Pelvic girdle physical examination Flashcards
describe the normal biomechanics of the Pelvis during hip flexion
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
describe how the gillet test/standing hip flexion test is conducted
patient standing
palpate inferior aspect PSIS on one hand
palpate S2 spinous process on other hand
examiner should feel PSIS move inferiorly
explain the normal biomechanics of standing hip extension test
ipsilateral PSIS - moves superior
Anterior innominate rotn = sacrum counternutates
explain the normal biomechanics of standing hip extension test
ipsilateral PSIS - moves superior
Anterior innominate rotn = sacrum counternutates
possible pain provocation tests for pelvis
SIJ Gapping test
SIJ compression test
Gaenslens test
posterior shear test
what would a positive Gillet test present as and what would it indicate
no moving of the inferior aspect of PSIS inferiorly - indicate hypomobility
purpose of compression test
pushes anterior innominate apart
tests sprain on sacroiliac joint and ligaments
how to conduct compression test
patient supine or side lying. Push right and left
ASIS (anterior superior iliac spine) towards each other.
positive sign of compression test
reproduction of symptoms
how is gaenslen test conducted
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.
what is a positive sign of gaenslen test
reproduce symptoms
purpose of gaenslen test
indicates the presence or absence SIJ lesion,
pubic symphysis instability
hip pathology
L4 nerve root lesion
can stress femoral nerve
how is the gapping test conducted
patient supine. Push right and left ASIS apart.
push anterior innominates together
purpose of gapping test
takes pressure off anterior side of SIJ and compress posterior side of SIJ
what is the purpose of supine to long sit test
limb length discrepency
how is the supine to long sit test conducted
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
describe posterior shear test
patient in supine
passively flex hip
compress contralateral anterior innominate
compress knee in direction of plinth both hands if necessary
purpose of posterior shear test
assess pain originating from SIJ
Treatment options to treat hypomobility
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
treatment options of hypermobility
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)
how would pelvic asymmetry
Muscle Energy Techniques
how are muscle energy techniques used to correct anterior innominate rotation
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.
how are muscle energy techniques used to correct posterior innominate rotation
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.
