Lumbopelvic Kinematics and Sacroiliac Joint Syndrome

Sacroiliac Joint Anatomy and Biomechanics

• The sacroiliac joint is a complex structure that plays a crucial role in maintaining pelvic stability and facilitating movement.
• The joint is formed by the articulation of the sacrum and ilium bones, with a complex system of ligaments, muscles, and fascia providing support and stability.
• The sacroiliac joint is capable of a wide range of movements, including flexion, extension, rotation, and counter-rotation.

Sacral Motion

• Sacral motion can be restricted in two ways: sacroiliac flexion restriction and sacroiliac extension restriction.
• Sacroiliac flexion restriction is characterized by a decrease in post-inferior glide, rotation restriction around the right or left oblique axis (ROA or LOA), and counter-rotation malposition of the PS-SB.
• Sacroiliac extension restriction is characterized by a decrease in post-inferior glide, rotation restriction around the left or right oblique axis (LOA or ROA), and counter-rotation malposition of the AI-SB.

PI Ilium (Anterior Glide Restriction)

• PI Ilium is a type of sacroiliac joint dysfunction characterized by an anterior glide restriction of the ilium.
• It is more common than AS Ilium and is often associated with ipsilateral lumbar scoliosis.
• Key findings include:
  • Low crest and PSIS on the same side as the ilium
  • High ASIS on the opposite side
  • Decreased prone thigh extension on the same side as the ilium
  • PSIS more pronounced on the same side as the ilium
  • PN in the lower half of the SI joint
• Treatment involves prone sacroiliac extension palpation and mobilization to restore normal motion.

AS Ilium (Posterior Glide Restriction)

• AS Ilium is a type of sacroiliac joint dysfunction characterized by a posterior glide restriction of the ilium.
• It is less common than PI Ilium and is often associated with contralateral lumbar scoliosis.
• Key findings include:
  • High crest and PSIS on the same side as the ilium
  • Low ASIS on the opposite side
  • Increased prone thigh extension on the same side as the ilium
  • PSIS less pronounced on the same side as the ilium
  • PN in the lower half of the SI joint
• Treatment involves prone sacroiliac flexion palpation and mobilization to restore normal motion.

Sacroiliac Joint Syndrome/Dysfunction

• Sacroiliac joint syndrome is a condition characterized by aberrant motion of the sacroiliac joint, leading to pain and dysfunction.
• It can be caused by a variety of factors, including hypomobility, ligamentous laxity, and trauma.
• Key findings include:
  • Local pain that may radiate into the lower back and buttocks
  • Dull ache to sharp and stabbing pain
  • Provocative factors include weight-bearing, sit-to-stand, motion, and pelvic flexion/extension
  • Palliative factors include recumbency (lying down)
• Treatment involves a combination of manual therapy, exercise, and education to restore normal motion and reduce pain and dysfunction.

Sacroiliac Joint Syndrome - History

• A thorough history is essential in diagnosing sacroiliac joint syndrome.
• Key questions to ask include:
  • Where is the pain located?
  • What is the nature of the pain?
  • Are there any provocative or palliative factors?
  • Are there any associated symptoms, such as numbness, tingling, or weakness?

Sacroiliac Joint Syndrome - Findings

• Key findings include:
  • Local pain and tenderness
  • Leg length inequality
  • Possible gait abnormalities
  • Palpation of misalignment or restricted motion/joint play (hard end feel)
  • Postural abnormalities

Sacroiliac Joint Special Test Cluster

• A special test cluster is a group of tests used to diagnose sacroiliac joint syndrome.
• The cluster includes:
  • Distraction test
  • Compression test
  • Thigh thrust test
  • Sacral thrust test
  • Gaenslen's test
• Each test is designed to assess a specific aspect of sacroiliac joint function and can help diagnose sacroiliac joint syndrome.

