Covering All the Bases: Getting the most out of your physical therapy evaluation

Patient Education

Many patients ask if their physical therapy evaluation for sacroiliac joint pain “covered all the bases”.  While many physical therapists’ practice using differing techniques, there are basic areas that should routinely be addressed.

The list below includes areas that a physical therapist may consider when evaluating your sacroiliac joint pain. Based on your medical history, personal goals, physical therapy evaluation, and the referring physician’s recommendations, the PT will develop a plan to help you achieve your objectives.

  1. Assessment of your posture, the positions you sit and sleep in, and how you use your body for certain daily activities (often called body mechanics).
  2. Assessment of any abnormalities with your walking pattern (gait), especially those caused by muscles in your buttocks or hip.
  3. Assessment of your muscle strength and muscle balance. Strength is the ability of your muscles to contract and produce force. This would include muscles in your torso and legs.8 Muscle imbalance is present when the muscles on one side of the body are stronger or weaker than the corresponding muscles on the opposite side of the body. When muscle imbalance is present the physical therapist may instruct you in specific exercises to improve muscle balance and correct muscle weakness.
  4. Assessment of the strength of the muscles that increase the stability of your sacroiliac joint (often called your “core” muscles).1-8
  5. Assessment of your muscle length balance. Muscle length imbalance is present when muscles on one side of a bony structure are longer than the muscles on the other side of a bony structure and cause an imbalanced pull on the bone. This would include muscles of the back, thigh and hip. If imbalance is present, the physical therapist may instruct you in stretching exercises to address muscle length differences.9-13
  6. Assessment with the physical therapist’s hands (often called palpation) of the muscles and tissues surrounding your sacroiliac joint for local tenderness or pain.
  7. Assessment of joints and muscles above or below the sacroiliac joint that may cause limitations in your movement. This may include the, lower and upper back, hip, knee, and ankle regions.
  8. Assessment of your sacroiliac joint with the use of special tests called “provocative tests” which are meant to stress the joint and re-create the typical painful symptom coming from your SI joint.14
  9. Assessment of your home and work environment, your health habits, activity level and your leisure and recreational interests.

Any physical therapy treatment should be individualized for each patient’s needs based on their individual evaluation, pre-existing and co-existing conditions, and the recommendations of their physical therapist and referring physician.

REFERENCES/CLINICAL EVIDENCE:

1. Stuge, B., Laerum, E., Kirkesola, G. & Vøllestad, N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 29, 351–359 (2004).

2. Stuge, B., Holma, I, Vøllestad  N. To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises? Manual Therapy 11 337-343 (2006).

3. Snijders, C. J., Vleeming, A. & Stoeckart, R. Transfer of lumbosacral load to iliac bones and legs. Part 2: Loading of the sacroiliac joints when lifting in a stooped posture. Clin. Biomech. 8, 295–301 (1993).

4. Snijders, C. J., Vleeming, A. & Stoeckart, R. Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin. Biomech. Bristol Avon 8, 285–294 (1993).

5. Hodges, P. W. & Richardson, C. A. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine 21, 2640–2650 (1996).

6. Richardson, C. A. et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 27, 399–405 (2002).

7. Pel JJ, Spoor CW, Pool-Goudzwaard AL, Hoek van Dijke GA, Snijders CJ. Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. Eur Spine J.  13 199–205 (2004).

 8. van Wingerden, J.P. , A. Vleeming, A.,  Buyruk, H.M., Raissadat K. Biomechanical analysis of  reducing sacroiliac joint shear load by optimization of pelvic muscle and ligament forces. Ann Biomed Eng. 36 415-424 b (2008).

9. Vleeming, A., van Wingerden, J. P., Snijders, C. J., Stoeckart, R. & Stijnen, T. Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics. Clin. Biomech. 4, 204–209 (1989).

10. Cibulka, M. T., Sinacore, D. R., Cromer, G. S. & Delitto, A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine 23, 1009–1015 (1998).

11. Lee, D. & Vleeming, A. Impaired load transfer through the pelvic girdle- a new model of altered neutral zone function. In Proceedings from the 3rd interdisciplinary world congress on low back and pelvic pain. (1998).

12. Vleeming, A., Stoeckart, R., Volkers, A. C. & Snijders, C. J. Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine 15, 130–132 (1990).

13. Vleeming, A., Volkers, A. C., Snijders, C. J. & Stoeckart, R. Relation between form and function in the sacroiliac joint. Part II: Biomechanical aspects. Spine 15, 133–136 (1990).

14. Laslett: Evidence Based Diagnosis and treatment of the painful Sacroiliac Joint Journal of Manual & Manipulative Therapy, (2008).

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