*Overview of Sacroiliac Dysfunction with LBP Sacroiliac Dysfunction as it Co-Exists with: Pelvic/Leg Length Discrepancy Facet Syndrome Discogenic Pain Chris Resch, DC Kari Resch, PT
Learning Objectives Anatomical Characteristics of the SI Joints regarding ligaments, muscles, joint surfaces and joint orientation { Subjective and Objective measures to differentiate a hypermoble and/or hypomoble SI Joint. Construct a treatment plan for a patient with a hyper and/or hypo mobile SI Joint.
SI Joint Anatomy
{ Bone Anatomy Sacrum Ilium 2x Anatomy of the SI Joint
{ Ligaments Iliolumbar Sacroiliac Sacrotuberal Anatomy of the SI Joint
{ { Anterior Musculature Posterior Musculature SI Joint Anatomy
{ { Hamstring Group Quadriceps SI Joint Anatomy
Diarthrodial Joint Sacrum concave thick hyaline Ilium-convex thin fibro { Mobility Under Debate 2-17 Degrees Most Common Agreement is 8 degrees in either direction SI Joint Anatomy
{ Joint Orientation is Very Complex Oblique 25-30 degrees Difficult to x-ray joint space SI Joint Anatomy
{ Mobility - 2-8 degrees { In both directions SI Joint Angle 25-30 degrees from sagittal SI Joint Anatomy - mobility
Hyper-mobile vs. { Hypo-mobile or BOTH SI Joint Conditions and LBP
Sacroiliac Hypermobility Sacroiliac joint hypermobility, refers to increased and/or abnormal movement of the joint. { The condition is the result of the joint becoming too loose as a result of ligaments and muscles designed to stabilize it in place have become overly loose as a result of damage. Trauma Pregnancy
Hypermobility SI Joint Symptoms { Lower back pain (below L5) Sensation of lower extremity: pain, numbness, tingling. Pelvis / buttock pain. Hip / groin pain. Feeling of leg instability (buckling, giving way) Disturbed sleep patterns due to pain. Same Side Disturbed sitting patterns (unable to sit for long periods, sitting on one side) Pain with prolonged walking
SI Joint Hypermobility Tests
{ { Prone Passive Motion Weight Bearing Active Sacroiliac Hypermobility
SI Joint Provocative Tests
SI Joint Hypermobility Treatment
SI Joint Hypermobility Treatment posture/body mechanics
Joint Manipulation of hypomobile Joints Co-Existing with the hypermobile SI Joint. { A body of evidence exists indicating that spinal manipulation impacts primary afferent and efferent neurologic structures affecting motor and sensory control systems within the ligamentous joint capsules of the spine. SI Joint Hypermobility Treatment
SI Joint Mobility Demonstration
{ Structural Functional Movement Assessment Customized Therapeutic Exercise Program SI Joint Hypermobility Treatment
SI Joint Belt { placement when to use SI Joint Hypermobility Treatment
SI Joint Injection { Diagnostic And Therapeutic SI Joint Hypermobility Treatment
{ Sacroiliac Surgical Fusion SI Joint Hypermobility Treatment
SI Joint Hypo-mobility { Sacroiliac joint hypo-mobility/fixation, refers to reduced movement of the joint. When the joint surfaces separate enough to move out of alignment, the main ridge, and/or smaller ridges, may move out of their respective grooves, and wedge out of position causing hypo-mobility.
SI Joint Hypo-mobility Symptoms { Sacroiliac joint dysfunction can mimic numerous other back and hip injuries. Sacroiliac joint dysfunction can cause lower back, hip, groin, buttock and sciatic pain. Sacroiliac pain is typically worse with standing and walking and improved when lying down, but not always.
SI Joint Hypo-mobility Tests
{ { Prone Passive ROM Prone Active Hip Extension SI Joint Hypo-mobility Tests
{ Seated Rotation and { Extension Marching SI Joint Hypo-mobility Tests
SI Joint Hypo-mobility Treatment
SI Joint Hypermobility Treatment posture/body mechanics
Joint Manipulation of hypomobile Joints Co-Existing with the hypermobile SI Joint. { A body of evidence exists indicating that spinal manipulation impacts primary afferent and efferent neurologic structures affecting motor and sensory control systems within the ligamentous joint capsules of the spine. SI Joint Hypo-mobility Treatment
SI Joint Mobility Demonstration
Structural Functional Movement Assessment { Customized: Muscular imbalance flexibility/strength Proprioception Somatics SI Joint Hypo-mobility Treatment
Learning Objectives Summary Anatomical Characteristics of the SI Joints regarding ligaments, muscles, joint surfaces and joint orientation { Subjective and Objective measures to differentiate a hypermobile and/or hypo-mobile SI Joint. Construct a treatment plan for a patient with a hyper and/or hypo mobile SI Joint.
Chris Resch, DC Kari Resch, PT Questions: resch.chris@yahoo.com