1 / 44

Sacroiliac Joint Dysfunction Rehabilitation Program

oihane
Download Presentation

Sacroiliac Joint Dysfunction Rehabilitation Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Sacroiliac Joint Dysfunction Rehabilitation Program By: Kristen Knorr

    2. Anatomy This joints bony articulation is between the ilium and the sacrum. This is a synovial joint. Males have more stable S.I. joints due to the females pelvis being lighter, thinner and wider. Females ligaments are also more lax causing this joint to be much more stable in males.

    3. Anatomy This joint contains some of the strongest ligaments in the body. Iliolumbar Lumbosacral Anterior Sacroiliac Anterior Longitudinal Inguinal Sacrospinous Sacrotuberous Anterior Pubic

    4. Motions of the Sacroiliac Joint The direction of movement is based on the movement of the top of the sacrum, also known as the base. Sacral flexion or nutation occurs with trunk extension. Sacral extension or counternutation occurs with trunk flexion. There is rotation to the right and left. And a lateral tilt to the right and left.

    5. Physiology Shock Absorption Weight distribution from the lower to upper body. Transmits weight and rotational forces from the right to left side of the body.

    6. What is Sacroiliac Joint Dysfunction? S.I. dysfunction causes low back pain due to a malalignment between the sacrum and ilium. Injury can also be caused if a patient has excessive force on the area due to abnormal lumbar lordosis. The patient may feel as if this joint needs to be realigned.

    7. Causes of Injury Injury to the S.I. joint can occur from hypermobility or hypomobility caused by muscular imbalances, spasms, or loose ligamentous structures. A leg length discrepancy A fall onto the side of the pelvis or the buttocks. A misstep when walking or running. Excessive rotation. Pregnancy. Excessive Q angles.

    8. Most Commonly Involved Athlete's Soccer Football Basketball Gymnastics Wrestling Track and field

    9. Signs and Symptoms Sacroiliac joint pain is usually a unilateral pain that presents itself on the posterior sacroiliac spine (PSIS). Pain can range from a dull ache to a sharp pain that can refer down into the buttocks or upper leg. Pain or stiffness when sitting or standing for long amounts of time. Previous leg length discrepancy

    10. Special Tests S.I. Compression S.I. Distraction Yeoman Gaenslen Faber Long Sit

    11. Treatment Short Term Goals: Reduce pain and inflammation, re-establish pelvic neutral, begin strengthening and stabilizing exercises while patient is in neutral position. Long Term Goals: Return to normal gait and strength, have increased stability and control of the pelvic girdle, no pain or inflammation, return to normal ROM, return to play.

    12. Phase 1: Short Term Goals Reduce pain Reduce inflammation Re-establish posture and neutral positioning Increase ROM Maintain cardiovascular endurance and strength.

    13. Phase 1: Pain Reduction To reduce pain and inflammation ice may be used for 15 20 minutes on the affected area. Interferential Stim may also be used with the ice to help promote pain reduction through endogenous opiates release. Quadripolar electrode placement. 80 120 MHz Vector scan on Patient should feel moderate to strong sensory level.

    14. Phase 1: Stretching Hamstrings Quadriceps/Hip Flexors Iliotibial Band Piriformis Erector Spinae/Low Back Musculature

    15. Phase 1: Joint Mobilization Muscle Energy Techniques Isometric Contraction Hold for 15. Grade 4 Joint Mobilization Heisman Inferior Glides.

    16. Phase 1: Stabilization/Strengthening Find pelvic neutral and maintain throughout all exercises. Superman On a stable surface Eyes open Lift arm and leg slightly off the table Can progress to eyes closed and lifting extremities further off the table. Hold each side for 3 seconds 15 times on each side If this is to too difficult the patient can begin supine.

    17. Phase 1: Stabilization/Strengthening Planks On a stable surface Hold for 15 seconds 3 reps Can increase time of hold as the person becomes stronger

    18. Phase 1: Stabilization/Strengthening Wall Squats Back against wall, do not let knees go past the ankle when bent. Hold at bottom of squat for 5 seconds. 15 reps Can progress to one leg. Bridges Begin on a stable surface Hold for 15 seconds, three times. Can increase the length of the hold as strength increases.

    19. Phase 1: Stabilization/Strengthening Crunches On a stable surface. Can begin with 3 sets of 15 and increase as needed. Can also progress to oblique crunches or bicycle/alternating leg and arm.

    20. Phase 1: Neuromuscular Control Balance Begin on stable surface with eyes open Progress to eyes closed and no shoes Start with tandem stance to one leg.

    21. Phase 1: Neuromuscular Control Sitting/Bouncing on a Swiss Ball Maintain pelvic neutral Continually correct posture and balance Progression can include closing the eyes or lifting one leg off the ground

    22. Phase 1: Cardiovascular Endurance The patient can begin using a stationary bike or elliptical as there pain subsides. An elliptical may be more comfortable because the patient may still have discomfort when sitting. 15 20 minutes.

    23. Phase 2: In this phase regular stretching should continue as well as ice and stim for pain relief when necessary. Joint mobilizations should also be continued if needed. Cardiovascular endurance can also be kept the same as long as the patient is pain free. Short Term Goals: Pain free, inflammation free, increase endurance, stabilization, and strength, increase/maintain ROM, continue postural and pelvic neutral education.

