SIJ Eval & Treat Flashcards by Tori Chatman

Lumbo-Pelvic-Hip Complex

-isolated SIJ dysfunction is rare
-check with hip and/or lumbar exams

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Sacroiliac Joint

-load tranfers from lumbar to pelvis to hips
-contributes to 15-30% of non-specific LBP

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Sacrum

-5 fused vertebra
-concave on anterior side, convex on posterior
-attachment for Piriformis, glutt max, ER, multifidi, TL fascia
-L shaped facet with innominate, noncongruent

Base: articulates with :L5
Apex: articulates w/ coccyx
Ala: articulates w/ ilium

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Innominates

-ischium, ilium, and pubic bone fused together at the acatabulum
-articulates with the sacrum= SIJ

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Anterior SIJ Ligaments

-binds sacrum to ilia
-limits all motions
-pain generators

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Interosseous Ligs

-most important
-thick
-binds sacrum to ilia posteriorly
-limits ant and inf movements of sacrum

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Posterior SIJ Ligs

-easily papable
-limit ant iliac rotatation (or sacral counternutation)
-attachment for: ES, glute max, TL fascia
-pain generators

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Sacrotuberous Lig

-isch tub to PSIS
-limits post iiac rotation (sacral nutation)

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Sacrospinous Lig

-ischual spine to sacrum
-limits post iliac rotation (sacral nutation)

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Pubic Symphysis

-transfer loads
-connected by fibrocartilage
-common source of groin pain

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Pelvic Floor Muscles

-assist im lumbosacral stability
-increase intra-abdominal pressure

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Muscles that can produce SIJ motion…

-piriformis
-Pubococcygeaous

2/35 SIJ muscles

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Posterior Oblique System

-lats, contra glue max, L fascia
-helps with SLS

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Anterior Oblique System

-EO/IO, contra hip add and abdominal fascia
-helps wih SLS

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Lateral Muscle System

-Glute med/min and contra hip add

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Inner Muscle System

-multifidi, pelvic floor, and diaphragm
-stabilize SIJ
-pressure management

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Nerve Supply of SIJ

Anterior portion : Post rami L2-S2
Posterior portion: post rami L3-S3

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Sacral Nutation

-flexion in relation to innominates
-base moves ant and inf
-Apex moves pos and sup
-Posterior innominate, PPT, decreased lordosis, hip flx

Sacral Counternutation

-extension in relation to innominates
-base moves post and sup
-Apex moves ant and inf
-Anterior innominate, APT, increased lordosis, hip ext

3 Categories of SIJ Pain

-Pregnancy
-Pathology: infection, fx, tumor
-Non-specific: MSK

Causes of Pelvic/SIJ Pain: Visceral

-Appendicittis
-GYN
-UTI/kidney stones
-GI tract
-Vascular: AAA, femoral

Causes of Pelvic/SIJ Pain: Serious Origin

-infection
-fx
-tumors: prostate, colon, gyn
-Inflammatory disorders: Ankylosing spondylitis starts in SIJ

Causes of Pelvic/SIJ Pain: MSK Origin

-SIJ dysfunction : instability and trauma
-L-Spine disorders
-Hip Dysfunction
-Hernia

Subjective Hx of SIJ Dysfunction

-Fortin Sign: pain over PSIS**
-Pain with transitional movements**
-Pain with SLS activities**
-Pain at end range of Active SLR
-Prolonged sitting/standing
-(-) Neuro
-No s/s below knee

Systems Review of SIJ Dysfunction

-vitals -cancer -infection -Trauma -Neuro -postpaterm psycological

SIJ Joint Diagnoses: Referred Pain

-Lumbar Spine -Hip joint

SIJ Joint Diagnoses: Hypomobility

Innominate Rotation -anterior rot on one side and posterior on the other -ASIS OR PISIS different heights and superficialness Upslip -ASIS, PSIS, ISCH tub ALL up on one side -leg forced up Downslip --ASIS, PSIS, ISCH tub ALL down on one side -rare -leg pulled down Pubic Lesion -superior or inferior Tx: -manual -core exercises MOI: -unilateral forces -falls -back lifting -swinging

SIJ Joint Diagnoses: Joint Arthritis (Sacroilitis)

S/s: -pain in post sacrum or groin -radiating into thigh -increase SLS pain -Turning in bed pain -lumbar extension painful -(+) SI stress tests -(+) Compression test with SI Belt Tx: -NSAIDs, ice, core exercises and LE exercises

SIJ Joint Diagnoses: Pelvic Girdle Instability

Form Closure: -assessed 1st with ASLR -passtive stability malfunction (joint shape, ligaments, bony stability) -Tx: SI Joint compression belt Force Closure: -assessed 2nd with ASLR -active stability malfunction (muscles and fascia) -Tx: core stabilization exercisess

SIJ Joint Diagnoses: Piriformis Syndrome

S/s: -persistent low back pain into butt and thigh -(+) pain provocation of piriformis -(+) pain w/ sitting or squatting -persistent hip ER -Difficuly lying -(+) LE paresthesias Tx: manual, stretching, core exercises

Diagnostic Imaging of SIJ Dysfuntion

-MRI best to see changes -no imaging indicated if no serious pathology syspected

Evaluation Order of SIJ Dysfunction

1. Do Hip and/or Lumbar Exam 2. Confirm Presence of SIJ dysfunction with Provocation 3. Determine side of Hypomobiltiy (mobility/functional tests) 4. Determine Pathology 5. Determine if Form or Force are a component 6. Select Intervention (treat lumbar or hip dysfunction first, then SIJ hypomobility first)

Conservative Management of SIJ Dysfunction

-Manips -SI Belt -Exercise -Education

Pharmacologic Management of SIJ Dysfunction

-NSAIDS -Muscle relaxants -Opioids -Implanted devices -Anti-depressants -Injections

Prolotherapy

-injection of dextrose into joint space -increases friction -painful

Platelet-Rich Plasma

-increases friction -increases healing

Surgical Techniques for SIJ Dysfunction

Stabilization -Fractures -SI joint fusion (last resort for chronic s/s)

Lumbar Disc Joint Clearing Tests

(+) pain with coughing and sneezing Decreased pain with walking

Lumbar Spine Joint Clearing Tests

(-) pain with coughing and sneezing (+) pain with extention or flx (+) pain with PA joint glides

Hip Joint Clearing Tests

(+) Trendelenburg signs (+) Pain or decreased ability to squat (+) Sign of buttock test

SI Joint Clearing Tests

(+) Fortin's Sign (+) Joint gapping or compression tests (+) TTP at SI ligs (+) Pain/weakness with SLS

Mobility Exercises (SIJ)

-foam roll -AROM -Stretches

Stability Exercises (SIJ)

-AROM -Spinal Stability -Pelvic Floor Strength** -Glute Strength**

SI Belt Application

1. Pt flexes hip and crease is where bottom of belt will go 2. Middle seam goes in mid back 3. Pull belt traps snugly 4. Pt exercises or performs ADLa for s/s reduction *belt goes on skin*