Final - Clinical conditions of the pelvis Flashcards
3 causes of pelvic dysfunction
- Direct trauma
- Indirect Trauma: traumatic force that is transferred to the pelvis via related bony structures
- Pregnancy/Menses: ligamentous laxity and anterior weight gain
Causes of sacroiliac sprain
- direct or indirect trauma
- fall on the ischial tuberosity, bumping down stairs, awkward twist and reach, pregnancy
Signs and symptoms of sacroiliac sprain
- may have had pain for a relatively long period of time
- localized pain over SIJ
- pain may be referred, typically to groin and posterior thigh, and less often to leg; pain can be in lower abdomen
- May radiate over lateral aspect of greater trochanter and down the front of the thigh
- increased pain with lying on affected side
Treatment for SIJ Sprain
- acute phase: rest, positional instruction, pain relief, normalize pelvic mobility, mobilizations for pain
- sub acute and beyond: add stability exercises and progress functional activities
Cause of SIJ hypermobility
repetitive minor trauma, one legged standing, sexual intercourse, pregnancy, childbirth
signs and symptoms of sacroiliac hypermobility
- dull ache (may worsen w/ posterior rotation)
- may have anterior hip pain
- pain or difficulty wit asymmetric activities
- sit to stand and walking may increase symptoms
Clinical Findings of sacroiliac hypermobility
- asymmetric mobility of the iliosacral and/or sacroiliac; asymmetric pelvic landmarks
- dysfunction which may or may not change
- tenderness
- soft tissue swelling
- increased muscle tone (glutes, piriformis, lumbar paraspinals)
- trunk weakness
- possible flexibility deficit
Sacroiliac Hypermobility Treatment
- muscle energy techniques
- education on modified activity: avoiding positions that exacerbate the symptoms (acute)
- SI belt
- strengthening of weak structures/ core stabilization
- lengthen/stretch tight structures
- neuromuscular re-education
- positional instruction
- patient education
Cause of sacroiliac hypomobility
- part of the normal aging process
- may be due to overuse with positions that stress the SIJ causing accelerated degeneration of the joint
signs and symptoms of sacroiliac hypomobility
- pain is typically felt on one side of the low back or buttocks
- can radiate down the leg –> typically above the knee but can go down to ankle/foot at times
treatment for sacroiliac hypomobility
manipulation
mobilization
what causes sacroiliac displacement
- excessive hypermobility leading to actual joint surface displacement
- severe force to joint
- possible rupture of pubic symphysis
signs and symptoms of sacroiliac displacement
- pelvic dysfunction which may change
- positive SI tests with pain
Treatment for sacroiliac displacement
- manipulation to reduce the lesion
- SI belt
- patient education on positioning
- stabilization/ strengthening exercises
Causes of degenerative changes to the SIJ
OA
- age >45
- female > male
- certain hereditary conditions such as defective cartilage and joint deformity
- joint injuries caused by sports, work-related activities, accidents
- obesity
signs and symptoms of degenerative changes of SIJ
- Swelling/tenderness at SIJ
- intermittent pain- usually better with movement
- loss of flexibility
- C/o stiffness
treatment for degenerative changes of SIJ
- pain control
- therapeutic exercises for stability and flexibility
- weight control
- cortisone injections
- extreme cases = surgery
What is Ankylosing Spondylosis?
- Disruption of the ligamentous-osseous junction that results in reactive bone formation as part of the repair process
- progressive ossification leads to fused SI then spine
what is the most common systemic condition that affects the SIJ?
ankylosing spondylosis
What are the symptoms of ankylosing spondylosis?
- may complain of insidious onset
- SIJ and lower lumbar pain, aching, morning stiffness that may last more than one hour
What is the role of PT in Ankylosing Spondylosis?
- Postural instruction and strengthening to minimize development of increased t/s kyphosis
- Breathing exercises
What is Reiter’s Syndrome?
- AKA reactive arthritis
- Arthritis occurs as a reaction to an infection that started elsewhere in the body
Where does infection that leads to Reiter’s Syndrome typically begin?
Genitourinary tract
spreads and embeds itself in SI
Signs and symptoms of Reiter’s Syndrome
- Swelling, redness, heat, and pain at SIJ
