Treatment of SI dysfunction
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- Dustin Dorsey
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1 + SIJ dysfunction 84 Treatment of SI dysfunction Move innominant into anterior tilt Decreased pain Perform manipulation for correction of a posterior innominant Increased pain/no change Move innominant into posterior tilt Decreased pain Perform manipulation for correction of an anterior innominant Increased pain/no change Perform ASLR Test Positive Use of Sacroiliac joint belt & stabilization exercise Negative Reassess
2 96 direct manual technique -anterior innominate correction- anterior Innominate Correction Patient Position: The patient is in a side lying position Clinician Position: stand facing the patient 1. The top leg of the patient is placed around the clinician and resting on the thigh 2. Place your hands on the patient s ASIS and the other on the ischial tubs 3. Then lean forward and imparts a rotational force through the ilium in the posterior direction 4. This is performed as a progressive oscillation Supine Posterior Innominate Correction Lie on your back with one knee and hip flexed as far as possible towards your chest. While firmly holding onto the knees with both hands gently push your knee down against your hands as if attempting to extend your leg
3 97 direct manual technique -posterior innominate correction- poster Innominate Correction Patient Position: The patient lies prone on a plinth with one foot on the floor and the side to be treated resting on the table. Clinician Position: Stands adjacent to the patient and places one hand under the knee and the other hand on the superior lateral aspect of the ilium 1. Lifts on the knee and applies pressure through the posterior lateral aspect of the ilium to move it in an anterior direction 2. This is performed as a progressive oscillation Supine Correction of an posterior Innominate Lie on your back with the involved hip flexed to a 90 degree angle. Extend your arms and place the palm of your hands flat against the top of your knee. Gently lift your knee into the resistance of your palms. Hold the static contraction for 6-8 seconds
4 98 muscle energy technique -anterior innominate correction- anterior Innominate Correction Patient Position: The patient is supine; ask about the resting symptoms Clinician Position: Standing Adjacent to the Patient 1. The hip and knee on the involved side is flexed as much as possible while the other leg rests extended in a comfortable position 2. Use one arm to wrap around the patients flexed knee to stabilize while stabilizing the other leg in extension. 3. You resist as you ask the patient to push their flexed knee into your arms while at the same time lifting the extended leg off of the plinth. 4. Hold for 5-6 seconds and repeat 3-5 times. 5. Reassess pain and illial movement Supine Posterior Innominate Correction Lie on your back with one knee and hip flexed as far as possible towards your chest. While firmly holding onto the knees with both hands gently push your knee down against your hands as if attempting to extend your leg
5 99 muscle energy technique -posterior innominate correction- poster Innominate Correction Patient Position: The patient is supine and resting symptoms are assessed Clinician Position: Standing adjacent to the patient 1. The leg on the involved side is extended and the opposite hip and knee is flexed 2. Firmly stabilize the flexed hip and knee and the extended leg. 3. Ask the patient to push their knee down against your resistance will concurrently lifting the extended (involved) leg off of the plinth 4. Hold for 5-6 seconds and repeat 3-5 times 5. Reassess symptoms and pelvic mobility Supine Correction of an posterior Innominate Lie on your back with the involved hip flexed to a 90 degree angle. Extend your arms and place the palm of your hands flat against the top of your knee. Gently lift your knee into the resistance of your palms. Hold the static contraction for 6-8 seconds
6 100 muscle energy technique -shot gun- Patient Position: The patient is supine hook-lying Clinician Position: Standing adjacent to the patient 1. Inquire about resting symptoms 2. The clinicians places their hands on the outside of the patients knees and asks the patient to push out into the hands and old for 6 seconds and repeated 3 times T 3. The clinician then places their forearm between the patients knees and asks the patient to push the knees together into the clinician and repeats 3 times 4. The final maneuver the patient is asked to perform a rapid adduction strong and quick
7 101 mobilization with movement -posterior innominate correction- posterior Innominate Correction Patient Position: The patient lies prone Clinician Position: Standing adjacent to the patient 1. Ask the patient to perform a prone press up and inquire about pain and mobility 2. Stand adjacent to the patient on the opposite side the mobilization is to be performed. 3. Place your thenar eminence of one hand on the posterior boarder of the ilium and apply pressure as it pushing it into an anterior rotation 4. Ask the patient to gently press up into an extended position. 5. Repeat 10 times 6. Reassess prone extension for pain and mobility 7. Ask the patient to extend and reassess symptoms; if symptoms have decreased completed two more sets of 10 Seated Correction of an Anterior Innominate Sit in an upright position towards the edge of a chair. Extend your arms and place the palm flat on top of the knee of the involved side. Gently flex your hip up into the resistance of your palms. Hold the static contraction for 6-8 seconds.
8 102 mobilization with movement -anterior innominate correction- Supine Anterior Innominate Correction Patient Position: The patient lies prone Clinician Position: Standing adjacent to the patient 1. Ask the patient to perform a half prone press up and inquire about the symptoms. 2. Stand adjacent to the patient opposite to the involved side. 3. Stabilize the sacrum with the boarder of one hand and scoop the ASIS with the other hand. 4. Pull up on the ilium while stabilizing on the sacrum. 5. While holding this pressure as the patient to perform 10 half press ups 6. Repeat 10 repetitions 7. Ask the patient to extend and reassess symptoms; if symptoms have decreased completed two more sets of 10. Supine Correction of an posterior Innominate Lie on your back with the involved hip flexed to a 90 degree angle. Extend your arms and place the palm of your hands flat against the top of your knee. Gently lift your knee into the resistance of your palms. Hold the static contraction for 6-8 seconds
9 103 mobilization with movement -anterior innominate correction- anterior innominate correction Patient Position: The is standing Clinician Position: Stand adjacent to the patient opposite to the involved side. 1. Stabilize the sacrum with the boarder of one hand and scoop the ASIS with the other hand. 2. Pull up on the ilium while stabilizing on the sacrum. 3. While holding this pressure as the patient to perform 10 extension movements 4. Reassess SUPPORTIVE TECHNIQUES Standing Correction of an Anterior Innominate While standing in a doorway lean against the door jam for support. Place the involved foot flat on the other side of the door jam just below hip height. Gently push into the door jam and hold for 6-8 seconds and repeat 3 to 5 times.
10 104 SI Belts External support may help control excessive movement They should only be used until force closure and motor control can be restored Used only as an adjunct to the restoration of force closure Damen et al (Damen, Spoor et al. 2002) were able to show using Doppler imaging that the stiffness of the SIJ increases when a belt is applied Assessments The ASLR is used to determine where and how much compression is needed Once the SI belt is applied the ASLR is repeated The patient should notice a marked difference in The ability to transfer load through the pelvic girdle effort should be required Less pain should be present Use Apply the SI belt in the supine position. The SI belt should be worn anytime a patient is vertical (standing or sitting) and during ADL activities Once adequate tension to achieve goals has been determined they should be weaned off Weaning can occur by: reducing the amount of compression Wearing for shorter periods of time
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