Term
| what to do if you ever have a segment that moves too much/too little |
|
Definition
| look for too little/too much movement above and below |
|
|
Term
|
Definition
| top wing at the base of the sacrum on each side |
|
|
Term
| where on the sacrum does the piriformis attach |
|
Definition
| S2-S4, anterolateral region of the sacrum |
|
|
Term
| does the piriformis pull on the sacrum |
|
Definition
|
|
Term
| what kind of cartilage covers the sacrum at the SIJ |
|
Definition
|
|
Term
| what kind of cartilage covers the ilium at the SIJ |
|
Definition
|
|
Term
| is hyaline or fibrocartilage thicker |
|
Definition
| hyaline cartilage is 2-5 times thicker than fibrocartilage |
|
|
Term
| does the SIJ surface change throughout the lifetime |
|
Definition
|
|
Term
| what is the SIJ surface like in childhood |
|
Definition
| flat, smooth, unstable. Gliding motions in all directions is possible |
|
|
Term
| what is the SIJ surface like after puberty |
|
Definition
| rougher. Motion is restricted to anterior/posterior movementss |
|
|
Term
| what is the SIJ surface like in aging |
|
Definition
| less smooth, less mobile. Decreased motion |
|
|
Term
| is there fluid/nutrition flowing to hyaline or to fibrocartilage |
|
Definition
|
|
Term
| at the SIJ, is the ilium convex or concave |
|
Definition
|
|
Term
| at the SIJ, is the sacrum convex or concave |
|
Definition
|
|
Term
| is there mobility at the pubic symphysis |
|
Definition
|
|
Term
| what kind of cartilage is at the pubic symphysis |
|
Definition
| thin hyaline cartilage layer, thick fibrocartilage interpubic disc |
|
|
Term
| which nerve roots go over the SIJ |
|
Definition
|
|
Term
| what do the L4-5 nerve roots over the SIJ cause when there is a problem |
|
Definition
|
|
Term
| what causes about a 3rd of sciatic pain |
|
Definition
| L45 nerve root going over the SIJ |
|
|
Term
| what is the purpose of the posterior SI ligament |
|
Definition
| stops anterior innominate rotation |
|
|
Term
| when is the posterior SI ligament painful |
|
Definition
| with pressure when innominate is anteriorly rotated and in patients who have compensatory gait for loss of hip hyperextension |
|
|
Term
|
Definition
| innominate = ischium, pubis, ilium on one side of the pelvis |
|
|
Term
| can the ilium rotate without the pubis and ischium |
|
Definition
| no. they are all connected |
|
|
Term
| what is the function of the sacrotuberous ligament |
|
Definition
| prevents posterior rotation of the innominate and forward flexion of the sacrum |
|
|
Term
| if someone has a posteriorly rotated innominte, how would that affect the sacrotuberous ligament |
|
Definition
| there would be increased tension/tenderness on that side's sacrotuberous ligament |
|
|
Term
| what muscle inserts onto the sacrotuberous ligament |
|
Definition
|
|
Term
| what is the path of the posterior SI ligament |
|
Definition
| runs along the SI joint posteriorly and vertically |
|
|
Term
| what is the location/path of the sacrospinous ligament |
|
Definition
| from the sacrum to the ischial spine |
|
|
Term
| what is the function of the sacrospinous ligament |
|
Definition
| same as sacrotuberous ligament: prevents posterior rotation of the innominate and forward flexion fo the sacrum |
|
|
Term
| is the sacrospinous ligament palpable |
|
Definition
|
|
Term
| what is the toughest ligament in the body |
|
Definition
| interosseous sacroiliac liagments |
|
|
Term
| what are the interosseous sacroiliac ligaments imporant for |
|
Definition
| maintaining the joint space of the SIJ during weightbearing |
|
|
Term
| what clothing accessory are the interosseous sacroiliac ligaments similar to |
|
Definition
|
|
Term
| what are the attachments of the iliolumbar ligament |
|
Definition
| attaches to the transverse process of L5 and to the iliac crest |
|
|
Term
| what is the function of the iliolumbar ligament |
|
Definition
| responsible for maintaining the stability of the lumbosacral junction in the coronal and sagittal planes |
|
|
Term
| what is the path of the superior pubic ligament |
|
Definition
| connects superior parts of pubic rami |
|
|
Term
| if there is tenderness at the pubic symphysis, what ligament may be affected |
|
Definition
|
|
Term
| which ligament are you touching as you palpate the superior rami of the pubic bones for rotation |
|
Definition
|
|
Term
| where is the arcute pubic ligament |
