SacroIliac Joint Treatment

Question 1

Concepts:

Answer 1

First, choose treatment techniques moving in the same direction of the deviation
–especially with pain dominant or irritable presentation
If no response choose treatment techniques in the opposite direction of the deviation
–or if presentation is stiffness dominant

Question 2

Posterior Steering When (Grades II-IV)

Answer 2

• Pt Position: SL with painful 
side up, head and knees 
supported by pillow, top arm 
allowed to rest on pt’s side
• PT position: Behind the pt at 
the level of the pelvis
• PT Instruction: Place head hand over ASIS; foot hand 
over post-inf aspect of the 
ischial tuberosity with fingers 
pointed up; Sink until palms 
come into contact with each 
bone; Oscillate by moving 
your entire body to rotate ilium
posteriorly

Question 3

Anterior Steering When: (Grades II-IV)

Answer 3

Pt and PT position same as posterior steering
wheel
• PT Instruction:
1. Place palm of the head hand on posterior aspect
of iliac crest
2. Place palm of foot hand on inferior-anterior
aspect of ischial tuberosity
3. Oscillate your whole body to gently rotate ilium
anteriorly
• Graded same as Posterior Steering Wheel

Question 4

Muscle Energy Concepts

Answer 4

Uses isometric contraction to impart force on proximal attachment.
–Hamstrings on ischial tuberosity imparts post rotation force
–Adductors to gap pubic symphysis
Contract/relax response for neuromuscular reeducation
Pt has control of forces, may be useful for painful patient, or one who does not “relax”

Question 5

Adductor Squeeze

Answer 5

• Pt Position: Supine with legs flexed and feet flat at hip width
• PT Position: At pt’s side at the level 
of the pelvis
• PT Instruction: 
1. Place hand on the lateral aspects of 
both knees and ask the patient to 
strongly abduct their thighs. sec.
2. Place forearm between pt’s knees 
instruct them to squeeze knees 
together against your arm; increase 
force until the pt is strongly 
contracting the adductors. 
3. May repeat 3-4 times; a “pop” may 
emanates from the pubic symphysis

Question 6

Sciccors

Answer 6

• For treatment of posteriorly rotated R inominate (going with
the deviation)
• Pt Position: Supine lying diagonally across the plinth with L
leg hanging over R side of the plinth at the knee
• PT position: standing between the pt’s legs allowing the pt’s
R foot to rest on PT’s L shoulder
• PT Instruction:
1. Place L hand in popliteal space of the pt’s R knee
2. Place R hand on the anterior aspect of the L knee
3. Instruct the pt to gently try to extend R leg and flex L hip
at the same time against your resistance
4. Hold 6-8 seconds; repeat 2-3x

Question 7

Belly Masher

Answer 7

• Isometric Technique for posterior rotation
• Pt position: SL with affected side up
• PT Position: Facing pt, at hip level
• PT Instruction:
1. Passively flex top leg and place pt’s knee into your own abdomen;
grip the pt’s back around the lumbar spinous processes
2. Instruct pt to hold leg in this position while you try to flex the hip
(pt contracts isometric hip extensors) for 6-8 second hold
3. Upon relaxation, passively flex until a mild joint resistance is felt;
Back slightly out of resistance and repeat the same isometric hold
as above
4. Repeat the steps 2 and 3 until the hip is able to be fully flexed;
oscillate at end range

Question 8

Pretzel

Answer 8

• Tx of left anteriorly rotated ilium going against the deviation without a
thrust
• Pt Position: supine with R side close to plinth edge; shoes removed; towel
under feet
• PT Position: Stand to the R side of the pt
• PT instruction:
1. Sidebend LEs away(to the L) until end range is felt
2. Instruct pt to clasp hands behind head
3. Sidebend the upper trunk to the L until R foot begins to slide
4. Stand at level of pt chest; reach across pt’s body with the head hand and
thread arm through the pt’s L flexed arm. The dorsum of the PT’s arm should
end up in the pt’s R axilla rotating pt to the R
5. Use head hand to rotate pt ASIS rises from plinth
6. Place foot hand on L ASIS and instruct pt to inhale and exhale; during exhale,
increase pressure on L ASIS
7. Release pressure when L pelvis touches plinth

Question 9

Prone Extension Grade IV

Answer 9

• Facilitates: anterior 
inominate rotation
• Pt Position: Prone with 
unaffected LE flexed off 
table with foot on the floor
• PT Position: Standing on 
unaffected side at level of 
hip
• PT Instruction: Grip just 
proximal to knee and extend 
hip to end range while 
applying PA mobilization through PSIS

Question 10

Piriformis Stretch

Answer 10

• L piriformis stretch described
• Pt Position: Long sitting on floor or plinth
• Pt Instruction:
1. Cross R leg as though sitting “Indian Style” so R
foot is under L buttock
2. Cross L foot across the R leg so that the Left foot
is resting with the sole on plinth above knee
3. Rotate trunk to the L; place R elbow against

Question 11

Lateral Distraction

Answer 11

• Pt Position: Supine on plinth
• PT Position: Standing on affected side
• PT Instruction:
1. Place bilateral interlocking finger tips medial
to PSIS on affected side
2. Apply a lateral distraction force to ilium;
sustain for 30-60 seconds

Question 12

SIJ Protection Techniques

Answer 12

1. Equal wt. bearing through both ischial tuberosities in
   sitting
2. Don’t cross your legs as this puts more stress through the
   SIJ
3. Equal wt. bearing in standing (i.e. while doing dishes) and
   while lifting objects
4. The mini skirt concept (keep legs together during
   transfers)
5. Explain “safe” sexual positions with SIJ dysfunction.
6. Stand up straight vs. leaning forward as you stand
7. Perform sitting pelvic tilts to help loosen up the joint,
   decrease pain before standing up.

Question 13

Longitudinal Distraction

Answer 13

• Acute Presentation:
– Pt position: Supine, relaxed affected leg over
pillow if needed
– PT position: Standing at affected side
– PT Instruction: Grip thigh just above knee;
perform a Grade II distraction along the length of
the femur
• Chronic Presentation:
– Grip at the malleoli and distract the LE for grades
II, III, or IV

Question 14

Leg UP and IN and Leg UP and OUT

Answer 14

UP AND IN
• Pt Position: Pt lying supine
• PT position: standing on affected side at the level of the pt’s
knee
• Instruction: Passively flex the hip and knee to greater than
90 degrees and ADD the leg across the body;
simultaneously use the head hand to apply a counter
pressure of an anterior pressure to the opposite posterior
pelvis
• Holding this position, forcefully push the flexed leg to
extend the hip
• UP AND OUT
• Same as above with ABD rather than ADD