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Sacroiliac Joint Dysfunction: Vahid - Marouf PT

The document discusses various types of sacroiliac joint dysfunction including innominate rotation, shear, and tilt. It describes techniques for assessing and treating these dysfunctions through joint mobilization and muscle energy techniques. Anterior and posterior innominate rotations are discussed as well as upslip, downslip, nutation, counternutation, and sacral torsions. Patient positioning and therapist techniques are provided for various mobilization approaches. Self-mobilization strategies are also outlined.

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vahidmarouf
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3K views

Sacroiliac Joint Dysfunction: Vahid - Marouf PT

The document discusses various types of sacroiliac joint dysfunction including innominate rotation, shear, and tilt. It describes techniques for assessing and treating these dysfunctions through joint mobilization and muscle energy techniques. Anterior and posterior innominate rotations are discussed as well as upslip, downslip, nutation, counternutation, and sacral torsions. Patient positioning and therapist techniques are provided for various mobilization approaches. Self-mobilization strategies are also outlined.

Uploaded by

vahidmarouf
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Sacroiliac joint

dysfunction
Vahid.marouf PT
Iliosacral Dysfunction
Innominate Rotation:

Anterior(forward)
Posterior(backward)
Innominate Shear:

Upslip (Superior innominate shear)


Downslip(Inferior innominate shear)
Iliac Out flare & In flare
Sacroilliac Dysfunction
Nutation & Counter nutation
Sacral Torsions
 Forward Sacral Torsion
Left on Left
Right on Right
 Backward Sacral Torsion
Right on Left
Left on Left
Unilateral sacral Flexion
Anterior Innominate Rotation
Treatment
Backward Rotation for Anterior Iliac Dysfunction
For anterior innominate rotation dysfunction, signs on
the involved side are as follows:
Superior and anterior PSIS
Inferior and posterior ASIS
Positive Standing Flexion Test ,long sitting test,prone
knee flexion test
Apparent Lengthening of leg in supine
JOINT MOBILIZATION TECHNIQUES

Patient Position:
Supine with the leg opposite to the side to be
mobilized hanging over the edge of the table.
Therapist Position:
Stands on the side to be mobilized.
Motion:
The therapist’s cephalic hand cups the ASIS in the palm
while the caudal hand grasps the ischial tuberosity.
Transfer your weight toward the patient's head; this
results in a backward rotation of the innominate on the
sacrum.
Advantages:
Technique can be modified to use muscle
correction, which can place a posterior
rotatory moment on the innominate (muscle
energy) using the gluteus maximus as the
desired force.
Have the patient resist a force provided by
your trunk (or against the patient's own
hands, which fixates the knee) with a
sustained submaximal contraction for 7 to 10
seconds.
This is repeated three or four times, not
allowing the hip to move into extension,
only flexion
Self Mobilization to counteract Anterior Iliac
Dysfunction
Self treatment technique to counteract anterior iliac
dysfunction consists of following techniques:
Standing:

The patient places the foot on a table or bench, leans


toward the knee, and stretches it into the axilla.
Repeat this exercise several times a day and always
making a correction when going to bed to relieve
the strain on the involved ligaments.
These techniques are powerful rotators of the
innominate and can be overdone unless specific
guidelines are given.
:Supine
Standing Bending
Forwards:
Method to correct right
anterior rotation: a right
posterior lever effect can
be created by resting right
foot on a high stool (hip
flexed 90° and abducted
45°), and then letting the
trunk hang down in
forward flexion as far as
feels comfortable.
Posterior Innominate Rotation
Treatment

Forward Rotation for Posterior Iliac Dysfunction


For posterior innominate rotation dysfunction, signs on
the involved side are as follows:
Inferior and posterior PSIS
Superior and anterior ASIS
Positive Standing Flexion Test
Apparent shortening of leg in supine
Hypermobility or restriction in innominate anterior
rotation
Patient Position:
Supine with the leg on the side to be mobilized extended
over the edge of the table.
Therapist Position:
Stands opposite of the side to be mobilized.
The patient or therapist flexes and stabilizes the opposite leg.
Motion:
Place the caudal hand over the thigh and use it to push the
hip into further extension; the cephalic hand can be applied
to the patient's PSIS, pushing upward to increase the forward
rotation of the innominate on the sacrum.
Advantages:
Technique can be modified to use
muscle correction, which can place
an anterior rotatory moment on the
innominate (muscle energy) using
the iliopsoas as the desired force.
Have the patient push the freely
hanging leg up against your hand
with a submaximal force while you
give unyielding resistance to the
contraction for 7 to 10 seconds.
This procedure is repeated three or
four times or until all the slack is
taken up.
Self Mobilization to counteract Posterior Iliac
Dysfunction
Self treatment technique to counteract posterior iliac
dysfunction consists of passive hip extension in prone
or supine.
In the supine correction technique it
is important that the (left) leg is off
the table.
• The hip should be maximally
adducted and literally be suspended
above the horizontal by the hip
capsule and soft tissue.
• This position should be held for
about 2 minutes.
Iliac Inflare
Mobilization for Innominate Inflare
Patient Position:
Prone with leg externally rotated
Therapist Position:
Stands on the left side.
The cephalad hand contacts the
medial aspect of the left ASIS and the
caudad hand contacts the area just
lateral to the PSIS.
Motion:
The cephalad hand pulls the ASIS
laterally and inferiorly while the
caudad hand applies medial and
superior force to the PSIS.
Muscle Energy Techniques
Iliac outflare
Mobilization for Innominate
Outflare
Patient Position:
Prone
Therapist Position:
Stands on the left side.
The caudad hand contacts the left
ankle and the cephalad hand the
right side of the sacral base.

