Sacroiliac joint
The sacroiliac (SI) joint is a diarthroidal joint as are the hip, knee and shoulder. The SI joint is responsible for connecting the spine to the pelvis and transmitting forces between the lower extremities and the spine. The joint can become hyper or hypo mobile in response to an injury.
Sacroiliac joint dysfunction
While there is no definitive cause for SI joint dysfunction, common causes are listed below and all cause some degree of pelvic torsion.
Risk factors
- Direct fall or other sever trauma to the hip
- Misstep off of curb
- Asymmetrical laxity of SI joint during pregnancy
- Leg length discrepancy causing abnormal posturing
- Degenerative osteoarthritis
- Repetitive rotational movements (e.g. shoveling snow)
- Poor trunk and abdominal control
Risk factors
- Over 50 years old
- Women > men
- Participation in rowing
- Participation in sports like throwing or kicking that load the body unilaterally
Signs and symptoms
- Dull ache in the low back, usually below the PSIS
- Symptoms may refer to the thigh in some cases
- Unilateral symptoms are most common (rare to have pain above L5)
- May report numbness, clicking or popping
- Transitional activities (e.g. getting up from a chair) will be most aggravating
Special Tests
- Anterior Gapping Test
- Posterior Distraction Test
- Gaenslen's provocation SIJ Test
- Posterior Pelvic Pain Provocation Test
- Patrick's (FABER or Figure-Four) Test
- Sacral Thrust
Two of four positive tests (anterior gapping, posterior distraction, posterior pelvic pain provocation test, and/or sacral thrust) or three positive tests of the above six is indicative of a SIJ dysfunction.
treatment
Treatment must be aimed at the underlying causes of the dysfunction if there was no traumatic event.
Movement
Stabilization
Movement
- Muscle Energy
- Joint Mobilization
- Soft Tissue Mobilization
Stabilization
- Local Motor Muscle Control
- Global Muscle Strength and Endurance
- External Support ("SI belts")
References
Dressendorfer R, Granado MJ. Sacroiliac Joint Dysfunction. In: Richman S, ed. Ipswich, Massachusetts: EBSCO Publishing; 2012:7p
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.Goodman CCM, PT Snyder, T.K. MN, RN, OCN. Differential Diagnosis for Physical Therapists: Screening for referral 4ed: Saunders Elsevier; 2007.
Laslett M, et al. Diagnosis of sacroiliac joint pain: validity of individual provocation and composites of tests. Man Ther. 2005; 10:207-218.
Images
http://www.ssrehab.com/wp-content/uploads/2009/07/SIJOINT.gif
http://www.eorthopod.com/images/ContentImages/spine/spine_lumbar/lumbar_spine_SI_joint/SI_joint_intro01.jpg
http://www.eorthopod.com/images/ContentImages/spine/spine_lumbar/lumbar_spine_SI_joint/SI_joint_treatment01.jpg
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.Goodman CCM, PT Snyder, T.K. MN, RN, OCN. Differential Diagnosis for Physical Therapists: Screening for referral 4ed: Saunders Elsevier; 2007.
Laslett M, et al. Diagnosis of sacroiliac joint pain: validity of individual provocation and composites of tests. Man Ther. 2005; 10:207-218.
Images
http://www.ssrehab.com/wp-content/uploads/2009/07/SIJOINT.gif
http://www.eorthopod.com/images/ContentImages/spine/spine_lumbar/lumbar_spine_SI_joint/SI_joint_intro01.jpg
http://www.eorthopod.com/images/ContentImages/spine/spine_lumbar/lumbar_spine_SI_joint/SI_joint_treatment01.jpg