Pelvic Girdle Flashcards
What are big ligaments in the pelvis (anterior and posterior views)?
Iliolumbar, anterior sacroiliac, sacrospinous, and sacrotuberous ligaments
Posterior view: iliolumbar, posterior sacroiliac, dorsal sacroiliac, sacrotuberous, sacrospinous
What muscles are in layer one of the pelvic floor musculature?
Bulbospongiosus, ischiocavernosus, superficial transverse perineal
What muscles are in layer 2 of pelvic floor musculature?
Sphincter urethrae, compressor urethrae, deep transverse perineal
What muscles are in layer 3 of pelvic musculature?
Iliococcygeus, puborectalis, pubococcygeus (elevator ani)
What are last two muscles of pelvic floor muscles?
Coccygeus and obturator internus
What is posterior musculature of the pelvis?
Gluteus max, med, min Pisiformis Obturator internus and externus Quadratus femoris Adductor magnus, long us Hamstrings Gemelli
What is anterior musculature of the pelvis?
Psoas Iliacus RA External/internal obliques TA Adductor longus/brevis Gracilis TFL
What are the “core” muscles?
Pelvic floor
TA
Multifidus
Diaphragm
What is importance of the “core” muscles?
Control intra-abdominal pressure
Important for proper body mechanics, breathing, and voiding
What is function of pelvic floor muscles?
Supportive: helps support organs and forms bottom of the core
Sphincteric: controls openings of urethra, rectum, and vagina
Sexual: orgasms, arousal, and relaxation
Stability: assist in stability of SI, pubic symphysis, lumbosacral, and hip joints
Sump-pump: venous, lymphatic pump
What are joint characteristics of the SI joint?
Synovial, hyaline cartilage on sacral side, fibrous cartilage on ilial side, fibrous/synovial joint capsule, L shaped
What are bones of the pelvic girdle?
Bony pelvis, sacrum, spine, two femur bones
What are the sacral biomechanics?
It is self locking Greater the WBing tighter it's held Moves in sagittal plane mostly, but can move in all 3 planes Moves as effect of hip and lumbar mvmt Somewhere between 2-12 degrees
What happens in nutation?
Transverse axis Base moves inferiorly and anteriorly Apex and coccyx moves superiorly and posteriorly Ilia rotate in Ischial tuberosities separate Lumbar spine extends
What happens in counternutation?
transverse axis
Base moves superiorly and posteriorly
Apex and coccyx move inferiorly and anteriorly
Lumbar spine flexes
What is innominate movement?
Ant-post direction together or opposite
Frontal plane motion around sacrum
Bicondylar joints; one can move anterior while other goes posterior (still meets rule of bicondylar joints)
What is anatomy and biomechanics of pubic symphysis joint?
Not synovial
Cartilagenous
Moves very little: 1-2 mm
What is biomechanics of pelvis during gait?
Swing phase (L): sacrum rotates R and lumbar spine rotates opposite Heel strike (L): L piriformis contracts, sacrum rot L Pubis moves cephally at heel strike on same side
What contributes to stability of SI joint?
Force and Form Closure
How is force closure achieved?
neuromuscular control
TrA, Multifidus, pelvic floor, and diaphragm
Anticipates movement
What is a good way to test force closure?
single leg stance, ASLR
How is form closure achieved?
ligamentous support, wedge shape/design of joint and weight bearing forces
What are dysfunctions of pelvic floor musculature?
Weakness
Hypertonus
What does weakness of pelvic floor muscles lead too?
incontinence, LBP, joint instability, prolapse, pelvic congestion, muscle imbalance
What does hypertonus of pelvic floor muscles lead to?
pelvic and low back pain, sacroiliac and hip imbalances, incontinence, voiding dysfunctions, constipation, pelvic congestion
What is clinical presentation of core muscle weakness?
Leaking urine (with sneeze, cough, activity, strong urge)
Voiding dysfunction (weak stream, hesitant stream, stops midstream, not empty completely, going too frequently)
Heavy feeling in perineum or abdomen
Pelvic, LB, SIJ, Hip pain
Poor posture
Poor force closure of SIJ, poor stability of lumbosacral region
Someone walks into your clinic and reports leaking urine, problems with going to the restroom, and heavy feeling in abdomen. You also notice they have poor posture. What might be their diagnosis?
Core muscle weakness
What are risk factors for core muscle weakness?
Pregnancy and child birth Persistent heaving lifting Being overweight Changes in hormone levels at menopause Lack of general fitness Chronic or prolonged coughing Pelvic or abdominal surgery Constant stress i.e. young athletes Muscle imbalances
What is clinical presentation for hypertonus dysfunction?
Pain in back, perivaginal, rectal, lower abdomen, coccyx, or posterior thigh
Vulvar or clitoral burning
Testicular, scrotal, penile pain or burning/tingling
Pain with intercourse, defecation, sitting, tampons
Incontinence or voiding dysfunction
Constipation
Poor posture, poor stability of lumbo-sacral region
Overuse of large, global musculature weakness of core system
Hip joint decreased ROM and/or joint play
Someone comes into your clinic and c/o constipation, incontinence, pain in coccyx and rectal area, and scrotal pain. You find they have poor posture and decreased hip ROM. What is possible diagnosis?
Hypertonus of pelvic floor muscles
What are risk factors for hypertonus?
Direct fall on butt, coccyx, or pubic bone
PFM tightening (stress, habit, crossing legs)
Abdominal and pelvic adhesions
Episiotomy or tearing with childbirth
Pelvic, abdominal, hip, or back surgery
Connective tissue disease (fibromyalgia)
History of sexual abuse
STDs, or recurrent perineal infections (yeast)
Muscle imbalances
Pregnancy/childbirth
Treatment for cancer
Where is pelvic girdle pain located and possible factors for it?
Pain in one or more of joints of pelvic girdle: symphysis pubis, lumbosacral joints, sacroiliac joints, hip joints
Possible factors include hormones, biomechanics, trauma, inadequate motor control and stress of ligamentous structures
Do women get pelvic girdle pain?
20% of pregnant women and 5-8% of women post partum experience pelvic girdle pain
Women with PGP show 32-68% more motion in pelvic joints than healthy controls
What is clinical presentation of pelvic girdle pain?
Sudden or insidious onset
Typically 24-36 weeks gestation, post partum
Pain posteriorly at SIJ/gluteal area, symphysis pubis, groin, perineum, posterior thigh
Lack specific nerve root distribution, but often have positive neural tension tests
Difficulty getting up from sitting, rolling in bed, sitting for prolonged periods, prolonged walking, dressing and carrying, climbing stairs, single leg stance
A women comes to your clinic and reports sudden pain in her gluteal area, difficulty sitting/walking for a long time, and walking stairs. She is pregnant. What is a possible diagnosis?
Pelvic girdle pain