Motion:
The cephalad hand applies
postero-anterior pressure to the
right side of the sacral base.
The caudad hand internally
rotates the left hip to inflare and
internally rotates the left
innominate.
Self Mobilization for Innominate
Outflare

The patient lies on her back and


bends the involved hip to 90°.
With her hand, she pushes the
thigh to the opposite side.
A cushion or folded pillow under
the foot and lower leg may be
necessary to maintain 90 of hip
flexion.
The stretch is maintained for 2
minutes
MET
Upslip
Inferior Glide for Innominate Upslip
An upslip is a superior subluxation of the innominate on
the sacrum at the SU. The dysfunction is primarily
articular with secondary muscle imbalances (as opposed
to anterior and posterior innominate rotations, which
primarily result from muscle imbalances that secondarily
restrict SIJ motion). Signs on the involved side include
Superior positioning of the ASIS, PSIS, iliac crest, pubic
tubercle, and ischial tuberosity.
Inferior Glide of ilium is restricted.
Patient Position:
Prone

Therapist Position:
Stands to the involved side at the head.

Motion:
The outer hand contacts the superior
aspect of the iliac crest and applies an
inferior and slightly medial force in the
plane of the joint.
Distraction in supine
Distraction in prone
Self Distraction in standing
Nutation & Counter nutation
Sacral Nutation Technique
This is used to reduce a sacral counternutation positional fault,
commonly caused by a postural flat back, or flexed sitting or
standing postures and coccygeal muscle spasm. Signs include
Lumbar spine hyperflexion
Shallow (posterior) sacral sulci
Deep (anterior) inferior lateral angles,
Less prominent PSIS
Sacral flexion restriction
L5 to S1 (and possibly generalized) restriction in lumbar
extension
Patient Position:
Prone with pillow under the abdomen
and the legs externally rotated
Therapist Position:
Stands at the level of the pelvis on the
involved side, facing the foot of the
table
Motion:
The base of the inner hand contacts
the sacral base, with the arm directed
at a right angle to the base.
The mobilizing hand glides the cranial
surface of the sacrum ventrally,
directing the sacrum into nutation.
Incline the pressure toward the
patient's feet.
Sacral Counternutation Technique
This is used for sacral nutation dysfunction, commonly
caused by an increase in the lumbosacral angle because of
structure or poor abdominal tone combined with lumbar
spine hyperextension and a weak gluteus medius and
maximus. Signs include
Deep (anterior) sacral sulci and shallow (posterior) inferior
lateral angles
Increased piriformis and psoas tone
Sacral flexion hypermobility or sacral extension restriction
Possibly tenderness and tightness bilaterally in the tensor
fasciae latae
Patient Position:
Prone with legs internally
rotated
Therapist Position:
To one side of the pelvis,
facing the head
Motion:
With thenar or ulnar contact
of the inner hand on the
sacral apex, apply a postero-
anterior force on the apex of
the sacrum when the sacrum
is felt to extend.
Sacral Torsion
Sacral Right Side-bending Technique for Left-
on-Left Sacral Torsion Dysfunction

A. Sacral Right Side-bending


Patient Position:
Prone
Therapist Position:
Stands on the right side of the patient facing the
feet.
The ulnar aspect of the left hand contacts the
posterior aspect of the left side of the sacrum
with the fingers pointed toward the feet.
Motion:
An inferior, slightly medial force is applied onto
the left side of the sacrum by taking up tissue
tension on the posterior aspect.
Sacral Right Rotation

Patient Position:
Prone
Therapist Position:
On the right side of the patient with the ulnar
aspect of the right hand on the posterior aspect
of the left inferior lateral angle.
The left hand contacts over the PSIS of the
right ilium.

Motion:
The right hand applies postero-anterior force to
the posterior aspect of the left inferior lateral
angle, and the left hand applies antero-lateral
force to the right ilium for stabilization.
Self Treatment of Left Sacral Rotation

The patient lies supine with the hips and knees flexed. A padded dowel
(2/5 cm x 10 cm) is placed vertically on the left side of the sacrum to
encompass L5-S 1 and S1-S3.
• The patient maintains this position for 2 minutes. After treatment,
retest mobility.
MET(forward sacral torsion)
Thank
you

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