|
Definition
| connecting the inferior borders of the pubic symphysis |
|
|
Term
| what ligament forms the superior border of the pubic arch |
|
Definition
|
|
Term
| how many muscles attach to each side of the pelvic girdle |
|
Definition
|
|
Term
| what muscles cross the SIJ with the purpose of moving the SIJ |
|
Definition
|
|
Term
| what are some key muscles for SIJ treatment |
|
Definition
| piriformis, glutes, ilipsoas, hamstrings, rectus femoris, hip adductors, lats, abdominals |
|
|
Term
| which muscles are anterior stabilizers of the SIJ |
|
Definition
|
|
Term
| which muscles are posterior stabilizers of the SIJ |
|
Definition
|
|
Term
| which muscles are important for treating posterior rotation of the SIJ |
|
Definition
| iliopsoas, rectus femoris |
|
|
Term
| do you get more ER or IR with outflare |
|
Definition
|
|
Term
| do you get more ER or IR with inflare |
|
Definition
|
|
Term
| does posterior rotation go with inflare or outflare |
|
Definition
|
|
Term
| does anterior rotation go with inflare or outflaire |
|
Definition
|
|
Term
| how to add stability at SIJ |
|
Definition
| pull opposite lats/glutes: glutes pull down and out, lats pull up and out in opposite direction. Tightens things up at the SIJ. |
|
|
Term
| are the L and R sacroiliac joints 2 separate joints? |
|
Definition
| the L and R sacroiliac joints are 2 structurally separate joints that functionally act as one singular joint |
|
|
Term
| in what plane of motion is innominate rotation |
|
Definition
|
|
Term
| in what plane of motion is sacral nutation/counternutation |
|
Definition
|
|
Term
| what does nutation look like |
|
Definition
| sacral base moves anteriorly. |
|
|
Term
| what does counternutation look like |
|
Definition
| sacral base moves posteriorly |
|
|
Term
|
Definition
| when the entire pelvis moves anteriorly or posteriorly in the sagittal plane |
|
|
Term
| does posterior rotation go with inflare/outflare and with IR/ER |
|
Definition
|
|
Term
| does anterior rotation go with inflare/outflare and with IR/ER |
|
Definition
|
|
Term
| how can you tell if your left innominate is posteriorly rotated |
|
Definition
| L ASIS is higher if it is posteriorly rotated |
|
|
Term
| how to correct L innominate posterior rotation |
|
Definition
| want to pull ASIS back down: isometrically contract L hip flexors to reverse the action and pull the ASIS anteriorly |
|
|
Term
| how to correct L innominate posterior rotation using R leg |
|
Definition
| want to pull PSIS down on R side: isometrically contract R hip extensors to pull PSIS posteriorly |
|
|
Term
| how long to hold contractions to correct innominate rotation |
|
Definition
|
|
Term
| what does sacroiliac motion refer to |
|
Definition
| sacral motion on the ilium |
|
|
Term
| is sacroiliac motion related to spine motion or to LE motion |
|
Definition
|
|
Term
| what does iliosacral motion refer to |
|
Definition
| movement of iliumon sacrum |
|
|
Term
| is ilosacral motion related to spine motion or to LE motion |
|
Definition
|
|
Term
| how much translation can occur at pubic symphisis |
|
Definition
|
|
Term
| how much rotation can occur at pubic symphysis |
|
Definition
|
|
Term
| if someone has an upslip because they've fallen and landed on one isch tube and they have pain at the right SI joint and PSIS and ASIS are both higher on the R side, is this rotation or translation |
|
Definition
|
|
Term
| how much can the SIJ move |
|
Definition
|
|
Term
| what are the 3 planes of motion of the pelvis |
|
Definition
| sagittal (flex/ext), frontal (lateral flexion), axial (twisting) |
|
|
Term
| what are the main stabilizers of the SIJ |
|
Definition
| anterior and posterior ligaments |
|
|
Term
| Is the pelvic girdle a closed osteoarticular rign |
|
Definition
|
|
Term
| what is the purpose of the pelvic girdl |
|
Definition
| efficient transmission and distribution of forces |
|
|
Term
| what are the 5 axes of rotation of the sacrum |
|
Definition
| superior/middle/inferior transverse and R/L oblique axes |
|
|
Term
| does the sacrum more often move on a transverse or an oblique axis |
|
Definition
|
|
Term
| where is the superior transverse axis of the sacrum |
|
Definition
| goes through sacral segment on medial-lateral line |
|
|
Term
| what is another term for the superior transverse axis |
|
Definition
|
|
Term
