MANAGING MOVEMENT: SOLUTIONS FOR THE SIJ AND PELVIS – KINETIC CONTROL (KC)

COURSE OVERVIEW: 

The pelvis represents a complex link between the low back and hip. Understanding its function and related uncontrolled movements is essential for the complete movement management of lumbo-pelvic presentations. This course details not the evaluation of movement restrictions but also the identification and individualized retraining of uncontrolled movement. 

COURSE OUTLINE: 

Traditionally, the sacro-iliac joint was considered not to ‘move’ and therefore is unlikely to contribute to lumbo-pelvic pain. This course considers this perspective and presents a contemporary clinical approach to the management of the SIJ and patients’ presentations linked to it. For example, questions arise such as ‘Can you identify and mobilise restrictive dysfunctions of the sacro-iliac joint? Can you diagnose the site and direction of compensatory mechanisms of uncontrolled movement within the sacro-iliac complex?’ This course supplies insight on such questions. 

The biomechanics of the sacro-iliac complex are integrated with contemporary osteopathic concepts. Myofascial restrictions, articular restrictions and mechanisms of what is typically referred to as ‘instability’ of the sacro-iliac are outlined. The diagnosis of mechanical ‘dysfunctions’ of the sacro-iliac complex is developed around a systematic process of assessing restrictions and identifying the associated compensation within the movement system. An identification of uncontrolled movement is made, based of Kinetic Control’s system of identifying the site (sacral, ilial or pubic) and the direction (rotation, shear, torsion or sidebend) of uncontrolled pelvic motion. 

Once the relevant (presentation associated) uncontrolled movement has been identified, specific techniques to mobilise myofascial and articular restrictions are demonstrated. These techniques include muscle energy techniques and direct manual mobilisation where appropriate. 

This course examines the role of both the local and global stabililser role synergists’ contributions to movement demands of the pelvis. The assessment of sacro-iliac joint ‘instability’ includes a manual assessment of sacro-iliac joint segmental articular motion, ‘hypermobility’ of pelvic motion, and specific functional tests of ‘self-locking failure’. 

Assessment of local stabilizer role synergist recruitment aims to identify and restore efficiency in these misunderstood contributors to Movement Health of the pelvis, low back and hip. The course identifies how both their assessment and retraining is highly individual specific – what may work for one individual may not be effective in another. A unique clinical reasoning assessment process then matches the most appropriate recruitment strategies to regain control of different self-locking deficits. 

While the local stabilizer role synergists possess the ability to manage intersegmental articular motion, they are effective in the control of hypermobile range. The global system is advantaged to maintaining control throughout large range motion. Strategies to facilitate and retrain the global system of lumbo-pelvic movement are detailed. 

Based on a diagnosis of the site and the direction of uncontrolled sacro-iliac motion, specific global system retraining is instituted to target mechanisms associated to sacral, innominate and pubic presentations. This individualised rehabilitation, integrating both local and global systems, is steered by a rigorous clinical reasoning framework. This course is orientated to a ‘hands on’ practical application of uncontrolled movement assessment and retraining, using patient examples where possible. 

KEY FEATURES: 

Perform a systematic movement assessment to identify uncontrolled movement in the SIJ and pelvis 

Understand the links between restrictions of motion, movement system compensation strategies and the development of uncontrolled movement 

Assess for pain related low threshold recruitment changes in local and global system muscle synergists 

Use evidenced based literature to support the choice of retraining strategies to these recruitment changes 

COURSE CONTENT WILL INCLUDE: 

Where we are at with movement assessment and retraining 

The functional anatomy and biomechanics of the sacro-iliac complex 

Myofascial restrictions, articular restrictions and mechanisms of ‘instability’ of the sacro-iliac Sequencing the mobilisation of sacro-iliac joint restrictions 

Muscle energy techniques and direct manual mobilisation 

Identifying impairments with the control of pelvic joint movement in people with low back and pelvic pain 

