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The SI Joint

Treatment and assessment of the SI Joint

Gemma Morris

on 30 January 2013

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Transcript of The SI Joint

The Sacroiliac Joint by Gemma Morris Assessing the SI Joint Treating the
SI Joint SIJ Dysfunction Sacroiliac Joint Treatment Sacroiliac Belt Further Special Tests Objective Assessment Special Tests Subjective Assessment Bones Muscles Other Ligaments Anatomy of
the SI Joint The SI Joint is made up of the sacrum
and ilium bones of the pelvis Other ligaments within the SI Joint are:
Long posterior sacroiliac ligament
Short posterior sacroiliac ligament
Posterior interosseous ligament
Lumbrosacral ligament Main muscles surrounding the joint are:
Multifidus, Erector Spinae, Gluteus Maximus and Latissimus Dorsi Mechanism of injury
Where is the pain & when does the pain occur
Quality, intensity & depth of pain
Patient's age, job or hobbies
Aggravating & easing factors
24-hour pattern
Abnormal sensation
Special questions Gait
Bony Levels
Equal loading
Pelvic tilt
Buttock levels
Lumbar lordosis
Foot position Gapping Test (transverse anterior stress test)
Approximation Test (transverse posterior stress test)
Hibb's Test (prone gapping test)
Squish Test
Femoral Shear Test
Sign of the Buttock Test
Gillet Test
Torsion stress test
Sacral Apex Pressure Test
Trendelenburg's Test

A multi-test regimen of 5 sacroiliac joint pain provocation tests is a reliable method to evaluate SIJ dysfunction (Kokmeyer et al, 2002) Nachlas Test
Flamingo Test
Piedalli's Sign
Gaenslen's Test
Mazion's Pelvic Maneuver
Laguere's Sign
Goldthwaite's Test
Yeoman's Tests SIJ Dysfunction is an abnormal function at the joint, which places stresses on the structures around it. soft tissue massage
electrotherapy (e.g. ultrasound)
the use of a sacroiliac belt or lumbar brace
the use of a lumbar roll for sitting
correction of any leg length discrepancy
education and ergonomic advice
activity modification advice
biomechanical correction
exercises to improve flexibility, strength, posture & core stability
home exercise programme Ligaments The main ligaments of the SI Joint are:
Sacroiliac ligaments
Sacrotuberous Muscles Movements of the SIJ nutation counternutation The muscles within the SI Joint are split into inner and outer groups.

Transversus Abdominus
Pelvic Floor Muscles

Consist of four systems:
1. Deep Longitudinal System
2. Superficial Posterior Oblique System
3. Anterior Oblique System
4. Lateral System Inner Group - Deep muscles: Outer Group: Observation: Examination: AROM
Neurological testing Posterior Gapping and 'Squish' Tests Gillet Test Neurological Testing Sensation
- Straight Leg Raise Contributing factors to the SIJ Dysfunction: • arthritis
• trauma
• muscle imbalances
• leg length differences
• muscle weakness or tightness
• biomechanical abnormalities
• a lifestyle involving large amounts
of sitting, bending or lifting • poor posture
• lumbar spine stiffness
• a sedentary lifestyle
• poor core stability
• inappropriate lifting technique
• being overweight The belt is designed to compress and support the sacroiliac joints, thereby relieving stress and instability at these weight bearing structures. Taping Techniques Home Exercises Lying supine with affected leg supported on a chair. A small ball is placed posteriorly on the trigger point. The patient relaxes their buttock into the ball. Exercise to decompress SIJ: Exercises for motor control: Squatting with a gym ball - the patient releases their hips & knees into flexion with an anterior pelvic tilt so that the line of gravity is optimally situated.

Lunges with theraband resistance, ensuring pelvic alignment and intrapelvic control. Other Interventions Pharmaceutical intervention
Corticosteroid injection into the sacroiliac joint
Podiatrist Mulligan Taping Technique References Jacob, H.A.C, & Kissling, R.O. (1995) ‘The mobility of the sacroiliac joints in healthy volunteers between 20 and 50 years of age’. Clinical Biomechanics 10(7): 352-361.

Kokmeyer, D.J., Van der Wurff, P., Aufdemkampe, G. & Fickenscher, T.C.M. (2002) ‘The reliability of multitest regimens with sacroiliac pain provocation tests’. Journal of Manipulative and Physiological Therapeutics 25 (1): 42-48.

Magee, D.J. (2008) 5th Edn. Orthopaedic Physical Assessment
Saunders Elsevier, Missouri.

Magee, D.J., Zachazewski, J.E. & Quillen, W.S. (2009) Pathology and Intervention in Musculoskeletal Rehabilitation. Saunders Elsevier, Missouri.

Potter, N.A. & Rothstein, J.M. (1985) ‘Intertester Reliability for Selected Clinical Tests of the Sacroiliac Joint’. Physical Therapy 65: 1671-1675.

Sturesson B, Selvik G, Uden A, (1989) ‘Movements of the sacroiliac joints a roentgen stereophotogrammetric analysis’. Spine 14 (2): 162 165.

Vleeming, A. el al (1992) ‘Mobility in the SI-joints in old people: a kinematic and radiologic study’. Clinical Biomechanics 7: 170-176.

[WEB] http://morphopedics.wikidot.com/sacroiliac-joint

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