SIJ Pain

I have a patient with R SIJ pain. She locates the pain exactly on her SIJ and feels that it is deep inside. At certain times when she rotates to the right, she feels a shapr pain in her SIJ and then it becomes dull and "locked and feels like it needs to be cracked" The patient is a yoga instructor for 10 years, and has had two children around 10 years ago. After she practices yoga, later that night she feels deep SIJ pain.

On examination her standing forward flexion test (SSFT) is postive on the R side. I place my thumb on PSIS and another thumb on Inferior Lateral Angle (ILA) of Sacrum and as she flexes forward the PSIS lengthens from the ILA (only on R side) she also feels pain in the SIJ as she does this. With feet externally rotated (to take biceps femoris off tension) there is no lengthening and no pain. I released her hamstrings with deep tissue work and also her R glute as there was EOR tightness with ext rotation. on reassesment there is no lenghtening of PSIS vs ILA and nil pain when SSFT is conducted in nuetral.

When she returned next week, she still feels there is a dull ache after her yoga sessions.

is there something else i should be looking at? any tips would be appreciated

I am definately no expert on SIJ and pelvic mechanics.

Can someone explain to me what is going on in this pattients case?

Thanks

Johnny:)

what makes u so sure that it is true SIJ pain??? in The body area u mentioned it could be LOW BACK pain from somatic structures in the lumbar spine (discs,facets,muscles)..Perhaps u should recheck the lumbar area, pay caution on the aggravating/relieving factors to pain and then embark on your treatment regime.

P.S. "palpation" tests on the SIJ are by far unreliable, as it has been proved in many studies...U better use "pain provocation" tests which can enlighten u much more!

Johnny, completely agree with Quorthon above, the most likely generator of perceived sacral area pain is the upper lumbar spine. If you are not familiar with mobilisation techniques to eliminate the most common , non trauma, non pathological cause of these kinds of presentations, may I suggest you undertake a basic spinal course .
Cheers

Thanks for the replies

I will do a full re assesment and check over lumbar spine again

Cheers