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SIJ
SIJ power point
182
Anatomy
Graduate
04/23/2012

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Term
what to do if you ever have a segment that moves too much/too little
Definition
look for too little/too much movement above and below
Term
what is the sacral ala
Definition
top wing at the base of the sacrum on each side
Term
where on the sacrum does the piriformis attach
Definition
S2-S4, anterolateral region of the sacrum
Term
does the piriformis pull on the sacrum
Definition
yes
Term
what kind of cartilage covers the sacrum at the SIJ
Definition
hyaline
Term
what kind of cartilage covers the ilium at the SIJ
Definition
fibrocartilage
Term
is hyaline or fibrocartilage thicker
Definition
hyaline cartilage is 2-5 times thicker than fibrocartilage
Term
does the SIJ surface change throughout the lifetime
Definition
yes
Term
what is the SIJ surface like in childhood
Definition
flat, smooth, unstable. Gliding motions in all directions is possible
Term
what is the SIJ surface like after puberty
Definition
rougher. Motion is restricted to anterior/posterior movementss
Term
what is the SIJ surface like in aging
Definition
less smooth, less mobile. Decreased motion
Term
is there fluid/nutrition flowing to hyaline or to fibrocartilage
Definition
to hyaline
Term
at the SIJ, is the ilium convex or concave
Definition
ilium is convex
Term
at the SIJ, is the sacrum convex or concave
Definition
concave
Term
is there mobility at the pubic symphysis
Definition
limited mobility
Term
what kind of cartilage is at the pubic symphysis
Definition
thin hyaline cartilage layer, thick fibrocartilage interpubic disc
Term
which nerve roots go over the SIJ
Definition
L4-5
Term
what do the L4-5 nerve roots over the SIJ cause when there is a problem
Definition
sciatic pain
Term
what causes about a 3rd of sciatic pain
Definition
L45 nerve root going over the SIJ
Term
what is the purpose of the posterior SI ligament
Definition
stops anterior innominate rotation
Term
when is the posterior SI ligament painful
Definition
with pressure when innominate is anteriorly rotated and in patients who have compensatory gait for loss of hip hyperextension
Term
what is the hemipelvis
Definition
innominate = ischium, pubis, ilium on one side of the pelvis
Term
can the ilium rotate without the pubis and ischium
Definition
no. they are all connected
Term
what is the function of the sacrotuberous ligament
Definition
prevents posterior rotation of the innominate and forward flexion of the sacrum
Term
if someone has a posteriorly rotated innominte, how would that affect the sacrotuberous ligament
Definition
there would be increased tension/tenderness on that side's sacrotuberous ligament
Term
what muscle inserts onto the sacrotuberous ligament
Definition
glute max
Term
what is the path of the posterior SI ligament
Definition
runs along the SI joint posteriorly and vertically
Term
what is the location/path of the sacrospinous ligament
Definition
from the sacrum to the ischial spine
Term
what is the function of the sacrospinous ligament
Definition
same as sacrotuberous ligament: prevents posterior rotation of the innominate and forward flexion fo the sacrum
Term
is the sacrospinous ligament palpable
Definition
no. it is too deep.