Benefits of Using Orthopedic Test Clusters

• Using orthopedic test clusters has several benefits, including:
  • Increased accuracy in diagnosis
  • Improved treatment outcomes
  • Reduced risk of misdiagnosis
  • Improved patient satisfaction
• However, there are also some drawbacks, including:
  • Limited evidence supporting the use of some tests
  • Variability in test performance and interpretation
  • Risk of over-testing or under-testing

Sacroiliac Joint Anatomy and Biomechanics

• Sacroiliac joint is a dynamic L-S joint that plays a crucial role in maintaining pelvic stability and facilitating movement
• The joint is composed of sacrum and ilium bones, with a complex system of ligaments, muscles, and nerves that provide stability and facilitate movement

Sacral Motion

• Sacral motion can be restricted in two ways: sacroiliac flexion restriction and sacroiliac extension restriction
• Sacroiliac flexion restriction is characterized by decreased lordosis, open packed position of the facets, and decreased post-inferior glide of the ilium
• Sacroiliac extension restriction is characterized by increased lordosis, closed packed position of the facets, and decreased post-inferior glide of the sacrum

PI Ilium and AS Ilium

• PI Ilium is a type of sacroiliac joint dysfunction characterized by an anterior glide restriction of the ilium
• AS Ilium is a type of sacroiliac joint dysfunction characterized by a posterior glide restriction of the ilium
• Both PI Ilium and AS Ilium can cause leg length inequality, lumbar scoliosis, and altered gait patterns

Sacroiliac Joint Syndrome

• Sacroiliac joint syndrome is a condition characterized by pain and dysfunction in the sacroiliac joint
• The condition is often caused by aberrant motion of the sacroiliac joint, which can lead to pain, inflammation, and instability
• Sacroiliac joint syndrome can be caused by hypomobility, ligamentous laxity, pregnancy, trauma, and leg length inequality

Orthopedic Tests for Sacroiliac Joint Syndrome

• Orthopedic tests are used to diagnose sacroiliac joint syndrome and distinguish it from other conditions
• The tests include distraction, compression, thigh thrust, sacral thrust, and Gaenslen's test
• Each test is designed to assess specific aspects of sacroiliac joint function and identify patterns of pain and dysfunction

Sacroiliac Joint Special Test Cluster

• The sacroiliac joint special test cluster is a group of orthopedic tests used to diagnose sacroiliac joint syndrome
• The tests in the cluster are designed to be used in combination to provide a more accurate diagnosis
• The cluster includes distraction, compression, thigh thrust, sacral thrust, and Gaenslen's test

Advantages and Disadvantages of Orthopedic Test Clusters

• Advantages of using orthopedic test clusters include increased accuracy, improved diagnostic reliability, and better patient outcomes
• Disadvantages of using orthopedic test clusters include potential for false positives, complexity of test administration, and need for specialized training

Sacroiliac Joint Syndrome: History and Physical Examination

• Patients with sacroiliac joint syndrome often report local pain that may radiate into the lower back and buttocks
• Pain patterns are variable and can include dull ache, sharp stabbing pain, and numbness or tingling
• Provocative factors include weight-bearing, sitting, standing, and motion
• Palliative factors include recumbency (laying down)

Grading of Sprains and Strains

• Grade 1: mild, characterized by less than 10% fiber damage
• Grade 2: moderate, characterized by 10-50% fiber damage
• Grade 3: severe, characterized by 50-100% fiber damage

Characteristics of Grade 1 Sprains and Strains

• Delayed muscle soreness within 24 hours
• Mild pain at end of range of motion (ROM)
• Mild point tenderness
• No edema
• Mild functional loss
• Functional recovery takes 2-14 days
• Structural recovery takes 10-20 days
• Neurovascular function is within normal limits (WNL)

Characteristics of Grade 2 Sprains and Strains

• 10-50% of fibers damaged
• Pain at end of ROM
• Moderate tenderness
• No edema
• Mild functional loss
• Possible antalgic posture (guarding posture)
• Functional recovery takes 14-40 days
• Structural recovery takes 30-60 days
• Neurovascular function is WNL

Characteristics of Grade 3 Sprains and Strains

• 50-100% of fibers damaged
• Pain with ROM
• Severe point tenderness
• Possible edema/palpable abnormality
• Significant loss of function
• Antalgic posture/abnormal gait
• Functional recovery takes 1-3 months
• Structural recovery takes 3 months to years
• Neurovascular function is WNL

Additional Facts

• Most common age range for sprains and strains is 30-50 years old
• Disc herniation is also common in this age range
• 60% of back injuries are sprains and strains
• Male to female ratio is 3:1

Pain Patterns

• Muscle strain: active range of motion (AROM) pain > passive range of motion (PROM) pain
• Ligament sprain: PROM pain > AROM pain
• Joint capsule damage: pain with ROM in multiple planes