SACROILIAC JOINT DYSFUNCTION AND TREATMENT

1. SACRO ILIAC JOINT
DYSFUNTION
(PROF.)DR. DEEPAK RAGHAV
PRINCIPAL
SANTOSH COLLEGE OF PHYSIOTHERAPY
SANTOSH MEDICAL AND DENTAL COLLEGE HOSPITAL
GHAZIABAD

3. ANATOMY
• Plane synovial joint → modified amphiarthrodial
joint
• Stable, rigid; relatively immobile; allowing effective
load transfer
• Each of two SI joints are about 1-2 mm wide

4. ANATOMY
• The sacroiliac joint can be considered as two
joints: the iliosacral and the sacroiliac
• The term iliosacral implies the innominates
moving on the sacrum. Conversely, the term
sacroiliac implies the sacrum moving within
the innominates.

5. LIGAMENTS
Primary Ligaments
a. Anterior sacroiliac
b. Posterior sacroiliac
c. Interosseous

6. LIGAMENTS
Secondary Ligaments
a. Sacrotuberous
b. Sacrospinous

7. PUBIS SYMPHYSIS
• Cartilaginous joint
• Joins 2 ends of pubic bones
• 3 ligaments associated are
• - superior pubic ligament
• - inferior pubic ligament
• - posterior ligament

8. SACRALISATION
UNILATERAL BILATERAL

9. LUMBARIZATION

10. FUNCTION
• Connects spine to pelvis
• Absorbs vertical forces from spine and
transmitting them to pelvis and lower
extremities

11. AXIS OF SI JOINT

12. MOVEMENT OF SI JOINT
Physiologic
1. Bilateral anterior
sacral nutation
2. Bilateral posterior
sacral nutation

13. MOVEMENT OF SI JOINT
Physiologic
3. Left sacral
torsion on left
oblique axis
4. Right sacral
torsion on right
oblique axis

14. MOVEMENT OF SI JOINT
Physiologic
5. Anterior sacral
nutation with
exhalation
6. Posterior sacral
nutation with
inhalation

15. Non physiological movt.
• Left sacral torsion on right oblique axis
• Right sacral torsion on left oblique axis
• Left unilateral anterior nutation
• Right unilateral anterior nutation
• Left unilateral posterior nutation
• Right unilateral posterior nutation
MOVEMENT OF SI JOINT

16. MUSCLES THAT REINFORCE
AND STABILIZE SIJ
• Erector Spinae
• Lumbar multifidi
• Abdominal muscles:
External & Internal
obliques
• Rectus abdominis
• Transversus abdominis
• Hamstrings such as
biceps femoris

17. CAUSES OF SACROILIAC
DYSFUNCTION
• TRAUMATIC
• MECHANICAL
a) HYPOMOBILE or SUBLUXATED
b) HYPERMOBILE or MICROTRAUMATIC
• SYSTEMIC

18. SYSTEMIC CAUSES OF
SACROILIAC DYSFUNCTION
• Inflammatory conditions
Ankylosying spodylitis, Rheumatoid Arthritis
• Joint infections
Brucellosis, Tuberculosis
• Metabolic disorders
Gout, Hyper parathyroidism
• Miscellaneous
Osteitis condensans illi, Paget’s disease
• SACROILIAC DYSFUNCTION

19. CLINICAL SIGNS OF
SACROILIAC DYSFUNCTION
• Stiffness and pain with walking
• Pain opposite side with walking
• Pain same side with walking
• Unilateral pain below L5
• Pain with sit to stand
• Coccydynia (torsions)
• Groin pain

20. SACROILIAC SOMATIC
DYSFUNCTIONS
• Forward sacral torsion
• Backward sacral torsion
• Bilateral sacral anterior nutation
• Bilateral sacral posterior nutation
• Unilateral sacral anterior nutation
• Unilateral sacral posterior nutation

21. EXAMINATION
ANTERIOR GAPPING TEST
test is positive if unilateral gluteal or posterior leg pain is
produced indicating a sprain of the anterior sacroiliac
ligaments.

22. FABER (PATRICK'S) TEST
positive test is indicated by the test leg's knee remaining
above the opposite straight leg.

23. PRONE LIMB LENGTH TEST

24. GILLET TEST (ONE-LEG STORK TEST)
If the SIJ on the side on which the knee is flexed moves
slightly or in a superior direction, the joint is considered
hypomobile, which indicates a positive test

25. PIEDALLU'S SIGN OR SEATED FLEXION TEST
If one PSIS, usually the painful one, is lower than the other, the
patient is asked to perform trunk flexion while remaining seated.
If the lower PSIS becomes the higher one on forward flexion, the
test is positive.

26. GAENSLEN'S TEST
pain indicates positive test pain caused by ipsilateral si joint
lesion, hip pathology, or L4 nerve root lesion.

27. Yeoman's Test
Pain localized to the SIJ indicates pathology of the
anterior sacroiliac ligaments.

28. Prone Knee Bending (Nachlas) Test
If the problem is a hypomobile SIJ, the ipsilateral ASIS rotates
forward, usually before the knee reaches 90 degrees flexion

29. DYSFUNCTIONS
1. ROTATORY
DYSFUNCTION OF
INNOMINATE
a) ANTERIOR OR
FORWARD ROTATED
INNOMINATE

30. DYSFUNCTIONS
1. ROTATORY
DYSFUNCTION OF
INNOMINATE
b) POSTERIOR OR
BACKWARD ROTATED
INNOMINATE

31. 2. SACRAL BASE DYSFUNTION
a) BASE ANTERIOR

32. 2. SACRAL BASE DYSFUNTION
• a) BASE POSTERIOR

33. 3. SACRAL TORSIONS
• They occur as fixations on either of the
oblique axes, usually during the gait cycle, and
are held in this dysfunctional position by the
piriformis.
• Torsions might be thought of as half the
sacrum flexing and the other half extending
on one of the two oblique axes.

34. 3. SACRAL TORSIONS
• Forward torsion to the Left on the Left oblique axis. (LOL)

35. 3. SACRAL TORSIONS
• Forward torsion to the Right on the Rt. oblique axis.(ROR)

36. 3. SACRAL TORSIONS
• Backward torsion to the Right on the left oblique axis.(ROL)

37. 3. SACRAL TORSIONS
• Backward torsion to the Left on the Right oblique axis.(LOR)

38. 4. UNILATERAL SACRAL FLEXIONS
• Sacral flexion lesions might be thought of as failure of one
side of the sacrum to extend (counter nutate) from the
flexed (nutated) position. Rt. And Lt. flexion

39. 5. PUBIC SHEAR LESIONS
a) SUPERIOR PUBIC
SHEAR
b) INFERIOR PUBIC
SHEAR
• Pubic shears are sliding
of one joint surface in
relation to the other in
either a superior or an
inferior direction.

40. 6. INNOMINATE SHEAR
Superior Innominate Shear (Upslip)
Inferior Innominate Shear (Downslip)

41. TREATMENT

42. EXERCISE

43. SURGICAL Rx

44. SLEEPING POSITION IN SI JT. PAIN

46. THANK
YOU