Feb 15, 2013

Friday 5: 5 Techniques for "SIJ" Dysfunction


Here are 5 Techniques I have found useful for patients who do not respond to repeated motions in the lumbar spine.

If you follow the research driven lumbar screen to rule in SIJ I suggested on Wednesday's post, and/or repeated lumbar or standard lumbar treatments are not working for your unilateral L/S pain patient, you can try the following treatments.

1) MWM Iliac Crest Hip Swing

Very useful for unilateral pain with walking and single limb stance. Also very easy to instruct for HEP to repeat hourly.



2) MWM Iliac Crest REIL

If the above technique does not work, I try this one next. Often, normal pressups without the iliac crest hold or cat-camels in quadruped work well to hold the results of getting it "moving."



3) The Sacral Spring

My next go to technique. It's a shotgun for sure and considering the sacrum moves very little to not at all in the ilium, the effects are neurophysiologic, but it tends like the above two techniques to be pain free with great and fast results.



4) Psoas Release

If the above techniques do not hold and the patient is compliant I also look to release any of the major common dysfunctional tissues including the psoas and the QL



5) QL Release



I also check why the lumbosacral area had pain in the first place and look at rolling patterns to screen for timing/motor control issues and movement asymmetry if the above techniques do not have lasting improvements.

3 comments:

Barb Carusillo PT, OCS, COMT said...

It is interesting how disparate in viewpoint intelligent, seasoned practitioners are on the SI treatment landscape. It amazes me how very skilled clinicians can view things so differently. When I took Richard Don Tigney's class he feels up to 85% or more of chronic low back pain had an SI component, but when I talked to Angelo DiMaggio, who taught for Mckenzie for 15 years, he said that McKenzie put it at 15% and he put it closer to 10%. I asked him how he treated it(back in 96) and he said he would "put a belt on them". I have read some of the latest research, and Cibulka and Chad Cook say there are only 2 movements of the SI joint, ant. and post. rotation of the ileum. They are the only ones evidence demonstrates you should test for, per what is out now. I really think research will show eventually much more than that, and it has in the past, just not the type research that everyone believes is most accurate now. I have had results from techniques from Richard Jackson and Jerry Hesch, Diane Lee, that I would not have gotten just from the ideas currently being put forth.

Dr. Erson Religioso III, DPT said...

Thanks HV! What's not to like about Mulligan's MWMs? They are quick, easy ways to make changes and lead to simple HEPs that the patients can often reproduce themselves, unlike some of the traditional realign the malposition approaches.

Dr. Erson Religioso III, DPT said...

Thanks Barb, coming from a Paris background, and a fellowship mentor who studied with DonTigny and took Greenman's courses, I'm familiar with much of what you are saying. The only thing is that we all probably make changes with skilled hands, interaction and education. I would argue that the research will show the positional and palpational approaches will come back into the research because they are not reliable, nor at this point valid with the current research stating there being very little movement at the SIJ.

It's tough to try something as simple as repeated movements and movement based assessment. For an analytical mind trained in OMPT, we want it to be more complex than it has to be. I just moved from that years ago, adopting MDT and now the SFMA for my assessments. They're easy and systematic.

I still had results with the traditional approaches, but they often lead to patients depending on their clinician as opposed to self management.

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