| what is the movement of the sacrum at the superior transverse axis with respiratoin |
|
Definition
| inhale: counternutation; exhale: nutation |
|
|
Term
| where is the middle transverse axis of the sacrum |
|
Definition
|
|
Term
| what is the middle transverse axis important for |
|
Definition
| it is the principle axis for SI flexion/extension |
|
|
Term
| where is the inferior transverse axis of the sacrum |
|
Definition
| it goes throug the inferior pole of SI articulatoin |
|
|
Term
| what is the principle axis for iliosacral motion |
|
Definition
|
|
Term
| what does it mean that the inferior transverse axis is the principle axis for iliosacral motion (what happens there, exactly)? |
|
Definition
| anterior/posterior innominate rotation |
|
|
Term
| what are the paths of the oblique axes of the sacrum |
|
Definition
| superior end of articular surface to contralateral inferior end of articular surface |
|
|
Term
| how do we name the oblique axis as right or left |
|
Definition
| by the top. The Right oblique axis is superior on the right side |
|
|
Term
| how to name a rotation that is going forward at the right and is facing left |
|
Definition
| rotated left on the left oblique axis |
|
|
Term
| how to name a rotation that is going forward at the left and is facing right |
|
Definition
| rotated right on the right axis |
|
|
Term
| how to name a rotation that is going backwards at the left and is facing left |
|
Definition
|
|
Term
| if you tilt your right innominate, which axis is being used |
|
Definition
|
|
Term
| if you tilt your left innominate, which axis is being used |
|
Definition
|
|
Term
| is there more stability in nutation or counternutatoin |
|
Definition
|
|
Term
| why is nutation more stable than counternutation |
|
Definition
| tightening of interosseous, sacrotuberous, sacrospinous, posterior SI ligaments puts increased pressure on SIJ |
|
|
Term
| relative to a nutated sacrum, how is a pelvis tilted |
|
Definition
|
|
Term
|
Definition
| lumbar motion in the sagittal plane |
|
|
Term
| describe nutation in terms of rotation of sacrum on ilium |
|
Definition
| anteriorly rotated sacrum on ilium |
|
|
Term
| describe nutation in terms of rotation of ilium on sacrum |
|
Definition
| posteriorly rotated ilium on sacrum |
|
|
Term
| if someone has a posteriorly rotated innominate, how does that affect femur position |
|
Definition
| femur is moved towards flexion |
|
|
Term
| if someone has a posteriorly rotated innominate, in what hip/leg direction/movement will they be limited |
|
Definition
|
|
Term
| if someone has a posteriorly rotated innominate, in what hip/leg direction/movement will they be painful |
|
Definition
| limited and painful in extension but also painful at end range flexion |
|
|
Term
| if someone has an anteriorly rotated innominate, how does that affect femur position |
|
Definition
| femur is moved towards extension |
|
|
Term
| if someone has an anteriorly rotated innominate, in what hip/leg direction/movement will they be limited |
|
Definition
|
|
Term
| if someone has an anteriorly rotated innominate, in what hip/leg direction/movement will they be painful |
|
Definition
| limited and painful in flexion, but also painful at end range extension |
|
|
Term
| if someone has a posteriorly rotated innominate, what is their direction of dysfunction |
|
Definition
|
|
Term
| if someone has an anteriorly rotated innominate, what is her direction of dysfunction |
|
Definition
|
|
Term
| describe counternutation in terms of rotation of sacrum on ilium |
|
Definition
| posterior rotation of sacrum on ilium |
|
|
Term
| describe counternutation in terms of rotation of ilium on sacrum |
|
Definition
| anterior rotation of ilium on sacrum |
|
|
Term
| is lordosis associated with nutation or counternutation |
|
Definition
| counternutation: anteriorly rotated pelvis |
|
|
Term
| is flat back posture associated with nutation or counternutation |
|
Definition
| nutation: posteriorly rotated pelvis |
|
|
Term
| does anterior or posterior innominate rotation result in increased leg length |
|
Definition
|
|
Term
| what are the 3 factors of SIJ stability |
|
Definition
| form closure, force closure, motor control |
|
|
Term
|
Definition
| SIJ is in close packed position (nutation) so no outside force is needed to provide stability |
|
|
Term
| what provides stability to the SIJ in form closure/close packed position/nutation |
