CASE PRESENTATION

SI Joint Dysfunction

By :- Rishan
BPT 4th Year
Enrollment Number : 00411202620
DEFINITION
SI (sacroiliac) joint dysfunction refers to a condition in which the sacroiliac
joints, which are located in the pelvis, do not function properly. These
joints are responsible for connecting the sacrum (the triangular bone at the
base of the spine) to the ilium (the uppermost bone of the pelvis). SI joint
dysfunction can lead to pain and discomfort in the lower back, buttocks,
and legs.
Name : Mr. Lal Chand
DEMOGRAPHIC DATA
Age/Sex : 70/Male

Address - Kalkaji, New Delhi

Phone Number : 94XXXXXXX7

Occupation : Retired

Date Of Examination : 13-September-2023

Dominance : Right

Chief Complaints : Patient presents with a chief complaint of lower back pain and discomfort,
which has been ongoing for the past one year. Primarily localized to the left side of his lower back
and occasionally on his buttock and left thigh. He also mentions that the pain sometimes limits his
ability to perform daily activities, such as lifting and bending.
 HISTORY
Duration : 1 year

Onset : Gradual onset not associated with any specific injury or trauma.

Pain History
Location : L4-L5 Spine + Left Leg

Pain Type : Episodic

Quality : sharp, shooting

Intensity : 6 On VAS

Aggravating Factors : Prolonged sitting, standing, walking, and bending

Relieving Factors : Rest, Hot Pack

Personal History
• Non-Alcoholic

• Non-Smoker

• Non-Vegetarian

HISTORY OF TRAUMA
• No History of trauma.
 OBSERVATION
Posture
• Notable scoliosis with a right-sided curve
• Notable Pelvic Tilt with right side elevated.

Gait
• Slight antalgic gait, favoring the left side.
 INSPECTION
Skin

• Color : Normal, no sign of inflammation

• Scar : Not Present

Soft Tissue Inspection

• Swelling : Grade 2 at L4-L5 Vertebrae

• Tenderness : Grade 2 at L4-L5 Vertebrae

• Paraspinals, Quadratus Lumborum, Glutes, Hamstrings Muscle Hypertrophy

• Callosities present at both foot.

 MOBILITY
Lumbar Spine
• Flexion: Limited to 30 degrees, with pain and discomfort.
• Extension: Reduced to 10 degrees, with pain reported.
• Left Lateral Bending: Restricted by pain, limited to 10 degrees.
• Right Lateral Bending: Restricted by pain, limited to 10 degrees.
 MMT

Lumbar Spine and Core Muscles Grade

Rectus Abdominis (L1-L4) 3

Obliques (Internal and External) 3

Erector Spinae 3
 SPECIAL TESTS

• Gaenslen's Test - Positive for left SI joint dysfunction.

• Patrick's Test (FABER Test) - Positive for SI joint dysfunction

 DIAGNOSIS

• Sacroiliac Joint Dysfunction (SI Joint Dysfunction)

• Lumbar Scoliosis (Right side curve)

• Radiculopathy
 MANAGEMENT
Goals

• Pain Relief

• Improve ROM

• Muscle Strengthening

• Maintain ROM and Muscle Strength

• Return to functional activities

 MANAGEMENT
Protocol Week 1

• Hot Pack - lower back and the left leg - 15 Minutes

• Gentle mobility and stretching exercises for the lumbar spine and hip.

• Gait training to address any walking abnormalities.

• Continuous Ultrasound - 0.8w/cm2 X 1Mhz X 6 Minutes over lower back and sacroiliac joint area.
 MANAGEMENT
Week 2

• Hot Pack - lower back and the left leg - 15 Minutes

• Pulsed Ultrasound - 0.8w/cm2 X 1Mhz X 6 Minutes over lower back and sacroiliac joint area.

• Therapeutic exercises to strengthen core muscles (pelvic tilts, bridges).

• Progressive resistance exercises for lumbar muscles.

• Gait training and balance exercises on balance board.

 MANAGEMENT
Week 3

• Hot Pack - lower back and the left leg - 15 Minutes

• Pulsed Ultrasound - 0.8w/cm2 X 1Mhz X 6 Minutes over lower back and sacroiliac joint area.

• Therapeutic exercises to strengthen core muscles (pelvic tilts, bridges).

• Flexibility exercises to improve range of motion in the lumbar spine.

• Progressive resistance exercises for lumbar muscles.

• Gait training and balance exercises on balance board.

RANGE OF MOTION AFTER 3 WEEKS
Range Of Motion : Lumbar Spine Day 1 Day 21

Flexion 0-30 0-60

Extension 0-10 0-30

Left Lateral Bending 0-10 0-20

Right Lateral Bending 0-10 0-20

 MMT AFTER 3 WEEKS

Shoulder Muscles Day 1 Day 21

Rectus Abdominis 3 4

Obliques (Internal and External) 3 4

Erector Spinae: 3 4
 Patient’s response
Week 1: Initial Assessment and Pain Management

• Patient experiences initial relief from heat therapy and begins to implement pain management techniques.
• He starts to understand the importance of proper body mechanics and the impact on his condition.

Week 2: Core and Lumbar Strengthening

• He starts to feel slight improvements in muscle strength.

• The exercises for core and lumbar muscles are challenging but manageable.
• He reports that walking is slightly less painful, and he notices improved gait stability.

Week 3: Flexibility and Neuromuscular Reeducation

• His range of motion in the lumbar spine shows improvement, and he reports less stiffness.
• He finds the ultrasound therapy helpful for pain relief and muscle tension.
• Exercises are helping him improve posture and movement patterns.
THANK YOU