Lecture 4B: SIJ Exam, Eval, Interventions

Question 1

what % of individuals with LBP will have SIJ related pain

Answer 1

15-30%

Question 2

3 categories of SIJ pain

Answer 2

pregnancy
pathology
non-specific

Question 3

causes of pelvic / SIJ pain (VISCERAL= non mechanical)

Answer 3

appendicits
gynecologic disosrder (uterine, ovarian, cervical)
UTI, kidney stone
Digestive tract disorders (IBS/Crohn’s and gallstone)
vascular (AAA, Gluteal, femoral)

Question 4

go over more causes of SIJ slide 5-6

Question 5

slide 9

Question 6

quick screen for SIJ pain is at

Answer 6

fortin finger test (over region or below PSIS)
- pain with transition
- SLS activity
- end range
- prolonged sit/stand
- NO SX BELOW KNEE
- NO NEURO S&S

Question 7

if you have SIJ patient, ALWAYS perform the SIJ exam in addition to

Answer 7

LUMBAR SPINE
OR
HIP EXAM

Question 8

what’s statistically the best test and most reliable for SIJ?

Answer 8

provocation / stress > alignement or mobility..

Question 9

to test for provocation/stress test: test ALL 6 Components

Answer 9

1. faber/figure 4/patrick
2. distraction
3. thigh thrust
4. compression
5. sacral thrust
6. Gaenslen’s test

Question 10

slide 12

Question 11

hypomobile innominate rotation

Answer 11

anterior innominate on one side, posterior on the other

Question 12

pubic lesion (superior and inferio shear) is due to

Answer 12

significant trauma/birth

Question 13

typical MOI of SIJ hypomobility

Answer 13

repeated unilateral standing
fall on isch tub
vertial thrust on exteneded LE
back lifting
golf/baseball swing
dashboard injury
forceful diagonal mvmt
foot caught in stirrups and dug around

Question 14

to treat SIJ hypomobility

Answer 14

manual techniques
core ex

Question 15

sacroilitis (arthritis)
S&S

Answer 15

post sacrum or groin pain (rare)
radiate pain in post. thigh
increase w/ walking at heel strike or mid-stance
increased when turning in bed
lumbar extension PAIN , not so much flexion
+ SI Stress test
+ compression test with SI Belt

Question 16

arthritis treatment

Answer 16

NSAIDS
ice
core
LE ex

Question 17

form closure

Answer 17

when passive instability (wedge-shaped sacrum, ligaments, and the high friction b/t articular surfaces) are lacking… causes abnormal movement

Question 18

force closure

Answer 18

when active stability of SIJ is lacking… causes abnormal movement

Question 19

way to treat form closure

Answer 19

SIJ Compression Belt

Question 20

way to treat force closure

Answer 20

core ex

Question 21

active stabiity (force closure) provided by?

Answer 21

external: ES, GM, lat, bicep fem
internal: TA, sacral multifidi, PFM, hip ER
TL fascia + mm contraction = ballooning effect ot force close SIJ

Question 22

If patient has both force and form closure issues… fix this one first

Answer 22

form

Question 23

Persistent, severe referred pain in low back, sacrum, buttocks, hip, post thigh and popliteal space
(+) severe pain w/ provocation of piriformis, sulcus or GT
(+) pain w/ sitting or squatting
Persistent hip ER on affected side
Difficulty lying or standing comfortably
(+) LE paresthesias

Answer 23

piriformis syndrome

Question 24

Tx for piriformis syndrome

Answer 24

manual techniques (i.e. HVLAT, STM), stretching, core ex’s

Question 25

slide 22

Question 26

SIJ dysfunction will resolve if you

Answer 26

treat lumbar or hip dysfunction first!! if it doens't resolve then focus on SIJ. treat hypomobile side FIRST

Question 27

T/F: side of pain may not always correspond w/ dysfunction... treat the dysfunction side (stabilize around it)... always treat hypomobility before hypermobility

Answer 27

True ( Pain >mobility> stability )

Question 28

which diagnostic imaging is best at detecing SIJ changes?

Answer 28

MRI scans

Question 29

Acute pelvic/SI joint pain and pt at risk for osteoporotic or stress fx Trauma w/ (+) clinical signs and/or altered consciousness

Answer 29

radiograph

Question 30

Suspect pain related to cancer or infection Suspect significant disc pathology

Answer 30

MRI

Question 31

Not appropriate for pelvic/SI joint pain

Answer 31

bone scans

Question 32

Awake and alert, absence of trauma w/ no clinical signs and no indications of pathology

Answer 32

no imaging indicated

Question 33

treatment progression for SIJ

Answer 33

conservative pharmacological surgery

Question 34

conservative tx ideas

Answer 34

Physical therapy - HVLAT (manipulation) SI belt Exercise (therapy) Pt education Acupuncture/dry needling Massage therapy Yoga/Pilates Progressive relaxation Cognitive behavioral therapy Intensive interdisciplinary rehabilitation

Question 35

read slides 33, 34, 35, 37

Question 36

T/F The last resort course of tx for SIJ is stabilizaiton surgery

Answer 36

FALSE (SI joint fusion surgery)

Question 37

Injection of dextrose solution into SI joint space Better results when compared to CS injection (at 15 months) 58.7% prolotherapy 10.2% CS injection

Answer 37

prolotherapy

Question 38

Injection of autologous biological blood-derived product High concentrations of platelet-derived growth factors & anti-microbial properties Enhance healing response Better results when compared to CS injection (at 3 months) 90% PRP injection 25% CS injection

Answer 38

platelet rich plasma (PRP)

Question 39

stabilization surgery indicated when

Answer 39

pelvic fracture / dislocaitons Ilium Sacrum

Question 40

this is only selected for pts with chronic , unresolved sx.

Answer 40

SIJ fusion

Question 41

slide 44,45

Question 42

take home message (4 points)

Answer 42

1. LBP + SI joint pain – common dx seen by PTs,** especially during pregnancy or w/ trauma** 2. Evidence suggests conservative tx > pharmacologic/surgical tx In s**table or non-serious cases** **SI belt** for sx management 3. Treatments should be **multi-modal and impairment-based ** **Treat LBP and hip pain 1st!!!** Use what works for your pt 4. Most valuable contribution PTs can make to ↓ burden: **Prevent acute pain → chronic pain!!! **