Diploma of Remedial Massage Case studies Pelvis & SIJ

1. Diploma of Remedial Massage Case studiesPelvis & SIJ

2. Pelvis SIJ Pathologies Common Pathologies • SIJ pain • SIJ dysfunction • Buttock pain • Piriformis Syndrome

3. Pelvis SIJ Pathologies SIJ pain • From the joint itself • Inflammation • Degeneration • Ligament issues • Anterior, posterior, interosseus sacroiliac

4. Pelvis SIJ Pathologies SIJ Dysfunction • Abnormal dysfunction at the joint • Hyper/hypo mobility • Can present as lumbar, buttock, hamstring or groin pain • Aetiology uncertain • Assessment for instability / mobility

5. Pelvis SIJ Pathologies Clinical Features: • Back pain below L5 • Usually unilateral – can be bilateral • Common referral points • Buttock • Groin • Antero-lateral thigh • Less common • Labia/scrotum

6. Pelvis SIJ Pathologies Clinical Features cont: • Deep seated pain • Aggs: • Difficulty with stairs • Turning over in bed • Single leg stance • Tender over SIJ, often pain reproduction over pubic symphysis

7. Pelvis SIJ Pathologies Treatment: • Inflammation? • Why is it there? Reduce and remove source • Dysfunction • Why? Glut control? • Bracing? Taping? / Pilates? • Treat kinetic chain • Lx – Femur • Uni lateral / Bilateral - compensation

8. Pelvis SIJ Pathologies Buttock pain • Hamstring origin tendinopathy • Frequently seen in sprinters • Chronic overuse or acute tear not managed well • Assessment to determine Lx or Hamstring • Ischiogluteal bursitis • Presents similar to Hamstring origin tendinopathy • Treatment: • Deep friction very effective • Initial – light Rx, with ↓ in inflammation ↑ depth

9. Pelvis SIJ Pathologies Buttock pain cont. • Myofascial pain • Trigger points; secondary phenomenon to primary causes which may be Lx or other • Treatment: • Isolate affected muscle • Gluts Max, Med, Min andPiriformis • DF, MFT • TP • MET

10. Pelvis SIJ Pathologies Piriformis Syndrome: • 15%, or more, of the population have the sciatic nerve passing through the Piriformis muscle • If the muscle is inflammed, shortened, or in spasm it will irritate the sciatic nerve resulting in abnormal neurological signs in the post thigh and calf and plantar foot.

11. Pelvis SIJ Pathologies Piriformis Syndrome cont.: • Pain and tenderness medial to the greater trochanter may be from Piriformis • Pain can be; deep and local or referred. • Examination of Lx and SIJ’s will be clear • Pain reproduced by resisted external rotation or passive internal rotation • Examination +ve with ↓ internal rotation

12. Pelvis SIJ Pathologies Piriformis Syndrome cont.: Treatment: • Longitudinal gliding • Stretching • MET • Active / Passive

13. Pelvis SIJ Pathologies Less Common Pathologies: • Fractured Pelvis

14. Pelvis SIJ Pathologies Pregnant clients: • Care must be taken with Pregnant clients • Tightness in muscular / ligamentous structures necessary for stability • Relaxin affecting ALL joints • Consider positioning during Rx • Separation at linea Alba = ↓ trans abdominal strength = ↑ stress on surrounding structures • Rx: Sacroilliac belt

15. Pelvis SIJ Pathologies Other considerations: • LLD • Structural abnormality v’s Functional abnormality

16. Treatment options • Soft Tissue: • DF; MFT/ Tissue tension; TP; MET/PNF……. • ST / joint mobilisation NOT MANIPULATION • Positioning • Active / Passive movement • Thermal – Heat / Ice • Strengthening / Stretching • Taping / Postural adjustment • Self Mx; spikey ball • Modification of activity