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.
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
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
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.
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.
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
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)
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.