SIJ Flashcards by Emily Harrell

what 2 m directly attach to the sacrum and directly produce SI motion

piriformis and pubo coccygeal m

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what does the long dorsal SI ligament limit

anterior iliac rotation or sacral counter-nutation

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what motions do the short SI ligament limit?

all motions

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what is the function of the anterior sacroiliac ligaments

bind the sacrum and ilia

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what are the most important ligaments of the SIJ and why?

interosseus sacroiliac ligaments
strong and thick, bind sacrum and ilia

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what ligament is continuous with the tendon of the biceps femoris

sacrotuberous ligament

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describe the attachments of the sacrotuberous ligaments

ischial tuberosity to ilia (PSIS)
lateral side of sacrum and coccyx

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the sacrotuberous ligament blends with _______ ligament and together they resist _____

sacrospinous lig
nutation and posterior innominate rotation

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what are the deep m that stabilize the SIJ

multifidi, TrA, pelvic floor and diaphragm

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what is the function of the piriformis in NWB

hip ER and ABD

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what is the function of the piriformis during WB

restrains excessive hip IR
(deceleration of IR)

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how does the function of the piriformis change with hip position

when hip flexed > 90, becomes a hip IR

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what structures are part of the deep longitudinal system (sling)

ES
deep thoracolumbar fascia
sacrotuberous ligament
biceps femoris

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what is the main function of the m sling systems

increase SIJ stability

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what structures are involved in the posterior oblique system

Lats
C/L glut max
thoracolumbar fascia

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what structures are involved in the anterior oblique system

EO
IO
C/L hip ADD
anterior abdominal fascia

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what structures are involved in the lateral m systems

glut medius
minimus
C/L hip ADD

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what are the inner muscles that stabilize the pelvis

miltifidi, TrA, pelvic floor

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what is the iliac articular surface of the iliac covered with

fibrocartilage

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what is the articular surface of the sacrum covered with

hyaline cartilage

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what structure connects the pubic symphysis

fibrocartilage

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what is a non-infectious inflammatory condition localized to the pubic area

osteitis pubis

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what are some common causes of osteitis pubis

pregnancy, childbirth, high-level athletic activity, urological or gynecological surgery, trauma, psoriatic arthritis

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the superior transverse axis travels through ______

the second sacral segment

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describe the motion that occurs at the superior transverse axis during respiration

with inhalation - sacrum extends/counter-nutates exhalation - sacrum flexes/nutates

the transverse pelvis axis travels through the _____

symphysis pubis

the middle transverse axis is located ____

at the 2nd sacral body

what is the principle axis of normal SI motion (nutation and counter nutation)

middle transverse axis

what is the principle axis of IS motion (anterior and posterior rotation)

Inferior Transverse Axis

the inferior transverse axis travel thru ___

inferior pole of SI articulation and PSIS

the R and L oblique axis runs thru ___

superior end of articular surface of sacrum to opposite inferior lateral angle

what is sacral motion

nutation and counternutation

nutation and counternutation occurs at what axis

middle transverse

what is the capsular pattern of sacral motion

pain with stress

describe the gliding motion of the sacrum during nutation

glides inferiorly down short limb and posteriorly along long limb

what is the CPP of the sacrum

nutation - occurs during WB

during nutation of the sacrum, what happens to the iliac bones and the ischial tuberosities

iliac bones move closer ischial tuberosities move farther apart

nutation is resisted by what 3 ligaments

sacroiliac, sacrotuberous, and sacrospinous

describe the gliding motion of the sacrum during counter-nutation

glides anteriorly along the long limb and superior along the short limb

what is the OPP of the sacrum

counternutation

what 2 m produce counter-nutation

piriformis and pubococogeal

what happens to the iliac bones and the ischial tuberosities during counter nutation

iliac bones move farther apart ischial tuberosities move closer

what ligaments resist counternutation

sacroiliac ligamnets

describe Forward torsion of the sacrum on the iliac bones

around the oblique axis Ex: when the R base of sacrum points forward (rotating to the L) --> L torsion around the L oblique axis = L on L also can look at L inferior angle --> when it is directed upwards --> L on L

describe backward torsion of the sacrum on the iliac bones

around the oblique axis Ex: R base of sacrum moves backwards --> R torsion around the L oblique axis = R on L

what happens to the articular surface of the ilium during anterior rotation

glides inferior and posterior relative to sacrum

what happens to the articular surface of the ilium during posterior rotation

glides anterior superior in relation to sacrum

flexion at the hip will produce what innominate motion

posterior rotation (coupled with ER)

extension at the hip will produce what innominate motion?

