SI Joint Dysfunction

Patient Support For Recovery From Low Back Pain

EZ FIX by Richard DonTigney, Manually Align The SI Joints

Corrective Exercises

Richard DonTigney

Clinical Basis for  Treatment As with the subluxation/dislocation of any joint, the first  priority is to reduce the subluxation. If it tends to recur the patient can be  taught to self-correct. If the lesion is unstable, a lumbosacral support or  invasive procedures may be necessary.
Dysfunction of the sacroiliac joint  is essentially always a pathological release of the balanced position with an  anterior rotation of the innominate bones on the sacrum. Treatment is simply  restoring the innominates back to the balanced position. It does not matter if  one leg appears to be longer or shorter on the more painful side of if they  appear to be of equal length, they will each always appear to shorten with  correction of the SIJ to the balanced position. If there is no history of a  congenital leg length difference, polio or serious leg fracture the legs  will appear to be of equal length after correction.
The corrections  should be done every 2-3 hours all day long for at least three days to take the  tension off of the tight ligaments and give them an opportunity to recover.  After that correct at any sign of recurrence.
Nature of the Correction The corrective procedure  is not a vertebral manipulation. No high or low speed manipulative thrust is  necessary or indicated. No jerking or popping is necessary or desirable.  Correction is achieved by specifically applied traction on the properly  positioned joint or by a precise manual rotation of the innominate bones  posteriorly on the sacrum. Manual Correction of  the S3 Subluxation Any of several methods can be used to restore the  SIJ to the balanced position: traction at about 45 degrees of PSLR; direct  posterior rotation of the innominates on the sacrum; or by using isometric or  muscle energy techniques.

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Traction correction with straight leg will pull the PSIS  caudad on the sacrum
Traction correction on flexed leg in the event of an  injured ankle.

Traction must be strong enough to lift the  buttock on that side and held for several seconds.

When distracting the leg have the patient lift his/her head and  tighten the abdominal muscles to enhance the posterior pelvic  rotation.
First do one side and then the other, checking the leg length  at the malleoli and watch for shortening. Do each leg, one at a time 4-5 times  on each side, alternating sides each time and checking leg length each time. The  movement of the PSIS caudad on the sacrum can be palpated.

Do not pull on the leg in a direct line  with the body.

THE EZ FIX For a correction on the right  side, put your left forearm under the right knee and your left hand over the  front of the left knee. Push off with your left foot to provide traction,  pulling on the leg with the left forearm. The left hand will help to lever the  traction. Put just enough force on the right ankle with your right hand to hold  the knee in flexion. Apply enough traction to lift the buttock on that side. Do  each side 3-4 times, alternating sides each time. To enhance the correction have  the patient lift his/her head to tighten the abdominal muscles. The tight SIJ  acts like a stuck drawer and gives just a little bit at a time on each  side.
SELF-TRACTION SUPINE The  patient can use traction for self-correction by pushing the thigh toward the  foot hard enough to lift the buttock on that side. Lifting the head at the same  time will enlist the abdominal muscles. Repeat several times on each side  alternating sides each time.
Do especially when you go to bed a  night.
SEATED PATIENT CORRECTION may  be done while at a desk or in a car. Push one knee out. Pull the other knee back  firmly to pull the pelvis down in back. Tighten your abdominal muscles to pull  the pelvis up in front. Do several times on each side alternating each time.  Repeat several times daily.
STANDING PATIENT  CORRECTION Tighten abdominal muscles and push the knee toward the  floor. Repeat on the other side. Alternate exercise several times on each side.  Repeat correction several times during the day.
DIRECT CORRECTION (Two  methods) 1. In the direct correction the leg can be used as a lever and  brought to the outside of the body. Knee to axilla. Put one hand under the  ischial tuberosity and the other on the top of the patient’s knee. While lifting  with the lower hand, push downward on the shaft of the femur while also rotating  the thigh into flexion.
2. The operator can also directly rotate the  pelvis posteriorly by placing one hand under the ischial tuberosity and the  other over the posterior aspect of the iliac crest. Rotate firmly pushing with  the thenar eminence.
DIRECT PATIENT  CORRECTION The patient can self-correct any time during the day no  matter what position he happens to be in at the time. Just by pulling the knee  into the axilla or bringing the axilla down to the knee. Stretch firmly several  times on each side, alternating sides each time.
When doing any of these  exercises in the supine position be certain to hold your abdominal muscles tight  when raising or lowering your leg to prevent anterior rotation of the  pelvis.
FLANK STRETCH Following  the direct correction a stretch of the quadratus lumborum and the hip abductors  can be helpful in achieving further correction.
Stretch gently as  indicated then have patient lift his leg against resistance and then  relax.
Take up the slack and put traction on the leg as indicated. This  may necessitate the aid of an assistant. Follow this with a hard isometric  correction.
ISOMETRIC CORRECTION Grasp  the knee with both arms, hold firmly and push very hard outward with the knee.  Be sure to tighten the abdominal muscles while pushing with the knee to enhance  posterior rotation of the pelvis and when lowering your leg.
A six-foot  luggage belt may be used for resistance or the patient can stand in a door frame  and push as shown. This is a very powerful correction. Push hard and hold for  several seconds each time.
STRETCHING THE CORE MUSCLES ON THE  ASYMMETRIC PELVIS As the core muscles are most active during normal  gait when the pelvis is asymmetrical, they are most effectively stretched when  the pelvis is asymmetrical. Seated, project one thigh and retract the other to  create an asymmetric pelvis. Flex and twist your trunk toward the side of the  retracted thigh. This stretches the piriformis, the sacral origin of the gluteus  maximus, the quadratus lumborum, the multifidus, the abdominal obliques, the  latissimus dorsi and others. Repeat toward the other side.
STRENGTHENING THE CORE ON THE  ASYMMETRIC PELVIS USING MUSCLE ENERGY TECHNIQUES In order to  strengthen the same muscle groups, retract your right thigh and project your  left. Twist trunk to the left and grasp the right leg with the left hand. Now  extend and rotate the trunk to the left while projecting the right thigh and  retracting the left. Provide resistance to the trunk rotation with the left  hand. Repeat on other side.
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MUSCLE ENERGY EXERCISE FOR THE CORE  ON THE SYMMETRICAL PELVIS Strengthening the rectus abdominis and the  abdominal oblique musculature is necessary to help maintain posterior pelvic  rotation throughout the day. This exercise is done on the symmetrical pelvis.  Place both hands on the same knee, tighten your abs and pinch your buttocks  tightly together. Push down hard on that knee for several seconds. Repeat on the  other side. Do five times on each side.
Repeat throughout the  day.

ACTIVE EXERCISE FOR THE CORE, GLUTES AND  THIGHS Seated, simply tighten your abs and glutes, hold tight, lean  forward and rise to standing, slowly. Then, still holding your abs and glutes  tightly, sit slowly. Repeat ten times.
Always tighten your abdominal  muscles when standing and sitting.

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