Orthopaedic Physiotherapy Grand Rounds 18 - Back to the Backcountry: Chronic SIJ, Hip, and Ankle Pain

The Case

A 39-year-old outdoor enthusiast presents with three distinct pain areas on her right side: the sacroiliac joint with referral into the glute and sit bone, the anterior hip with referral into the abdomen, groin, thigh, and iliotibial band, and the medial and lateral ankle. 

Her story spans more than a decade, from bilateral Achilles injuries on a 154 km hike, to a sacroiliac injury after a long drive, and a hip flexor injury during a week of snowshoeing and skiing. 

Two orthopaedic consults, a neurology consult with normal nerve conduction studies, an unremarkable rheumatology assessment, and leg X-rays have not explained her current symptoms. 

In this Grand Rounds session from the Orthopaedic Division of the Canadian Physiotherapy Association, you will work through her subjective history, objective findings, and treatment response alongside an expert panel, and see how experienced clinicians reason through a case that does not fit a single explanation.

Learning Objectives

By the end of this course, participants will be able to:

1. Analyze a multi-site presentation of right sacroiliac, anterior hip, and ankle pain using subjective history, objective findings, and treatment response.

2. Differentiate possible nociceptive, neuropathic, and nociplastic contributors when imaging and specialist workups are unremarkable.

3. Examine how thoracolumbar junction mobility, hip mechanics, and neural sensitivity may interact in a persistent lumbopelvic presentation.

4. Evaluate why some manual therapy and loading strategies flared symptoms while pelvic floor, hip adductor and core work improved function, and neurodynamic exercises reduced pain.

5. Identify assessment gaps worth closing, including sacroiliac provocation testing, expanded neurodynamic testing, and when to revisit systemic inflammatory conditions.

Audience

This online physiotherapy course track is designed for orthopaedic physiotherapists but is open to any interested healthcare professionals including but not limited to; occupational therapists, chiropractors, naturopathic doctors, athletic therapists, medical doctors, nurses and kinesiologists.

This is also a great continuing education course track for students or new grads looking to keep on top of their clinical reasoning skills.

Why This Course Matters

Most practitioners have at least one patient whose story sounds like this one: several pain sites, normal imaging, multiple specialists, and treatments that help one area while flaring another. These cases are where clinical reasoning matters most, and where it is easiest to get stuck. This session shows what happens when the hip responds poorly to distraction and resisted flexion, the thoracic spine barely responds to manual therapy, and pelvic floor activation becomes the most helpful piece of the plan. You will see how the panel weighs neural tension, thoracolumbar junction mechanics, and a family history of ankylosing spondylitis, and why they recommend a staged, “less is more” approach. You will leave with a sharper framework for your own complex cases.

Case Presenter: Laura Battcock, MScPT

Laura is a physiotherapist who graduated from Dalhousie University in 2017 and has practiced in both the public and private sectors. She is passionate about orthopaedics and women’s postnatal health, has continued her postgraduate training in both fields, and is committed to bringing evidenced-based rehabilitation to rural communities across Labrador.

Panelists:

Lorrie Maffey, BMRPT, MPhty, FCAMPT, CGIMS, Medical Acupuncture, Clinical Specialist MSK

After graduating from The University of Manitoba, Lorrie completed a Clinical Masters from the University of Queensland in Australia.  Since 1997, she has been an FCAMPT member and has been actively engaged in mentoring, teaching and examining with the National Orthopaedic Division (NOD) and is currently a Lead Examiner. Since 2000 she has taken an active role in teaching and policy making for Gunn Intramuscular Stimulation (CGIMS). Her decades spent with Canadian national athletes, in particular speed skaters, fuelled her curiosity and research into areas such as groin injury risks, prevention, and management.

Elaine Maheu PT, FCAMPT, Grad Dip Manip Ther (Aus), MClSc(Manip)

Elaine has been teaching in Canada, Switzerland and France for many years and acts as a consultant to numerous professionals. Elaine has many fields of interest but is particularly interested in spinal conditions, headaches and neurodynamics. She has received numerous awards including the Golden Hands Award from the NOD (2012), Lifetime Membership Award to CAMPT (2012), the Carol L Richards award from the OPPQ (2017), Fellow of the OPPQ (2021), a distinction medal from the CPA (2021), the 2024 Enid Graham Memorial Lecture Award as well as a Lifetime Membership Award to the CPA (2023).

Terry Woodard, BMR(PT), B.Sc., FCAMPT, MClSc (Manip)

Terry graduated from the University of Manitoba in 1989 with a BSc and in 1993 with a Bachelor of Medical Rehabilitation (Physiotherapy). He became a Fellow of the Canadian Academy of Manipulative Physical Therapists (FCAMPT)  in 2004. He obtained his MClSc (Manipulation) at Western University (WU) in 2014.  Terry works in practises  in Winnipeg and holds part time teaching positions at the U of M and WU. Terry is a mentor, instructor, and examiner in the CPA Orthopaedic Division AIM system.

Related Learning

Courses

• Orthopaedic Physiotherapy Grand Rounds 19 - Beyond the Back: Differentiating and Treating Complex Leg Pain
• Orthopaedic Physiotherapy Grand Rounds 13 - Low Back/Hip Pain and Return to Pickleball
• Orthopaedic Physiotherapy Grand Rounds 7 - Runner’s Knee (and Hip and Pelvic Pain)

Blogs

• Why Every Clinician Treating Low Back Pain Needs a Structured Core Assessment Framework
• How to Turn Down the Volume on Persistent Pain A Practical, Neuroscience-Informed Approach for Physiotherapists