|
Definition
| joint shape (convex/concave), friction against joint surfaces, ligaments, anterior widening of sacrum |
|
|
Term
|
Definition
| SIJ is in loose packed position (counternutation) so outside forces are needed for stability |
|
|
Term
| what creates force closure |
|
Definition
| any outside force that results in nutation of sacrum: muscles, joint capsule |
|
|
Term
| what are the myofascial units that provide force closure |
|
Definition
| inner unit, oblique outer unit, deep longitudinal outer unit |
|
|
Term
| what muscles provide force closure from the inner unit |
|
Definition
| multifidus, thoracic diaphragm, transverse abdominis, pelvic floor mm |
|
|
Term
| what myofascial structures provide force closure anteriorly from the oblique outer unit |
|
Definition
| external/internal obliques, anterior abdominal fascia, contralateral adductors |
|
|
Term
| what myofascial structures provide force closure posteriorly from the oblique outer unit |
|
Definition
| lats, thoracolumbar fascia, contralateral glutes |
|
|
Term
| how to use outer unit to provide stability to SIJ posteriorly |
|
Definition
| do arm raise and squat to contract contralateral glutes and lats. Can do both at the same time: squat-stand-pull |
|
|
Term
| how to use outer unit to provide stability to SIJ anteriorly |
|
Definition
| do a SLR with leg ER to work adductors. Abdominal crunch up toward raised leg to work obliques and and adductors simultaneously |
|
|
Term
| what myofascial structures provide force closure from the deep longitudinal outer unite |
|
Definition
| erector spinae, ilocostalis, biceps femoris via sacrotuberous ligament |
|
|
Term
| if someone has deficient motor control stability of SIJ, what can you expect |
|
Definition
| weaknes with SIJ pain, aberrant SIJ motion |
|
|
Term
| what are common MOIs for SIJ problems |
|
Definition
| sudden jarring motion: step of curb or extra step unexpectedly; fall on butt; lift/twist maneuver; recent pregnancy/childbirth/breastfeeding |
|
|
Term
| where is SIJ pain usually localized |
|
Definition
| unilateral PSIS, glutes, groin, can refer to thigh, usually not below knee |
|
|
Term
|
Definition
|
|
Term
|
Definition
| turning in bed, during WB phase of gait, standing with weight on painful side |
|
|
Term
| what are eases of SIJ pain |
|
Definition
| slouched sitting/sacral sitting |
|
|
Term
| what are the 3 main parts of the SIJ exam |
|
Definition
| lumbar screen, standing tests, lying tests |
|
|
Term
| what determines whether to do more detailed exams/tests of SIJ |
|
Definition
|
|
Term
| what are the standing tests of SIJ |
|
Definition
| iliac crest levels, palpate PSIS for pain/tenderness, standing flexion tests, gillet test |
|
|
Term
| how to do standing flexion test |
|
Definition
| palpate both PSIS as pt flexes. Look for asymmetry in flexion. Both sides should move anteriorly the same amount. |
|
|
Term
| what to palpate in Gillet test |
|
Definition
| PSIS and S2 spinous proces |
|
|
Term
| what is normal motion in Gillet test |
|
Definition
|
|
Term
| why would the PSIS move up as the hip flexes in Gillets |
|
Definition
| because they are laterally tilting or hip hiking to raise their leg |
|
|
Term
| will an anteriorly rotated innominate cause a leg to appear shorter or longer in standing/lying |
|
Definition
|
|
Term
| will an anteriorly rotated innominate cause a leg to appear shorter or longer in sitting |
|
Definition
|
|
Term
| what tests of the SIJ are done in supine |
|
Definition
| check ASIS height, do supine to long sit test |
|
|
Term
| what does the supine to long sit test show |
|
Definition
| rotational malalignment; pelvis not rotating/moving as a unit |
|
|
Term
| what is the rule of three L's |
|
Definition
| leg lengthens lying = anterior rotation |
|
|
Term
| if a patient has a true leg length, will the short leg in sitting be the same as the short leg in lying |
|
Definition
|
|
Term
| if the pelvis is rotated, with the long leg in lying be the long leg in sitting? |
|
Definition
|
|
Term
| what to palpate in supine to sit test |
|
Definition
|
|
Term
| what to do before long sit test |
|
Definition
| have patient bridge to reset pelvis. I passively lower their legs. |
|
|
Term
| if a leg lengthens in sitting, what does that indicate for that side |
|
Definition
| posterior rotation of innominate |
|
|
Term
