Q&A Time! How Do I Evaluate a Sacroiliac Joint Without Biomechanical Approach?

This Q&A comes from a blog reader who says he mentored with some osteopathic trained PTs. You know what that means, a whole bunch of left on left, right on left, and sacroiliac upslips and downslips.

Whew, it's enough to make your head spin! Those osteopaths sure know how to complicate things. And by complicate things, I mean add movement and palpation based tests to a region that barely moves. For a quick take and video to share on just how much the SIJ moves, plus how much force it takes to take it apart, after every other supporting structure is removed, check out this Physio Answers #GetPT1st PT PSA.

Here is the reader's concern....

"In one of my clinical rotations in DPT school I worked with two osteopathic trained PTs who happened to see a lot of SIJ dysfunctions so I ended up with a lot of exposure to the same. Now, I'm seeing a similar trend as a local DO has started sending me all his SIJD and pelvic instabilities.I can "correct" a pelvis no problem, and often see immediate results and improved symptoms, but the carry over is inconsistent and I'm looking for a better way. The corrections are too passive and often not reproducible for the patient at home.
In the aforementioned post you criticized pelvic METs for the same and referenced using repeated movements instead. I was hoping you could elaborate on that and/or suggest and resources on alternatives for addressing the "rotated" pelvis. Thanks in advance."

You're on the roller coaster ride of your career! Many manual therapists who are exposed to pain science and Modern Manual Therapy quickly realize that passive assessment and treatment ends up being both a quick fix and transient improvement.

acute lumbar case - pain on left, standing extension deviation to the right

normal sidegliding left

limited sidegliding right, correlating with right hip/lumbar issues

Steps to assess unilateral low back pain (let's not call it by structure)

assess standing lumbar extension - look for deviation away from the painful side
correlate with sidegliding in standing assessment, look for loss of sidegliding to the painful side
check involved side hip, often there is a active and passive loss of flexion and IR on the involved side
these are the Clinical Practice Patterns I teach for the LQ in The Eclectic Approach seminars

Explanation to the patient

static and dynamic ADLs like standing and walking are affected due to the loss of ability to accept load on the painful side
the more you have pain on one side, the more you move away from it (trying to unload and "stretch it")
this lack of variability, also makes the brain thing that loading that side is dangerous
we have to restore ability to load that side by taking it to end range, and convincing the brain through repeated motion/exposure that loading/accepting weight on the painful side is both normal and safe
once this reset occurs, mobility/pain/function often improve, but this must be reinforced by you with your assigned homework
the dosage is often enough to keep improved and symmetrical as possible in SGIS and extension (10x hourly is a good place to start)
for a few days, try to avoid end range or repeated unloading of the painful side (I use the +1 for the rest and -1 for unloading activities example - patient should try to stay on the positive side)

reaching the negative side sets of the alarm in the brain again, lowering pain and movement thresholds

the patient can easily self assess looking in the mirror for SGIS and have someone else look at their extension for deviation

Here is an example of sidegliding in standing manual correction and prone modified press up for HEP.

Hopefully this helps you with some assessments. Treatments for "SIJ" are the same as any lumbar case, repeated motions, and manual therapy to help attain threat free end range! The entire lectures and videos for Clinical Practice Patterns of the UQ and LQ are on Modern Manual Therapy! Subscribe now for only $4.99/month, $49.99/year and check them out!

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...