    24. Phase 2: Stabilization/Strengthening Superman This should be done with a swiss ball under the abdomen while keeping pelvic neutral. This can be held for 3 seconds. 15 reps on each side.

    25. Phase 2: Stabilization/Strengthening Planks with a swiss ball Feet or legs should be on the ball, not the toes. Patient may roll from a prone position on the abdomen, to where there feel comfortable on the ball. Hold for 15 x 3 The patient may roll back onto the abdomen. Reps or time may be increased as needed.

    26. Phase 2: Stabilization/Strengthening Wall Squats Put a swiss ball inbetween the patients back and the wall. Control the speed. Hold for 5 seconds, 15 reps. Can progress to one leg. Bridges The patient will begin sitting on the ball, then rolling under the back, then slowly walk out letting the ball roll towards the head. They may stop when they feel comfortable. Hold 15 x 3. increase, 1 leg.

    27. Phase 2: Stabilization/Strengthening Swiss ball with thera-band The patient will sit on the swiss ball while holding a thera-band out in front of them. The clinician will pull the thera-band in an attempt to disrupt the patients balance. Record errors.

    28. Phase 2: Stabilization/Strengthening Crunches on a swiss ball Movements should be controlled 3 sets of 20 Can increase amount as strength increases. Incorporate a medicine ball to be held above chest and progressing to overhead.

    29. Phase 2: Neuromuscular Control Balance On unstable surface. Can do with shoes off. Can progress to eyes closed. Squats Can be done on flat or round side of bosu. 3 sets of 10. Can progress to rhythmic stabilization in next stage.

    30. Phase 2: Neuromuscular Control Lunges on a bosu ball Knees should go to 90o bend. Keep neutral position. Hand on hips Quadrant Hops Begin in one direction, can switch direction or call out numbers, progress from 2 legs to one leg. Can close eyes or add theraband resisitance.

    31. Phase 2: Functional Activity Straight line jogging Lateral shuffle Jogging figure 8s Agility ladder Front Lateral jumps

    32. Phase 3: Continue ice and stim for pain and inflammation as needed. Continue stretching program. Continue joint mobilizations if needed. Continue cardiovascular endurance in conjunction with cardio from functional activities. Short Term Goals: Pain free, inflammation free, further increase endurance, stabilization, and strength, increase/maintain ROM, continue postural and pelvic neutral education, begin functional activities

    33. Phase 3: Strengthening/Stabilization Superman Can be done with a dyna disc under hands and feet. Hold for 3 5 seconds. 15 reps on each side. Planks A swiss ball under the legs and the patient is holding the bosu, flat surface up. 15 seconds x 3.

    34. Phase 3: Strengthening/Stabilization Wall Squats Swiss ball on back and standing on bosu or balance pad. Or weight could be given. 5 second hold x 15. Bridges Swiss ball under back and feet on the bosu or balance pads. Can progress to one leg.

    35. Phase 3: Neuromuscular Control Balance One leg, pad, catching a ball or holding a medicine ball. Hold for 1 minute x 3. Squats On a bosu holding a medicine ball or with weight. 3 sets of 10.

    36. Phase 3: Neuromuscular Control Lunges Either done on a bosu or on balance pads. Can add weight or a medicine ball to the activity.

    37. Phase 3/4: Functional Activity Sprinting Shuffle Figure 8 Diagonal/Z Agility ladder 4 corner drill Sport specific Forward, backpedal, shuffle, carioca.

    38. Phase 3/4: Plyometrics Jump in place, jump forward, squat jump over a barrier. Lateral hops, lateral hops over a barrier, progress from 2 legs down to one. Barrier Hops: increase height and length of hop, 2 to1. Depth Jump: different heights and patterns, 2 to 1. Lunge Jump: increase speed. Hurdles: start with a jog and progress to sprint.

    39. Functional Testing: Return to Play Sprints Sprint figure 8 Sprint diagonal/Z Explosive hops and jumps: front to back, lateral. Sport specific: tackling, throwing, swinging, catching, kicking.

    40. Article Information Formative Dynamics: The Pelvic Girdle Studies show that up to 22% of low back pain is caused by the S.I. joint. Passive methods of stabilization include S.I. belts, tapings, prolotherapy injections to reduce pain in tendons and ligaments, and surgery in a small number of patients.

    41. Article Information Active methods include progressive strengthening, mobilizations, stabilization, and flexibility. Each treatment should begin with stretching, massage, and joint mobilizations. Followed by any modalities needed to assist proper muscular functioning before the strengthening phase begins. Studies showed that patient's who used this format overall had improved gait, ROM, alignment, and muscle strength.

    42. Summary S.I. joint dysfunction will present pain over the PSIS as well as down into the buttocks or legs. Pain can range from a dull ache to a sharp pain. Proper neutral pelvic positioning should be shown to the patient and maintained through all exercises. Strengthening should be focused on the core muscles to help stabilize the area around the joint.

    43. Summary Rehabilitation programs for this injury should include flexibility, mobilization, strength, stabilization, and functional activities to fully prepare the patient for return to play.

    44. Questions?

More Related