SIJ, Pelvis Flashcards
What tethers the L5 vertebral body to the ilia?
Iliolumbar ligaments
In general, is the sacrum wider anteriorly or posteriorly?
Wider anteriorly / front
What joins the sacrum to the coccyx?
Fibrocartilaginous disk // symphysis
The pelvis being the midpoint of the skeleton results in it being greatest at what principle job?
Force attenuation - dissipates forces generated from walking, running, jumping
Activation of what two posterior chain muscles results in inc stiffness in the SIJ?
Glute max, biceps femoris
What becomes primary stabilizer when muscular system isn’t properly activated?
Ligamentous system -> inflammatory response
What is the ‘typical’ gold standard/reference standard for SIJ diagnosis?
Intraarticular block - BUT found extraarticular blocks also alleviated pain due to high prevalence of ligamentous involvement - inaccurate
True/false: the shape and alignment as well as sacral/pelvic ROM are similar from person to person, race to race, etc
False - highly variable, shape changes with age, between races, and can be different from one side of pelvis to other
What are the shapes of the sacrum and ilia? What motion primarily occurs at the joints?
Sacrum = concave
Ilia = convex
Boomerang shaped surface/ planar with biaxial motions to allow gliding (no rotation)
Four ligamentous structures for the sacrum: name the superior, anterior, inferior and posterior complex/ligaments
Superior: lumbosacral band of iliolumbar ligament
Anterior: anterior SI ligament
Inferior: sacrospinous ligament
Posterior: posterior interosseous, short posterior SI ligament (complex)
True/false: the sacrum and ilia maintain space during load
True - only approximate when ligaments are cut
What are normative values for SIJ ROM?
1 to 2.5 deg of rotation
0.4 to 0.9 mm of translation
What are normative values for pubic symphysis vertical translation for males, females?
Males 0.8 mm
Females 1.6 mm
Which ligament is considered a primary source of pain due to multidirectional fiber orientation?
posterior SI ligament
The biceps femoris shares an insertion with which ligament which aids with SIJ stabilization?
Sacrotuberous - inc biceps femoris force = inc tension on ligament
Sacrotuberous ligament resists what sacral motion?
Flexion/ nutation
Long dorsal sacroiliac ligament resists what sacral motion?
Extension/ counter nutation
Do the iliolumbar ligaments provide lumbosacral or sacroiliac stability?
Both - stabilizes L5 and restricts SIJ mobility
Generally, where does the upper section of the SIJ refer to:
Upper buttock, middle buttock, lateral thigh
Generally, where does the lower section of the SIJ refer to:
Middle buttock, lower buttock, thigh and lower leg
Hypertonicity in the piriformis
because of low back pain can result in sacral pain due to compression on what nerve?
S2 - nerve passes through belly of piriformis
Which type of closure does PT have an impact on in regards to the SIJ?
Force closure = muscle activation
Tensioning/strengthening of what UE muscle produces posterior fascial system tension and thus compression of the SIJ?
Latissimus dorsi
In the lumbar spine, which group of the erector spinae does not have an attachment?
Spinalis
What two muscle groups provide guy wire support and dynamic restraint to anterior/posterior shear forces to the SIJ?
Erector spinae and iliopsoas/psoas major
What muscle adds to guy wire support, providing inferior support for the SIJ?
Quadratus lumborum
True/false: multifidus size remains the same through each region of the spine.
False - much larger in the lumbar region
Multifidus in the lumbar region tension what fascial layer?
Erector spinae aponeurosis - produces extensor torque
True/false: multifidus demonstrate fibrosus and/or atrophy after surgery/injury?
True - fibrosis with surgery and atrophy with low back pain which does not resolve when pain does
What muscle attaches to the iliac crest between the bands of iliolumbar ligament and then to the 12th rib as well as transverse processes of L1-4?
Quadratus lumborum
What muscle is one of the most important muscles in stability of the lumbopelvic mechanism?
Glute max - tenses thoracolumbar fascia, tenses TFL for lateral stability with insertion on femur
In single leg stance, how many times body weight is on the stance leg?
3-4x times - tensing glute and TFL
Psoas major attaches on all lumbar bodies and disks except?
L5
What major hip flexor/trunk flexor atrophies in the presence of low back pain?