| what tests of the SIJ exam are done in prone |
|
Definition
| sacral apex test, sacral sulcus test |
|
|
Term
| what is the sacral apex test |
|
Definition
| posterior to anterior compression of the sacrum at the apex |
|
|
Term
| what is the sacral sulcus test |
|
Definition
| posteror to anterior compression of the sacrum directly medial to the PSIS |
|
|
Term
| how to identify SIJ hypermobility |
|
Definition
|
|
Term
| what can cause SIJ hypermobility |
|
Definition
| pregnancy, being an athlete, trauma |
|
|
Term
| what causes SIJ hypomobility |
|
Definition
| overuse/trauma/pelvic asymmetries |
|
|
Term
| what are SIJ dysfunctions |
|
Definition
| hyper/hypomobile, anterior/posterior innominate, sacral torsion, upslip/downslip, inflare/outflare |
|
|
Term
| what is the most common malalginment issue of the SIJ |
|
Definition
|
|
Term
| what is a common MOI for innominate rotation |
|
Definition
| forward trunk flexion with twist. (reach for something on the ground.) |
|
|
Term
| what are the 2 most common innominate rotation directions |
|
Definition
| right anterior and/or left posterior |
|
|
Term
| if R ASIS is down, R pubic tubercle is down, and R PSIS is higher, what is the problem |
|
Definition
|
|
Term
| if you have R anterior rotation, what is the L, relatively? |
|
Definition
|
|
Term
| if you have L posterior rotatoin, are you more likely to see outflare or inflare |
|
Definition
|
|
Term
| if you have the L posteriorly rotated, are you more likely to see L IR or ER |
|
Definition
|
|
Term
| if you have a R anteriorly rotated innominate and a L posteriorly rotated innominate, what is the sacral torsion |
|
Definition
|
|
Term
| when you rotate the sacrum to the L, how is the lumbar spine affected |
|
Definition
|
|
Term
|
Definition
| to get relaxation following contraction; to get reciprocal inhibition; to balance the asymmetries; to restore normal funciton/ROM; neuromuscular re-education |
|
|
Term
| if you have an anteriorly rotated innominate, is that leg longer in sitting or lying |
|
Definition
|
|
Term
| how to treat an anteriorly rotated innominate with muscle energy |
|
Definition
| isometrically contract extensors so that extensors pull innominate posteriorly |
|
|
Term
| if the iliac crest is higher, the PSIS is lower, the ASIS is higher, and the leg lengthens in sitting, what is the problem? |
|
Definition
| posteriorly rotated innominate |
|
|
Term
| how to treat a posteriorly rotated innominate with muscle enery |
|
Definition
| isometrically contract the hip flexors so that they pull the innominate anteriorly |
|
|
Term
| if you have sacral torsion of L on L, where will you have a deep sacral sulcus |
|
Definition
|
|
Term
| how to treat sacral torsino |
|
Definition
|
|
Term
| if the iliac crest is higher, the PSIS is higher, the ASIS is higher, and the pubic tubercle is higher, what SIJ dysfunction do you have |
|
Definition
|
|
Term
| what is the treatment for upslip |
|
Definition
|
|
Term
| if the iliac crest is lower, the PSIS is lower, the ASIS is lower, and the pubic tubercle is lower, what SIJ dysfunciton do you have |
|
Definition
|
|
Term
| what is the treatment for downslip |
|
Definition
| passive cephalad motion through ischium: put hand on isch tube. Upglide. Tell patient to push against you with their isch tube. |
|
|
Term
|
Definition
| isometrically contract adductors so that they pull out the pubis |
|
|
Term
|
Definition
| isometrically contract external rotators so that they pull in the ilium |
|
|
Term
| what muscles are contracted in outflare contraction |
|
Definition
| Hip Ers, hip abductors, iliacus |
|
|
Term
| how often to do inflare/outflare corrections |
|
Definition
|
|
Term
| how to tell if a patient has inflare |
|
Definition
| they are anteriorly rotated and they can internally rotate a lot |
|
|
Term
| how to tell if a patient has outflare |
|
Definition
| they are posteriorly rotated and they can externally rotate a lot |
|
|
Term
| is it more important to treat the rotation or the flare |
|
Definition
| more important to treat the rotation |
|
|
Term
| if you're anteriorly rotated, are your hamstrings shortened or lengthened |
|
Definition
| lengthened; they'll feel tight |
|
|
Term
| besides muscle energy, what are some treatments for SIJ dysfunctions |
|
Definition
| modalities, mobilization, stabilizing belt for hypermobility, lower extremity alignment |
|
|
