Pelvic SI

Question 1

Depth of Sacral Sulcus

Answer 1

Check to see if each side is equal

Question 2

Long Siting Test

Answer 2

Patient Position: Supine

Clinician Position: Stand @ patient’s feet. Place thumbs distal to prominence of malleoli & observe levels of malleoli.

Method: Ask the pt to bend knees & place feet flat, pt lifts pelvis from table, returns pelvis to table. The therapist passively extends the legs. The patient is asked to sit up with knees extended; observe malleoli for changes in length relative to supine

Positive Response: Indicates abnormal mechanical relationship of innominate moving on the sacrum (iliosacral motion).

 Posterior Innominate = Short to Long
 Anterior Innominate = Long to Short

Question 3

Distraction

Answer 3

Patient Position: Supine

Clinician Position: Stand @ level of patient’s hips

Method: Crossed arms with hands on the ASIS. Apply pressure to both ASIS in a posterolateral direction. Hold the force for 20 seconds

(Provocation Test)

Question 4

Thigh thrust

Answer 4

Patient Position: Supine with towel under sacrum.

Clinician Position: Standing @ level of patient’s hips. Hand placement: Around patient’s knee OR around knee and other hand on sacrum

Method: Flex hip to 90°. Apply posteriorly directed force through the femur OR the therapist uses his/her chest to apply an anterior to posterior force through the femur while applying a posterior to anterior force with the hand under the sacrum. Either is to provide a shearing force through the SI joint.

(Provocation Test)

Question 5

Gaeslen’s

Answer 5

Patient Position: Supine on the edge of plinth/table asymptomatic leg hanging over the edge

Clinician Position: Stand @ patient’s side

Method: Patient flexes symptomatic knee and hip into full flexion, other hip is fully extended, therapist provides overpressure. Creating hip flexion on symptomatic side and creating hip extension on asymptomatic side

(Provocation Test)

Question 6

Compression

Answer 6

Assessment: Positive if pain is reproduced. Compresses anterior structure which will distract the posterior structures of the SI joint.

Patient Position: Sidelying

Clinician Position: Stand @ level of patient’s hips

Method: Hands on iliac crest. Apply downward pressure to the uppermost iliac crest directed towards the opposite iliac crest.

(Provocation Test)

Question 7

Sacral Thrust

Answer 7

Patient Position: Prone

Clinician Position: Stand @ level of patient’s hips. Hand placement: On sacrum.

Method: Apply an anteriorly directed force through the Sacrum

(Provocation Test)

Question 8

FABER

Answer 8

Patient Position: Supine, hip is (F)lexed, (AB)ducted, and (E)xternally (R)otated by resting the lateral malleolus on the opposite knee.

Clinician Position: Standing @ same side of tested hip. Carefully place one hand on opposite ASIS and the other on lateral aspect of isolateral knee.

Method: The ASIS is stabilized and pressure is applied to the knee.

(Provocation Test)

Question 9

Pubic Symphysis Test

Answer 9

Is the pubic symphysis even and straight?

Question 10

Standing Forward Bend

Answer 10

Stand behind the pt with thumbs on PSIS. Have pt bend forward and see how PSIS move. Are they equal? If one moves more than the other that SIJ is hypomobile.

Question 11

Sitting Forward Bend

Answer 11

Stand behind the seated pt with thumbs on PSIS. Have pt bend forward and see how PSIS move. Are they equal? If one moves more than the other that SIJ is hypomobile.

Question 12

Gillet Test

Answer 12

One thumb on S2 and the other on PSIS. Have pt lift leg to 90. PSIS should move down.

Question 13

In fare/Outflare

Answer 13

Pt standing. Put most of the weight on unaffected leg. Pt “squishes bug” with affected leg. Feel ASIS, if it doesn’t move appropriately (enough) positive for inflate/outflare

Question 14

Unilateral Squish Test

Answer 14

Pt supine. Apply post late force on R hip slowly (about 30 seconds) if tight, L hi will come up into other hand.

