Pelvic Girdle Flashcards
What are the 11 joints that make up Pelvic Girdle?
L4-L5 intervertebral L5-S1 intervertebral L4-L5 facet joints L5-S1 facet joints (R) and (L) SIJ Pubic-symphasis 2 hip joints
True Pelvic Girdle made up of:
2 SIJs
1 PS
Innominate formed by?
fusion of ilium, ischium, and pubis
Anterior Ilial Rotation
5 degrees
ASIS moves anterior and inferior
PSIS moves superiorly
Occurs during hip extension
Posterior Ilial Rotation
5 degrees
ASIS moves posterior and superior
PSIS moves inferior
Occurs during hip flexion > 90 degrees
Inflare
ASIS moves anterior and medial
PSIS moves anterior and lateral
Outflare
ASIS moves posterior and lateral
PSIS moves posterior and medial
Ilial upslip
superior shear
normally occurs during heel strike
Ilial downslip
inferior shear
return from upslip during swing phase gait
Ilial upslip Injury
Ilium is forced into upslip it will move into either
Upslip with anterior rotation
Upslip with posterior rotation
To realign manipulate with leg pull–correct upslip first.
How to notice an upslip?
ASIS look level–it takes a 2cm difference to be worried for PSIS to be uneven= anterior rotation upslip
ASIS uneven, PSIS are level for posterior rotation upslip
Posterior pull leg in supine; Anterior pull leg in prone
Sacral Flexion (Nutation)
base moves anterior and inferior
occurs during initiation of spinal extension, exhalation, and completion of spinal flexion
*will feel thumbs on PSIS go in when person extends
Sacral Extension (counternutation)
base moves posterior
early spinal flexion
inhalation
Sacral Rotation
(R) and (L) rotation around a (R)/(L) oblique axis
SB (R)- sacrum rotates (L)
Think of it as the L6 vertebra…SB (R) it will rotate (L). SB (R) (R) thumb on PSIS should go forward.
Treatment of rotated sacrum
Stuck in right rotation= unable to left rotate. Sacral sulcus test reveals that the right joint is not moving. Treat by using isometric contraction of right pirifomis
Stuck in right rotation= unable to rotate left. Sacral sulcus test reveals that the left joint isn’t moving. Treat by contracting the left multifidi.
Anterior Sacroiliac ligament
runs from sacrum to ilium laterally and inferiorly
reinforced by ilio-lumbar ligament
stressed during ilial outflare, hyper hip ER
taut in hip flexion and ilial ER
Ilio-lumbar
Attaches from TP of L4 and L5 to ilium
Checks posterior ilial rotation and contralateral lumbar SB and rotation
taut in post. rotation, can help prevent lateral shift
Short Posterior SI ligament
runs from PSIS promentory to the sacrum. Limits all ilial motion on sacrum mainly anterior ilial rotation
tender with SI malalignment
Long Posterior SI ligament
runs from the inferior margin of PSIS to lower 1/2 sacrum
checks anterior ilial rotation
Sacrotuberus
runs from the ischial tuberosity to distal 1/3 sacrum
checks: sacral flexion ipsilateral sacral rotation ilial posterior rotation becomes taut when biceps femoris is stretched
Sacrospinous
deep to sacrotuberous (cannot palpate)
Pelvic Girdles need for load transfer
Mobility-ilium moves on sacrum AROM hip in OC and sacrum on ilium in spine flexion, extension, SB, and ROT
Stability- static and dynamic stabilizers
Self locked/closed pack position of SIJs
full posterior innominate rotation=ideal position for loading tasks
sacral (nutation) during active flexion and extension of the spine the sacrum nutates (flexes)
Form Closure-static stabilizers
ability to transfer loads through the PG, while keeping joint surfaces stable.
