Sacroiliac joint Flashcards
During gait, which piriformis is active?
The one on the weight bearing side
Why is the flexion test positive in the event of SI joint dysfunction?
If the SI joint is locked up, it drags the innominate with it.
What does a flexion test tell us in relation to the SI joint?
Which side may have a dysfunction
Dysfunctions of the pelvis
Innominate rotation, innominate flare and subluxation at the pubic symphysis
Which muscles will pull the pubic symphysis into subluxation?
The adductors
Sacral dysfunctions
Sacral torsions (anterior or posterior)
Anterior torsions of the sacrum involve…
Sacral flexion and rotation
Anterior sacral torsions
Right on right and left on left
Posterior sacral torsions involve…
Extension and rotation
Posterior sacral torsions
Right on left and left on right
What does the first blank in a sacral torsion name tell you?
Which way the sacrum is rotated
What does the second blank in a sacral torsion name tell you?
The axis that it’s stuck on
How is the side of rotation in a sacral torsion identified?
By palpating the depth of the sacral ulcus and the inferior lateral angle.
Neutral spine mechanics
Rotation and side bending occurs to oppostie sides
Non-neutral spine mechanics
Rotation and side bending occur to the same side
Spine mechanics of the neck
Non-neutral; rotation and sidebending occur to the same side.
MOI in a same on same sacral torsion
Same multifidus, opposite piriformis, same psoas, opposite quadratus lumborum
MOI in a same on opposite sacral torsion
Opposite piriformis, same multifidus, same psoas, opposite QL
Why is the multifidus the primary MOI in anterior torsions?
It holds the sacrum in a flexed position
Why is the opposite side piriformis the primary MOI for posterior torsions?
It holds the sacrum extended.
The effects of psoas and QL on sacral torsions
They don’t usually cuase the torsions, but they can reinforce previously created issues.
Psoas is on the same side as which primary MOI in sacral torsions?
Multifidi
QL is on the same side as which MOI in sacral torsion?
Piriformis
What does the psoas do in response to sacral torsion?
It adaptively shortens to the rotated positions.
What does the QL do in response to sacral torsion?
It increases isometric or eccentric tone to match the multifidus on the oppostie side.
False positives in the standing flexion test
Trust the seated flexion test over the standing due to the effects of the hamstrings.
Why does sitting down make the hamstrings shorter?
The femur just spins in the acetabulum, but the knee joint rolls and glides. It travels enough that the total path length is altered.
MOI in anterior innominate rotation
Tight rectus femoris, weak hamstrings
MOI in posterior innominate rotation
Tight hamstrings, weak rectus femoris
MOI of innominate inflare
Tight iliacus, weak TFL, glute med or glute min. Tight fibers of the internal oblique below the ASIS may also contribute.
MOI of innominate outflare
Tight TFL, glute med or glute min, weak iliacus. Weak fibers of the internal oblique below the ASIS may also contribute.
Apparent short leg test application
The patient lies prone. The therapist palpates the medial malleoli and compares their distance from the body.
What can the apparent short leg test be used for?
If the right leg appears shorter, it may indicate that the sacrum is rotated right. Can be used as a backup if the sulcus and ILA show opposite findings.
Springy lumbar test application
Patient lies prone and the therapist compares the springiness of the thoracic and lumbar vertebrae.
Positive sign in springy lumbar test
The thoracic and lumbar vertebrae have the same springiness.
If the lumbar vertebrae is not springy, what does this mean?
The lumbar vertebrae is stuck flexed. This means that the sacrum is extended and there may be a posterior sacral torsion.
What can a non-springy lumbar confirm?
A posterior sacral torsion