Question 15

Force Closure

Answer 15

Have pt do a SLR. Add pressure on the shoulder in order to get ab contraction, with this added pressure, preforms another SLR and compare pain to the first.

Question 16

Form Closure

Answer 16

Have pt do a SLR. Add pressure on the pelvis (both sides), with this added stability preform another SLR and compare pain to the first.

Question 17

Assessment of TA

Answer 17

Pt 1) supine 2) sidelying or 3) on hands and knees. Have the pt tighten pelvic floor and (potentially) bring belly button up and in. Be sure Rectus Abdominus is not firing.

Question 18

Assessment of Multifidus

Answer 18

Pt prone. Go through and palpate Multifidus to find if one belly is either smaller than it should be or smaller than the other side. At this portion of the mutifidus push in slightly and have the pt flex this muscle. Be sure erector spinae are not firing.

Question 19

Pubic Shear

Answer 19

Grasp knees & hold them together. Ask pt to “pull your knees apart” (abduct) while you resist. Hold 7-10 sec & relax. Allow knees to abduct keeping feet together “let your legs fall apart.” Ask the pt for an isometric abduction contraction in this position while you provide resistance. Hold 7-10 sec. When contraction is stopped, place your forearm between the pts knees & ask pt for an isometric contraction of the adductors, “squeeze your knees together against my arm.”

Question 20

Flexed Sacrum (Correcting)

Answer 20

(Correcting a nutated Sacrum) The heel of your mobilizing hand makes contact with the sacrum and is reinforced by your other hand. Abduct 15° and internally rotate both legs to gap the joints to facilitate correction. Place the heel of your hand between the ILA’s. Apply a posterior to anterior pressure for 45 seconds.

Question 21

Extended Sacrum (Correcting)

Answer 21

(Correcting a counternutated Sacrum) The heel of your mobilizing hand makes contact with the sacrum and is reinforced by your other hand. Abduct 15° and internally rotate both legs to gap the joints to facilitate correction. Place the heel of your hand on the mid sacral base. Apply caudal pressure for 45 seconds.

Question 22

Inflare Correction

Answer 22

Patient Position: Supine
Clinician Position: Stand at hips on unaffected side facing head.
Method: Flex hip & knee on affected side to about 45° and rest the foot on the table. Palpate ASIS on unaffected side. Externally rotate and abduct until you find the barrier. Back off of the barrier slightly. Ask the patient to gently push knee medially and hold for 8-10 seconds. Wait for the contraction to completely relax for 2-3 seconds. Repeat procedure 3-5 times taking the involved side to a new barrier each time. Reevaluate.

Question 23

Outflare Correction

Answer 23

Patient Position: Supine
Clinician Position: Stand at hips on affected side facing head.
Method: Flex hip & knee on affected side to about 45° and rest the foot on the table. Palpate ASIS or PSIS on affected side. Move knee medially into adduction until the barrier is detected. Back off of the barrier slightly. Ask the patient for a gentle isometric contraction of hip abductors which is held for 8-10 seconds. Wait for the contraction to completely relax for 2-3 seconds. Repeat procedure 3-5 times taking the involved side to a new barrier each time. Reevaluate.

Question 24

Anterior innominate Correction

Answer 24

Patient Position: Supine
Clinician Position: Standing on involved side facing patient
Method: One hand palpates the sacrum or ilium, the other is used to grasp the knee of the involved side. Find the barrier in (l) Flexion; (2) Adduction; (3) Internal Rotation and then back off slightly from the barrier. Ask the patient for a gentle isometric contraction of hip Extensors which is held for 8-10 seconds. (“Gently push your knee into my chest”) Wait for the contraction to completely relax for 2-3 seconds. Repeat procedure 3-5 times taking the involved side to a new barrier each time. Reevaluate.

