SIJ Comprehensive

Diagnosis, Mobilisation and Functional  Motor Control Retraining of the Sacro-iliac Joint and Pelvis

Restrictions of pelvic joint mobility contribute to compensatory uncontrolled movement. The diagnosis of this uncontrolled movement, the mobilisation of the related restrictions and active restabilisation of the uncontrolled translation and range is detailed in this course.

This is a 4 day course.  However we occasionally run it in two parts of two day courses:

• Diagnosis of Uncontrolled Movement and Restoration of Sacro-iliac Joint and Pelvis Mobility (SIJ 1)
• Diagnosis of Segmental Instability and Functional Motor Control Retraining of the Sacro-iliac Joint and Pelvis (SIJ 2)
  

Course Outline

In the past manual therapists were taught that the sacro-iliac joint does not move and therefore does not contribute to lumbo-pelvic pain. This view has now been discredited. Can you identify and mobilise restrictive dysfunctions of the sacro-iliac joint? Can you diagnose the site and direction of compensatory mechanisms of uncontrolled movement within the sacro-iliac complex?
Functional biomechanics of the sacro-iliac complex are integrated with contemporary osteopathic concepts. Myofascial restrictions, articular restrictions and mechanisms of instability of the sacro-iliac are outlined. The diagnosis of mechanical dysfunctions of the sacro-iliac complex is developed around a systematic process of assessing restriction dysfunctions and identifying the associated positional compensation. A diagnosis of stability dysfunction is made, based of Kinetic Control's system of identifying the site (sacral, ilial or pubic) and the direction (rotation, shear, torsion or sidebend) of uncontrolled pelvic motion.
Once the diagnosis of dysfunction has been made, specific techniques to mobilise the myofascial and articular restriction components and restore normal motion are demonstrated. These techniques include muscle energy techniques and direct manual mobilisation where appropriate.

This course examines the role of both local and global muscle contributions to stability function of the pelvis. The assessment of sacro-iliac joint instability includes a manual assessment of sacro-iliac joint segmental articular motion, hypermobility of pelvic motion, and specific functional tests of 'self-locking failure'.
Assessment of local muscle recruitment identifies the optimal recruitment exercise for each individual. It is highly specific (what may work for one individual may not be effective in another). A new and unique clinical reasoning assessment process then matches the most appropriate local muscle recruitment to regain functional control of different self-locking instabilities.

While the local muscles control intersegmental articular motion, they do not effectively stabilise hypermobile range. The global muscle system has a primary role here in maintaining stability throughout large range motion. Strategies to facilitate and retrain global muscle control of lumbo-pelvic movement are detailed.
Based on a diagnosis of the site and the direction of uncontrolled sacro-iliac motion, specific global muscle retraining is instituted to regain control and increase functional stability for sacral, innominate and pubic dysfunctions. Functional rehabilitation of the stability system is integrated at a local and global level and rehabilitation strategies are based upon a clinical reasoning framework to regain sacro-iliac complex stability. This course is orientated to a 'hands on' practical application of dysfunction assessment and stability retraining using patient examples where possible.

Key Features

This course addresses:

• The functional anatomy and of the biomechanics sacro-iliac complex.
• Myofascial restrictions, articular restrictions and mechanisms of instability of the sacro-iliac are outlined.
• The diagnosis of uncontrolled movemnt of the sacro-iliac complex
• Muscle energy techniques and direct manual mobilisation
• What goes wrong with the control of pelvic joint movement when people have low back and pelvic pain
• How to test for uncontrolled range and translation of the pelvic girdle
• How prioritize the where to start therapeutic retraining exercise and how to develop appropriate progressions

This course will help you to:

• Re-evaluate muscle function around the pelvis
• Identifying global muscle imbalances that directly contribute to restriction dysfunctions
• Look at pain producing activities and making links to dysfunction
• identify direction - related uncontrolled movement related to symptoms
• Use of palpation assessment to test for uncontrolled, long arm & short arm glides and identify which muscles are better at controlling this hypermobility
• Diagnose instability mechanisms of the pelvis and assess for related uncontrolled movement
• Identify and retrain motor control dysfunction in the local muscle system of or the pelvic joints
• Design specific individual retraining programmes

Learning Outcomes

At the end of this course the participant should be able to:

• Understand the development of movement and stability dysfunction
• Analyse the inter-relationship between restriction and compensation in articular and myofascial tissues
• Identify and palpate all relevant landmarks, ligaments and muscles of the lumbopelvic region
• Understand how the articular structure, muscles and ligaments interact to optimise or compromise lumbo pelvic function
• Perform and interpret the relevance of tests of sacro-iliac complex mobility
• Based on a sequence of testing, be able to diagnose the site and direction of uncontrolled sacro-iliac complex motion
• Perform and interpret tests of sacro-iliac articular hypermobility
• Perform and interpret tests of sacro-iliac self-locking to identify functional instability within the sacro-iliac complex
• Evaluate the local stability muscles of the sacro-iliac complex and identify the optimal recruitment strategy for each muscle for different individuals
• Assess and retrain local stabiliser function at the sacro-iliac complex
• Using a clinical reasoning process, demonstrate the ability to choose the appropriate muscle and recruitment strategy to best stabilise the assessed functional self-locking instability
• Based on a diagnosis of the site and direction of uncontrolled sacro-iliac complex motion, identify and assess the effectiveness of global stabiliser muscles to stabilise the uncontrolled movement

The participant should demonstrate the ability to apply principles of assessment and motor control retraining to:

• Develop an evidence based management plan rehabilitation strategies to improve functional control
• Use clinical reasoning to prioritise initial management and plan a progression of rehab
• Apply and use re-assessment tools to guide the rate of progression of an individual patient through their rehab programme 

Programme Outline

• Sacro-Iliac Complex (theoretical component)

• Sacro-Iliac Movement & Stability Mechanisms (practical / lab component)

• Myofascial Control System - Form & Force Closure: (theoretical component)

• Sacro-Iliac Motion Dysfunction Tests (practical / lab component)

• Diagnosis of Positional Compensation (theoretical component)

• Identify the site and direction of uncontrolled compensation

  •  Sacral

  • Innominate

  • Pubic

Management Strategies (practical / lab component)

• Differentiate Lumbar Spine and Sacro-Iliac Joint

Mobilise Restriction Dysfunctions: (practical / lab component)

Exercise to maintain normal movement (practical / lab component)

Tests of Sacro-Iliac Motion Hypermobility

• Arthro-kinematic Tests:

Sacro-Iliac Complex Stability Dysfunction

• Signs & symptoms of instability

Identification of optimal recruitment for the local stability muscle system

Tests of Sacro-Iliac Joint Self-Locking Functional Instability

Global Control of Site & direction of uncontrolled motion Direction Dissociation

Control of Mobiliser Extensibility

Integration and progression of retraining of Local and Global stability systems