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Flashcards in Sacroiliac Joint Assessment & Treatment Deck (21):
1

What is the function of the pelvis?

- Weight-bearing & protective structure
- Basic platform with 3 large levers acting on it (spine & legs)
- Shock absorber (2 x SIJ & pubic symphysis)
- Birth canal capable of accommodating baby

2

What is the purpose of form and force closure?

To stop the bones of the pelvis from falling apart

3

What is form closure?

- Shape (form) of the sacrum & pelvic bones creates a keystone

4

What is force closure?

**Exam Q on form/force closure + diagrams

- Additional closing force from compression (ligament & muscle)

5

How is the stability of the SIJ further increased?

Matching ridges & depressions on the articular surfaces

6

What is the most recent observation about the movement of the SIJ?

- Largest movement occurs when moving from lying to standing
- But still ongoing debate

7

How is the movement of the sacral promontory relative to the ilium described?

- Nutation (forward nodding, i.e. coccyx moving posteriorly)
- Counternutation (backward nodding, i.e. coccyx moving anteriorly)

8

Why can you get pain in the SIJ?

Articular cartilage contains sensory nerve fibres

9

What are the causes of LBP in pregnancy?

- Hormonal changes (relaxin)
- Biomechanical changes (weight of baby/placenta sitting anteriorly, causes increased lumbar lordosis)
- AAA can caused referred back pain

10

What is the role of the hormone relaxin in pregnancy?

- With progesterone, relaxes ligaments in the pelvic girdle
- Softens the public symphysis (preparation for delivery)

11

What are the pain provocation tests for the SIJ?

- Compression
- Distraction
- Posterior pelvic pain provocation test (p4)
- Gaenslen's test
- Sacral thrust test (sacral PA)
- Faber

12

What are the load transfer tests for the SIJ?

- Stork test
- Active SLR

13

What are the 2 categories of degenerative damage to the the SIJ?

- Insufficient compression (positive ASLR)
- Excessive compression (trauma, ankylosing spondylitis)
- Usually caused by trauma or micro trauma

14

What are the management paradigms for the SIJ?

- Motor control (TA, multifidus, diaphragm, pelvic floor)
- Muscle slings
- Strengthening (global muscles)
- Joint mobilisations

15

What is the best positioning for a non-elastic SIJ belt in rehabilitation?

Positioning at the ASIS is more effective than at the level of the pubic symphysis in reducing laxity

16

What are the symptoms of ankylosing spondylitis?

- Morning stiffness >30 mins
- Eased by exercise, not by rest
- Night pain (2nd half of the night)
- Buttock pain alternating sides

17

What are the clinical features of AS?

- Stiff lumbar slide
- Positive SIJ tests
- Reactive arthritis, IBD, Crohn's disease

18

What does the treatment of AS involve?

- Medical monitoring & management
- Home-based/group exercise (strength & flexibility)

19

What is osteitis pubis?

- Overuse of pubic symphysis & adjacent bone
- Caused by abnormal stress at symphysis
- Pain with palpation, running, change of direction, kicking

20

How is osteitis pubis diagnosed?

- Adductor squeeze test
- XR (moth-eaten appearance)
- MRI

21

What is the treatment for osteitis pubis?

- Hip ROM
- SIJ & lumbosacral movement/control
- Gradual introduction of activity while monitoring symptoms
- Prolonged rest & passive treatment associated with delayed recovery & ongoing symptoms