Question 25

Posterior Innominate Correction

Answer 25

Patient Position: Supine with the hip and buttocks close enough to the edge to allow hip extension Clinician Position: Standing on affected side facing patient. Method: One hand stabilizes the iliac crest/ASIS and the other is placed under the knee on the affected side. Find the barrier in (1) Extension; (2) Abduction; (3) External Rotation and then back off slightly from the barrier. Ask the patient for a gentle isometric contraction of hip flexors "Push your knee toward the ceiling" which is held for 8-10 seconds. Wait for the contraction to completely relax for 2-3 seconds. Repeat procedure 3-5 times taking the involved side to a new barrier each time. Reevaluate.

Question 26

Upslip Manipulation

Answer 26

Patient Position: Prone with feet near end of plinth. Clinician Position: Standing at end of the plinth nearer to the affected side. Method: Grasp the distal lower leg around the ankle. (You can use a more superior grip if necessary). Passively raise the leg into about 10° of hip extension & slight hip adduction, then internally rotate leg (you are trying to find a relaxed position). Take up the slack by distracting the leg until the barrier is felt. Apply this caudal traction for about 30 seconds. Give a short, quick thrust caudally. (HVLA)

Question 27

How are the facets of L5-S1 oriented?

Answer 27

In the frontal plane. This orientation allows flexion/extension and rotation yet also disallows these movements.

Question 28

What is the function of the iliolumbar ligament?

Answer 28

Limits all planes of movement between the lumbar spine and the sacrum

Question 29

What does the central ligament limit?

Answer 29

Limits anterior tapping of the joint.

Question 30

What does the interosseous limit?

Answer 30

Limits posterior tapping and torsion across the joint

Question 31

What does the long dorsal ligament limit?

Answer 31

Limits backward movement of the sacrum

Question 32

What is Sacral nutation?

Answer 32

Flexion, anterior tilt, occurs during exhalation

Question 33

What is Sacral counternutation?

Answer 33

Extension, posterior tilt, occurs during inhalation

Question 34

What does the sacrotuberous ligament limit?

Answer 34

Limits nutation

Question 35

What does the sacospinous ligament limit

Answer 35

nutation

Question 36

How is Sacral motion described

Answer 36

By the way the anterior surface is facing

Question 37

How does the innominate move compared to the sacrum

Answer 37

Opposite

Question 38

What is form closure?

Answer 38

The closure of the SIJ due to bones and ligaments

Question 39

What is force closure?

Answer 39

The closure/stability of the SIJ due to muscles and outside forces

Question 40

What kind of joint is the SIJ?

Answer 40

Diarthoid anteriorly and syndesmosis posteriorly

Question 41

Describe Anterior innominate

Answer 41

Location: SI local or referral pattern Agg Factors: Gait, Stair Descent Ease Factors: hip flexion, Non WB History: Activity related like kicking a soccerball ROM: Decreased mobility with unilateral squish Special Tests: Positive Fillets and SFB test Palpation: Inferior ASIS and Superior PSIS. Longer LE in supine, shortens in long sit Muscle Length/Muscle Strength: Chronic: Shortened hip flexors

Question 42

Describe Posterior innominate

Answer 42

Location: SI local or referral pattern Agg Factors: Gait, Stair Ascent Ease Factors: Hip extension, Non WB History: slipping on ice with one LE forward ROM: Decreased mobility with unilateral squish Special Tests: Positive Gillet's and SFB test Palpation: Superior PSIS and Inferior ASIS. Shorter LE in spine, Lengthens in long sit. Muscle Length/Muscle Strength: Chronic: shortened Hamstrings

Question 43

Describe Inflare Innominate

Answer 43

Location: SI local or referral pattern Agg Factors: Gait Ease Factors: Hip IR, Non WB History: Activity related: hip in end range IR, for example plant leg when kicking soccer ball while cutting ROM: Decreased mobility with unilateral squish Special Tests: Positive inflate/outflare test Palpation: Medial ASIS and lateral PSIS Muscle Length/Muscle Strength:

