An Orthopedic and Pelvic Health Approach to Dysfunction
Illinois Physical Therapy Association
Thomas Dillon, PT, DPT
Teri Elliott-Burke, PT, MHS, WCS, PRPC, BCB-PMD
Sacroiliac joint (SIJ) pain can be a challenge to evaluate and treat. Traditionally the SIJ has been evaluated with pain provocation tests. Increasingly studies are focusing on the evaluation of the stability of the joint. This program provides an overview of SI anatomy, stability theories, and related pelvic girdle components including the pelvic floor musculature. Techniques for the evaluation and treatment of SI stability will be presented and practiced.
1. Participants will describe the interaction of anatomical structures involving the sacroiliac joint.
2. Participants will describe and perform 3 evaluative measures for structures relates to sacroiliac joint stability.
3. Participants will describe and perform 3 treatment techniques to address sacroiliac joint stability deficits.
4. Participants will identify common dysfunctional patterns present in people with sacroiliac stability conditions.
General Anatomy Overview Lumbopelvic-Hip Complex: Today focuses on muscle structures in relation to SI stability.
Latissimus dorsi and erector spinae (Pardehshenas, 2013)
Third Layer – levator ani, Pubococcygeus, Iliococcygeus
SIJ Stability Theories (Normal Presentation) Load Transfer Theory
The primary function of the lumbopelvic-hip complex is to transfer loads safely while fulfilling the movement and control requirements of any tasks (Lee, 2011).
Bipedal posture in humans requires greater resistance to gravity. In the upright posture increased lumbopelvic compressional forces are necessary for stability (Vleeming, 2012).
Form/Force Closure Theory
Form closure: A stable situation where no extra forces are needed to maintain the state of the system (Snijders, et al 1993), as well as ability to resist shear or translation when loaded (Lee, )
Configuration of interfacing joint surfaces and “wedging” of sacrum into ilia, along with ridges and grooves of the surfaces themselves (Vleeming, 2012).
Force Closure: extra forces needed to keep the object in place (Snijders, et al 1993)
Nutation of sacrum will tighten SIJ ligaments to prepare for increased loading (Vleeming, 2012).
Muscles noted above
Deep muscles of the lumbopelvic increase the stiffness of the SIJ. These muscles include transverse abdominis, multifidus, and the pelvic floor. Stiffness augmented by superficial muscles external and internal oblique, rectus abdominis, and erector spinae. (Richardson et al 2002)
Unilateral versus Contralateral loading: (Vleeming 2012, Hamed 2013)
“cross-bracing” (Vleeming 2012)
Diaphragm, inter abdominal and thoracic pressure, pelvic floor (Beales, 2009, Lee, 2012)
A soda-pop, three-dimensional model for trunk muscle support for breathing and postural control. Vocal folds to the pelvic floor. A breach in pressure anywhere along the cylinder will impair the total function (Massery, 2012)
A. Treatment techniques/Muscle activation corrections
Stork with cues
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