Term
what is the toughest ligament in the body
Definition
interosseous sacroiliac liagments
Term
what are the interosseous sacroiliac ligaments imporant for
Definition
maintaining the joint space of the SIJ during weightbearing
Term
what clothing accessory are the interosseous sacroiliac ligaments similar to
Definition
suspenders
Term
what are the attachments of the iliolumbar ligament
Definition
attaches to the transverse process of L5 and to the iliac crest
Term
what is the function of the iliolumbar ligament
Definition
responsible for maintaining the stability of the lumbosacral junction in the coronal and sagittal planes
Term
what is the path of the superior pubic ligament
Definition
connects superior parts of pubic rami
Term
if there is tenderness at the pubic symphysis, what ligament may be affected
Definition
superior pubic ligament
Term
which ligament are you touching as you palpate the superior rami of the pubic bones for rotation
Definition
superior pubic ligament
Term
where is the arcute pubic ligament
Definition
connecting the inferior borders of the pubic symphysis
Term
what ligament forms the superior border of the pubic arch
Definition
arcuate pubic ligament
Term
how many muscles attach to each side of the pelvic girdle
Definition
>30
Term
what muscles cross the SIJ with the purpose of moving the SIJ
Definition
none
Term
what are some key muscles for SIJ treatment
Definition
piriformis, glutes, ilipsoas, hamstrings, rectus femoris, hip adductors, lats, abdominals
Term
which muscles are anterior stabilizers of the SIJ
Definition
abs
Term
which muscles are posterior stabilizers of the SIJ
Definition
lats
Term
which muscles are important for treating posterior rotation of the SIJ
Definition
iliopsoas, rectus femoris
Term
do you get more ER or IR with outflare
Definition
ER
Term
do you get more ER or IR with inflare
Definition
IR
Term
does posterior rotation go with inflare or outflare
Definition
outflare
Term
does anterior rotation go with inflare or outflaire
Definition
inflare
Term
how to add stability at SIJ
Definition
pull opposite lats/glutes: glutes pull down and out, lats pull up and out in opposite direction. Tightens things up at the SIJ.
Term
are the L and R sacroiliac joints 2 separate joints?
Definition
the L and R sacroiliac joints are 2 structurally separate joints that functionally act as one singular joint
Term
in what plane of motion is innominate rotation
Definition
sagittal
Term
in what plane of motion is sacral nutation/counternutation
Definition
sagittal
Term
what does nutation look like
Definition
sacral base moves anteriorly.
Term
what does counternutation look like
Definition
sacral base moves posteriorly
Term
what is pelvic tilt
Definition
when the entire pelvis moves anteriorly or posteriorly in the sagittal plane
Term
does posterior rotation go with inflare/outflare and with IR/ER
Definition
outflare and ER
Term
does anterior rotation go with inflare/outflare and with IR/ER
Definition
inflare, IR
Term
how can you tell if your left innominate is posteriorly rotated
Definition
L ASIS is higher if it is posteriorly rotated
Term
how to correct L innominate posterior rotation
Definition
want to pull ASIS back down: isometrically contract L hip flexors to reverse the action and pull the ASIS anteriorly
Term
how to correct L innominate posterior rotation using R leg
Definition
want to pull PSIS down on R side: isometrically contract R hip extensors to pull PSIS posteriorly
Term
how long to hold contractions to correct innominate rotation
Definition
3x 3s
Term
what does sacroiliac motion refer to
Definition
sacral motion on the ilium
Term
is sacroiliac motion related to spine motion or to LE motion
Definition
spine motion
Term
what does iliosacral motion refer to
Definition
movement of iliumon sacrum
Term
is ilosacral motion related to spine motion or to LE motion
Definition
LE motion
Term
how much translation can occur at pubic symphisis
Definition
up to 2 mm
Term
how much rotation can occur at pubic symphysis
Definition
up to 3 deg
Term
if someone has an upslip because they've fallen and landed on one isch tube and they have pain at the right SI joint and PSIS and ASIS are both higher on the R side, is this rotation or translation
Definition
translation
Term
how much can the SIJ move
Definition
0.5-7mm
Term
what are the 3 planes of motion of the pelvis
Definition
sagittal (flex/ext), frontal (lateral flexion), axial (twisting)
Term
what are the main stabilizers of the SIJ
Definition
anterior and posterior ligaments
Term
Is the pelvic girdle a closed osteoarticular rign
Definition
yes
Term
what is the purpose of the pelvic girdl
Definition
efficient transmission and distribution of forces
Term
what are the 5 axes of rotation of the sacrum
Definition
superior/middle/inferior transverse and R/L oblique axes
Term
does the sacrum more often move on a transverse or an oblique axis
Definition
oblique
Term
where is the superior transverse axis of the sacrum
Definition
goes through sacral segment on medial-lateral line
Term
what is another term for the superior transverse axis
Definition
respiratory axis
Term
what is the movement of the sacrum at the superior transverse axis with respiratoin
Definition
inhale: counternutation; exhale: nutation
Term
where is the middle transverse axis of the sacrum
Definition
at the 2nd sacral body
Term
what is the middle transverse axis important for
Definition
it is the principle axis for SI flexion/extension
Term
where is the inferior transverse axis of the sacrum
Definition
it goes throug the inferior pole of SI articulatoin
Term
what is the principle axis for iliosacral motion
Definition
inferior transverse axis
Term
what does it mean that the inferior transverse axis is the principle axis for iliosacral motion (what happens there, exactly)?
