SIJ DD and Treatment

Axial Spondyloarthritis​

• Intervention

  • Combination of​

  • *_______ exercises ​

  • *_________ and _________ _______ exercises ​

  • Stretching​

  • B______ exercises

• Combination of medication and rehabilitation​

• *Extension exercises ​

  • both thoracic and sacral extension

• *Cardiovascular and general strengthening exercises ​

• Stretching​

  • hip flexors, anterior core

• Breathing exercises

Pregnancy-related pelvic girdle pain

• Diastasis recti

  • corrective exercises:

• Diastasis recti

  • corrective exercises:

    • Head lift and self-approximation of diastasis​

    • Progression would be a PPT with the head lift

Pregnancy-related pelvic girdle pain ​

• Presentation can vary dependent on

  • Whole pelvic girdle → +_______, _____ _____

    • Also ______, ______ ​

  • Pubic symphysis → +______, _______ _____ ______ ​

• The cause may be self-limiting, but 25% of patients have

• Presentation can vary dependent on location of pain/dysfunction​

  • Whole pelvic girdle+FABER, thigh thrust​

    • Also lunge, ASLR ​

  • Pubic symphysis → +TTP, single leg stance

    • single leg stance is difficult for them → shear force at pubic symphysis​

• The cause may be self-limiting, but 25% of patients have pain a year later

CPG for Pelvic girdle pain in the Antepartum

• pelvic floor exercises

• core exercises (especially earlier on in pregnancy)

• cat/cow

• posterior pelvic tilt

• hip flexor stretching

• HS strengthening

• seated figure 4

• heat and estim on other parts of the body

• ice on SIJ or lower back

• no more than 5 mins in supine

  • baby presses on inferior vena cava

Pregnancy Induced Pathology Interventions

• Posture related LBP​

  • Traditional L

  • Proper

  • Posture

  • Many modalities _______

  • Addressing ​

  • _______ therapies

• Posture related LBP​

  • Traditional Lower back exercises​

  • Proper body mechanics​

  • Posture instruction​

  • Many modalities contraindicated​

  • Addressing psychosocial issues and fearavoidance ​

  • Manual therapies

Pregnancy Induced Pathology Interventions

• Sacroiliac/Pelvic girdle pain​

  • ______ exercises​

  • Avoid

  • Possible external stabilization with ​

  • Addressing ​

  • ________ therapies

• Sacroiliac/Pelvic girdle pain​

  • Stabilization exercises​

  • Avoid inflammatory activities​

  • Possible external stabilization with belt​

  • Addressing psychosocial issues and fear avoidance ​

  • Manual therapies

The Expectant Mother—What to know about general exercise

• Patient Response to Aerobic exercise​

  • Reaches max exercise capacity at a lowerwork level because of increased ​

  • _______ occurs more readily during pregnancy—500 additional calories needed if exercising ​

  • _______ and _______ levels increase during exercise which may be of concern to those patients at risk for premature labor.​

• Patient Response to Aerobic exercise​

  • Reaches max exercise capacity at a lower work level because of increased oxygen requirements of exercise​

  • Hypoglycemia occurs more readily during pregnancy—500 additional calories needed if exercising ​

  • Norepinephrine and epinephrine levels increase during exercise which may be of concern to those patients at risk for premature labor.​

    • these hormones promote contractions

The Expectant Mother- Fetal response to maternal aerobic exercise

• Fetal heart rate usually increase 10-30 bpm at the onset of exercise, returns to baseline in approximately

• Newborn children of women who continue exercise into 3rd trimester have decrease in

• Fetal response to maternal aerobic exercise​

  • Fetal heart rate usually increase 10-30 bpm at the onset of exercise, returns to baseline in approximately 15 minutes​

  • Newborn children of women who continue exercise into 3rd trimester have decrease in birth weight, slightly better neurodevelopmental status and higher percentage of lean body mass.

The Expectant Mother

• Aerobic Exercise recommendations​

  • ____-____ minutes most days of the week​

  • Modify intensity to _____ ​

  • Avoid

  • ______ protection

  • ________ adjustments

• Aerobic Exercise recommendations​

  • 15-30 minutes most days of the week​

  • Modify intensity to tolerance ​

  • Avoid contact sports, ”hot” yoga, high altitude activities and scuba diving​

  • Joint protection​

  • Balance adjustments

The Expectant Mother

Absolute Contraindications to Aerobic Exercise During Pregnancy:

• Hemodynamically significant heart disease​

• Restrictive lung disease

  • ​COPD

• Incompetent cervix: early dilation of the cervix before full term, or cerclage​

• Vaginal bleeding, especially second or third trimester​

• Placenta previa after 26 weeks gestation: placenta is located on the uterus in a position in which it may detach before the baby is delivered​

• Multiple gestation with risk of premature labor

• Preeclampsia or pregnancy-induced hypertension​

• Rupture of membranes: loss of amniotic fluid before the onset of labor​

• Premature labor: labor beginning before the 37th week of pregnancy​

• Maternal type 1 diabetes​

• Severe anemia

The Expectant Mother

• Guidelines for managing the pregnant woman​

  • Patient education​

  • <5 minutes supine after the first trimester ​

  • Avoid orthostatic hypotension—rise slowly​

  • Avoid holding breath, Valsalva maneuver​

  • Hydrate​

  • Encourage full bladder emptying before exercise

  • Warm up and cool down​

  • No pain with exercise​

  • Limit SLS exercises ​

  • Avoid ballistic movement with stretching​

  • Stay within normal joint ROM ​

  • Careful stretching of HS and adductors

PRECAUTIONS: Observe participants closely for signs of overexertion or complications.The following signs are reasons to discontinue exercise and contact a physician

• *Vaginal bleeding​

• *Persistent pain, especially in the chest, pelvic girdle, or low back​

• *Leakage of amniotic fluid​

• *Regular painful uterine contractions that persist beyond the exercise session​

• *Decreased fetal movements​

• *Persistent shortness of breath, especially before exertion​

• *Irregular heartbeat​

• *Tachycardia​

• *Headache​

• *Dizziness/faintness​

• *Swelling/pain in the calf (rule out phlebitis)​

• *Difficulty in walking or maintaining balance

CPG Postpartum Mother’s with Pelvic Girdle Pain

• Strong Evidence ​

  • Patient education on normal postpartum changes​

  • Use of pelvic belt only in conjunction with other interventions​

  • Manual therapy is no better than stabilization for long-term relief and should not be used alone.​

  • Exercises to improve the performance of the pelvic floor,back flexors, back extensors,and hip extensors. *Must not increase pain

Nonspecific Pelvic Girdle Pain ​

• Presentation​

  • Similar to

  • Pain over

  • Pain provocative tests

• Treatment​

  • Manual therapies—

  • Exercise ​

  • Patient Education​

    • stay _______

• Presentation​

  • Similar to Nonspecific low back pain ​

  • Pain over PSIS area ​

  • Pain provocative tests positive ​

• Treatment​

  • Manual therapies—mobilization and manipulation​

  • Exercise ​

    • Stabilization​

    • Glut max activation​

      • Step ups, lunges, squatting ​

    • Functional activities ​

  • Patient Education​

    • Stay active