made to promote discussion on the

doutfanaticalΜηχανική

14 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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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

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

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