1. Sacroiliac Joint

2. Clinically, the sacroiliac joint cannot be palpated directly due to its anatomic location.
The sacrum is mechanically associated with the spine, whereas the innominate is aligned with and affected by movement of the femur.
Crucial Realities

3. During ambulation the S1Js decrease the effort of ambulation and absorb shear forces to protect the disks and to decrease the effects of impact-loading on the femoral heads.
Weight is transmitted to the sacrum via the lumbosacral junction (fifth lumbar vertebra and lumbosacral disk to the first sacral segment), distributed equally along the alae of the sacrum, and transmitted through the S1Js to the acetabulum and hence to the lower limbs.
The force of the body weight tends to separate the sacrum from the ilia and tends to push the first sacral segment into flexion (nutation).
Crucial Realities

4. The pelvis can move in all three body planes: in the sagittal plane during forward- and backward-bending, in the coronal plane during side bending (lateral flexion), and in the axial plane during twisting of the trunk.
Middle transverse axis (located at the second sacral body). This is the principal axis of normal sacroiliac flexion and extension (nutation/counternutation)
In osteopathic medicine, the SIJ is often described as two joints: the iliosacral and the SIJ.
The term iliosacral implies the innominates moving on the sacrum; conversely, the term sacroiliac implies the sacrum moving within the innominates.
Crucial Realities

5. Kinematics of the SI Joint
Principal SI joint axis is in the transverse plane at the S2 level.
The SI joint is unique in that its range of movement is extremely small and there are no muscles that directly produce active motion at this joint.
In effect, SI joint movements are passive and occur in response to the loads it must transmit and the stresses it must relieve.
The SI joint has two principle motions, nutation and counter nutation.
Kinematics of the SI Joint

7. NUTATION/COUNTER NUTATION
During nutation, the sacral promontory moves anteriorly and inferiorly and the coccyx moves posteriorly.
During counter nutation, the sacrum moves in an opposite direction with the sacral promontory moving posteriorly and superiorly and the coccyx moving anteriorly.
NUTATION/COUNTER NUTATION

8. Contents Introduction Examination and Treatment Techniques
When Applicable Tests
Examination and Treatment Techniques
Subjective Examination
Areas of the symptoms
Opening the Anterior and Posterior Surfaces
Behavior of Symptoms
Special Questions
Further Tests
History
Palpation
Physical Examination
Treatment Techniques
Observation
The Symphysis Pubis Treatment
Movements

9. Introduction
The sacroiliac joint has a diverse and extensive innervation from L2 toS4.
Needs DD because of complexity of the joint
It needs series of relevant findings to announce the Sacroiliac joint as source of the symptoms
Most patients with pain in the sacroiliac area do not have sacroiliac disorder. The pain is usually referred from the lumbosacral spine

10. Subjective Examination
Areas of the symptoms
Behavior of Symptoms
Special Questions
History

11. Subjective Examination
True involvement usually found in 2nd and 3rd decade
Elderly: Prostate Tumor
Jabs of Pain with certain activities

12. Areas of Symptoms
True Sacroiliac joint strains or sprains are unlikely to produce the symptoms that crosses midline.
Bilateral Sacroiliac joint in the absence of pregnancy and inflammatory disorders is referred from spine
Pain in the groin
Inside the leg or under the testicles in men
Tenderness over the symphysis pubis
Crepitus, shearing inside the joint during walking

13. Behavior of Symptoms Painful Weight bearing during weight transfers
Disabling pain, even can’t get out of the bed
In acute phase unable to distinguish from lumbar spine and hip
Night pain with prolonged morning stiffness can be a red flag
Patients with SIJ strain often flex their hips or flatten their back against a wall for relief
The hip may felt out of place
Heaviness of the whole leg

14. Special Questions
Genitourinary
Bowl and Bladder
Saddle Anaesthesia

15. History Common in pregnancy
Repeated in sports activities like cricket, football,
Disturbed pelvic postural alignments

16. Physical Examination
Observation
Movements
When Applicable Tests

17. Observation
Prominence of the Posterior and Anterior Iliac Spine, greater trochanter
Any change in the gluteal and abdominal musculature should be noted

18. Movements
Sacroiliac joints should be functionally tested along with lumbar spine and hip
Quality of the movements should be recorded

19. When Applicable Tests Neurodynamics tests
SLR
SLUMP
Exclusion of the hip and spine also plays an integral part of the examination of the pelvis region

20. Examination and Treatment Techniques
Opening the Anterior and Posterior Surfaces
Further Tests
Palpation
Treatment Techniques

21. Opening the Anterior and Posterior Surfaces
Opening Anterior Surfaces
Opening Posterior Surface
Direct Pressure over the Sacrum and the Ilium

22. Further Tests

23. Palpation
Soft Tissue Changes
Buttocks
ASIS
PSIS
Abdominals

24. Treatment Techniques

25. The Symphysis Pubis

26. Thanks