Lumbar Spine/Pelvis

Question 1

Nutation is? And occurs with?

Answer 1

Nutation is __ and occurs with lumbar extension

Question 2

Counter-nutation is? And occurs with?

Answer 2

Counter-nutation is__ and occurs with lumbar flexion

Question 3

SI Joint Epidemiology

• Discogenic:
• Zygopopseal:
• Sacroiliac Pain:
• Undefined:

Answer 3

Discogenic: 65%
Zygopopseal: 15%
Sacroiliac Pain: 7%
Undefined: 13%

Question 4

Three possible Components to SIJ/Pelvic Involvement

Answer 4

1: SIJ Dysfunction
2: SIJ Pain
3: Pelvic Girdle Pain

Question 5

SIJ Dysfunction Definition:

Answer 5

…pain that arises from the sacroiliac joint and is caused by a lack up, asymmetry, or alteration in the stability of the sacroiliac joint

Question 6

SIJ Pain Definition:

Answer 6

…pain localized in the region of the SI joint, and reliability relieved by selective infiltration of the SI joint with a local anesthetic

Question 7

Pelvic Girdle Pain (PGP) Definition:

Answer 7

• Generally arises from in relation to pregnancy, trauma, and OA
• Experienced between the posterior iliac crest and gluteal fold, particularly in the vicinity of the SIJ
• Pain may radiate into the posterior thigh and can also occur in conjunction with/or separately in the symphysis.
• Diagnosis of PGP can be reached after exclusion of lumbar causes

Question 8

Risk Factors for SIJ Pain (4)

Answer 8

1: True and apparent leg length discrepancy
2: Gait abnormalities
3: Prolonged vigorous exercise
4: Scoliosis

Question 9

SIJ Pain Clinical Presentation (4)

Answer 9

• Numbness, popping, clicking, or groin pain can occur
• Pain usually not above the belt line
• Unilateral pain > bilateral pain (4:1)
• History of trauma in 44-58% of individuals with SIJ pain

Question 10

Risk Factors for Pelvic Girdle Pain (4)

Answer 10

• 15% greater symphyseal width (>10mm)
• Poor muscular control
• Typically during or post- pregnancy (< 2 years)
• Pluripara (2+ pregnancies with full term fetus)

Question 11

Pelvic Girdle Pain Clinical Presentation (7)

Answer 11

• Pain localized to the pelvic girdle either posteriorly close to the SIJ or anteriorly near pubic symphysis
• Peak onset 3rd trimester
• Pain with sit to stand
• Pain with coughing, sneezing
• Altered gait pattern (slower velocity)
• Catching or clicking with hip flexion
• Pubic symphysis tenderness

Question 12

Bad Likelihood Ratios for SIJ Palpatory Motion Tests (6)

Answer 12

• Gillet’s Test: +LR: 1.2
• Long-sit Test: +LR: 1.13
• Standing Flexion Test: +LR: 0.81
• Standing ASIS Asymmetry >3mm: +LR: 0.94
• Standing PSIS Asymmetry >3mm: +LR: 1.11
• Seated PSIS Asymmetry >3mm: +LR: 0.88

Question 13

SIJ Pain Provocation Tests

Answer 13

3 of 5 = +LR 4.16 (Sn: 91; Sp: 87)

• SI Compression Test: hold 30 seconds and bounce at end
• SIJ Gapping: hold 30 seconds and bounce at end
• Sacral Thrust: 3 to 5 hard thrusts
• Thigh Thrust: hold 30 seconds and bounce at end
• Gaenslen’s Test: Thomas test with 3 to 5 torsions

Question 14

SIJ Active Stabilizers (Primary and Secondary)

Answer 14

Primary
- Multifidi
- Inferior Internal Oblique
- Transverse Abdominus 
Secondary
- Gluteus Maximus
- Hamstrings
- Erector Spinae
- Latissimus Dorsi