SIJ Eval & Treat Flashcards
Lumbo-Pelvic-Hip Complex
-isolated SIJ dysfunction is rare
-check with hip and/or lumbar exams
Sacroiliac Joint
-load tranfers from lumbar to pelvis to hips
-contributes to 15-30% of non-specific LBP
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
Innominates
-ischium, ilium, and pubic bone fused together at the acatabulum
-articulates with the sacrum= SIJ
Anterior SIJ Ligaments
-binds sacrum to ilia
-limits all motions
-pain generators
Interosseous Ligs
-most important
-thick
-binds sacrum to ilia posteriorly
-limits ant and inf movements of sacrum
Posterior SIJ Ligs
-easily papable
-limit ant iliac rotatation (or sacral counternutation)
-attachment for: ES, glute max, TL fascia
-pain generators
Sacrotuberous Lig
-isch tub to PSIS
-limits post iiac rotation (sacral nutation)
Sacrospinous Lig
-ischual spine to sacrum
-limits post iliac rotation (sacral nutation)
Pubic Symphysis
-transfer loads
-connected by fibrocartilage
-common source of groin pain
Pelvic Floor Muscles
-assist im lumbosacral stability
-increase intra-abdominal pressure
Muscles that can produce SIJ motion…
-piriformis
-Pubococcygeaous
2/35 SIJ muscles
Posterior Oblique System
-lats, contra glue max, L fascia
-helps with SLS
Anterior Oblique System
-EO/IO, contra hip add and abdominal fascia
-helps wih SLS
Lateral Muscle System
-Glute med/min and contra hip add
Inner Muscle System
-multifidi, pelvic floor, and diaphragm
-stabilize SIJ
-pressure management
Nerve Supply of SIJ
Anterior portion : Post rami L2-S2
Posterior portion: post rami L3-S3
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
- Do Hip and/or Lumbar Exam
- Confirm Presence of SIJ dysfunction with Provocation
- Determine side of Hypomobiltiy (mobility/functional tests)
- Determine Pathology
- Determine if Form or Force are a component
- 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
- Pt flexes hip and crease is where bottom of belt will go
- Middle seam goes in mid back
- Pull belt traps snugly
- Pt exercises or performs ADLa for s/s reduction
belt goes on skin
