Sacroiliac Fixation (upslip)
During forward bending, each sacroiliac joint should open slightly. This causes a slight delay between the movement of the sacrum and that of the ilium.
- When the joint doesn’t open, the sacrum and the ilium will move at the same time. This causes one PSIS to move superiorly before the other. This deviation usually occurs near the beginning of forward bending, but may occur later.
- The side that moves prematurely is the side where the sacroiliac fixation is. This is the treatment side, or the upslip.
- When one PSIS moves prematurely of the other, it is usually because of a fixated sacroiliac joint on that side, but may also be due to short hip extensors (hamstrings and gluteus maximus).
Standing Forward Bending Test - Upslip
- Comparison of the two PSIS during forward bending.
- Palpate the groove beneath the PSIS on both sides, by placing both thumbs into the hollows just inferior to the PSIS.
- Grasp the ilia with the fingers, pulling back so the client doesn’t feel that he’s being pushed forward.
- Instruct the client to bend forward as far as comfortably possible. If the client, due to pain, cannot perform this motion, use the alternate assessment technique.
- Keeping your eyes directly behind your thumbs, observe for a deviation in the movement of the two PSISs. If one PSIS moves superior to the other, that is the side of the upslip.
Alternate Upslip Test: Standing Single Leg Lift (Gillet Test)
- Same PSIS palpation as forward bending test, but client is instructed to lift one knee up towards the chest while balancing on the other leg.
- The PSIS should move inferiorly when the leg lifts.
- If the PSIS moves only minimally or in a superior direction that is indicative of a “fixed” SI joint. The sacrum and ilium are “stuck” in a closed position.
Upslip Corrections to Mobilize the Sacroiliac Joint (SIJ)
- These are very dependable ways to mobilize the SIJ. If it doesn’t work, consider referring to a joint manipulator.
- Clients often have symptoms on the side opposite the upslip, due to hypermobility that is a characteristic aspect of SIJ dysfunction. When one SIJ is fixed, the normal balanced movement pattern created by the two SIJ’s is impossible, so the mobile SIJ has to move much more than it should. Particularly in active people, the mobile SIJ will become irritated.
- It is also important to note that pain in the SIJ area is often referred from trigger points in the lumbar region. To achieve long-lasting results, lumbar dysfunctions and their associated lesions must be treated as well.
Technique #1: Upslip Mobilization
- Client lies supine with the therapist standing at the edge of the table on the side of the upslip.
- Grasp the client’s leg with both hands, just below the knee and just above the ankle.
- With the leg completely relaxed (client remains passive), slide the heel along the table top in a smooth, gliding motion from a flexed to extended position (repeat 2 -3 times).
- Vibration through the hip and into the SI joint is induced by actively pulling the client’s leg from a bent position into an extended position.
- On the last repetition, accelerate the movement with your own effort, following through to full extension of the leg.
- This will cause a gapping of the SIJ, thus mobilizing the sacroiliac joint by vibration.
- No traction is applied to the joint and there is a total absence of any thrusting.
- Contraindications would be pain on full active knee extension or pain in the hip or low back during easy practice movements. These techniques are also contraindicated for patients with sacroiliac hypermobility.
Technique #2: Inferior Glide (perform after upslip mobilization)
- Place the treatment leg into slight abduction and internal rotation. This locks out the hip joint and directs the mobilization to the SI joint.
- Stabilize the opposite side by placing the foot of the opposing leg against your thigh with their knee straight.
- Traction the affected side by grasping just above the ankle and pulling while maintaining the internal rotation.
- Use your body weight to apply the traction, not just your arms.
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