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Sacroiliac dysfunction
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Sacroiliac dysfunction - September 27, 2001 9:42:00 PM
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ptahanson
Posts: 4
Joined: September 27, 2001
From: riverisde, CA
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Does anyone have any protocols or suggestions about sacroiliac dysfunction?
Hypomobile and hypermobile
PLEASE HELP!!!!
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Re: Sacroiliac dysfunction - October 3, 2001 3:52:00 AM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
Status: offline
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Hi ptahanson,
I recently asked the same question, and here is what one person suggested. Hope it helps!
One person wrote:
"SIJ instability problems are usually very easy to treat if your confident.
Firstly you need to make sure that there is no dysfunction or altered position within the SIJ. If this is OK then the treatment is specific exercises to gain control around the structure.
Make sure that she has good core stability (Transversus and multifidus).
To gain force closure of the joint you need to get the following muscles working in groups.
a) gluts (max and med) - walking with buttocks squeezed together as if trying to carry a £50 note in the bottom crease.
b) gluts and lat dorsi. Stand on one leg and try and externally rotate the foot whilst pulling down on a piece of theraband (blue) with the opposite arm. She should try and push the other leg into a wall etc to prevent pelvic rotation during this exercise. (It is easier than it sounds - honest!!).
c) adductors and obliques (to control the pubic symp.) Squeeze a ball between the knees whilst trying to do a opposite hand to knee mini sit-up.
d) gym ball control exercises.
Honestly Henry most of hte above exercises are much easier to perform than they sound. If she is having to much of a problem you could also try a SIJ belt but be warned if you tighten to much its switches off hte stability muscles causing an increase in their symptoms when they take the belt off."
Another person wrote,
"From my personal experience, this is a common presentation in pregnant women. However, the sources can be multiple. I would be careful not to jump to SIJ dysfunction (or to any other common clinical pattern) although it may be tempting to do so due to pregnancy.
The risk of getting an SIJ instability increases at later stages of pregnancy and in the presence of a female fetus due to the secretion of relaxin from the placenta which is more pronouced when the fetus sex is female. This one of the reasons why CDH is more prevalent in girls. If the pattern indicates that instability is present then a catching pain while walking or other weight-bearing activities may be a feature BUT mobility tests of the SIJ should be positive (ie reproduce pain). According to my experience this is perhaps the only clinical presentation where you can find true positive mobility tests of the SIJ. This also might explain in part the poor reliability of the SIJ tests when they are examined in 'normal' or even symptomatic subjects in which diagnosis of SIJ dysfunction may be wrong.
Another possibility may be the buttock muscles especially the gluteus maximus and medius. We have to remember that shifting of the center of gravity (asymetrical- due to the position of the fetus in the uterus) requires overwork from these buttock muscles in weight bearing activities and in the transition from sit to stand. Pain with prolongues walking may suggest a basic ischaemic state of muscles that increases as the activitiy goes on and activates muscle nociceptors. Also, it is interesting to note that the population of substance P immunoreactive fibers increases in muscular pain states which may explain partly the increased sensitivity.
Referred pain from the lumbar or the lower thoracic spine may be a possibility (neuropathy of the dorsal ramus of T11-12 has been termed 'Maigne syndrome'). However, if we talk about a dorsal ramus syndrome of lower Tx then we should get 'typical' neuropatic pain which is more superficial, perhaps also burning or 'nervy' in nature. This possibility seems unlilkely as the 'spasmy' nature of the disorder may not clearly indicate the involvement of a Tx dorsal ramus.
The lumbar spine has to be ruled out. If this lady has an history of Lx dysfunction then it increases the risk of aggravation as a result of pregnancy. The fact that extension of the lumbar spine aggravates her symptoms doesn't necesseraly indicate that the lumbar spine is the area at fault. Extension in prone or standing involves also movements of the pelvis and activity of buttock muscles.
In summary, the human movement (not to forget the neurohormonal system which may play a significant role in the modulation of pain) system changes dramatically in pregnancy. I think it's a miracle that in most cases things go so smoothly. My 'gut feeling' says that you should try the muscular component. It is not always easy to get rid of pain in this cases as the most significant contributing factor is pregnancy in itself, although some relief may be obtained.
I think it is also important to remember that even when pain disappears after pregnancy, the patient has to be followed up as the 'memory' (tissue and pain) may lead to relapses. Prevention then becomes of primary importance. "
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Re: Sacroiliac dysfunction - October 3, 2001 4:50:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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You ask a loaded question???? My question back to you is........"How would we ever know if a patient has Sacroiliac hypo or hypermobolity?" I have seen many techniques and theories but none of them are supported by research.
That having been said.......if the SIJ was truly hypermobile then I know of two approaches......one would be to belt them........(not sure of efficacy on that one), and the other would be a segmental stabilization program. The lower multifidi of the lumbar spine actually cross over and insert into the Sacrum thus POTENTIALLY adding some stability to the joint.
Muscle energy techniques are used widely to address SIJ problems. They seem to work anecdotaly but there is no research in support and the basis for evaluation needs to be explored a little further. I am not sure that humans can actually feel what they think they are feeling but who knows.
The SIJ is implicated as a pain generator in a significant percentage of LBP patients. I have seen estimates that range from 10-30%.
Respectfully,
mcap
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Re: Sacroiliac dysfunction - October 5, 2001 7:58:00 PM
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ptahanson
Posts: 4
Joined: September 27, 2001
From: riverisde, CA
Status: offline
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Thanks henry and mcap! That info sure will help.
Mcap, I think that mobility will slightly differ from one person to the next. This said, I suppose that a person who has a unilateral SI joint pathology has a hypermobility or a hypomobility IN RELATION to the unaffected side. Using the unaffected side as the standard, we can deduce weather a hyper/hypomobility is the case. Let me know if this sounds correct.
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