SI Joint a stable joint , it is the cause of pain during pregnancy in many women during antenatal and postnatal period ,in this slideshare some exercises for SI joint during pregnancy ,the assesment and the basic relaxation exercise is given

1. SI JOINT
BY
S.CHRISTY SOPNA

2. SI JOINT
◦ SI joint is stable joint and permits very little movement . Pain may begin at any time during
antenatal or postnatal period but commonly begins at the 18th weeks of pregnancy and may
increase as the pregnancy progresses. According to one study there is four times greater
incidence of posterior pelvic pain than LBP in pregnant women .
◦ Pregnancy – symptoms persisting postpartum >6 months .

3. LIGAMENTS
◦ ANTERIOR SACROILIAC LIGAMENT
◦ POSTERIOR SACROILIAC LIGAMENT
◦ INTEROSSEUS LIGAMENT
◦ SACROTUBEROUS LIGAMENT
◦ SACRO SPINOUS LIGAMENT
◦ ILIO LUMBAR LIGAMENT

4. 35 MUSCLES
Latissimus dorsi Piriformis Superior gemellus Levator ani
Erector spinae Tensor fascia lata Gracilis Sphincter urethrae
Semimembranosus External oblique Illiacus Superficial transverse
perineal
ischiocavernosus
Semitendinosus Internal oblique Adductor magnus Coccygeus
Biceps femoris Transverse abdominis Rectus femoris
Sartorius Rectus abdominis Quadratus lumborum
Inferior gamellus Pyramidalis Pectineus
Multifidus Gluteus minimus Psoas minor
Obturator internus Gleutal maximus Adductor brevis
Obturator externus Quadriceps femoris Adductor longus

5. ASSESMENT

6. HISTORY
◦ a history of sharp pain (unilateral ) started with a particular activity (pregnancy ) and that
awakens the patient from sleep upon turning in bed.
◦ Pain with walking , ascending or descending stairs, or hopping or standing on the involved leg(
asymmetrical loading )
◦ Pain with forward bending of the trunk and pain with standing hip flexion (poor movement
dissociation )
◦ Pain with transitional movements such as rising to stand from a sitting position or getting in and
our of the car (movement transitions)
◦ Pain with a straight leg raise or near the end of range (ligament stretch/sensitivity).
◦ Pain that is worsened with long periods of sitting or standing if the lumbar lordosis is not
maintained (poor stability)

7. SI JOINT PAIN
◦ Onset – traumatic/ insidious/repetitive minor trauma /pregnancy induced
◦ Site – localized/diffuse,unilateral ,referred to lumbar/buttocks/posterior or lateral thigh/
◦ Can shift to contralateral side
◦ Occasional refers to hip / groin/abdomen
◦ Rarely down the leg and foot
◦ PAIN PATTERN
◦ 94%- buttock pain
◦ 72%-lower lumbar region pain
◦ 50%- lower extremity pain
◦ 24%groin pain

8. Components of clinical examination
◦ Joint tenderness
◦ Soft tissue palpation
◦ Pain referral patterns
◦ Associated fascial or musculotendinous restrictions
◦ Regional abnormal length –strength muscle relationships
◦ Postural analysis
◦ Static and dynamic osseous landmark exmaninations
◦ Provocation testing: special tests
◦ Motion demand tests
◦ Ligament stress tests

9. CLASSIFICATION OF SIJ PAIN
◦ LBP with or without SIJ involvement .
◦ SIJ primary – pregnancy
◦ SIJ secondary –movement dysfunction
◦ SIJ movement dysfunction – moving more or less
◦ SIJ movement dysfunction – articular / myofascial / translation /range

10. Fortin finger test
◦ Localisation of pain
◦ The patient points to the area of pain with one finger
◦ The result is positive if the site of pain is within 1 cm of the PSIS, generally infermedially

12. CLUSTER OF LASLETT
◦ Originally 6, now diagnostic algorithm proposes 4
◦ Sensitivity -88%, specificity – 78%
◦ The following provocative tests
◦ Distraction
◦ Thigh thrust
◦ Compression
◦ Sacral thrust test
◦ FABER
◦ Gaenslen’s manoeuvre

14. Force closure and motor control
◦ LOCAL SYSTEM
◦ Anterior abdominal fascia
◦ Deep fibres of multifidus
◦ Pelvic floor muscles
◦ Co-contraction
◦ GLOBAL SYSTEM
◦ Sling system

15. Funtion
◦ Gait
◦ Posture
◦ Regional movements
◦ Standing flexion test
◦ Gillet test
◦ Diagnostic block test
◦ FUNCTIONAL PELVIC TEST : active straight leg raising test (ASLR)
◦ Symphysis test : palpation and modified trendlenburg test for pelvic girdle

