Sacroiliac Joint Assessment & Treatment

Question 1

What is the function of the pelvis?

Answer 1

• Weight-bearing & protective structure
• Basic platform with 3 large levers acting on it (spine & legs)
• Shock absorber (2 x SIJ & pubic symphysis)
• Birth canal capable of accommodating baby

Question 2

What is the purpose of form and force closure?

Answer 2

To stop the bones of the pelvis from falling apart

Question 3

What is form closure?

Answer 3

• Shape (form) of the sacrum & pelvic bones creates a keystone

Question 4

What is force closure?

**Exam Q on form/force closure + diagrams

Answer 4

• Additional closing force from compression (ligament & muscle)

Question 5

How is the stability of the SIJ further increased?

Answer 5

Matching ridges & depressions on the articular surfaces

Question 6

What is the most recent observation about the movement of the SIJ?

Answer 6

• Largest movement occurs when moving from lying to standing

- But still ongoing debate

Question 7

How is the movement of the sacral promontory relative to the ilium described?

Answer 7

• Nutation (forward nodding, i.e. coccyx moving posteriorly)

- Counternutation (backward nodding, i.e. coccyx moving anteriorly)

Question 8

Why can you get pain in the SIJ?

Answer 8

Articular cartilage contains sensory nerve fibres

Question 9

What are the causes of LBP in pregnancy?

Answer 9

• Hormonal changes (relaxin)
• Biomechanical changes (weight of baby/placenta sitting anteriorly, causes increased lumbar lordosis)
• AAA can caused referred back pain

Question 10

What is the role of the hormone relaxin in pregnancy?

Answer 10

• With progesterone, relaxes ligaments in the pelvic girdle

- Softens the public symphysis (preparation for delivery)

Question 11

What are the pain provocation tests for the SIJ?

Answer 11

• Compression
• Distraction
• Posterior pelvic pain provocation test (p4)
• Gaenslen’s test
• Sacral thrust test (sacral PA)
• Faber

Question 12

What are the load transfer tests for the SIJ?

Answer 12

• Stork test

- Active SLR

Question 13

What are the 2 categories of degenerative damage to the the SIJ?

Answer 13

• Insufficient compression (positive ASLR)
• Excessive compression (trauma, ankylosing spondylitis)
• Usually caused by trauma or micro trauma

Question 14

What are the management paradigms for the SIJ?

Answer 14

• Motor control (TA, multifidus, diaphragm, pelvic floor)
• Muscle slings
• Strengthening (global muscles)
• Joint mobilisations

Question 15

What is the best positioning for a non-elastic SIJ belt in rehabilitation?

Answer 15

Positioning at the ASIS is more effective than at the level of the pubic symphysis in reducing laxity

Question 16

What are the symptoms of ankylosing spondylitis?

Answer 16

• Morning stiffness >30 mins
• Eased by exercise, not by rest
• Night pain (2nd half of the night)
• Buttock pain alternating sides

Question 17

What are the clinical features of AS?

Answer 17

• Stiff lumbar slide
• Positive SIJ tests
• Reactive arthritis, IBD, Crohn’s disease

Question 18

What does the treatment of AS involve?

Answer 18

• Medical monitoring & management

- Home-based/group exercise (strength & flexibility)

Question 19

What is osteitis pubis?

Answer 19

• Overuse of pubic symphysis & adjacent bone
• Caused by abnormal stress at symphysis
• Pain with palpation, running, change of direction, kicking

Question 20

How is osteitis pubis diagnosed?

Answer 20

• Adductor squeeze test
• XR (moth-eaten appearance)
• MRI

Question 21

What is the treatment for osteitis pubis?

Answer 21

• Hip ROM
• SIJ & lumbosacral movement/control
• Gradual introduction of activity while monitoring symptoms
• Prolonged rest & passive treatment associated with delayed recovery & ongoing symptoms