slide 1 mechanical sacroiliac dysfunction 1. a brief ......slide 17 2°- iliosacral test pelvic...

Assessment & Treatment of mechanical SIJ dysfunction ©MTI 2020 Page | 1

Slide 1

ASSESSMENT & TREATMENT OF MECHANICAL SACROILIAC DYSFUNCTION

Slide 2

WEBINAR OUTLINE

1. A brief review of challenges of assessing and treating the SIJ.

2. A visual guide to hypothetical SIJ motion.

3. A visual guide to assessing and treating the SIJ.

4. Non mechanical causes of SIJ dysfunction and suggested

treatment approaches.


Slide 3

INTRO

- First introduction to sacroiliac dysfunction.

- Research proves SIJ motion and that it

can contribute to low back pain.

- Clinical utility testing inconclusive (palp vs pain).

- I don’t find pain provocation tests that helpful.

Slide 4

INTRO

- Innominate dysfunction can create

painful hypermobility in the SIJ.

- Palpation for anomalies also is unreliable

and can yield false positives.

- Clustering of tests most helpful.


Slide 5

HYPOTHETICAL SIJ MOTION

Figure 1. Transverse sacral axis. From (1) Figure 2. Nutation and Counternutation from (1)

Slide 6


Figure 3. Flexion from (2) Figure 4. Extension from (2)


Slide 7


Figure 6. Sacral AxisFigure 5. Left Quadrant or Sidebending. From (2)

Slide 8

Figure 7. Weight distribution from (3)


Slide 9

ILIOSACRAL MOTION

The iliosacral joints move from a position

of anterior rotation and inflare at heelstrike

to a position of posterior rotation and

outflare at heel off.

Slide 10

SACROILIAC MOTION

During the walking cycle the sacrum moves from

a position of left rotation to a left torsion on a left

oblique axis as the right leg heelstrikes. By push

off of the right foot, the sacrum has moved to a

right torsion on a right oblique axis.


Slide 11

KEY CONCEPTS

• Structural positional dysfunction

• Adaptive positional dysfunction

• Traumatic positional dysfunction

Slide 12

KEY CONCEPTSImagine a line drawn

through both ears. Are they

parallel with lines drawn

through the tips both a/c

joints and both iliac crests ?

INDIRECT METHOD LLDVisually compare the heights of the iliac crests. The lower side may represent a short leg.

The indirect method using lifts had superior validity, interobserverreliability, and specificity over the direct supine method using tape measure. Both clinical methods underestimated LLD compared with radiograph 4.


Slide 13

KEY CONCEPTS

LEG LENGTH INEQUALITY (LLI)

Anatomic LLI common (90%) with average

5.2mm and 15% with 10mm or more.

Right leg shorter 50-75%5

Slide 14

KEY CONCEPTS

•

FUNCTIONAL LLD 6

A: 60% have a C-type scoliosis,

a posterior innominate rotation

on the side of the elevated

innominate and an atlas

elevated on the side opposite to

the elevated innominate.

B: 40% have a S-type scoliosis

with an anterior innominate

rotation on the side of the

elevated innominate and an

atlas elevated on the same side

as the elevated innominate

Image from 6


Slide 15

1° - ILIOSACRAL TESTPELVIC SPRING TEST

The patient lies supine and lifts their

pelvis off the bed before repositioning the

pelvis in neutral.

The operator stands to the side and

places the palm of each hand over

the lateral pelvic rim and ASIS.

The operator introduces a gentle glide of

the ilium on the sacrum at a 45º angle.

The positive side is the side that feels

most restricted.

+/- STANDING FWD FLEXION OR GILLET TEST

Slide 16

2°- ILIOSACRAL TEST


Slide 17

2°- ILIOSACRAL TESTPELVIC LANDMARKS

The patient lies supine and the operator

lightly palpates both ASIS for alignment in

the superior /inferior & medial/lateral

directions.

The side of dysfunction is the side with the

most restricted pelvic spring test.

