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Sacroiliac Joint Chicago Technique
Sacroiliac Joint Chicago Technique (SJCT) is an evidence-based form of treatment for SIJ-related neck pain and low back pain. It is a comprehensive, manual-based therapy that addresses dysfunctional motions, muscular immobility and joint instability. It is designed to reduce pain by restoring function and stability to the sacroiliac joint. This is done through a combination of manual techniques, including massage, mobilization, manipulation, trigger point release and stretching. SJCT
Transcript
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This is Brent of the Brookbush Institute, and in this video we're going to go over
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...blank
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manipulations or high-velocity thrust techniques. I assume that if you're
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watching this video you're watching it for educational purposes, and that you
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are a licensed professional with high- velocity thrust or manipulation
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techniques in your scope of practice. If you are not sure check with your state
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board. Most physical therapists, chiropractors and osteopaths you're in
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the clear. I believe that ATC's you can't do manipulations in the United States,
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although other countries again check your scope. Of course massage therapists
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and personal trainers these are generally not within your scope. Of
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course you could continue to watch these videos just for educational purposes,
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learn a little Anatomy, learn a little biomechanics. If you're going to do these
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techniques please make sure that you have a good rationale for putting your
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hands on a patient. This should be based on assessment, and if you're going to
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assess I'm hoping that you'll assess, use these interventions and reassess to
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ensure that you're getting the result that you're looking for and have good
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reason to continue using this technique. In this video we're going to go over
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sacroiliac joint manipulation, the technique is commonly referred to as the
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Chicago technique or the Chicago roll. I'm going to have my friend a Yvette come out,
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she's going to help me demonstrate. Now this technique we could use for sacroiliac
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joint stiffness. Obviously we want to base that on several assessments, not
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just palpation skills. However, if you want to look up how to do a passive
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accessory motion exam, which is basically a joint mobilization P-A check out
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our sacroiliac joint mobilization posterior to anterior video, and you'll
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get a good idea of all of the palpation and how to actually place your hands and
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use that technique. Now the technique itself is one of those that is going to
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look really easy when I do it, and then not feel so easy when you do it, so be
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prepared. It is one of those deceptively hard techniques, but essentially what
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we're going to do is we're going to set our patient up in supine, with the
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involved side -the stiff side opposite us. So the way Yvette is set up now, we have
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to assume that I am working on her left SI joint. Now I kind
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of want to lock up that SI joint the best I can, and the way I'm going to do
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that is I'm going to place this leg over the top of this leg, alright so maybe we
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get a little bit of posterior tilting there, and then I'm going to go ahead and
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side-bend that way. This is sometimes referred to as smile away
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position, so you're making like a little smiley face. So she's all locked
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up down there, now we have to rotate her torso to lock up all of the segments
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above, right which would be all of her lumbar spine. So as you can imagine in a
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way this is going to have some similarities to that lumbar manipulation
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you saw in a previous video. Now what I'm going to have Yvette do is she's
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going to go ahead and interlock her fingers behind her head, I'm going to use this hand
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over the top of her ASIS to brace her pelvis. Now be careful, just because
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you put the palm of your hand over there ASIS doesn't mean that I can't feel
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very bony and very pokey to them. So adjust your hand so that you get nice
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wide purchase, a lot of surface area right but you're nice and stable, so we
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don't want any pinch there. I'm then going to try to lace my hand through her
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arm. Now again I'm a lot bigger than Yvette is,
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so I'm not going to be able to get all of my arm through her arm, but I can get the
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back of my hand onto her sternum, and that's probably enough. I can feel her
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chin on my hand, but I think that's okay. Now what we're going to do is keep this
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down and rotate as far as we can into rotation, trying to make sure that Yette
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keeps her hands nice and locked up; and when I start feeling a good amount of
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force pressing in to my right hand here, I lock out and thrust, and that's
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it. Again that's not particularly complicated, but it does take a little
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bit of practice. Let me kind of go through one more time
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and then give you a couple little pointers to try to get that feeling of a
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lock, and to get all the force right here so that when you do that manipulation
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you actually get a successful movement of the SI joint. So we said this leg goes
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over this leg. This gets side -bent away. Now you could experiment with a little
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side-bending of the upper-torso. All right so we get as much side bending as
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you can and then again we'll put the hands back here. If you don't like this,
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you could do this. All we need is rotation of the spine. So if I rotate
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this way and maybe even like plant my fist into the table, and then I can kind
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of straighten out my arm, right now I actually I feel a lot better in this
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position. Especially me being unable to get my hand in between her her arms here
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because her biceps are actually so huge that I can't get them in between her
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forums, she works out a lot. But that being said, I get her rotated up, all
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right so I got flexion, rotation, I got her locked out this way;
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and actually I just, I lost it moving her around so much. All
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right and this happens, like this is part
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of the practice right. So let's try it again. We learned a couple things that
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time. So we move this leg over this leg, smile away, we side-bent you this way when we
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first did that, that actually helped, we locked you up really fast. Now,
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we also learned in this last time for me personally that I don't like the arm
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through. Now if you're a smaller person you might be able to get your arm all
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the way through and hook your other arm on the other end of the table, I've seen
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that right and then that kind of ends up looking, can you just hook your arm
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around this arm, right like so that ends up looking something like this but with
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her hands all the way hooked back, I've seen that. If she was doing this to me
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that's what I would recommend. But for me on the other hand,
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you can put your hands behind your head and be comfortable but we've
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found that I get you all set up into side-bend, pull this way, use her forearms
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a little bit to get me started, but then place my fist here. All right
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rotate up by straightening my arm out, now that I have her all locked up, make
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sure I get that force coming through this right hand, like I feel this coming
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up like this and now I can, and thrust. How'd that feel? Better than the first
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time? All right, big things to remember, leg far
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away goes up, and you're going to side-bend, somehow I've seen this done where people
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just side-bend from the bottom. I've seen it done where if people side-bend from
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both sides. I think you need to experiment and try to figure out how
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you're going to get locked position. You can go just hand through if you're a smaller
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person, on a larger person you can go full arm through and hook through the
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table, or you can start this way and then go behind and use your whole forearm
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against their back to try to pull in as much rotation as you possibly can.
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Now if you do that, keep in mind that you might have to continue to adjust so that
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you don't lose all of your lateral flexion in the process. Your goal is to
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get lock through here so that you start feeling pressure into this hand, so that
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when you go down to press, you're pressing the innonimate through a
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sacrum that's trying to rotate in the opposite direction. Boom.
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Practice, a lot a lot of practice. Take some time to set this up with your
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clients. Remember it's not a race, take as much time as you need. If you have
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any questions about this technique please leave them at the bottom. A couple
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of points to recap, knowing your anatomy and knowing your biomechanics will
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certainly help you choose the right technique for the right patient. If
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you're unsure whether manipulations are appropriate due to their higher
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intensity it's okay to do mobilizations. Most research points to manipulations
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being slightly more effective, but mobilizations being very effective, and
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of course we have those videos for you if you want to start with those less-
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intense techniques. Make sure that if you are doing any technique that is based on
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assessment, and of course that you're reassessing ensuring that the technique
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is effective for the patient that you're working on, and when it comes to all
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manual techniques, manipulations maybe more than any other, look for
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opportunities to get live education. Although I know videos are convenient
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and I'm happy to have these up for you to watch, it would be so much more
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helpful to use those videos as a recap of one-on-one attention with somebody
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who's experienced with manipulation techniques. At the very least grab a
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colleague, grab a friend and start practising these before you bring them
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into clinic and start using them on patients and clients. I hope you enjoyed
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this video, if you have any questions please leave them in the comments box