Definition
anterior/posterior innominate rotation
Term
what are the paths of the oblique axes of the sacrum
Definition
superior end of articular surface to contralateral inferior end of articular surface
Term
how do we name the oblique axis as right or left
Definition
by the top. The Right oblique axis is superior on the right side
Term
how to name a rotation that is going forward at the right and is facing left
Definition
rotated left on the left oblique axis
Term
how to name a rotation that is going forward at the left and is facing right
Definition
rotated right on the right axis
Term
how to name a rotation that is going backwards at the left and is facing left
Definition
left rotated right axis
Term
if you tilt your right innominate, which axis is being used
Definition
left
Term
if you tilt your left innominate, which axis is being used
Definition
right
Term
is there more stability in nutation or counternutatoin
Definition
nutation
Term
why is nutation more stable than counternutation
Definition
tightening of interosseous, sacrotuberous, sacrospinous, posterior SI ligaments puts increased pressure on SIJ
Term
relative to a nutated sacrum, how is a pelvis tilted
Definition
posteriorly tilted
Term
what drives nutation
Definition
lumbar motion in the sagittal plane
Term
describe nutation in terms of rotation of sacrum on ilium
Definition
anteriorly rotated sacrum on ilium
Term
describe nutation in terms of rotation of ilium on sacrum
Definition
posteriorly rotated ilium on sacrum
Term
if someone has a posteriorly rotated innominate, how does that affect femur position
Definition
femur is moved towards flexion
Term
if someone has a posteriorly rotated innominate, in what hip/leg direction/movement will they be limited
Definition
extension
Term
if someone has a posteriorly rotated innominate, in what hip/leg direction/movement will they be painful
Definition
limited and painful in extension but also painful at end range flexion
Term
if someone has an anteriorly rotated innominate, how does that affect femur position
Definition
femur is moved towards extension
Term
if someone has an anteriorly rotated innominate, in what hip/leg direction/movement will they be limited
Definition
flexion
Term
if someone has an anteriorly rotated innominate, in what hip/leg direction/movement will they be painful
Definition
limited and painful in flexion, but also painful at end range extension
Term
if someone has a posteriorly rotated innominate, what is their direction of dysfunction
Definition
extension
Term
if someone has an anteriorly rotated innominate, what is her direction of dysfunction
Definition
flexion
Term
describe counternutation in terms of rotation of sacrum on ilium
Definition
posterior rotation of sacrum on ilium
Term
describe counternutation in terms of rotation of ilium on sacrum
Definition
anterior rotation of ilium on sacrum
Term
is lordosis associated with nutation or counternutation
Definition
counternutation: anteriorly rotated pelvis
Term
is flat back posture associated with nutation or counternutation
Definition
nutation: posteriorly rotated pelvis
Term
does anterior or posterior innominate rotation result in increased leg length
Definition
anterior
Term
what are the 3 factors of SIJ stability
Definition
form closure, force closure, motor control
Term
what is form closure
Definition
SIJ is in close packed position (nutation) so no outside force is needed to provide stability
Term
what provides stability to the SIJ in form closure/close packed position/nutation
Definition
joint shape (convex/concave), friction against joint surfaces, ligaments, anterior widening of sacrum
Term
what is force closure
Definition
SIJ is in loose packed position (counternutation) so outside forces are needed for stability
