This Power Point Presentation is
made to promote discussion on the
proposed postulate.
It aims at re-interpretation of
scientific data on sacroiliac
kinematics ,diagnosis and treatment.
It aims even more at future
approach of practical and
theoretical scientists
DUALISTIC
KINEMATIC
CONCEPT
PELVIC
FUNCTION
HYPOTHESIS:
PELVIC MOTION PATTERNS
BEHAVE AS
TWO KINEMATIC CHAINS
ANTERIOR
JOINT
POSTERIOR
JOINT
ARTICULAR
FACES ILIUM
ANTERIOR
JOINT
POSTERIOR
JOINT
SACROILIAC KINEMATICS
DEMONSTRATE A
DUAL PATTERN
WITH DIFFERING ANTERIOR
AND POSTERIOR
CHARACTERISTICS
SACROILIAC STIFFNESS
IS VARIABLE AND
DIFFERS IN
ANTERIOR JOINT FROM
POSTERIOR JOINT
ANGLES BETWEEN SACRAL
ARTICULAR SURFACES OF
THE
SI JOINT AT
THE LEVEL OF S1 AND S3
Dijkstra P.F., A. Vleeming, R .Stoeckart
Posterior
Anterior
SELF- BRACING MECHANISM
OF THE PELVIC RING
IN SACRAL NUTATION
• Snijders and Vleeming have succesfully
proposed a self bracing mechanism of the
sacro-iliac joints with the combination of
FORCE ClOSURE and FORM CLOSURE.
• This applies to the upright loaded situation ,
in nutation of the sacrum
versus the iliac bone.
SELF BRACING of ANTERIOR
PART of THE SACRO ILIAC JOINT
in COUNTERNUTATION
OCCURS DUE TO:
1. FORM OF THE ANTERO SUPERIOR PART
2. FORM OF THE NEIGHBOURING BONY PARTS OF THE
SACRUM AND MEDIAN ILIAC CREST
3. FORCE OF THORACOLUMBAR FASCIA,
INTEROSSEOUS LIGAMENTS AND SUPERIOR
AND LONG PART OF the ILIOLUMBAR LIGAMENT
VERTICALLY ALIGNED MULTIFIDI, HAMSTRING
MUSCLES, PIRIFORMIS MUSCLE.
4. POSITIONING AS IN “STOOPED”LIFTING,
SLOUCHING SITTING ,SWING PHASE IN GAIT.
ANTERIOR
AND POSTERIOR
LOCATIONS OF BRACING
GO TOGETHER WITH
SEPARATE CLOSURE
( Bracing)
ANTERIOR AND POSTERIOR
JOINT ASPECT
CAN FUNCTION
ALTERNATING IN
CLOSURE POSITION
or
FREE POSITION
IlIO SACRAL
LORDOSIS = NUTATION
BEHAVES ACCORDING TO
CLOSURE
OF THE
POSTERIOR JOINT
NUTATION
B
NUTATION
SACRAL KYPHOSIS
= CONTRANUTATION
BEHAVES ACCORDING TO
CLOSURE OF THE
ANTERIOR JOINT
B
COUNTERNUTATION
HIP JOINT
AREA
A SHIFT BETWEEN
TWO DIFFERENT
STABILITY PATTERNS
CORRESPONDS WITH
THE CLIC-CLAC
PHENOMENON
of the spine
as described by C.J.Snijders
THE SELFBRACING MECHANISM
OF THE
SACRO ILIAC JOINTS CAN
TAKE PLACE SEPARATELY IN THE
TWO DIFFERENT FUNCTIONAL
UNITS OF
SI-JOINTS
AND
ON EACH SIDE
Pelvic kinematics
allow the sacrum to be
in NUTATION
on one side
and CONTRANUTATION
on the other side
MUSCLES Behave Different
in the various positions
NUTATION
NEUTRAL
COUNTERNUTATION
and
according to the needed function, as
MOVERS or STABILISERS
THE FUNCTION OF THE
LIGAMENTS
IS NOT THE SAME
WHEN SERVING
THE ANTERIOR PART OF THE
SACROILIAC JOINT
COMPARED TO SERVING
THE POSTERIOR PART
SHIFT BETWEEN PATTERNS
(AS IN GAIT MECHANISM)
TAKES PLACE
IN NEUTRAL ZONE
A DUAL LUMBOSACRAL
NEUROMOTOR CONTROL
must be served by
TWO DIFFERENT
MOVEMENT STEREOTYPES
ON EACH SIDE
Front / Superior
and Back / Inferior
POSTERIOR AND ANTERIOR
PART OF THE SACROILACS
