03-09: The Pelvic Girdle Flashcards
Joints of the pelvis (3)
Sacroiliac Joint, Pubic Symphysis, Lumbrosacral Joint
Pelvic Motions (4)
Anterior Tilt, Posterior Tilt, Lateral Tilt, Rotation
Anterior Tilt (re: Lordosis)
Increased Lordosis, lumbar back-bending
Anterior Tilt (re: ASIS-PSIS, Pelvis Positioning)
- Pelvis moves anteriorly
- ASIS inferior, PSIS superior
- “Donald Duck”
Anterior Tilt (re: Deficiencies, Dysfunctions)
- Weakened abs (lengthened), restricted ES (shortened)
- May lead to stenosis of lateral foramen, which may impinge nerves
Posterior Tilt (re: Lordosis)
Decreased Lordosis, lumbar goes into flexion (forward bend, flat back)
Posterior Tilt (re: ASIS-PSIS, Pelvis Positioning)
- Pelvis moves posteriorly
- ASIS superior, PSIS inferior
- “PInk Panther”
Posterior Tilt (re: Deficiencies, Dysfunctions)
- Weakened ES (lengthened), restricted abs (shortened)
- History of disk herniation
- FHP
ASIS-PSIS positioning (degrees)
- ASIS should sit inferiorly to PSIS by 8-10˚
- Greater than 10˚ = anterior tilt
- Less than 8˚ = posterior tilt
Anterior/Posterior Tilt - Planes of motion
- Motion occurs at lumbarsacral joint (L5-S1)
- Sagittal plane about a frontal axis
Lateral Tilt - Definition
- Ability of pelvis to drop down or elevate on one side
- Lateral Tilt = Drop down
- Hip Hike = Rise
Lateral Tilt - Osteokinematic Motion
- ABD on one side, ADD on the other side
Lateral Tilt - Planes of Motion
- Side to Side
- Frontal plane about sagittal axis
Pelvic Rotation - Description
- Pelvis moves as a whole
- Only occurs with single leg standing
Pelvic Rotation - Planes of motion
- Motion occurs at iliofemoral joint
- Tranverse plane about a vertical axis
Iliorotation - Planes of motion
- Motion occurs at pubic symphysis, SI joint
- Unilateral
- Sagittal plane about a frontal axis
Anterior iliorotation (re: ASIS-PSIS)
ASIS inferior, PSIS superior
Posterior iliorotation (re: ASIS-PSIS)
ASIS superior, PSIS inferior
Anterior Rotation during gait
Internal rotation at hip joint
Posterior rotation during gait
External rotation at hip joint
Sacrotuberous and sacrospinous ligaments
Prevents rotation
- Limits excessive posterior rotation
Interosseous Membranes (Anterior/Posterior SI)
- Prevents flaring
- Anterior SI prevents ASIS outflare
- Posterior SI prevents ASIS inflare
Iliolumbar Ligaments
- Anterior ilial rotation = pulls L4
- Posterior ilial rotation = pulls L5
Pelvic joint locks up…(results)
…other movable areas move more to compensate
Male vs. Female = Males are…
- Sturdier
- Pubic symphysis is taller
- Ischial tuberosities less far apart
- Iliac wings less flared
Male vs. Female (Sacral surface, stability)
- Females = S1-S2
- Males = S1-S3
- Greater surface area = more stability
Sacrum (Joint Types)
- Sacrum lined with Hyaline cartilage (synovial)
- Ilium lined with Fibrocartilage (Amphiarthrodial)
- Sacrum also lined with ligaments (synarthrodial)
- Cornerstone of pelvic girdle = wider anterior and narrow posterior
Transverse Axis Movement
- Really movement of sacrum around frontal axis
- Refers to flexion/extension motion of sacrum
Nutation of sacrum
- Resting position is 30˚
- Sacrum nods forward (flex)
- Anterior and inferior
- Back moves into increased lordosis (extension)
Counter nutation of sacrum
- Sacrum nods backward (extension)
- Posterior and Superior
- Back moves into decreased lordosis (flexion)
Nutation-Counter nutation relationship
Inverse relationship between spine and pelvis
Muscles that move the pelvis
- Erector Spinae = Anterior Tilters
- Abdominals = Posterior Tilters
- QL/Obliques = HIp Hikers/Lateral Tilters
- Multifidi = Nutators
- Piriformis = Counter Nutators
Piriformis
O: Anterior aspect of sacrum at S1-S2
I: Superior aspect of the greater trochanter
A: Lateral rotation, UL = contralateral rotator of sacrum, BL = counter nutation of sacrum
N: Nerve to the piriformis
***Beyond 90˚, piriformis becomes internal rotator (see piriformis stretch)
Multifidi (re: sacrum and nutation)
- Forms into one big muscle chunk at L3; anchors to posterior proximal aspect of sacrum
- Becomes sacral nutator when multifidi contracts bilaterally (pulls sacrum anteriorly)
Sciatic Nerve
- Emerges directly under piriformis and above superior gemellus
- Impingement = sciatica
- If SN comes through piriformis = piriformis syndrome
Ilial Movements
- Primary: Anterior/Posterior Rotation
- Accessory: Superior/Inferior (upslip/downslip); ER/IR (inflare/outflare)
- Displacement will be greater anteriorly than posteriorly
Evaluation of SI Joint (Test for Position)
- Iliac Crest Height
- Trochanter Height
- ASIS/PSIS positions
- Gluteal mass
- Pelvic inclination (Normal is 8-10˚)
- Pubic position
Evaluation of SI Joint (Test for Mobility)
- Forward Bend Test
- Gillet’s Test
Forward Bend Test
Side that moves first and most is dysfunctional
GIllet’s Test
Dysfunctional PSIS will rise, not drop down