1. Superior ASIS = posterior rotated

innominate

2. Inferior ASIS = anterior rotated

innominate

3. Lateral ASIS = outflared innominate

4. Medial ASIS = inflared innominate

1 2

3 4Images from 1

Slide 18

1°- SACROILIAC TESTSACRAL SPRING TEST

The patient lies prone while the operator places the heels of their hands over the sacral base. The operator applies a gentle ventral force to the sacral base feeling for ease of sacral nutation. Lack of motion is considered a positive test.

The operator can also reverse the hand positions to apply force at the sacral apex and test for ease of counternutation.

+/- Recoil


Slide 19

2°- SACROILIAC TESTSACRAL POSITION

1. Depth of the sacral sulcii

The operator places their thumbs on the

patients PSIS bilaterally and curls their

thumbs medially and caudally to compare

the depth of the sacral sulcus bilaterally.

Check also for sulcus tenderness.

2. Level of the inferior lateral angles

The operator places the pads of both

thumbs 15-20mm lateral to the sacral

hiatus and compares the level bilaterally

on the coronal plane. The operator then

rolls their thumbs under the sacral ILA’s

to compare the level bilaterally on the

horizontal plane.

Slide 20

SACRAL JCS POINTS


Slide 21

JCS TECHNIQUE1. Locate the tender point.

2. Find position of comfort or mobile point.

3. Monitor point response but take pressure off.

4. Hold 90 seconds.

5. Return to neutral slowly.

6. Recheck tender point – 70% improved.

Slide 22

SACROILIAC JOINT L PS1 POSTERIOR SACROILIAC 1

DX: SS deeper on R and ILA more posterior

on left. +ve Spring Test

PD = LST/ROA

Tender point: 1.5cm medial to PSIS

RX: Patient Prone.

Apply a ventral pressure with the heel of the

hand on the opposite corner of the sacrum

(right sacral apex). Produces a left backward

sacral torsion on an oblique axis.


Slide 23

SACROILIAC JOINT L PS5 POSTERIOR SACROILIAC 5

DX: SS deeper on R and ILA more posterior on

left. –ve Spring test

PD = LST/LOA

Tender point: 1cm medial and 1cm superior

from left ILA.

RX: Patient Prone. Apply a ventral pressure on

the opposite corner of the sacrum (right sacral

base) to produce a forward sacral torsion on an

oblique axis.

Slide 24

NON MECHANICAL SIJ DYSFUNCTION

Dx - Sphenobasilar dysfunction

Rx – Counterstrain or Craniosacral therapy

Dx – Cecal, Sigmoid or Uterus dysfunction

Rx – Counterstrain or Visceral manipulation

Dx – Sacral epidural vein dysfunction

Rx - Counterstrain


Slide 25

For references, a copy of the slide notes and

information about the 2 day Assessment &

Treatment Intro course please got to:

manualtherapyinstitute.com/mma

References

1. “Glossary of Osteopathic Terminology,” 2011. https://www.aacom.org/docs/default-

source/insideome/got2011ed.pdf

2. Lee D, The Pelvic Girdle: an approach to the examination and treatment of the lumbo-pelvic-hip region., 2nd ed.,

London: Churchill Livingstone, 1999.

3. Richter P & Hebgen E, in Trigger Points and Muscle Chains in Osteopathy, Thieme, 2009

4. Badii M et al. "Comparison of Lifts Versus Tape Measure in Determining Leg Length Discrepancy." The Journal of rheumatology 41.8: 1689-1694. 2014.

5. Knutson G, "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance," Chiropr Osteopat, vol. 13, no. 11, 2005. 6. Timgren J & Soinila S, "Reversible Pelvic Asymmetry: An Overlooked Syndrome Manifesting as Scoliosis,Apparent Leg-Length Difference, and Neurologic Symptoms," Journal of Manipulative and Physiological Therapeutics, vol. 29, no. 7, pp. 561-565, 2006.

slide 1 mechanical sacroiliac dysfunction 1. a brief ......slide 17 2°- iliosacral test pelvic...

Documents