Sacroiliac Joint Assessment & Treatment Flashcards
What is the function of the pelvis?
- 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
What is the purpose of form and force closure?
To stop the bones of the pelvis from falling apart
What is form closure?
- Shape (form) of the sacrum & pelvic bones creates a keystone
What is force closure?
**Exam Q on form/force closure + diagrams
- Additional closing force from compression (ligament & muscle)
How is the stability of the SIJ further increased?
Matching ridges & depressions on the articular surfaces
What is the most recent observation about the movement of the SIJ?
- Largest movement occurs when moving from lying to standing
- But still ongoing debate
How is the movement of the sacral promontory relative to the ilium described?
- Nutation (forward nodding, i.e. coccyx moving posteriorly)
- Counternutation (backward nodding, i.e. coccyx moving anteriorly)
Why can you get pain in the SIJ?
Articular cartilage contains sensory nerve fibres
What are the causes of LBP in pregnancy?
- Hormonal changes (relaxin)
- Biomechanical changes (weight of baby/placenta sitting anteriorly, causes increased lumbar lordosis)
- AAA can caused referred back pain
What is the role of the hormone relaxin in pregnancy?
- With progesterone, relaxes ligaments in the pelvic girdle
- Softens the public symphysis (preparation for delivery)
What are the pain provocation tests for the SIJ?
- Compression
- Distraction
- Posterior pelvic pain provocation test (p4)
- Gaenslen’s test
- Sacral thrust test (sacral PA)
- Faber
What are the load transfer tests for the SIJ?
- Stork test
- Active SLR
What are the 2 categories of degenerative damage to the the SIJ?
- Insufficient compression (positive ASLR)
- Excessive compression (trauma, ankylosing spondylitis)
- Usually caused by trauma or micro trauma
What are the management paradigms for the SIJ?
- Motor control (TA, multifidus, diaphragm, pelvic floor)
- Muscle slings
- Strengthening (global muscles)
- Joint mobilisations
What is the best positioning for a non-elastic SIJ belt in rehabilitation?
Positioning at the ASIS is more effective than at the level of the pubic symphysis in reducing laxity
What are the symptoms of ankylosing spondylitis?
- Morning stiffness >30 mins
- Eased by exercise, not by rest
- Night pain (2nd half of the night)
- Buttock pain alternating sides
What are the clinical features of AS?
- Stiff lumbar slide
- Positive SIJ tests
- Reactive arthritis, IBD, Crohn’s disease
What does the treatment of AS involve?
- Medical monitoring & management
- Home-based/group exercise (strength & flexibility)
What is osteitis pubis?
- Overuse of pubic symphysis & adjacent bone
- Caused by abnormal stress at symphysis
- Pain with palpation, running, change of direction, kicking
How is osteitis pubis diagnosed?
- Adductor squeeze test
- XR (moth-eaten appearance)
- MRI
What is the treatment for osteitis pubis?
- Hip ROM
- SIJ & lumbosacral movement/control
- Gradual introduction of activity while monitoring symptoms
- Prolonged rest & passive treatment associated with delayed recovery & ongoing symptoms