Dynamic Stability-force closure
Optimal muscle fxn provides PG with dynamic stability=force closure
Local muscle system
Pelvic floor muscles
Diaphragm
Transverse Abdominus
Lumbo-sacral multifidi
Global muscle system
Opposite Latissimus dorsi and glut max
abdominal obliques and adductors
glut med in weight bearing
Diaphragm-local PG
the roof, provides stability by increasing intra-abdominal pressure
Pelvic floor muscles-local PG
need to activate for PG stabilization and bladder control. Co-activated with TA contraction
Multifidi and TA-Local PG
both put tension on the thoraco-dorsal fascia creating a corset of support for the LB and PG—circle of integrity
Posterior Oblique Sling
aides in force closure
(L) lats with (R) glut max and intervening thoracodorsal fascia
Anterior Oblique Sling
External Oblique and opposite internal oblique and opposite adductor of thigh and intervening abdominal fascia
Lateral Sling
Stabilizes body in frontal plane in single limb support
Keeps pelvis level–prevents ilial upslip
Stance leg glut med and adductors and opposite side Quad Lumb
Glute Med in single limb stance
keeps pelvis level, prevents trendelenberg
limits unwanted superior shear or upslip forces of the ilium on sacrum
Role of Biceps femoris for CC and ECC
It is coupled with erector spinae through sacrotub ligament. At end of swing phase hamstrings eccentrically contract to control hip flexion and knee extension.
Contraction of BF pulls sacrotub taut, assists in stabilizing SIJ
Motor Control & PG Fxn
In a healthy back and PG CNS anticipates when muscles need to activate to handle an oncoming load and muscle fire before the load or required motion occurs.
Integrated model of function
Form Closures-Bones, Jts, Ligs
Force Closure-Muscle, Fascia
Motor Control-Neural patterning
Emotions-Awaremess
MOI to PG
LLD Superior shearing force-causes innominate upslip weak lateral sling and jump landing hormonal influence-relaxin systemic hypermobility
Hyperabduction force to hip
Separation force to PS
Hyperflexion force of hip
excessive posterior ilial rotation, stresses sacrotub and ilio-lumbar ligs
Hyperextension force of hip
excessive anterior rotation of ilium, stresses short and long SI ligs
Hyper ER of hip
possible damage to anterior SI ligament and possible PS separation
Common PG S&S
Local SI joint pain and tender palpation
Local PS pain and tender palpation
Unilateral complaint
Pain with stairclimbing, gait, standing, sitting
**Referred pain buttock to posterior thigh with SI involvement
**Referred pain to adductors with PS involvement
Painful palpation of one or more SI ligaments
Painful palpation of hip adductors and lower RA with pubic problem
Active SLR sign
PG Assessment
S&S Posture/LLD Palpate Special tests Core and sling fxn Muscle length ** No one test proves anything in this area of the body mulitple tests showing it will
Restricted SIJ
(+) March and/or flare test
Local ligament tenderness
Referred pain buttock/thigh
(+) pain provocation tests such as Squish
ASIS or PSIS asymmetry
(B) hip ROM asymmetry
(-) hypermobility tests such as ASLR and posterior ilial translation.
Hypermobile PS
MOI=childbirth or forced hip abduction or ER
Hypermobility
Hormonal influences
Poor tolerance to sitting standing or walking
(+) pain over pubic tube, adductors or RA
(+) ASIS gapping test
(+) FABER
Hypermobile SIJ
Hx of hypermobility
Hormonal influences
Local SIJ pain and referred pain buttock and thigh
Local ligament tenderness
Difficulty holding stable pelvic posture in stork standing
(+) pain on squish, ASIS gapping, FABERs
(+) ASLR
(+) Sidelying posterior ilial translation test
(B) hip ROM asymmetry
PG Treatments
Direct mobilization-upslip correction (leg pull)
Isometric mobilization “muscle energy”
Soft tissue mobilization- massage hypertonic muscles
Lumbopelvic taping/strapping
Core stabilizing-improves force closure
Improve motor control-muscle fire sequencing
deal with emotional compoinent
prolotherapy
Upslip treatment
Upslip with anterior rotation
- Prone leg pull-manipulation
Upslip with posterior rotation
-Supine leg pull-manipulation
Anterior Ilial Rotation
Direct mobilization into posterior rotation
Isometric contraction of gluteus maximus or RA; opposite limb gives a counterforce
Posterior Ilial Rotation
Direct mobilization into anterior rotation
Isometric contraction of hip flexors, hip adductors, opposite limb gives counterforce
Ilial inflare
isometric mobilization using gluteus medius and minimus
Ilial outflare
isometric mobilization using iliacus
Prolotherapy
intraligamentous or intratendinous injection at a fibro-osseous jxn (SI or PS) of a solution induces temporary inflammatory reaction.
How does prolotherapy work?
6-10 treatments at 1-2 week intervals
activity limited
Who is a candidate for prolo?
patient with disabling joint pain and instability that has lasted greater than 6 months
demonstrates significant joint instability
(+) hypermobile tests
cannot tolerate prolonged sitting or standing
