Flashcards in 03 SI 1 Deck (50):
Why don't we do MMT and gonio for the SI joint?
- When you do lumbar and hip ROM, you get Si as well for gonio
- When you do lumbar, abdominal, and hip MMT, it takes care of SI as well
Why do some therapists choose not to treat SI?
- don't believe it moves at all
- anatomically can't produce pain
- doesn't get pathology or symptoms
Why do some therapists base a lot of their treatments on SI joint?
- believe it's a huge pain generator
- primary cause for most butt pain
Before you treat for SI, you should always check this first
SI is the articulation between which two bones?
Pain over this landmark can refer pain to the SI joint
Can you palpate the SI joint directly?
- palpate the PSIS instead
What is one of the biggest indicators of true SI joint dysfunction according to research?
- pain surrounding the PSIS
primary symptoms for the SI joint
unilateral buttock pain
What are some other reasons for developing buttock pain?
- piriformis syndrome
- hamstring strain
- referral from lumbar spine
- hip problem
- ischial tuberosity bursitis
Must you always clear lumbar spine first?
- even if you have palpable pain over PSIS
- if you don't clear lumbar spine, you'll be sure to miss something
What are some of the most important things to check when clearing lumbar spine?
- repeated motion testing (if distal s/s)
What would make you think it's not lumbar?
- full, unrestricted lumbar ROM
- pain free
- doesn't reproduce their symptoms
differentiating between lumbar spine and piriformis
- repeated flexion tugs on sciatic nerve and could bring on symptoms
- repeated extension will not have a centralizing effect because it has nothing to do with the disc
If there is centralization with repeated motion testing, should you move on to SI?
- no, don't perform tests
- If there's centralization, SI joint testing is completely inaccurate
SI issues can be _____ or ______
traumatic etiology of SI problems
- SI joint sprain
- fall and land on the butt
- jumping and landing one legged
Why would jumping and landing on one leg cause SI problems?
get shearing of the sacrum on the ilium
atraumatic etiology of SI problems
Why are pregnant women more susceptible to SI problems?
- relaxin released during 3rd trimester
- causes ligamentous laxity
- may make SI hypermobile
Why do we not test MMT and ROM at the SI joint?
- There's really no motion at the joint
- test ROM and MMT at the hip and lumbar spine instead
Because the ASIS area is potentially ticklish, what can you do to stop this?
What are the posterior structures to palpate?
- SI joint/PSIS
- posterior greater trochanter
- ischial tuberosity
What are the anterior structures to palpate?
- iliac crest
- iliac tubercle
- greater trochanter
- pubic tubercle
When you observe the SI structures, what are you checking for?
When you're assessing for symmetry in standing, where should the patient's arms be?
down by their sides
How do you know if there's something going on with the ischial tuberosity?
may feel one further than the other
What covers the ischial tuberosity that can become inflamed?
If you palpate your patient in standing, do you need to palpate them lying down as well?
- need to test in WB and non-WB positions
- improved reliability and accuracy
What must you always do when palpating in this area?
Tell your patient everything you're going to do. Ask their permission!
How do you determine which side is abnormal?
- depends on the side with pain
- if they have a difference without pain, we aren't concerned about it
How do you name the abnormality if there's asymmetry?
based on the side that has pain
If there's pain on the right side and the ASIS is lower on the right, what would I call it?
right anteriorly rotated innominate
If there's pain on the right and the ASIS is higher on that side, what would I call it?
right posteriorly rotated innominate
two types of leg length differences
- true leg length difference
- functional/apparent leg length difference
true leg length difference
What is considered a significant difference?
- greater than ½ inch will cause symptoms » treat
How do you treat a true leg difference?
- build up the shoe
- insert for the shoe
What is a functional leg length difference?
- SI joint mobility has allowed a pelvic rotation on one side
- makes it look like one side is longer than the other
What may be indicative of a true leg length difference?
- ALL pelvic landmarks are higher on the right than on the left
- NOT rotation
For a rotated innominate, how would you name it if the patient is symptomatic bilaterally?
name based on the more symptomatic side
How do you determine femur length difference?
- hooklying position, feet together
- look at height of knees
How do you determine tibia length difference?
- prone, bend knees to 90˚
- look at heel height
What is the gold standard for determining leg length difference?
Why would you need to use a scanogram?
- significant difference in leg length
- want to know how much needs to be corrected
Why do radiologists not like doing the scanogram?
- have to take measurements of every single bone
- measuring femur and tibia length vis their bony landmarks
How would you measure for true leg length difference for the whole leg?
- measure from belly button to medial malleolus on both feet
- some PTs use the ASIS
What could potentially be a problem with measuring leg length from the ASIS?
If they have a rotated pelvis, may skew the measurement
What positions can you do leg length measurements in?
At what point will a shoe lift be a likely treatment?
over 1 inch asymmetry and symptomatic