anterior rotation (coupled with IR)

flexion of the lumbar spine will produce what sacral motion and what innominate motion

sacral - nutation THEN counternutation innominate - anterior rotation

extension of the Lumbar spine will produce what sacral motion and what innominate motion

sacral - nutation innominate - posterior rotation (slight)

during heel strike of R LE, what position is the R innominate in and what position is the L innominate in?

R (I/L side) - posterior rotation L (C/L) - anterior rotation

during R heel strike - what axis is motion occuring at

R oblique axis - R on R or L on R

during R heel strike with the L foot still in contact with the ground - what m pulls the sacrum forward on the L side? what motion is occurring?

L psoas pulls sacrum forward R on R motion

During Mid-stance (L LE toe off and beginning to flex hip) what position is at the L iliac and what position is the R side

L - posterior rotation R - Anterior roation

during midstance on the R LE (the R LE is the WB leg) - what axis is motion occurring at

R oblique

during R sided midstance, and the L innominate is posteriorly rotated, what torsion occurs ?

L on R torsion

at the moment of L heel strike, the axis _____

changes from R oblique axis to L oblique axis

what is the main cause of pelvic pain

sacroiliac arthritis

describe the referral pattern of the SIJ

TO the: lumbar spine, butt, hip, upper thigh Hip and Lumbar spine can refer to the SIJ

do pts with SIJ pain have positive or negative neuro signs?

(-) SLR

what sign is used to determine SIJ pain

Fortin - can pinpoint pain in buttock region/over SIJ

S/S of sacroiliac arthritis

- pain in posterior sacrum - radiating to post thigh increased with walking (unilateral WB) or hopping - increased with turning in bed - lumbar ext is most painful + stress test + compression test with belt

the following will cause what injury to the IS: - repeated unilateral standing - fall on ischial tub - vertical thrust onto and extended leg - back lifting

posterior innominate

the following will cause what injury to the IS: - golf or baseball swing - horizontal thrust to the knee (dashboard) - forceful diagonal mvmt

anterior innominate

what do kinetic tests look for

hypomobility

what structures are responsible for force closure of the SIJ

TrA, sacral multifidi, pelvid floor and hip ER

what is responsible for form closure of the pelvis

- high friction coefficient compared to other joints - wedge shape of sacrum -ridges and grooves on articular surface - extensive ligement support

the active SLR is for?

funcitonal test for pelvis girdle stability

a positive ASLR is ____

decreased ability to actively lift leg in supine position from pain or difficulty

a positive ASLR is highly correlated with ______

excessive mobility of pelvic girdle

how do you augment form closure?

compression of SIJ - manual or SI belt

how can you augment force closure of the SIJ

use of slings

Pts with SIJ pain have a delayed activity of what m?

IO, MF, glut max

what is intra-articular SIJ injection used for?

short-term pain relief

what is prolotherapy and when is it effective?

- glucose compound injection used to stiffen SIJ - effective ONLY when used in conjunction with other PT interventions

what has better evidence for longer lasting effects? Prolotherapy or SIJ steroid injection

prolotherapy

pelvic belt causes a significant decrease in ___

sagittal plane rotation of the SIJ

does the use of an SI belt have an effect on abdominal m thickness during ASLR?

no immediate effects on TrA or IO thickness

in comparison of 2 exsc for SIJ laxity (ADIM - TrA or general abdominal bracing exsc) which one is more effective?

BOTH decreased joint laxity BUT ADIM decreased laxity more