How to test for uncontrolled range and translation of the pelvic girdle 

How prioritise and where to start retraining interventions and how to develop appropriate progressions 

This course will help you to: 

Re-evaluate muscle function around the pelvis 

Identify changes in global system synergists likely to contribute to the presence of restrictions 

Look at pain producing activities and making links to identified uncontrolled movements Identify direction – related uncontrolled movement related to symptoms 

Use of palpation assessment to test for uncontrolled, long arm & short arm glides and identify which muscles are best advantaged to controlling this range 

Identify mechanisms of the pelvis related to pain and assess for related uncontrolled movement 

Identify and retrain uncontrolled movement and altered recruitment strategies linked to the local stabilizer role synergists 

Design specific individual retraining programmes 

LEARNING OUTCOMES: 

At the end of this course the participant should 

be able to: 

Understand the development of uncontrolled movement 

Analyse the inter-relationship between restriction and compensation in articular and myofascial tissues 

Identify and palpate all relevant landmarks, ligaments and muscles of the lumbopelvic region 

Understand how the articular structure, muscles and ligaments interact to optimise or compromise lumbo pelvic function 

Perform and interpret the relevance of tests of sacro-iliac complex mobility Based on a sequence of testing, be able to diagnose the site and direction of uncontrolled sacro-iliac complex motion 

Perform and interpret tests of sacro-iliac articular hypermobility 

Perform and interpret tests of sacro-iliac self-locking to identify functional ‘instability’ within the sacro-iliac complex 

Evaluate the recruitment efficiency of the local stabilizer role synergists of the sacro-iliac complex and identify enhanced recruitment strategies for each muscle, for different individuals 

Assess and retrain local stabiliser role synergist function at the sacro-iliac complex Using a clinical reasoning process, demonstrate the ability to choose the appropriate muscle and recruitment strategy to more efficiently manage the identified functional self-locking problem 

Based on a diagnosis of the site and direction of uncontrolled sacro-iliac complex motion, identify and assess the effectiveness of global stabilizer role synergists to address uncontrolled movement 

PROGRAMME: 

DAY ONE: 

9.00 – 10.30 Sacro-Iliac Complex (theoretical component) 

Review of key concepts of movement control impairments 

Anatomy, Function, the sacro-iliac joint as a source of pain (peri-articular and intra-articular), evidence of sacro-iliac joint movement, biomechanics, strain and stress: mechanisms. 

Sacro-Iliac Movement & Control Mechanisms (practical / lab component) Biomechanical Control Systems – Form Closure and Force Closure: 

Ligamentous Support System: 

1: Anatomy review 

2: Palpation of bony landmarks of the lumbo-pelvic region 

3: Palpation of ligaments for asymmetry and pain sensitivity 

10.30 -10.50 Coffee 

10.50 – 12.30 Myofascial Control System – Form & Force Closure: (theoretical component) Review of muscle function affecting the sacro-iliac complex 

Factors optimising sacroiliac function 

Factors compromising sacroiliac function 

12.30 – 13.30 Lunch 

13.30 – 15.00 Sacro-Iliac Motion Dysfunction Tests (practical / lab component) Trunk Flexion Tests: 

Standing (Tests for the presence of inappropriate intra-pelvic torsion) 

Sitting (Tests for the presence of inappropriate intra-pelvic torsion) 

Standing Hip Flexion Tests: 

Ipsilateral (I/S motion restriction) 

Contralateral (S/I motion restriction) 

Prone Extension Tests for Torsion: 

L5 – S1 restriction causing sacro-iliac motion strain (backward sacral torsion) Piriformis asymmetry causing sacral compensation (forward sacral torsion) 

15.00 – 15.20 Tea 

15.20 – 17.00 

Arthro-kinematic Tests: 

Myofascial vs. articular restriction 

Hypo-mobile vs. hyper-mobile articular glides (Lee) (Emerson) (Fowler) 

