Pelvic girdle physical examination

Question 1

describe the normal biomechanics of the Pelvis during hip flexion

Answer 1

pelvis rotate the inominate in a posterior direction
ipsilateral - PSIS moves inferiorly and laterally
contralateral - (SACRUM MOVING ON OPPOSITE ILIUM
sacral nutation - anterior sacral-on-iliac rotation

Question 2

describe how the gillet test/standing hip flexion test is conducted

Answer 2

patient standing
palpate inferior aspect PSIS on one hand
palpate S2 spinous process on other hand
examiner should feel PSIS move inferiorly

Question 3

explain the normal biomechanics of standing hip extension test

Answer 3

ipsilateral PSIS - moves superior
Anterior innominate rotn = sacrum counternutates

Question 3

explain the normal biomechanics of standing hip extension test

Answer 3

ipsilateral PSIS - moves superior
Anterior innominate rotn = sacrum counternutates

Question 4

possible pain provocation tests for pelvis

Answer 4

SIJ Gapping test
SIJ compression test
Gaenslens test
posterior shear test

Question 5

what would a positive Gillet test present as and what would it indicate

Answer 5

no moving of the inferior aspect of PSIS inferiorly - indicate hypomobility

Question 6

purpose of compression test

Answer 6

pushes anterior innominate apart
tests sprain on sacroiliac joint and ligaments

Question 7

how to conduct compression test

Answer 7

patient supine or side lying. Push right and left
ASIS (anterior superior iliac spine) towards each other.

Question 8

positive sign of compression test

Answer 8

reproduction of symptoms

Question 9

how is gaenslen test conducted

Answer 9

patient supine with leg hanging over side of plinth.
Patient hugs contralateral knee to chest. Place one hand above knee of extended leg and other hand over knee of flexed leg. Apply an opposing force to each leg simultaneously.

Question 10

what is a positive sign of gaenslen test

Answer 10

reproduce symptoms

Question 11

purpose of gaenslen test

Answer 11

indicates the presence or absence SIJ lesion,
pubic symphysis instability
hip pathology
L4 nerve root lesion
can stress femoral nerve

Question 12

how is the gapping test conducted

Answer 12

patient supine. Push right and left ASIS apart.
push anterior innominates together

Question 13

purpose of gapping test

Answer 13

takes pressure off anterior side of SIJ and compress posterior side of SIJ

Question 14

what is the purpose of supine to long sit test

Answer 14

limb length discrepency

Question 15

how is the supine to long sit test conducted

Answer 15

patient in supine
have the feet fully exposed to show the medial malleoli
grasp foot blace thumbs below medial malleolus instruct patient to sit up

Question 16

describe posterior shear test

Answer 16

patient in supine
passively flex hip
compress contralateral anterior innominate
compress knee in direction of plinth both hands if necessary

Question 17

purpose of posterior shear test

Answer 17

assess pain originating from SIJ

Question 18

Treatment options to treat hypomobility

Answer 18

Passive Physiological Movements: in neutral or end range - Sacral Nutation via Posterior Innominate rotation in sidelying: via ASIS & ischial tuberosity
Sacral Counternutation via Anterior Innominate rotation in prone: via PSIS & ASIS / leg hold
Accessory Movements:
AP through ASIS (palm) – Graded I – IV
PA through PSIS (pisiform – same hand position as lumbar PA) – Graded I – IV
PA through sacrum (upper / lower) – same hand position as lumbar PA

Question 19

treatment options of hypermobility

Answer 19

Aim to stabilise Pelvic ring
Passively (Form closure): using Serola SIJ belt (see image) – be guided by Active SLR results and pain irritability
Actively (Force closure): Stabilisation exercises (Transversus Abdominis – see lumbar spine) & anti-gravity muscle exercises (gluteals)

Question 20

how would pelvic asymmetry

Answer 20

Muscle Energy Techniques

Question 21

how are muscle energy techniques used to correct anterior innominate rotation

Answer 21

patient in supine
Flex patient’s hip and knee up and out towards axilla.
Lean your ipsilateral shoulder on their knee and brace yourself in stride stance while holding table edge.
Instruct the patient to attempt to push their knee into your shoulder, via hip extension not knee extension,
block all movement with your counter pressure
Hold for 6 secs and bring their hip up to the new motion barrier of flexion.
Repeat 6 times.

Question 22

how are muscle energy techniques used to correct posterior innominate rotation

Answer 22

patient in prone
Stand on contralateral side of the table and hold distal thigh, under knee.
Other hand promotes anterior rotation from PSIS, during MET.
Extend their hip until you meet resistance and ask patient to attempt pulling knee back down towards bed, at this point of resistance, blocking all unwanted movement with your counter pressure.
Hold for 6 secs before bringing their hip to new motion barrier of hip extension.
Repeat 6 times.