Pelvic SI Flashcards
Depth of Sacral Sulcus
Check to see if each side is equal
Long Siting Test
Patient Position: Supine
Clinician Position: Stand @ patient’s feet. Place thumbs distal to prominence of malleoli & observe levels of malleoli.
Method: Ask the pt to bend knees & place feet flat, pt lifts pelvis from table, returns pelvis to table. The therapist passively extends the legs. The patient is asked to sit up with knees extended; observe malleoli for changes in length relative to supine
Positive Response: Indicates abnormal mechanical relationship of innominate moving on the sacrum (iliosacral motion).
Posterior Innominate = Short to Long Anterior Innominate = Long to Short
Distraction
Patient Position: Supine
Clinician Position: Stand @ level of patient’s hips
Method: Crossed arms with hands on the ASIS. Apply pressure to both ASIS in a posterolateral direction. Hold the force for 20 seconds
(Provocation Test)
Thigh thrust
Patient Position: Supine with towel under sacrum.
Clinician Position: Standing @ level of patient’s hips. Hand placement: Around patient’s knee OR around knee and other hand on sacrum
Method: Flex hip to 90°. Apply posteriorly directed force through the femur OR the therapist uses his/her chest to apply an anterior to posterior force through the femur while applying a posterior to anterior force with the hand under the sacrum. Either is to provide a shearing force through the SI joint.
(Provocation Test)
Gaeslen’s
Patient Position: Supine on the edge of plinth/table asymptomatic leg hanging over the edge
Clinician Position: Stand @ patient’s side
Method: Patient flexes symptomatic knee and hip into full flexion, other hip is fully extended, therapist provides overpressure. Creating hip flexion on symptomatic side and creating hip extension on asymptomatic side
(Provocation Test)
Compression
Assessment: Positive if pain is reproduced. Compresses anterior structure which will distract the posterior structures of the SI joint.
Patient Position: Sidelying
Clinician Position: Stand @ level of patient’s hips
Method: Hands on iliac crest. Apply downward pressure to the uppermost iliac crest directed towards the opposite iliac crest.
(Provocation Test)
Sacral Thrust
Patient Position: Prone
Clinician Position: Stand @ level of patient’s hips. Hand placement: On sacrum.
Method: Apply an anteriorly directed force through the Sacrum
(Provocation Test)
FABER
Patient Position: Supine, hip is (F)lexed, (AB)ducted, and (E)xternally (R)otated by resting the lateral malleolus on the opposite knee.
Clinician Position: Standing @ same side of tested hip. Carefully place one hand on opposite ASIS and the other on lateral aspect of isolateral knee.
Method: The ASIS is stabilized and pressure is applied to the knee.
(Provocation Test)
Pubic Symphysis Test
Is the pubic symphysis even and straight?
Standing Forward Bend
Stand behind the pt with thumbs on PSIS. Have pt bend forward and see how PSIS move. Are they equal? If one moves more than the other that SIJ is hypomobile.
Sitting Forward Bend
Stand behind the seated pt with thumbs on PSIS. Have pt bend forward and see how PSIS move. Are they equal? If one moves more than the other that SIJ is hypomobile.
Gillet Test
One thumb on S2 and the other on PSIS. Have pt lift leg to 90. PSIS should move down.
In fare/Outflare
Pt standing. Put most of the weight on unaffected leg. Pt “squishes bug” with affected leg. Feel ASIS, if it doesn’t move appropriately (enough) positive for inflate/outflare
Unilateral Squish Test
Pt supine. Apply post late force on R hip slowly (about 30 seconds) if tight, L hi will come up into other hand.
Force Closure
Have pt do a SLR. Add pressure on the shoulder in order to get ab contraction, with this added pressure, preforms another SLR and compare pain to the first.
Form Closure
Have pt do a SLR. Add pressure on the pelvis (both sides), with this added stability preform another SLR and compare pain to the first.
Assessment of TA
Pt 1) supine 2) sidelying or 3) on hands and knees. Have the pt tighten pelvic floor and (potentially) bring belly button up and in. Be sure Rectus Abdominus is not firing.
Assessment of Multifidus
Pt prone. Go through and palpate Multifidus to find if one belly is either smaller than it should be or smaller than the other side. At this portion of the mutifidus push in slightly and have the pt flex this muscle. Be sure erector spinae are not firing.
Pubic Shear
Grasp knees & hold them together. Ask pt to “pull your knees apart” (abduct) while you resist. Hold 7-10 sec & relax. Allow knees to abduct keeping feet together “let your legs fall apart.” Ask the pt for an isometric abduction contraction in this position while you provide resistance. Hold 7-10 sec. When contraction is stopped, place your forearm between the pts knees & ask pt for an isometric contraction of the adductors, “squeeze your knees together against my arm.”
Flexed Sacrum (Correcting)
(Correcting a nutated Sacrum) The heel of your mobilizing hand makes contact with the sacrum and is reinforced by your other hand. Abduct 15° and internally rotate both legs to gap the joints to facilitate correction. Place the heel of your hand between the ILA’s. Apply a posterior to anterior pressure for 45 seconds.