HAVE
A
POSTERIOR and ANTERIOR
SET OF STABI LISERS
and MOVERS
both ISPSILATERAL
and CONTRALATERAL
PELVIC TORSION
PELVIC TORSION
CONSISTS OF
ROTATION
AROUND LONGITUDINAL AXIS
lATEROFLECTION
AS ROTATION AROUND
SAGITTAL PLANE AXIS
RECIPROCAL NUTATION
COUNTERNUTATION
PELVIC TORSION
TAKES PLACE WHEN
BRACING ON ONE SIDE
FUNCTIONS IN NUTATION
AND THE OTHER SIDE
IN COUNTER NUTATION
IN PELVIC TORSION
BRACING AND MOTION
TAKE PLACE IN
RECIPROCAL OBLIQUE
CHAINS
BRACING
MOTILITY
CORRECT PELVIC
KINEMATICS REQUIRE
THE OBLIQUE CHAINS
TO PRESENT A FINE TUNED
COÖRDINATED OSCILLATION
( AS IN GAIT )
FAILURE OF THE
COORDINATED OSCILLATION
OF THE OBLIQUE CHAINS
GOES WITH PELVIC
DYSFUNCTION
SUCH AS : INSTABILITY,
SACROILIAC BLOCKADE
OR SACRO-ILEITIS
THE MEANING OF
THE PELVIC TORSION
IS NOT SO MUCH
THE MOVEMENT IT ADMITS
BUT MORE THE LIGAMENTOUS
LOADING THAT GOES WITH IT AS A
MEANS OF PRESERVING AND
TRANSDUCING VERTICALLY
APPLIED ENERGY
INTO A HORIZONTAL VECTOR
THE ROTATORY ASPECT
PELVIC TORSION
ROTATION
of LUMBAR V
and SACRUM – BASE
INDUCE ACTIVATION
OF
OBLIQUE AXIS KINEMATICS
ROTATION
LUMBAR . V ( and sacrum base)
INDUCES OPPOSITE
SACRO ILIACAC
KINEMATICS
in LORDOSIS
versus KYPHOSIS
LORDOSIS
ILIUM
anteriorly
KYPHOSIS
ILIUM
posteriorly
ROTATORY POSITION
OF THE SACRUM
CAN BE INDUCED
TOPDOWN ( lumbar 5 )
or
BOTTOM UP ( acetabulum )
PELVIC TORSION KINEMATICS
ARE NOT A CONSEQUENCE OF
THE SACRO ILIAC JOINT
CHARACTERISTICS
BUT
A PRIMARY BIPED FUNCTION
OF WHICH
THE SACROILIACS ARE
THE AVAILABLE TOOLS
DIAGNOSIS OF
SACROILIAC DYSFUNCTION
SUBLUXATION
BLOCKAGE
INSTABILITY
PAIN
SCOLIOSIS
STRAIN
MUST INCLUDE ALL OF
THE FOUR ENDPOINT LOCATIONS AND
THEIR FUNCTION
SACRO - ILIAC
DIAGNOSTIC TESTS
LOOK FOR JOINT PLAY AND
VARIATION IN STIFFNESS IN
a. NUTATION
b. COUNTERNUTATION
c. NEUTRAL POSITION
d. OBLIQUE LOADING
c. COMPENSATORY
ILIAC MECHANISMS
But do not mention the differences in positioning that are
of importance for the treatment prescription
PAIN PALPATION AND PAIN
PROVOCATION TESTS
OF THE LUMBOPELVIC AREA
CAN LEAD TO STRONG SUGGESTIONS
OF PELVIC KINEMATIC DISTURBANCE
BUT DO NOT GIVE US A DIAGNOSIS
OR TREATMENT PRESCRIPTION
LOSS OF CAPACITY TO SHIFT
FROM NUTATION TO NEUTRAL AND
COUNTERNUTATION
OCCURS WHEN POSITION AND DIRECTION OF
FORCE OF MUSCLE FIBRES AND LIGAMENTS
CROSS THE LINE OF THE AXIS OF
THE SACROILIAC JOINT COMPLEX
WHICH CONVERTS THESE FORCES FROM COUNTER
NUTATORS TO NUTATORS
INSTEAD OF OPPOSING FURTHER NUTATION
THEY NOW REINFORCE THE NUTATION
Ligg. and muscles that
override the axis in
over nutation
AXIS AREA of
ANGULAR ROTATION
Over-Nutation
Counternutation
Ligg. and muscles
TREATMENT OF SACROILIAC
DISTURBANCES
MUST AIM AT
FUNCTIONAL
FREEDOM OF NUTATION AND
COUNTERNUTATION
AT BOTH SIDES
OF THE PELVIC RING
MUSCLES (or parts of those)
INFORCING THE MOVEMENT
AND STABILITY OF
THE SACROILIAC JOINT
CAN BEHAVE DIFFERENT
WHEN SERVING THE ANTERIOR
VERSUS
THE POSTERIOR FUNCTION