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 Anterior Posterior

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 ( B racing )

ANTERIOR AND POSTERIOR JOINT ASPECT CAN FUNCTION ALTERNATING IN CLOSURE POSITION or FREE POSITION

IlIO SACRAL LORDOSIS = NUTATION BEHAVES BEHAVES ACCORDING TO CLOSURE OF THE POSTERIOR JOINT

NUTATION

B

KYPHOSIS SACRAL KYPHOSIS CONTRANUTATION = CONTRANUTATION BEHAVES ACCORDING TO CLOSURE OF THE JOINT 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 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

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

AXIS AREA of ANGULAR ROTATION Counternutation Ligg. and muscles Ligg. and muscles that override the axis in over nutation Over-Nutation

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