Sacroiliac Joint Dysfunction Corrective Exercise and Sample Routine

**Sacroiliac Joint (SIJ) Dysfunction: Corrective Exercise and Sample Routine

**

By Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

Typical Findings During Movement Assessment:

Overhead Squat Assessment (Typical findings are asymmetrical right to left):

• Knee Bow in
• Knee Bow out
• Anterior Pelvic Tilt
• Excessive Forward Lean
• Asymmetrical Weight Shift (best predictor of SI joint dysfunction)

Goniometry:

• Limited Knee Extension (90/90) (Greater than 20°)
• Limited Hip Internal Rotation (90/90) (Less than 45°)
• Limited Hip External Rotation (90/90) (Less than 45°)
• Limited Hip Extension (Thomas Test) (Less than 15°)
• Limited Hip Flexion (Supine/Knee Bent) (Less than 120°)

Specific Flexibility:

• Ober's Test
• Ely's Test
• Thomas Test

Strength Assessment:

• Gluteus Medius Weakness and/or Compensation (hip flexion)
• Gluteus Maximus Weakness or Compensation (knee flexion, external rotation, or adduction)
• Core Compensation (abdominal distension)
• Psoas Weakness (Inability to hold hip flexion above 90°)

Typical length change and motor behavior of involved musculature:

Note: The example below is based on dysfunction of the Left SI Joint: If presented with right SIJ dysfunction switch rights and lefts.

Overactive (Release and Stretch):

• Left Piriformis
• Left Biceps Femoris
• Left Adductor Magnus
• Right Tensor Fasciae Latae (TFL)
• Anterior Oblique Subsystem (Left external obliques & right adductors )

Underactive (Activate and Integrate):

• Right Gluteus Medius
• Right Gluteus Maximus
• Intrinsic Stabilization Subsystem (under activity of deep stabilizers)
• Posterior Oblique Subsystem (left latissimus dorsi and right gluteus maximus )

For a complete analysis of SI Joint Motion and a predictive model of SI Joint Dysfunction please refer to the article "Lumbo Pelvic Hip Complex Dysfunction "

Brookbush Institute – Integrated Warm-up/Corrective Exercise Template:

1. Release
2. Mobilize (When appropriate)
3. Stretch
4. Isolated Activation
5. Core Support (Optional)
6. Stability Integration (Optional)
7. Reactive Integration (Optional)
8. Subsystem Integration

It is the intent of Brookbush Institute that the personal trainer will artfully select exercises from the appropriate progressions to create a workout that has an immediate impact on the quality of movement and “feels-like” a warm-up. To create this effect it is important to choose at least one exercise for each modality, that each exercise can be done in quick succession (without rest), and the exercises increase in intensity from “Activated Isolation to Whole Body Exercise.” Be careful not to rely too heavily on unilateral exercises as this will decrease intensity. The result is a sophisticated approach to exercise selection that can improve the quality of movement while maintaining the intensity of a general warm-up.

It is not uncommon for a new client to feel like a significant amount of work has been accomplished at the end of the integrated warm-up, especially when the sequence is repeated 2-3 times. Further, it is not uncommon for Brookbush Institute faculty to solely utilize the “Integrated Warm-Up template” as the initial phase of training, or in periods between high intensity training.

Exercise Repertoire:

The repertoire and video playlists below are the same as those found in the article "Lumbo Pelvic Hip Complex Corrective Exercise and Sample Routine" . If you have read this article please skip to the sample routine below. The same exercises are used in both dysfunctions (except for a couple of techniques used exclusively for SI Joint Dysfunction). The most complicated aspect of SI Joint dysfunction is determining which structures are involved, on which sides. Sample routine below.

Sacroiliac Joint Dysfunction Self Administered Release Techniques Playlist:

Sacroiliac Joint Dysfunction Self Administered Mobilization:

Sacroiliac Joint Dysfunction Static Stretching Playlist:

Note: The"Latissimus Dorsi," "Kneeling Hip Flexor," & "Standing Adductor," are the most commonly used for Lumbo Pelvic Hip Complex Dysfunction. The "Piriformis" and "Adductor Magnus" stretch are used for an Asymmetrical Weight Shift and/or SI Joint Dysfunction

Sacroiliac Joint Dysfunction Activation Playlist:

Core Integration:

Sacroiliac Joint Dysfunction Integration Playlist:

Typical Integrated Warm-Up/Corrective Exercise Routine:

Note: All exercises are linked to video

Release (Hold each for 30 -120 seconds or until a release is felt):

• Left Biceps Femoris
• Left Adductor Magnus
• Left Piriformis
• Right TFL

**Stretch *(Hold each for 30 -120 seconds or until a release is felt):***

• Left Adductor Magnus
• Left Piriformis
• Left Active Biceps Femoris
• Right Kneeling Hip Flexor Stretch (Focus on TFL)

Mobilization (Perform 10 - 15 repetitions, holding for 2 seconds at end range):

• Left SI Joint (Trunk Rotation: Left Hip Down on Group, Right Hip Up)

Isolated Activation (10-20 reps, 1-3 sets, form is more important than load):

• Q-Ped Alternate Arm/Leg Raise
• Right Gluteus Maximus
• Right Gluteus Medius

Core Support (10-20 reps, 1-3 sets, form is more important than load):

• Ball Bridge

Integrated Stabilization (Try and maintain single leg balance for 60 seconds on each side)

• Right Single Leg Touchdown

Reactive Integration (10-20 reps, 1-3 sets, form is more important than load):

• Gluteus Maximus Reactive Activation

Subsystem Integration (10-20 reps, 1-3 sets, form is more important than load):

• POS Integration - Static Lunge to Unilateral Row (Right Leg forward & Pull w/ Left Hand)

Note: You may perform the exercises from "Isolated Activation" to "Subsystem Integration" in circuit (no rest in-between sets), and perform that circuit 1 - 3 times.

© 2011 Brent Brookbush

Questions, comments, and criticisms are welcomed and encouraged –