Exercise For SI

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Exercise For SI

• David D. Wise, PT, Ph.D

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SI Theories and Models

• SI pain is referred from problems in the L5-S1
  segment.
• Exercise Stabilization and mobilization of
  L5-S1 and structures that affect that area.
• SI is the problem area that is indirectly
  affected by dysfunction elsewhere (mostly LE).
• Exercise Correct dysfunction in other areas
  then look at the SI.

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SI Theories and Models

• Muscle Energy (Osteopathic model)
• SI can distort and become stuck
• SI can be unstable
• Exercise Use a combination of passive
  mobilization and active (muscle mobilization) to
  correct dysfunction.
• Manipulation approach
• Exercise Most common dysfunction is that SI
  gets subluxated and stuck forward. Rx is
  manipulation.

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SI Theories and Models

• Lee-Vleeming
• SI can be too stable and in need of mobilization
  or manipulation followed by exercise to balance
  forces through SI.
• SI can be unstable and in need of stabilization
  by exercise. Exercise adds stability and balance
  forces
• The one approach that seems to have some research
  basis.

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Muscle Energy Approach

• Ilium can sublux (distort) on the ilium
  (iliosacral problem)
• Sacrum can sublux within the two ilia
  (Sacro-iliac problem)
• Palpation and movement tests battery are used to
  determine the type of problem. Some more
  prevalent than others.

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Muscle Energy Approach

• Palpation and movement tests

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Muscle Energy Approach

• Treatment based on using muscles to mobilize
  opposite the subluxation.
• In most of the mobilizations there is
• Position to do the mobilization
• Stabilizing muscle
• Mobilizing muscle

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Muscle Energy Approach

• Example treatment
• Posteriorly rotated innominate
• Position to do the mobilization
• Supine with affected LE off table
• Stabilizing muscle
• Gluteus max/hamstring unnaffected side
• Mobilizing muscle
• Hip adductor or rectus femoris on affected side.

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Muscle Energy Approach

• Example treatment
• Anteriorly rotated innominate
• Position to do the mobilization
• Supine with unaffected straight and affected knee
  bent with foot flat
• Stabilizing muscle
• Iliopsoas on affected side.
• Mobilizing muscle
• Gluteus max/hamstring affected side

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Muscle Energy Approach

• Intensity 3-5 lbs isometric contraction of
  mobilizing muscle
• Duration 3-5 second hold
• Frequency 6 10 times per day.
• Adjunctive RX sacro-iliac belt for
  stabilization between bouts of exercise.

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Muscle Energy Approach

• Special Role of Hamstrings
• Hamstrings are considered an extension and
  tension device off the sacrospinous ligament. A
  tight sacrospinous ligament is desirable.
  Therefore, strong hamstrings (exercise to achieve
  this) is desirable.

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Belt and Ball Exercises

• Seem to be off-shoot of MET
• Alternating isometrics between hip adductor and
  abductor muscles.
• Ball or pillow of significant size between knees
  belt around outside of knees.
• Alternating 3-5 sec. isometric contractions done
  with 5-10 lbs of force. Repeated 6-10 times per
  day.

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Lee-Vleeming Approach

• Form closure shape of joints and ligaments that
  support.
• Force closure muscles that act across the SI
  joint need strength, endurance and balance.
• Patients can have excessive form closure and need
  to be manipulation
• Patients can have diminished force closure and
  need stabilization.

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Lee-Vleeming Approach

• Force closure is produced by muscle groups,
  systems or loops members in each group must be
  balanced.
• The Core System
• The Posterior Oblique System
• The Anterior Oblique System
• The Deep Longitudinal System
• The Lateral System

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Lee-Vleeming Approach

• Force closure The core group

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Lee-Vleeming Approach

• Force closure Posterior Oblique System

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Lee-Vleeming Approach

• Force closure Anterior Oblique System

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Lee-Vleeming Approach

• Force closure Deep Longitudinal System

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Lee-Vleeming Approach

• Force closure The Lateral System

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Lee-Vleeming Approach

• Treatment Overview
• Assess muscles for strength, endurance and length
• Look for imbalances, especially in the systems or
  groups
• Strength/endurance training for weak or easily
  fatigued stretching for tight strengthen in
  shortened range for positionally weak.
• Motor control exercises to retrain timing.
• Adjunct bracing and taping, EMG, Psycho-social
  support.

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Belt and Ball

• Treatment Overview
• Assess muscles for strength, endurance and length
• Look for imbalances, especially in the systems or
  groups
• Strength/endurance training for weak or easily
  fatigued stretching for tight strengthen in
  shortened range for positionally weak.
• Motor control exercises to retrain timing.
• Adjunct bracing and taping, EMG, Psycho-social
  support.