SIJ Exam + Interventions Flashcards
Elimination tests for SIJ
- Active SLR Test
- post partum pelvic pain
- Hip Flexion test
- pelvic ring frx
- Sign of the Buttock
- bursitis, abscess, tumor in buttock region
what is a positive test for the active SLR?
if stabilization relieves symptoms
research properties and clinical implications for the active SLR test
- Research
- +LR → 1.7-14.5
- -LR → 0.13-0.42
- Clinical Implications
- utility as treatment decision modifier
- studies in populations with PPPP
what is a positive test for the hip flexion test?
concordant pain or inability to raise leg
research properites and clinical utility for hip flexion test
- Research
- +LR → 18
- -LR → 0.10
- Clinical Implications
- screening tool when Hx/interview suggests pelvic frx
positive test for the sign of the buttock
hip motion restrictions or same pain continues with last step
research properties and clinical implications of the sign of the buttock test?
- research
- NONE known
- clinical implications
- common screening tool w/o evidence
- de-sentizing does not change pain
list bone and joint structures to palpate during SIJ exam
- L5
- S2 (in line with PSIS)
- Sacral base (sacral sulci)
- medial and superior 1 thumb-width each PSIS
- Inferior lateral angle of sacrum
- Iliac crest
- PSIS
- ASIS
- Symphysis Pubis/Pubic tubercle
- Ischial tuberosity
reliability of palpating various bony structures of the pelvis
- sacral base → 0.08
- sacral sulci → 0.11
- inferior lateral angle → 0.11
soft tissue structures to palpate during SIJ exam
- erector spinae
- dorsal SI ligament
- glut max muscle belly
- glut med muscle belly and insertion
- area between ASIS and symphysis pubis
joint mobility testing for the SIJ exam
- ilium anterior rotation
- ilium posterior rotation
Confirmation tests for SIJ exam
- Thigh Thrust/4P Test
- Distraction Test
- Compression Test
- Gaenslen’s Test
- Sacral Thurst Test
- Partick’s Test/FABER
- Resisted Hip Abduction
- Other:
- Long Sit Test
- Fortin Finger Test
- Gillet Test
SIJ Clusters
- Laslett’s Cluster II
- Van Der Wurff
what is a positive test for the thigh thrust/4P test?
concordant pain (tested side) at posterior hip/SIJ
research properties and clinical implications for the thigh thrust/4P test
- Research
- +LR = 0.72-3.29
- -LR = 0.17-1.28
- Clinical implications
- best utilized with cluster
positive test for distraction test
concordant pain
research properties and clinical implications for distraction test
- research
- +LR = 3.2-1.24
- -LR = 0.5-0.94
- clinical implications
- best used with clusters
postive test for compression test
concordant pain provocation
research properties and clinical implications for compression test
- Research
- +LR = 1.6-3.95
- -LR = 0.4-0.92
- Clinical Implications
- best used with cluster
positive test for Gaenslen’s Test
concordant pain provocation
research properities and clinical implications for the Gaenslen’s Test
- Research
- +LR → 1.02-2.29
- -LR → 0.65-1.11
- Clinical Implications
- best used with cluster
positive test for the Sacral Thrust test
concordant pain provocation
research properties and clinical implications for the Sacral Thrust Test
- Research
- +LR → 0.74-4.39
- -LR → 0.49-1.62
- Clinical Implications
- best used with cluster
- avoid placing force far superior, as this will likely extend the L/S and alter the test
postive test for Patrick’s Test/FABER Test
concordant POSTERIOR/SIJ-AREA pain provocation
research properties and clinical implications for Patrick’s Test/FABER Test
- Research
- +LR → 0.82-1.43
- -LR → 0.64-1.94
- Clinical Implications
- best used with cluster
- careful not to confuse with hip distribution of pain
positive test for resisted hip abduction
SIJ pain provocation
research properties and clinical implications for the hip abduction resisted test
- Research
- +LR → 2.0
- -LR → 0.80
- Clinical implications
- consider potential provocation test
Laslett’s Cluster II
- Thigh Thrust Test
- Distraction test
- Sacral Thrust
- Compression Test
- Gaenslen’s Test
notable observations and research properties of Laslett’s Cluster II
- Apply after having ruled out L/S origin (centralization)
- Research
- +LR → 4.16
- -LR → 0.11
Van Der Wuffs Cluster
- Thigh Thrust
- Distraction Test
- Patrick’s Sign
- Compression test
- Gaenslen’s Test
Confirmation tests → Functional Movements
- Sit to Stand
- Deep Squat
- Step-Up Test
- 6 inch step w/symptomatic LE onto anterior box
T/F: the long sitting test has strong evidence to support it
FALSE
poor reliability and validity
use with caution
Positive test for Fortin Finger Test
pt can localize the are of pain with one finger
the indicated area is within 1cm inferiomedial to the PSIS
the patient is consistent with localizing the same area with both trials
postiive test for Gillet Test
the PSIS ipsilateral to the lifted LE does not change position or migrates superiorly
Intervention planning for SIJ
- Educate
- Reduce Pain
- manual
- exercise
- Improve Stability
- internal → pelvic stabilizer coordination training
- external → belt
- Improve Functional Activity Performance and Partipicipation
prognostic factors for Antepartum populations
- History of pregnancy
- Increased BMI
- smoking
- work dissatisfaction
- lack of belief of improvement
T/F: a lot of evidence supports the use of belts
FALSE
conflicting evidence with grade D recommendation
support belt utilization
- placement at the level of ASIS has demostrated increased resistance to vibration forces at SIJ
- +Active SLR Test = positive prognostic indicator for use of support belt
Pelvic Floor Exercise
- instruct how to perform
- gradually increase timing of isometrics
- gluteals and thigh muscles relaxed
- begin to work into contraction during daily activities
What does research say about joint manipulation and SIJ?
clinical improvement reported with intervention
position of SIJ not altered with manipulation
List joint mobilizations for the pelvic girdle and lumbpelvic spine
- Oscillations and Sustained Hold mobilizations
- innominate anterior rotation
- innominate posterior rotation
- Thurst manipulations
- long leg distraction
- supine lumbopelvic thrust manipulation
- Other
- adduction isometric of the pubic symphysis