Term
what creates force closure
Definition
any outside force that results in nutation of sacrum: muscles, joint capsule
Term
what are the myofascial units that provide force closure
Definition
inner unit, oblique outer unit, deep longitudinal outer unit
Term
what muscles provide force closure from the inner unit
Definition
multifidus, thoracic diaphragm, transverse abdominis, pelvic floor mm
Term
what myofascial structures provide force closure anteriorly from the oblique outer unit
Definition
external/internal obliques, anterior abdominal fascia, contralateral adductors
Term
what myofascial structures provide force closure posteriorly from the oblique outer unit
Definition
lats, thoracolumbar fascia, contralateral glutes
Term
how to use outer unit to provide stability to SIJ posteriorly
Definition
do arm raise and squat to contract contralateral glutes and lats. Can do both at the same time: squat-stand-pull
Term
how to use outer unit to provide stability to SIJ anteriorly
Definition
do a SLR with leg ER to work adductors. Abdominal crunch up toward raised leg to work obliques and and adductors simultaneously
Term
what myofascial structures provide force closure from the deep longitudinal outer unite
Definition
erector spinae, ilocostalis, biceps femoris via sacrotuberous ligament
Term
if someone has deficient motor control stability of SIJ, what can you expect
Definition
weaknes with SIJ pain, aberrant SIJ motion
Term
what are common MOIs for SIJ problems
Definition
sudden jarring motion: step of curb or extra step unexpectedly; fall on butt; lift/twist maneuver; recent pregnancy/childbirth/breastfeeding
Term
where is SIJ pain usually localized
Definition
unilateral PSIS, glutes, groin, can refer to thigh, usually not below knee
Term
what is Fortin finger
Definition
pain at PSIS
Term
what are SIJ aggs
Definition
turning in bed, during WB phase of gait, standing with weight on painful side
Term
what are eases of SIJ pain
Definition
slouched sitting/sacral sitting
Term
what are the 3 main parts of the SIJ exam
Definition
lumbar screen, standing tests, lying tests
Term
what determines whether to do more detailed exams/tests of SIJ
Definition
lumbr screen
Term
what are the standing tests of SIJ
Definition
iliac crest levels, palpate PSIS for pain/tenderness, standing flexion tests, gillet test
Term
how to do standing flexion test
Definition
palpate both PSIS as pt flexes. Look for asymmetry in flexion. Both sides should move anteriorly the same amount.
Term
what to palpate in Gillet test
Definition
PSIS and S2 spinous proces
Term
what is normal motion in Gillet test
Definition
PSIS drops as hip flexes
Term
why would the PSIS move up as the hip flexes in Gillets
Definition
because they are laterally tilting or hip hiking to raise their leg
Term
will an anteriorly rotated innominate cause a leg to appear shorter or longer in standing/lying
Definition
longer
Term
will an anteriorly rotated innominate cause a leg to appear shorter or longer in sitting
Definition
shorter
Term
what tests of the SIJ are done in supine
Definition
check ASIS height, do supine to long sit test
Term
what does the supine to long sit test show
Definition
rotational malalignment; pelvis not rotating/moving as a unit
Term
what is the rule of three L's
Definition
leg lengthens lying = anterior rotation
Term
if a patient has a true leg length, will the short leg in sitting be the same as the short leg in lying
Definition
yes
Term
if the pelvis is rotated, with the long leg in lying be the long leg in sitting?
Definition
no
Term
what to palpate in supine to sit test
Definition
medial malleoli
Term
what to do before long sit test
Definition
have patient bridge to reset pelvis. I passively lower their legs.
