Functional Anatomy
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| primary stabilizing ligaments of the SI Joint | Physically cross the SI joint; iliolumbar ligaments, ant sacroiliac ligament, short & long post sacroiliac ligaments, interosseus ligament
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| secondary stabilzers | stabilize, but don't physically cross SI joint; sacrospinous & sacrotuberous ligaments
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| iliolumbar ligaments | transv processes of L4 & L5 to iliac crests/sacral ala; strong bonds btwn L5 & ilium; stabilize lumbosacral joint; reinforce ant side of SI joint; decrs shearing btwn L4/L5 & sacrum
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| ant sacroiliac ligaments | thickening of ant & inf regions of capsule
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| interosseous ligament | deep to short posterior SI ligaments; fills gap of post & sup margins of SI joint; blends into capsule
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| sacrotuberous ligament | PSIS, Inf lat angle of the sacrum, & the lat sacrum/coccyx to the ischial tuberosities
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| sacrospinous ligament | controls lat/torsional strain & rotational strain; pelvic floor muscs have attachments to this ligament
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| sxs of SI joint dysfxn | pain in lower lumbar & med buttock area; may be pain in the post thigh; wider distribution of pain
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| symphysis pubis | end of each pubic bone is covered w/ articular cartilage, but joint itself contains a fibrocartilaginous disc.
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| ant stabilization of symphysis pubis | musc expansion of TA, rectus abd, int abd oblique, & adductor longus muscs that forms an ant "ligament" restricting ant translation/shear
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| pelvic floor | shares innervation with the TA musc; therefore, both TA & pelvic floor muscs help stabilize the pelvis
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| saggital plane motions of the SI joint | nutation & counternutation; axis of motion= med/lat at S2 joint (mid transverse axis)
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| nutation | aka sacral flexion; relative ant & inf motion of the sacral base; coupled with lumbar extension
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| counternutation | aka sacral extension; post & sup motion of sacral base; coupled with lumbar flexion
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| sacral torsions | named for the direction that the ant surface of the sacrum is facing
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| side of deeper sacral sulcus | opposite side of torsion direction; ant sacrum is rotated in the opposite direction
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| stabilizing muscs of the SI joint | pelvic floor, abs, erector spinae, quadratus lumborum, lats, hip flexors, hip abductors, hip adductors, hip extensors, hip IR, hip ER
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| hypomobile SI joint dysfxn | pain increases with strain (activities involving rotation or torque through the joint); responds well to treatment
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| hypermobile SI joint dysfxn | athletes, standing & walking increases pain, any act involving torque; treat w/ rest, supports, & stability exercises for gluts, pelvic floor, & multifidi.
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| testing for SI joint pathology | 2/4 positive tests indicate SI joint is the source of the problem/pain; order of tests: distraction, thigh thrust, compression, & sacral thrust; Gillet's test; supine active straight leg raise
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| true leg length difference | true diff in length of the femurs &/or tibia
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| apparent leg length difference | pelvic rotation is contributing to the leg length diff- APT, PPT, etc...
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| tests for LLD | long sit test, measure ASIS to med malleolus
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| distraction test | hold for 30 secs, then quick force in direction of applied pressure; positive test= production of comparable sign
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| thigh thrust test | examiner on opp to symptomatic side; positive test= reproduction of comparable sign on the thrust side
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| compression test | pt in side lying & the symptomatic side uppermost;
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