Question 44

Describe outflare innominate

Answer 44

Location: SI local or referral pattern Agg Factors: Gait Ease Factors: Hip ER, Non WB History: Activity related: hip in end range ER, such as with a ballet dancer ROM: Decreased mobility with unilateral squish Special Tests: Positive inflate/outflare test Palpation: Lateral ASIS and medial PSIS Muscle Length/Muscle Strength: Chronic: shortened gluteal muscles

Question 45

Describe upslip Innominate

Answer 45

Location: SI local or referral pattern Agg Factors: Gait Ease Factors: Non WB History: step off curb with knee straight ROM: Decreased mobility with unilateral squish Special Tests: Positive Gillet's and SFB test Palpation: Superior ASIS and PSIS Muscle Length/Muscle Strength: Chronic: shortened Quadrants Lumborum

Question 46

Describe downslip Innominate

Answer 46

Location: SI local or referral pattern Agg Factors: Gait Ease Factors: Non WB History: trauma: example being pulled by one LE ROM: Decreased mobility with unilateral squish Special Tests: Positive Gillet's and SFB test Palpation: Inferior ASIS and PSIS.

Question 47

Describe Sacral Torsion

Answer 47

Location: SIJ local or referral pattern Agg Factors: Gait, lumbar rotation, closed chain rotation activities Ease Factors: Non WB History: Insidious onset (piriformis tightness), traumatic, or activity related ROM: Normal mobility with forward (flexed) Sacral torsion, stiffness with backward (extended) Sacral torsion Special Tests: Positive seated forward bend test. Positive prone on elbows. Palpation: Prone on elbows deep Sacral sulcus anterior torsion, shallow posterior torsions. Muscle Length/Muscle strength: Anterior torsion with tight piriformis

Question 48

Describe Instability

Answer 48

Profile: Most likely female post pregnacy Location: SIJ local or referral pattern Agg Factors: Turning over in bed, lumbar rotation, getting in and out of cars Ease Factors: Tight pants or belt History: Recent childbirth or trauma. C/o frequent "popping" ROM: Normal, but may be guarded due to pain Special Tests: Excessive motion SIJ compared to other side Palpation: Painful SIJ - Inconsistent landmark palpation Muscle Length/Muscle strength: Decreased TAR and Gluteal strength

Question 49

Describe Locking

Answer 49

Profile: Post trauma Location:SIJ local or referral pattern Agg Factors: Gait, lumbar rotation activities Ease Factors: When still without moving History: Trauma or sudden jarring movement on pelvis ROM: Severely limited on involved side Special Tests: Positive seated or standing forward bend test. Decreased motion with squish test Palpation: Painful SIJ Muscle Length/Muscle strength: Muscle spasm possible around involved SIJ due to pain

Question 50

Describe Degeneration

Answer 50

Profile: Chronic SIJ pain Location: SIJ local or referral pattern Agg Factors: Weight bearing and movement Ease Factors: Decreased with NWB and decreased movement History: Early onset ankylosing spondylitis, RA, post lumbar fusion, hip arthritis, leg length discrepancy, infection ROM: Limitation with ll AROM. Severely limited if degeneration progresses to SIJ fusion. Special Tests: Painful provocation tests Palpation: Painful SIJ

Question 51

``` What innominate movement occurs during: Trunk flexion Trunk extension LE extension LE flexion ```

Answer 51

Bilateral anterior rotation Bilateral posterior rotation Unilateral anterior rotation Unilateral posterior rotation

Question 52

``` When do the following Sacral movements occur: Bilateral flexion Bilateral extension Unilateral flexion Unilateral extension ```

Answer 52

Supine to stand; initial stages of trunk flexion Supine lying; sometimes at end of trunk flexion Flexion of the LE Extension of the LE