16. Outcome measures
◦ Disability rating index
◦ Pelvic girdle questionnaire (PGQ)
◦ Pain catastrophisation questionnaire

17. DIFFERENTIAL DIAGNOSIS FOR PELVIC GIRDLE PAIN

18. MANAGEMENT

19. MANAGEMENT
◦ Modifications of daily activities
◦ Single leg weight bearing should be avoided
◦ Excessive lower limb abduction should be avoided
◦ Sitting on very soft surface should be avoided
◦ Getting into a car is done by sitting down first then pivoting both legs and trunk into the car .
Avoid lowerlimb abduction during getting in and out from the car
◦ During a sidelying place a pillow between the knees and under the abdomen
◦ Avoid climbing more than one step at a time
◦ Avoid crossing the legs while sitting
◦ Avoid high heeled shoes
◦ Avoid using heat

20. Modification of exercises
◦ Avoid exercises that require single leg standing
◦ Avoid exercise that require abduction or hyperextension
◦ Teach the patient to activate transverse abdominals and pelvic floor when transferring from one
position to another to stabilize the pelvis .

21. TENS
◦ NARROW rectangular single pulse of 0.1-0.2 milli second duration
◦ Frequencies – high frequency TENS -1000HZ
◦ Low frequency TENS – 2 and 10HZ
◦ ELECTRODE PLACEMENT : 2 electrode in paravertebral location at level of L3 and 2 elctrodes
in the distal and lateral aspect of sacroiliac joint

22. In case of pregnancy related SI joint dysfunction initially focus should be on core stability of trunk and pelvic girdle .
Sacroiliac belt
Core stability exercise
PELVIC FLOOR EXERCISE :
Squeezing and lifting of pelvic floor and hold for 10 seconds
maximum 10 reps
precaution :
breath holding
contraction of buttocks
squeezing leg together

23. Strudge et al,2004
Stabilisation exercise for
postpartum mother who
have pelvic pain on weight
bearing
Exercise is given using
theramaster for lifting body
weight and exercising

24. Core stabilization exercises
◦ Pelvic floor exercises – 10 squeezes for 10 secs hold (3-5days /week)
◦ Trasverse abdominins activation exercise
During week 1, the patient was in the hook-lying position and only performed the ADIM. During week 2, the
arms were moved overhead in an alternating pattern, every two seconds during the contraction phase. During
week 3, the legs lifted off the table in an alternating pattern, every two seconds during the contraction phase.
During week 4, the opposite arm and leg moved over head/lifted off the table in an alternating pattern, every
two seconds during the contraction phase

25. For the side-bridge exercise, the patient started by lying on their right side, with the weight-bearing elbow flexed and both knees flexed. The patient
was instructed to perform an ADIM, then lift into a side plank position with the elbow and knees flexed, keeping the hip and shoulder in line. The
position was held for 10 seconds, with a 15-second rest. Then the patient switched to the left side and performed the same half version of the side-
bridge. This was repeated three times. During week 2, the elbow remained bent, but the knees were extended. During week 3, the elbow was
straight and the knees bent. During week 4, both the elbow and knees were extended.
Weekly progression of the side-bridge exercise.
A=Week 1: half side plank with elbows and knees
flexed, B=Week 2: full side plank with elbow flexed,
C = Week 3: half side plank with elbow straight and
D=Week 4: Fill side plank with elbow straight.

26. Swiss ball exercise
STATIC FOREARM
PLANK
STATIC FOREARM PLANK
IN KNEELING
SWISS
BALL
BRIDGE
FREE
STANDING
SQUAT

27. SIDE BALANCE ON BALL SIDE BALANCE ON
BALL WITH
ABDUCTION

28. POSTYURAL EXERCISES

29. Other treatments
◦ Acupuncture
◦ Cognitive behavioral therapy (CBT)
◦ Massage
◦ HEAT THERAPY
◦ COLD THERAPY
◦ Proprioceptive neuromuscular facilitation
◦ Maternal clothing – light wear , dimensional stable clothing
◦ Acupressure
◦ Pillows – c shaped pillow

30. Low sitting SIJ belt High sitting SIJ belt
C shaped
pillow

32. Yoga poses to prevent pelvic girdle pain
(I TRIMESTER )
Utthitatrikasan
(extended triangle
pose)
Vribhadrasan (warrior
pose )
Vrikshasan (tree pose )

33. Second trimester
Vajrasan
(thunderbolt pose )
Matsyakridasan
(flapping fish pose )
Majariasan (cat stretch
pose )
Tadasan (mountain
pose )
Bhadrasan (gracious
pose )
Katichakrasan (waist
rotating pose )

34. Third trimester
Ardhatitaliasan (half
butterfly)
Chakkichalanasan
(churning mill pose )
Utthanasan (squat
and rise pose )