Pelvic Joint Dysfunction Diagnosis + Treatment: An Osteopathic Approach

The posterior pelvic joint (s) are also known as the sacroiliac joints.

The Sacroiliac Joint ( Posterior Pelvic Joint) and Low Back Pain

The Sacroiliac Joint has been identified as the source of low back and buttock pain for approximately 15% to 30% of the population. Pain resulting from mechanical disorders, including innominate (ilium) positional and movement abnormalities appears to be the most commonly reported causes for non-specific LBP of SIJ origin.  As it has been shown that movement of innominate bones of pelvis can indicate relationships between innominate kinematic anomalies and LBP of SIJ origin., This indicates that SIJ (pelvic joint) pain reproduction is closely linked in people with clinically diagnosed LBP (Adhia et al. 2016).

How do Osteopaths Diagnose a Sacroiliac Joint Dysfunction (Posterior Pelvic Joint)

Gillet Test

The Gillet test assesses SIJ mobility with sensitivity 8% and specificity 93% . To perform this test, the subjects stands while the examiner sits behind the patient and palpates each of the patient’s PSIS, one at a time, with one thumb on the inferior aspect of the PSIS while simultaneously palpating the sacrum with the other thumb staying parallel to the first thumb. The subject is then instructed to stand on one leg while pulling the opposite leg up toward the chest with hip and knee flexion. The test is then repeated on the other side and compared bilaterally. The test is negative when either PSIS moves posterior inferiorly in relation to the sacrum. If the PSIS on the ipsilateral side of the knee flexion does not move or moves posterior-inferiorly only minimally or even paradoxically moves superiorly, it indicates a positive test (Soleimanifar et al. 2017).

Standing in Flexion Test (SIFT)

The standing flexion test assesses SIJ (pelvic joint) mobility with sensitivity 17% and specificity 79% . To perform this test, the subject stands while the examiner sits behind the patient and palpates both of the patient’s posterior superior iliac spines on their inferior margins. The examiner maintains his/her eyes level with the palpating thumbs while the subject bends forward slowly as if to touch his/ her toes as far as comfortable while keeping both legs straight (knees extended). The examiner assesses the symmetry of movement of both PSIS landmarks. The test is negative if both PSIS landmarks appear to move equally and symmetrically; the test is positive on the side in which the PSIS moves superiorly more than the other side. A positive result in a standing flexion test indicates limited movement of the ilium on the sacrum, and therefore limited SIJ (pelvic joint) motion on the side of the superior PSIS (Soleimanifar et al. 2017).

The Sitting in Flexion Test

The sitting flexion test assesses SIJ mobility with sensitivity 9% and specificity 93% (Levangie, 1999). The procedure is similar to standing flexion test except that it is performed with the patient sitting on a level surface. A positive result in this test indicates limited movement of the sacrum on the ilium, and limited SIJ (Pelvic Joint) motion on the side of the superior PSIS (Soleimanifar et al. 2017).

How Osteopaths Treat a Sacroiliac Joint Dysfunction

Osteopaths can manual therapy interventions such as joint manipulation, joint mobilisation and soft tissues techniques as treatment for a sacroiliac joint dysfunction.

SIJ ( Posterior Pelvic Joint) manipulation

The patient was supine and the therapist stood contralateral to the side which was to be manipulated (e.g. right) (Fig. 2). The patient was passively moved into side bending toward the side to be manipulated. The patient interlocked the fingers behind his or her head. The therapist passively rotated the patient, and then delivered a quick thrust to the Anterior Superior Iliac Spine (ASIS) in a posterior and inferior direction (Cleland et al. 2006).

Lumbar rotational manipulation

The patient lay on a treatment table in lateral recumbent position with the more painful side uppermost (e.g. right) (Fig. 3). The therapist stood opposite the patient. The therapist then flexed the top leg until the lumbar spine was flexed and placed the patient’s foot in the popliteal fossa of the lower leg. Next, the therapist grasped the patient’s lower shoulder and arm, and introduced left trunk side bending and right rotation, until motion was felt at the desired segment of the lumbar spine. The patient’s arms were positioned around the therapist’s right arm. The set up was maintained while the patient was rolled toward the therapist. Finally, the therapist’s left arm was used to apply a high-velocity low-amplitude thrust of the pelvis in an anterior direction (Cleland et al. 2006).

Conclusion

It is concluded that both treatment techniques, e.g. SIJ (Pelvic Joint) manipulation and lumbar & SIJ manipulation, significantly improve pain and functional disability in patients diagnosed with SIJ syndrome (Kamil and Esmaeil, 2012).

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Reference List

Adhia DB, Milosavljevic S, Tumilty S, Bussey MD (2016). Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin.  Manual Therapy, Volume 21, February, Pages 100-108

Cleland, J.A., Fritz, J.M., et al., (2006). Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: study protocol of a randomized clinical trial [NCT00257998]. BMC Musculoskelet. Disord. 7, 11

Kamali F, Esmaeil Shokri E (2012). COMPARATIVE STUDY The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork & Movement Therapies 16, 29e35.

Soleimanifar M, Karimi N, Arab AM (2017). Association between composites of selected motion palpation and pain provocation tests for sacroiliac joint disorders. Journal of Bodywork and Movement Therapies, Volume 21, Issue 2, April, Pages 240-245

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