SI and pelvis

Question 1

what is considered the functional pelvic girdle?

Answer 1

L4/L5, two innominates, sacrum, two SI joints, pubic joint, and two hip joints

Question 2

How can we think about the pelvis?

Answer 2

it is a force generator as well as a force attenuator. It allows for the absorption of force during running and walking.

Question 3

what three muscles are most commonly slow to activate in SIJ pain?

Answer 3

multifidis, internal oblique, gluteus maximus

Question 4

what low back issue commonly presents with SIJ pathology as well?

Answer 4

disk herniation, be aware that folks with a disk herniation usually have some form of SIJ pain as well

Question 5

what happens to the SIJ as we age?

Answer 5

it changes shape!

Question 6

what type of joint are the SIJs?

Answer 6

planar

Question 7

how much motion occurs at the SIJ in degrees and mm?

Answer 7

1.15 to 2.5 degrees, or less than one mm

Question 8

what two muscles can influence the sacrotuberous ligament and provide stability to the SIJ via tensioning?

Answer 8

glute max, hamstrings

Question 9

in what motion does the sacrotuberous ligament restrict motion and provide stability? Why is this important?

Answer 9

flexion, if people sit slouched and the SI is in extension this mechanism does not work

Question 10

what innervates the upper and lower region of the SIJ?

Answer 10

anterior and posterior rami of L5.

Question 11

Where does the S2 nerve root go upon exiting the foramen?

Answer 11

through the piriformis, need to be aware of.

Question 12

Does the sacrotuberous ligament control anterior or posterior rotation?

Answer 12

posterior

Question 13

does the long posterior sacroiliac ligament control anterior or posterior rotation?

Answer 13

anterior

Question 14

what is the sacroilitis CPR?

Answer 14

thigh thrust, compression, distraction, sacral thrust, gaenslan

Question 15

how many tests need to be positive in the sacroilitis CPR?

Answer 15

3 of 5

Question 16

what is the stenosis CPR? (5things)

Answer 16

bilateral symptoms, leg pain more than back pain, pain during walking/standing, pain relief upon standing, age >48

Question 17

how do you perform gaenslen test?

Answer 17

think like a torsion test, symptomatic knee to chest, thomas test position with other leg and give pressure

Question 18

what leg goes to chest on the gaenslen test?

Answer 18

symptomatic

Question 19

what is the gold standard for limb length discrepancies?

Answer 19

radiographs, look at sacral base position to see if tilted one way or another

Question 20

what two factors affect the sacral base?

Answer 20

idiopathic scoliosis, and limb length discrepancy

Question 21

if you determine someone has a limb length discrepancy and decide to correct with a heel lift, within how many mm should it be corrected to?

Answer 21

5mm

Question 22

what is a test to rule out pelvic fx?

Answer 22

active straight leg raise, if they can’t in ER, high probability of a fx, if they can, low probability of fx

Question 23

what is the most commonly fractured part of the pelvis?

Answer 23

pubic ramus

Question 24

is it common to see centralization with SIJ dysfunction?

Answer 24

no, this is very rare and usually indicates a lumbar issue

Question 25

what 3 findings help rule in lumbar stenosis and rule out PGP?

Answer 25

older age, absence of symptoms with coughing, full resolution of symptoms with sitting

Question 26

what is the hip CPR for OA?

Answer 26

limited in adduction, flexion, ER/IR at 90 degrees of flexion

Question 27

which two tests of the SIJ cluster should be performed first and why?

Answer 27

thigh thrust and distraction, high sensitivity and specificity

Question 28

do pelvic belts decrease muscle activity?

Answer 28

no, but they help decrease pain which can actually lower inhibition and increase muscle activity

Question 29

what is the purpose of prolotherapy in the SIJ?

Answer 29

cause an inflammatory response that facilitates fibroblastic activity to promote collagen synthesis and provide additional stability