The Pelvis and Sacroiliac Joint

Question 1

List 3 of the most common area of referred pain from the pelvic girdle?

Answer 1

1. groin
2. below L5 (absence of midline lumbar pain)
3. PSIS

Question 2

List 4 of the most common signs and symptoms of pelvic girdle pain.

Answer 2

1. pain with loading (prolonged standing, sitting, walking)
2. catching when lifting leg (SLR)
3. unilateral pain (PSIS or groin)
4. localized to SIJ region or pubic symphysis (possible that sx refer into LE but rare that pain travels below knee)

Question 3

List all 22 muscles that attach to the pelvis and cross the hip joint.

Answer 3

1. tensor fascia latae
2. sartorius
3. rectus femoris
4. gluteus medius
5. gluteus minimus
6. gluteus maximus
7. gracilis
8. adductor longus
9. adductor brevis
10. adductor magnus
11. adductor minimus
12. superior gemellus
13. inferior gemellus
14. obturator internis
15. obturator externis
16. piriformis
17. pectineus
18. quadratus femoris
19. semitendinosus
20. semimembranosus
21. biceps femoris
22. iliacus

Question 4

Van Wingerden et al showed that even low-level contraction of which 2 muscles created increased stiffness/stabilization at the sacroiliac joint?

Answer 4

gluteus maximus & biceps femoris

Question 5

Hungerford et al found delayed ipsilateral contraction of which 3 muscles in subjects with sacroiliac joint pain vs controls? Which muscle displayed earlier contraction?

Answer 5

1. internal oblique
2. gluteus maximus
3. multifidi

biceps femoris activity was earlier than those without SIJ pain

Question 6

What are the estimated rotation and translation of the sacroiliac joint?

Answer 6

• 1.15°-2.5° of rotation
• 0.4-0.9 mm

(during position changes like supine to sit, supine to stand, etc.)

Question 7

List the 3 intrinsic ligaments of the sacroiliac joint

Answer 7

1. short posterior sacroiliac ligament (posterior SI ligament)
2. long posterior sacroiliac ligament (long dorsal ligament)
3. posterior interosseous ligament (interosseous ligament)

Question 8

List the 3 extrinsic ligaments of the sacroiliac joint.

Answer 8

1. sacrotuberous ligament
2. sacrospinous ligament
3. iliolumbar ligament

Question 9

Describe the innervation of the upper and lower portions of the sacroiliac joint.

Answer 9

• upper portion: anterior & posterior rami of L5

- lower portion: some or all of the sacral plexus

Question 10

Describe the respective referral patterns of the upper and lower sacroiliac joint.

Answer 10

• upper portion: upper buttock, middle buttock, lateral thigh
• lower portion: middle buttock, lower buttock, thigh, lower leg

Question 11

The current concepts of diagnosis of painful sacroiliac joint pathology includes a cluster of which 6 basic types of clinical findings?

Answer 11

1. provocation testing
2. pain location
3. palpation
4. strength testing
5. mobility testing
6. quadrant length screening

Question 12

List the 5 components of the sacroiliitis clinical prediction rule established by Laslett et al. What is important to remember about the patient population studied in this CPG?

Answer 12

1. thigh thrust
2. compression
3. distraction
4. sacral thrust
5. Gaenslan

Lumbar spine repeated movements were performed first, and those with centralizing symptoms were excluded from the study

Question 13

What is the general specificity/sensitivity of Laslett’s sacroilitis CPG?

Answer 13

excellent sensitivity (91%) and good specificity (87%)

Question 14

Describe the performance of the Fortin Finger test

Answer 14

• pt should be able to point to the region of pain with one finger consistently & it should be within 1 cm of the posterior superior iliac spine (can perform provocative tests first)

Question 15

Which clinical test not included in Laslett’s sacroiliits CPG is also commonly used to provoke SI joint pain?

Answer 15

FABER (Patrick test)

Question 16

What is the general specificity/sensitivity of the Fortin Finger test?

Answer 16

when combined with groin pain, good specificity (85%) & poor sensitivity (16%)

Question 17

Describe the 5 phases of the lumbopelvic joint stabilization program used to treat low back and SI joint pain.

Answer 17

• Phase 1: train abdominals, pelvic floor, multifidi, erector spinae, and gluteals
• Phase 2: co-contraction while moving other body parts (Big 3 - modified curl-up, side bridge, & bird dog)
• Phase 3: reduce biofeedback and begin planks, supine planks, and advanced side bridges. Add balance and functional/weighted exercise
• Phase 4: build endurance, build repetitions (not hold times) with phase 3 exercise
• Phase 5: build strength. decrease reps & increase weight

Question 18

The FABER test has high sensitivity for ruling out SIJ pain in which specific population?

Answer 18

pregnant and postpartum patients

Question 19

Describe the sequence of SI joint manipulation and pelvic mobilizations described in the monograph.

Answer 19

1. long axis distraction manipulation (2-3x in flexion / slight abduction / slight ER)
2. mobilization of ilium in sagittal plane (isometric alternating hip flexion/extension in 90° flexion)
3. mobilization of ilium in transverse plane (isometric hip abduction in 90° flexion & isometric flexion in 45° flexion / full adduction)
4. transverse plane rotational mobilization (alternate isometric posterior rotation of pelvis in sidelying / slight rotation & isometric horizontal abduction in the same position)
5. prone sacrum mobilization (flexion/extension pressure + exhale & hold)