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

CONCEPTPELVIC

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 ANTERIORPART 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 = NUTATIONLORDOSIS = NUTATION

BEHAVESBEHAVES ACCORDING TO CLOSURE

OF THE

POSTERIOR JOINTPOSTERIOR JOINT

NUTATION

B

NUTATION

SACRAL KYPHOSISKYPHOSIS

= CONTRANUTATION CONTRANUTATION

BEHAVES ACCORDING TO

CLOSURE OF THE

ANTERIOR JOINT 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 CANTAKE PLACE SEPARATELY IN

THE TWO DIFFERENT FUNCTIONAL UNITS OF

SI-JOINTS AND AND ON EACH SIDEON 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 LUMBOSACRALNEUROMOTOR CONTROL

must be served by TWO DIFFERENT

MOVEMENT STEREOTYPESON EACH SIDEFront / 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 OFTHE 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 OFSACROILIAC DYSFUNCTION

SUBLUXATIONBLOCKAGE

INSTABILITYPAIN

SCOLIOSISSTRAIN

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. COUNTERNUTATIONc. NEUTRAL POSITION

d. OBLIQUE LOADING c. COMPENSATORY

ILIAC MECHANISMSBut 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