Sacroiliac Joint Pain: Difference between revisions
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[[Category:Sacroiliac Joint]] | [[Category:Sacroiliac Joint]] | ||
== Pelvic Malalignment == | == Pelvic Malalignment == | ||
Timgren et al assessed pelvic asymmetry in neurologic patients with symptoms that weren't explained by a neurological diagnosis. They found pelvic asymmetry in 87%. Reestablishment and maintenance of symmetry correlated with improvement in pain and function. They found the following patterns. <ref>Timgren J1, Soinila S. Reversible pelvic asymmetry: an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms. J Manipulative Physiol Ther. 2006 Sep;29(7):561-5.</ref> | |||
[[File:Pelvic_malalignment.png]] | [[File:Pelvic_malalignment.png]] | ||
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Revision as of 11:18, 14 June 2020
Pelvic Malalignment
Timgren et al assessed pelvic asymmetry in neurologic patients with symptoms that weren't explained by a neurological diagnosis. They found pelvic asymmetry in 87%. Reestablishment and maintenance of symmetry correlated with improvement in pain and function. They found the following patterns. [1]
| Innominate | A. Posterior rotation | B. Anterior Rotation |
|---|---|---|
| Iliac Crest | Elevated ↑ | Elevated ↑ |
| ASIS | Elevated ↑ | Depressed ↓ |
| PSIS | Depressed ↓ | Elevated ↑ |
| scapula | Depressed ↓ | Elevated ↑ |
| leg | Longer ↑ | Shorter ↓ |
| 10-15mm lift | Increased crest difference ↑ | Reduced crest difference ↓ |
| Spinal curvature | C type scoliosis | S type scoliosis |
| C0-C1 function | Symmetric rotation in flexion | Restricted rotation in flexion |
All changes are in reference the ipsilateral side.
Rising of the crest upon anterior SI rotation is paradoxical, and its explanation cannot be reduced to a two-dimensional model.
Schamberger’s rule of the five Ls, which relates to the side of the anteriorly rotated innominate: “Leg Lengthens Lying, Landmarks Lower” (supine vs long sitting) [2]
Manual Therapy
Alignment can be reacquired through various means such as muscle energy techniques, and mobilisation with movement.
Mulligan Techniques
Anterior Innominate Rotation
The most common malalignment is anterior rotation. This can usually be easily corrected with a mobilisation with movement technique called anterior innominate extension in lying mobilisation with movement. The sacrum is stabilised, the innominate is rotated and glided posteriorly, while the patient extends in lying. Ensure mobilisation is a combination of glide +/- rotation of the innominate with opposing forces on the sacrum. This technique often corrects posterior rotation, too.
Mulligan Videos
Muscle Energy Techniques
Pelvic asymmetries can also be corrected with muscle energy techniques.
Anterior Innominate Rotation
The technique can be visualised via the image below where the origin and insertion of the hamstrings are reversed to pull and rotate the innominate. Ensure to lean cranially, and allow some abduction of the ipsilateral hip. Stabilise the contralateral ASIS. Reach the end range of hip flexion and complete a muscle energy technique. The patient can treat themselves by grasping under their knees and resisting thigh extension, alternating on both sides. This again produces a correctional rotational force on the pelvis.
HVLA techniques
High-velocity and low-amplitude thrust technique can be applied through the ankle on the side of the dysfunctional SI joint
