Sacroiliac Joint Dysfunction (SIJD)Examination and Treatment

Question 1

What is Sacroiliac Joint Dysfunction (SIJD)?

Answer 1

• SIJD refers to pain in the sacroiliac joint region caused by dysfunction in the joint itself, often presenting as low back pain.

Question 2

What are common causes of SIJD?

Answer 2

Common causes include pregnancy, trauma (e.g., falls, motor vehicle accidents), and certain repetitive activities like running or lunges.

Question 3

What is the incidence and prevalence of SIJD?

Answer 3

SIJD is more common in females and may affect 10% to 25% of patients with persistent mechanical low back pain below L5.

Question 4

What are the symptoms associated with SIJD?

Answer 4

Symptoms include pain with transitional movements, running, lying on the affected side, and trauma-related pain.

Question 5

What activities exacerbate SIJD pain?

Answer 5

Activities that exacerbate pain include sit to stand, getting out of a car, running, lunges, and pelvic end range movements.

Question 6

What are the gender differences in SIJD?

Answer 6

SIJD is relatively equal in mobility between men and women from ages 19-45, but after 60, ankylosis occurs in 82% of males and 30% of females.

Question 7

What is the biopsychosocial model of pelvic girdle pain?

Answer 7

It emphasizes the interaction between biological, psychological, and social factors in the development and management of pelvic girdle pain.

Question 8

What are common differential diagnoses for low back pain vs. SIJD?

Answer 8

Common differential diagnoses include mechanical low back pain, discogenic pain, facet joint pain, and muscular dysfunction.

Question 9

What is the role of pain provocation tests in diagnosing SIJD?

Answer 9

Pain provocation tests help identify SIJ pain, with clusters of these tests increasing the probability of accurate diagnosis.

Question 10

What is the role of imaging in diagnosing SIJD?

Answer 10

Imaging has limited evidence for diagnosing SIJD, with more reliance on clinical tests and patient history.

Question 11

What is the Thigh Thrust Test?

Answer 11

The Thigh Thrust Test involves flexing the hip to 90°, applying axial force through the femur to reproduce SIJ pain.

Question 12

What is the Distraction/Gapping Test?

Answer 12

The Distraction Test involves applying pressure to the ASIS to reproduce SIJ pain.

Question 13

What is the SI Joint Compression Test?

Answer 13

The Compression Test involves applying pressure over the iliac crest to reproduce SIJ pain.

Question 14

What is the Sacral Thrust Test?

Answer 14

The Sacral Thrust Test involves delivering an anteriorly directed thrust over the sacrum to reproduce SIJ pain.

Question 15

What is Gaenslen’s Test?

Answer 15

Gaenslen’s Test involves flexing one hip while extending the opposite hip to apply torque to the pelvis and reproduce SIJ pain.

Question 16

What is the Hip Test for SIJ involvement?

Answer 16

The Hip Test involves placing the leg in a figure-four position and applying pressure to assess SIJ-related pain.

Question 17

What are motor control/stabilization exercises for SIJD?

Answer 17

• gluteus maximus strengthening
• supine clamshells
• resisted hip hinge exercises

Question 18

What are mobilization techniques for SIJD?

Answer 18

Mobilization techniques include manual therapy techniques like muscle energy techniques and joint mobilizations.

Question 19

What is the use of SI joint belts and kinesiotaping?

Answer 19

SI joint belts and kinesiotaping provide external support to the SIJ, helping stabilize and reduce pain.

Question 20

What are muscle energy techniques for anterior innominate rotation?

Answer 20

These techniques involve the patient resisting against the therapist’s force to correct the anterior rotation of the innominate.

Question 21

What is the upslip correction technique?

Answer 21

Upslip correction involves applying traction to the leg to pull the pelvis down, often combined with muscle energy contractions.

Question 22

What is the treatment for innominate outflare?

Answer 22

Treatment includes placing the leg in adduction and internal rotation, and resisting against abduction to correct the outflare.

Question 23

What is the treatment for innominate inflare?

Answer 23

Treatment includes abducting the thigh and resisting against adduction to correct the inflare.

Question 24

What are manual correction techniques for pubic symphysis?

Answer 24

Techniques include resisted abduction and adduction exercises to realign the pubic symphysis.

Question 25

What are specific exercises for SIJ stability?

Answer 25

Exercises include bridges, clamshells, resisted hip movements, and pelvic floor strengthening exercises.

Question 26

How effective are physiotherapy interventions for SIJD?

Answer 26

Physiotherapy interventions like manipulation, exercise, and kinesiotape are effective in reducing pain and disability associated with SIJD.

Question 27

What is the role of specific stabilizing exercises in reducing pain and disability?

Answer 27

Specific stabilizing exercises target deep and superficial muscles to improve stability and reduce pain.

Question 28

What are non-mechanical sources of SIJ pain?

Answer 28

Non-mechanical sources include ankylosing spondylitis, reactive arthritis, and psoriatic arthritis.

Question 29

How does ankylosing spondylitis relate to SIJ pain?

Answer 29

Ankylosing spondylitis can cause inflammation and pain in the SIJ, often affecting younger males.

Question 30

What is reactive arthritis (Reiter’s Syndrome)?

Answer 30

Reactive arthritis is an inflammatory condition that affects the joints, including the SIJ, and is characterized by conjunctivitis, urethritis, and arthritis.

Question 31

How does psoriatic arthritis affect the SIJ?

Answer 31

Psoriatic arthritis can cause pain and inflammation in the SIJ, contributing to lower back pain.

Question 32

How should SIJD be managed during pregnancy?

Answer 32

Management includes exercises for pelvic stability, use of SI belts, and gentle manual therapy techniques.

Question 33

What is the impact of age on SIJ mobility?

Answer 33

Mobility decreases with age, with higher rates of ankylosis in older males compared to females.

Question 34

What is the evidence against the 'bone out of place' model?

Answer 34

Current literature does not support the 'bone out of place' model, favoring pain provocation tests over asymmetry evaluations.

Question 35

Why are pain provocation tests preferred over asymmetry evaluations?

Answer 35

Pain provocation tests have higher reliability and diagnostic accuracy for SIJD compared to asymmetry evaluations.

Question 36

What are the guidelines for selecting therapeutic exercises for SIJD?

Answer 36

Therapeutic exercises should be selected based on whether the joint is too tight or too loose, aiming to diversify the patient’s movement patterns.

Question 37

What is the Sacroiliac Joint Exercise Algorithm?

Answer 37

The algorithm involves using SI belts, stability exercises, and specific maneuvers like Gaenslen’s manipulation to address SIJ pain.

Question 38

What is the role of pelvic floor exercises in SIJ pain management?

Answer 38

Pelvic floor exercises help stabilize the SIJ, reducing pain and improving function.