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.

4. 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

5. 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

6. LIGAMENTS
PRIMARY SECONDARY
• Anterior Sacrotuberous
• Posterior Sacrospinous
• Interosseous

8. 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.

9. 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.

10. 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

11. 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.

14. SI joint Dysfunction
• Sacroiliitis
• Pelvic till
• Osteoarthritis of SI joint
• Piriformis syndrome

15. 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

16. 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.

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

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

21. Fascia and muscles

22. 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

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

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

26. 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.

27. 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

28. Diagnosis
• X-rays
• CT scan
• MRI
• fluroscopy

29. Differential diagnosis
• Sciatica
• Piriformis syndrome
• Herniated disc
• Low back ache

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

31. Special test
• Compression test
• Thigh Thrust test
• Distraction test
• FABER test
• Gaenslen test
• Sacral thrust

34. Medical management
• Anti-inflammatory
• Muscle relaxants
• Corticosteroids injections

35. Physiotherapy
• Goal
Decrease pain
Increase ROM
Improve mobility
Balance training
Postural correction education

36. Electrotherapy
• TENS
• IFT
• Ultrasound
• Hot/cold fermentation

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

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

40. 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

41. 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

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

43. Thank you 