Term
if a leg lengthens in sitting, what does that indicate for that side
Definition
posterior rotation of innominate
Term
what tests of the SIJ exam are done in prone
Definition
sacral apex test, sacral sulcus test
Term
what is the sacral apex test
Definition
posterior to anterior compression of the sacrum at the apex
Term
what is the sacral sulcus test
Definition
posteror to anterior compression of the sacrum directly medial to the PSIS
Term
how to identify SIJ hypermobility
Definition
unstable pubic symphysis
Term
what can cause SIJ hypermobility
Definition
pregnancy, being an athlete, trauma
Term
what causes SIJ hypomobility
Definition
overuse/trauma/pelvic asymmetries
Term
what are SIJ dysfunctions
Definition
hyper/hypomobile, anterior/posterior innominate, sacral torsion, upslip/downslip, inflare/outflare
Term
what is the most common malalginment issue of the SIJ
Definition
innominate rotation
Term
what is a common MOI for innominate rotation
Definition
forward trunk flexion with twist. (reach for something on the ground.)
Term
what are the 2 most common innominate rotation directions
Definition
right anterior and/or left posterior
Term
if R ASIS is down, R pubic tubercle is down, and R PSIS is higher, what is the problem
Definition
R anterior rotation
Term
if you have R anterior rotation, what is the L, relatively?
Definition
posteriorly rotated
Term
if you have L posterior rotatoin, are you more likely to see outflare or inflare
Definition
outflare
Term
if you have the L posteriorly rotated, are you more likely to see L IR or ER
Definition
ER
Term
if you have a R anteriorly rotated innominate and a L posteriorly rotated innominate, what is the sacral torsion
Definition
L facing on L axis
Term
when you rotate the sacrum to the L, how is the lumbar spine affected
Definition
lumbar spine rotates L
Term
why use muscle energy?
Definition
to get relaxation following contraction; to get reciprocal inhibition; to balance the asymmetries; to restore normal funciton/ROM; neuromuscular re-education
Term
if you have an anteriorly rotated innominate, is that leg longer in sitting or lying
Definition
longer in lying
Term
how to treat an anteriorly rotated innominate with muscle energy
Definition
isometrically contract extensors so that extensors pull innominate posteriorly
Term
if the iliac crest is higher, the PSIS is lower, the ASIS is higher, and the leg lengthens in sitting, what is the problem?
Definition
posteriorly rotated innominate
Term
how to treat a posteriorly rotated innominate with muscle enery
Definition
isometrically contract the hip flexors so that they pull the innominate anteriorly
Term
if you have sacral torsion of L on L, where will you have a deep sacral sulcus
Definition
right
Term
how to treat sacral torsino
Definition
muscle energy technique
Term
if the iliac crest is higher, the PSIS is higher, the ASIS is higher, and the pubic tubercle is higher, what SIJ dysfunction do you have
Definition
upslip
Term
what is the treatment for upslip
Definition
leg pull
Term
if the iliac crest is lower, the PSIS is lower, the ASIS is lower, and the pubic tubercle is lower, what SIJ dysfunciton do you have
Definition
downslip
Term
what is the treatment for downslip
Definition
passive cephalad motion through ischium: put hand on isch tube. Upglide. Tell patient to push against you with their isch tube.
Term
how to correct inflare
Definition
isometrically contract adductors so that they pull out the pubis
Term
how to correct outflare
Definition
isometrically contract external rotators so that they pull in the ilium
Term
what muscles are contracted in outflare contraction
Definition
Hip Ers, hip abductors, iliacus
Term
how often to do inflare/outflare corrections
Definition
3x, 3s, 2-3x/day
Term
how to tell if a patient has inflare
Definition
they are anteriorly rotated and they can internally rotate a lot
Term
how to tell if a patient has outflare
Definition
they are posteriorly rotated and they can externally rotate a lot
Term
is it more important to treat the rotation or the flare
Definition
more important to treat the rotation
Term
if you're anteriorly rotated, are your hamstrings shortened or lengthened
Definition
lengthened; they'll feel tight
Term
besides muscle energy, what are some treatments for SIJ dysfunctions
Definition
modalities, mobilization, stabilizing belt for hypermobility, lower extremity alignment
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