Clinical Chiropractic Handbook - NIKITA VIZNIAK

CHAPTER 7 SACROILIAC SYNDROME) Relevant Anatomy Static Characteristics of Sl lesions Extremely strong surrounding ligaments Sacral side: concave groove, thick hyaline AS (Extension) PI (Flexion) cartilage Iliac side: convex ridge, thinner fibrocartilage High ilium, PSIS Low ilium, PSIS Grooves/ridges allow locking of joint Females generally have increased SI motion Long leg Short leg Presentation Possible lumbar Possible lumbar Local pain, possible LB & buttock radiation Pain may be worse with: scoliosis to opposite scoliosis to same side • Weight bearing • Moving from sitting to standing side PSIS more pronounced • Motion, walking PSIS less pronounced ASIS high Relieved by recumbency (-l. weight bearing) ASIS low Exam Lift therapy Focal SI tendemess, t w/ joint challenge Purpose Leg length inequality (LlI) Reduce spinal scoliosis, lordosis, kyphosis Possible guarded gait Normalize lower extremity weight bearing Myospasm - gluteaVlow back Assist in correction of SI misalignment Palpatory &lor postural signs of misalignment Relieve back pain associated w/ Lli Altered SI motion &lorjoint play Minimize premature degeneration Orthopedic tests to consider Application • Belt test Anatomical leg length discrepancy >6-10 mm • Gaenslen's test with symptom may require lift • SLR Adjustments prior to therapy may enhance • Laguerre effect • Patrick's (FABER) Use greater trochanters & iliac crests as • Hibb's markers • Yeoman's Height of lift should be detemnined by: • SI compression/distraction • Age of patient • Fortin finger test • Severity of scoliotic curve • Sit-up test, leg length check • Spinal mobility • Tibia vs. femur shortening Treatment • Activities of the patient Adjustments - restore motion & alignment 1 :2:4 Rule of Logan PT modalities - reduce edema, -l. pain )1,\" heel lift will do the following, ipsilaterally: Trigger point therapy, Soft tissue manipulation Raise femur head - )t,\" Home Care -Raise sacral base X\" Stretching, exercise, heat Raise L5 vertebral body - '/a\" Prevention Heel liftlorthotics Heel lift >10 mm requires a sole lift Patient education (2:1 Heel:sole) Environmental factors: sitting posture, leg­ crossing, waliet, furniture Do NOT increase heel lift by >50% at any one Aerobic conditioning & muscle strength time. Watch forchanges in relative knee height and let patient symptoms dictate further evaluation. :@2003 NIKITA VIZNIAK CLINICAL CHIROPRACTIC HANDBOOK 227)