Psoas major - results in altered recruitment patterns
What other muscle group can have decreased function during low back pain resulting in ASLR?
Pelvic floor
Persistent lumbopelvic pain at 3 months postpartum is referred to as what diagnosis?
Pregnancy related pelvic girdle pain (PGP) - 50% of all pregnant women
What are effective treatments coupled with pelvic floor training to treat urinary incontinence?
Diaphragmatic breathing
Abdominal strengthening
Functional expiratory patterns
What ilial rotation is coupled with hip extension?
Anterior
What ilial rotation is coupled wtih hip flexion?
Posterior
What inflare occurs with hip IR (on axis)?
ASIS medial rotation / PSIS lateral rotation
What outflare occurs with hip ER (on axis)?
ASIS lateral rotation/ PSIS medial rotation
When the trunk extends, what action does the sacrum tend to perform? (lumbar lordosis)
Sacrum tends to flex/ nutate
When the trunk flexes, what action does the sacrum tend to perform? (lumbar kyphosis)
Sacrum tends to extend/ counter nutate
What five tests did Laslett use for SIJ provocation testing?
1) thigh thrust
2) sacral thrust
3) compression
4) gapping
5) Gaenslen
What five tests did Van der Wurff use for SIJ provocation testing?
1) thigh thrust
2) ASIS compression
3) FABER
4) Gaenslen
5) ASIS gapping
What is the HABER test and what are its implications in SIJ testing/pathology?
Placing pt in prone and performing incremental motion of 10 deg of hip abduction and ER - can discriminate in those with SIJ pain versus LBP
What is a named area generally painful area for the SIJ and where is it located?
Fortin’s area - 3 cm lateral, 10 cm caudal to PSIS
What has more value with palpation in the SIJ, ligamentous or bony palpation?
Ligamentous - may have more sensitivity
What is the Stork/standing hip flexion test looking at/for? (knee flexion, hip flexion, posterior rotation of ilium, lumbar flexion, sacral extension)
For mobility of the SIJ - pelvis may hike in frontal plane, rotate in transverse plane - SIJ may not allow innominate to rotate posteriorly –watching side to side differences in movement pattern
What is the contributed value of lumbar flexion and hip flexion for lumbopelvic rhythm?
60 deg lumbar flexion, 60 deg hip flexion
What are functional tests for pelvic pain, which are more specific for confirming pelvic pain?
1) deep squat
2) 8” lateral step up
3) lunging
Differentiating between LBP and PGP, in which pathology will you see more lumbar motion than pelvis/hip motion?
PGP - pelvic girdle pain
Will see more hip/pelvic motion with LBP
How long, typically, does it take for pelvic girdle pain to resolve spontaneously after childbirth?
6-12 months
What two diagnoses may be discerned by assessing the levelness of the sacral base via radiographs?
1) idiopathic scoliosis
2) leg length discrepancy
What are five factors for screening for cauda equina?
1) saddle anesthesia
2) bladder dysfunction
3) sexual dysfunction
4) bowel dysfunction
5) neurological deficits in the LE
What are the 3 clinical features of cancer:
1) age > 50
2) hx of cancer
3) no improvement in one month intervention
What active combination of movement for the LE is 95% specific for pelvic fractures?
Active hip flexion with knee extension
What diagnosis is common in IV drug use, inflammatory bowel disease, develops in post operative infections and correlates with septic infection?
Chronic destructive pyrogenic sacroilitis
What are sxs of Reiter’s syndrome (reactive arthritis)?
- Conjunctivitis
- pain/stiffness in knees/ankles/feet
- inc frequency, discomfort with urination
- enthesitis (pain at soft tissue insertion on bone) -> SIJ
- low back pain
What are the two most useful Rivels criteria to rule in/rule out facet joint as source of pain?
1) absence of pain during cough/sneeze
2) no pain when rising from flexed seated posture
What test is most specific in ruling in facet joint for source of low back pain?
Extension rotation test / Kemps test - positive will reproduce pain at low back for facet inclusion
What stance test for > 30 seconds rules out PGP?
Single leg stance - absence of pain, can rule out pelvis/SIJ
Are pelvic belts like other spinal supports and cause weakness?
No, decrease pain and improve stability but don’t cause weakness
