Pelvic and SI Dysfunction Flashcards
3 Functions of the SI joint
- Transfer load from trunk to legs
- Absorb LE motion/forces
- Dissipate force before it reaches the L-spine
3 Parts of the Osseous ring
- Ilium
- Sacrum
- Pubis
Term: Inter-related movement between the lumbar and pelvic joints
Lumbopelvic rhythm
Term: L4-S1
Lumbosacral Junction
Facets L5-S1
- Orientation
- Function
- Coupling
- Frontal/Caudal (the rest of the L-spine in sagittal plane)
- WB (on base of sacrum)
- SAME direction
Structure: Attached from L4/L5 TP to iliac crest and restricts lumbopelvic motion
Iliolumbar ligament
Portion of Iliolumbar Ligament: Tight with flexion
Posterior
Portion of Iliolumbar Ligament: Tight with extension
Anterior
Portion of Iliolumbar Ligament: Tight with rotation and SB
Superior
Structure: Blends into quadratus lumborum
Iliolumbar ligament
2 Features that add stability to the sacrum
- Triangle shape
- Ridges and depressions
Joint Type: Anterior SI joint
Diarthrodial (synovial)
Joint type: Posterior SI Joint
Syndesmosis
2 Types of articulating surfaces in the SI joint
- Sacral surface covered in hyaline cartilage
- Iliac surface covered in fibrocartilage
4 Characteristics providing stabilty to the SI Joint
- 2 joint types in one capsule
- 2 types of cartilage prevent gliding
- Irregular joint surfaces add friction
- Extensive ligaments surrounding joint
Structure: Sacral surface/vertical plane level with S1
Short Arm of the Sacrum
Structure: sacral surface/AP plane level with S2 to S4
Long Arm of the Sacrum
Term: Sacrum moving on ilium
Sacroiliac motion
Term: Innominate moving on the sacrum
Iliosacral motion
Term: Innominate
Ilium
Term: Lumbar motion
Sacroiliac motion
Term: Flexion of the sacrum
Nutation
Term: Sacrum moving anterior and inferior
Nutation
Term: Extension of the sacrum
Counternutation
Term: Sacrum moving superior and posterior
Counternutation
Term: Unilateral nutation and counternutation
Sacral Axial rotation
Axis: Axial rotation
Hypothetical oblique axis
Left oblique = right side moving
Right oblique = left side moving
Term: Hip motion
Iliosacral motion
Term: ASIS inferior, PSIS superior
Anterior rotation
Term: ASIS superior, PSIS inferior
Posterior Rotation
Functional Biomechanics: Trunk forward bend
Sacrum nutates, then counternutates
Innominates rotate anteriorly
Functional Biomechanics: Trunk backward bending
Sacrum nutates/counternutates/remains relatively stable
Innominates rotate posteriorly
Functional Biomechanics: Hip flexion
Sacrum nutates
Unilateral innominate posterior rotation
Functional Biomechanics: Hip extension
Sacrum counternutates
Unilateral innominate anterior rotation
Term: Passive stability of bones, joints, and ligaments
Form closure
Term: Active/dynamic stability of muscle, fascia, or motor control
Force closure
Structure: Blends into biceps femoris and gluteus medius
Sacrotuberous ligament
4 (Local) Muscles of the Pelvic Girdle Inner Tube
- TA
- Multifidus
- Diaphragm
- Pelvic floor
4 (Global) Muscles of the Pelvic Girdle Outer Tube Longitudinal System
- Erector spinae
- T/L Fascia
- Biceps femoris
- Sacrotuberous ligament
4 (Global) Muscles of the Pelvic Girdle Outer Tube Anterior Oblique System
- Internal obliques
- External obliques
- Abdominal fascia
- Contralateral adductors
3 (Global) Muscles of the Pelvic Girdle Outer Tube Posterior Oblique System
- Latissimus dorsi
- Contralateral gluteus maximus
- T/L fascia
Term: Systems that compress the SI joint
Outer tube oblique systems
3 (Global) Muscles of the Pelvic Girdle Outer Tube Lateral System
- Gluteus medius
- Gluteus minimus
- Contralateral adductors
Term: System the copresses the SI joint, prevents shearing in SB, and aids in load transfer
Outer Tube Lateral System
2 Muscles that attached directly to the sacrum
- Piriformis
- Biceps femoris
Structure: When tight rotates the sacrum
Piriformis
Structure: When tight counternutates the sacrum
Biceps femoris/HS
Condition: MOI can include trauma, pregnancy, chronic L/S or hip problems, pelvic floor dysfunction
SI Joint dysfunction
Condition: Body chart can include unilateral pain, buttock pain, LBP, or posterior leg pain to knee
SI Joint Dysfunction
Condition: Aggravating Factors
- WB activities: standing, single leg stance, hopping, running
- Ascending/descending staris
- Pain with change of position: sit to stand, moving in bed
SI Joint Dysfunction
Term: Most reliable predictor of SI joint dysfunction
Pain provocation tests
3/5 + has modest predictive power
2 mobility tests that assess SI motion
- Lumbar flexion
- Lumbar extension
2 mobility tests that assess IS motion
- Gillet flexion
- Hip extension
Describe how sacral dysfunction is named
Named after directio nof rotation and direction of axis
Condition:
- Difficulty with activities requiring posterior rotation
- ASIS anterior and inferior
- PSIS superior
- Functionally long leg
- Decreased hip flex and posterior rotation
Anteriorly Rotated Ilium
Condition:
- Difficulty with activities requiring anterior rotation
- ASIS posterior and superior
- PSIS inferior
- Functionally short leg
- Decreased hip extension and anterior rotation
Posteriorly rotated ilium
Condition:
- Entire ilium higher
- ASIS/PSIS superior
- May have decreased anterior/posterior rotation
- Decreased hip ABD strength
Upslip
Condition: ASIS more medial and PSIS more lateral
Inflare
Condition: ASIS more lateral and PSIS more medial
Outflare
MET: Correction of ilial anterior rotation
Isometric gluteal(/HS) contraction
MET: Correction of ilial posterior rotation
Isometric hip flexion contraction
CPR to Predict success of lumbopelvic manipulation
- < 18 on fear avoidance
- sx < 15 days
- No sx distal to knee
- L-spine hypomobility at any level
- Either hip with > 35 degree IR
Condition:
- Pain with change in position
- Deep shift/clunk
- Difficulty with WB activities
- Positive stability tests
- Active SLR +
- Pain provocation +/-
Hypermobile Pelvic Girdle
