SI JOINT DYSFUNCTION.pptx

SI joint dysfunction, causes,risk factors,muscles, ligaments affected the most, differentional diagnosis, x-findings, special test, muscles strengthening, ligament strengthening, daily physiotherapy protocal, electrotherapy treatment, strengthening and stretching protcol, precautions, postural correction

1. SI JOINT DYSFUNCTION By- kajal sansoya

2. INTRODUCTION TO SI JOINT The sacroiliac joint connects the bottom of the spine (sacrum) with the pelvic bone. The sacroiliac joint is the largest joint in the body and serves to distribute forces from the upper body to the lower limbs.

3. ANATOMY Plane synovial joint Stable , rigid, relatively immobile; allowing effective load transfer Connects spine to pelvis Absorbs vertical forces from spine and transmitting them to pelvis and lower extermities

4. Function Provide stability and attenuate forces to the lower extremities. Act as a shock absorber for spine. The SI joint provides a "self-locking" mechanism (where the joint occupies or attains its most congruent position, also called the close pack position) that helps with stability during the heel-off phase of walking. The joint locks on one side as weight is transferred from one leg to the other, and through the pelvis the body weight is transmitted from the sacrum to the hip bone

5. LIGAMENTS PRIMARY SECONDARY Anterior Sacrotuberous Posterior Sacrospinous Interosseous

6. WHAT IS SI JOINT DSYFUNCTION ? SI JOINT dysfunction is a term used to describe the pain of the SI joint. It is usually caused by abnormal motion or malalignment . The sacroiliac joint is normally subjected to large shearing forces .

7. Form closure and force closure Form closure - describes the stability of SI joint from the design of pelvic stability. The position of the bones in the SIJ creates a “keystone-like” shape which adds to the stability in the pelvic ring. Force closure - Force closure is the term used to describe the other forces acting across the joint to create stability. This force is generated by structures in a direction perpendicular to the sacroiliac joint and is adjustable according to the loading situation. Muscles, ligaments and the thoracolumbar facia all contribute to force closure . Force closure is particularly important during activities such as walking when unilateral loading of the legs creates shear forces.

8. Motion at SI joint Motion at SI joint occur during movement of trunk and lower extremities Flexion of sacrum – nutation Extension of sacrum- counter- nutation

9. Conti… Nutation - occurs in one direction of gravitational force. When the sacrum absorbs shock, it moves downwards, forwards and rotates to opposite side, as sacrum moves anteriorly &inferiorly, the coccyx moves posteriorly relative to the ilium . Counter- nutation - body defence lefting the joint up against gravity. When sacrum moves up, backwards & rotates to the same side that absorbs the force. Torsion- when left/right base of sacrum moves anterior/posterior.

10. SI joint Dysfunction Sacroiliitis Pelvic till Osteoarthritis of SI joint Piriformis syndrome

11. Sacroiilitis inflammation of the SI joint The pain associated with sacroiliitis most commonly occurs in the buttocks and lower back. It can also affect the legs, groin and even the feet. Sacroiliitis pain can be aggravated by: Prolonged standing Bearing more weight on one leg than the other Stair climbing Running Taking large strides

12. Pelvic tilt Pelvic tilt  is the amount of change in orientation between the pelvic bowl and the upper leg bones, as well as its orientation in space. Anterior pelvic tilt  – Where the top edge of the pelvis (iliac crest) is rotated forward and bottom edge (pubic bone) is rotated backward. Posterior pelvic tilt  – Where the top edge is rotated backward and bottom edge is rotated forward.

13. Why it happens? Too much movement-(instability/ hypermobility ) Too little movement( hypomobility /fixation)

14. Traumatic Mechanical causes- hypomobile & hypermobile Systemic causes- bone infection, inflammation condition, metabolic disorders Poor posture

15. Fascia and muscles

16. The sacroiliac joint receives its nerve supply from the major anterior branches of the  L4 and L5 spinal nerves , superior gluteal nerve, and other major branches of the spinal nerves L5 to S2

17. Aggravating factors Osteoarthritis Gout Abnormal walking pattern Pregnancy Ankylosing spondylitis Prolonged static posture/poor posture Piriformis syndrome

18. Symptoms Symptoms mimic pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation or pinched nerves. Can cause sciatica like symptoms

19. Clinical presentation Pain is usually localized over the buttock Patients can often complain of sharp, stabbing, and/or shooting pain which extends down the posterior thigh usually not cross the knee.  Pain can frequently mimic and be misdiagnosed as radicular pain Difficulty sitting in one place for too long due to pain Local tenderness of the posterior aspect of the sacroiliac joint Pain occurs when the joint is mechanically stressed like forward bending Aberrant sacroiliac movement pattern Patients will frequently complain of pain while sitting down, lying on the ipsilateral side of pain, or climbing stairs.

20. Conti… Stiffness or burning sensation in the pelvis Numbness Weakness Pain in the groin Pain in lower back Feeling like your legs may buckle and not support your body

21. Diagnosis X-rays CT scan MRI fluroscopy

22. Differential diagnosis Sciatica Piriformis syndrome Herniated disc Low back ache

23. Physical examination First observe- the gait pattern - tenderness -swelling - spasm Motion

24. Special test Compression test Thigh Thrust test Distraction test FABER test Gaenslen test Sacral thrust

25. Medical management Anti-inflammatory Muscle relaxants Corticosteroids injections

26. Physiotherapy Goal Decrease pain Increase ROM Improve mobility Balance training Postural correction education

27. Electrotherapy TENS IFT Ultrasound Hot/cold fermentation

28. Exercises Day 1-7 Knee-chest SLR ATP’s Spinal rotation Piriformis stretch Knee isometrics Breathing exercises

29. Day 8-15 Bridging Hip flexion mobility Hamstring stretch Prone extension Prone on elbow Curl up (grade1) Child pose Sciatic nerve glide

30. Day 15-25 Side hip abduction Figure 4 stretch 90-90 heel taps Banded quadruped fire hydrant Supine adductor stretch Gleut bridge with abduction Bridging with VMO’s Wall sits

31. Precautions Postural correction Do not put extra stress on 1 leg Do not perform repeative activities Mattress should not be too hard or too soft

32. Surgical treatment SI joint fusion- small plates and screws hold the bones in the SI joint together so the bone fuse, or grow together.

33. Thank you 