Articular Glide palpation 

Diagnosis of Positional Compensation (theoretical component) 

DAY TWO: 

9.00 – 10.30 Identify the site and direction of uncontrolled compensation Sacral: 

Torsion (forward or backward) 

Sidebend (nutated or counternutated) 

Innominate: 

Rotation (anterior or posterior) 

Shear (superior or inferior) 

Flare (out or in) 

Pubic: 

Shear (superior or inferior) (anterior or posterior) 

10.30 – 10.50 Coffee 

10.50– 12.30 Management Strategies (practical / lab component) 

Differentiate Lumbar Spine and Sacro-Iliac Joint: 

Identify which is primary and which is secondary if both regions are contribution to dysfunction and pain 

Assess and correct different positional restrictions: 

Manual techniques to mobilise the diagnosed dysfunctions are detailed 

Myofascial and articular techniques 

Demonstration and practice 

Mobilise Restriction Dysfunctions: (practical / lab component) 

Assess and correct different positional restrictions (continued) 

Manual techniques to mobilise the diagnosed dysfunctions are detailed 

Myofascial and articular techniques 

Demonstration and practice 

12.30 – 13.30 Lunch 

13.30 – 15.00 Exercise to maintain Movement Health (practical / lab component) Develop exercise options to maintain mobility of the specific restrictions that have been mobilised 

Tests of Sacro-Iliac Motion Hypermobility: 

Arthro-kinematic Tests: 

– Hypo-mobile vs. hyper-mobile articular glides 

– Articular Glide palpation 

– Short arm glides 

– Long arm glides 

– Innominate anterior rotation (coupled glide testing) 

Pubic symphysis instability 

15.00 – 15.20 Tea 

15.30 – 17.00 Review 

DAY THREE: 

9.00 – 10.30 Sacro-Iliac Complex Dysfunction: 

Signs & symptoms of dysfunction 

Revisiting the local system of lumbo-pelvic region 

– Lumbo-pelvic local muscle synergist review 

Identification of optimal recruitment for the local stabilizer role synergists: Transversus Abdominis 

Pelvic Floor 

Posterior Fascicles Psoas Major 

Deep Sacral fibres of Gluteus Maximus 

Segmental Lumbar Multifidus 

Diaphragm dissociation 

10.30 – 10.50 Coffee 

10.50– 12.30 Continue 

12.30 – 13.30 Lunch 

13.30 – 15.00 Tests of Sacro-Iliac Joint Self-Locking Dysfunction: 

Open chain functional tests (non-weight-bearing) 

Closed chain functional tests (weight-bearing) 

Self-Locking Re-stabilisation: 

Clinical reasoning framework 

Matching local system recruitment to enhanced self-locking properties 

Matching local system recruitment to enhanced management of articular glide hypermobility 15.00 – 15.20 Tea 

15.30 – 17.00 Continue 

DAY FOUR: 

9.00 – 10.30 Coordination efficiency: test and retraining: 

Flexion 

Extension 

Rotation 

Lateral flexion / shift 

10.30 – 10.50 Coffee 

10.50– 12.30 Global Stabiliser Role Synergists: Uncontrolled Movement: Retrain Global Stabiliser role synergists: 

– Gluteus Maximus, Gluteus Medius, Gluteus Medius, Lateral Abdominals, Iliacus, Anterior Psoas, Stabilising Adductors 

To manage Specific SIJ Uncontrolled Movement 

– Sacral, innominate and pubic compensations 

12.30 – 13.30 Lunch 

13.30 – 15.00 Control of Mobiliser Role Synergist Extensibility: 

Lengthen, inhibit & regain extensibility of global mobiliser role synergists: – Quadratus Lumborum, Tensor Fascia Latae and the Ilio-tibial band, Piriformis, Iliocostalis,  Latissimus Dorsi, Rectus Femoris, Hamstrings 

15.00 – 15.20 Tea 

15.30 – 16/17.00 Review