pt comes in with unilateral LBP, around the SIJ not below the knee

differential - could be disc, could be SIJ, could be facet, could be muscle imbalance



it's not below the knee, and it's unilateral, rule out SI?



supine to long sit - never "sat" well with me



look at PSIS, S2, levels - hated this



do the stupid stork/Gilet test - this always made me feel dumb



palpate all over the place - you get the hang of this after a while



try to rationalize it in your head that something is moving earlier, something else is higher or deeper or some other such you have to palpate it 1000 times to feel it (which is really just believing it)



then look at lumbar PIVM



believe that you can tell which vertebrae you're on, not to mention feeling whether or not something is gapping or approximating



after perhaps 10-15 minutes palpation and passive assessment, excuse yourself politely while you figure out what to do



it's no wonder the SIJ and palpation tests have some of the worth reliability in the history of special tests

pt comes in with unilateral LBP, around the SIJ not below the knee

what do they "have?" - low back pain



is pain intermittent? --> most likely lumbar rapid responder



check lumbar repeated motion for asymmetries and directional preference



if too painful to move repeatedly in WB, move to NWB



if too painful to move in NWB, try positioning in what you think will be the directional preference



for unilateral complaints - try prone modified hips offset position as in this post





lumbar rotation in flexion, loading (closing) the involved side in sidelying (painful side on the table)



go heavy on the pain science education, decrease fear avoidance



use OMPT techniques - IASTM, DN, Joint mob, manip, neurodynamics, functional mobilization, to get them to be able to move



instruct them how to do hopefully a WB repeated loading strategy by the time they leave, if not, they may have to take off of work if acute and do NWB loading strategies for 1-2 days

after putting out the fire, use the SFMA to look for other head to toe asymmetries in movement and motor control, clean those up

As you can see, the more modern way of forgetting about SI, IS, AF, FA, positional faults, intervertebral motion, stabilization, etc, is much easier. On the occasion that repeated motions are ruled out, thoracic and hip motions are also symmetrical and normal, and they patient is a very lax female, possibly either a dancer/gymnast younger than 18 yo or pregnant or recently pregnant, they may need some stabilization. An SI stabilization belt works best to calm down the peripheral sensitizaiton as well as stabilization exercises or those for motor control as needed.





I hope this answered your question. You are struggling at the point where I was were you were given TOO MUCH INFORMATION. A simple and thus more reliable and systematic way of assessment that dictates treatment is needed for not only the lumbar spine but any area. Once you let go of pathoanatomy and look at movement and pain science education it is very liberating, but it can be a tough change.





In summary

eliminate the threat pain science education

repeated motions exam for directional preference or position of relief

OMPT to get them moving

HEP keeps them better use a system like the SFMA to clear the movement clear up asymmetries in motor control to help prevent future injury

get their capacity up to speed - ROM and pain free sometimes not enough to prevent recurrence Keeping it Eclectic...

Today's Q&A Time is regarding an often asked question regarding SIJ vs lumbar assessment and treatment sequencing. It's a very good question, even if the pseudo science behind "SIJ" assessment and treatment is not.Blame the osteopaths with their overly complex right on right, left on right, unilateral flexion/extension, upslips, downslips, METs etc... and the influence they've had on countless of orthopaedic PTs and PT instructors. Trust me, this stuff absolutely does not have to be this complex.What used to go on in my head after fellowshipWhat goes through my head now