior/posterior rotated)

Question 3

Laslets cluser: SIJ provocation test
* Before doing these you must have ruled out patients that have pain that centralizes (lumbar radicululopathy) before using these
* So clear out lumbar radiculopathy before doing this cluster
* Need 3/5 to rule in
* Positive = brings on pain (need 3/5)
* Negative = 2/5 = if its negative that means they don’t have it
* So you can use this cluster to rule in or rule out

1) Distraction Provocation (ASIS gap)
2) ASIS Compression PRovocation
3) Thigh Thrust Provocation (Ostgaard’s test)
4) Gaenslen’s Provocation
5) Sacral Thrust Provocation

Question 4

Treating SIJ related pain in symptom modulation classification:
* Education (dont create fear / reliance on healthcare provider / dont reinforce maladaptive beliefs that the body is weak and fragile)
* Manual therapy / manipulative therapy (CPR for LBP stands strong for this as well) - shown on next slide (16 day thing)
* Self isometric manipulation
* Modalitites focused on analgesia
* If true hypermobility due to connective tissue disorder or pregancy - may consider use of support belts

Question 5

What is the CPR for LBP (if we should manipulate)

Answer 5

1) Duation of symptoms < 16 days
2) No symptoms distal to the knee (radic)
3) At least one hip with > 35 degrees of internal rotation
4) FABQ work < 19
5) Hypomobility w/ lumbar PA PAIVM testing

I think you need 2/5 but im not sure (bolded more important)

Question 6

Does manipulation make someone more hypermobile?

Answer 6

Nope - these arent end range manipulations - so you can manip someone who is hypermobile

Probs would do it for someone who is hypermobile at one segment because you think the ones above and below are hypomobile

Question 7

pt presents w/ hypermobility have acute injuries, no symptoms past the knee and their in pain. Should you manipulaute

Answer 7

Yep, fit the cluster
* less than 16 days
* No symptoms distal to the knee

Once you manipulate you work on strenghtening EX for pain reduction

Question 8

What are muscle energy techniques?

Answer 8

Involves the pt actively contracting their muscles against the therapists counter force, while therapist resists the pts effort

Question 9

What was the OG thought process behind muscle energy techniques working (contracting against therapist)

Evidence based new one

Answer 9

OG = re-aligning joints / correcting movement dysfunctions

New:
* Isometric contraction leads to muscle inhabition –> relaxiation of tense muscles –> analgesic response
* submax isometric holds, 6sec x 6 reps (note tendon isometrics are like 30 second holds)

Question 10

Treating SIJ pain under movement control classification:
* Education
* Lumbopelbic mobilization / manipulation
* Muscle energy tehcniques
* Self direct muscle energy tehcniques
* Stretching EX (for tight muscles)
* Manual therapy for STM
* Motor control and global lumbopelvic strengthening (rememebr specific selective EX are no greater than generalized lumbopelvic strengthening)