Pelvis Flashcards
- pelvic floor innervation
Pudendal nerve
- From portions of the S2–4
levator ani muscles innervation
levator ani nerve, originating from the S3–5 foramina
Osteitis condensans ilii
non-inflammatory condition characterized by sclerotic bone lesions affecting the iliac surfaces of the SIJs
- Different from axSpA, no joint space narrowing or eventual joint ankylosis
impairment-based approach is recommended
Assessment for pregnancy related pelvic girdle pain
- resisted hip adduction test (performed with a hand-held dynamometer at the medial aspect of the knee with patient in a hook lying position being asking to squeeze the device),
- standard lunge
- ASLR test
- pain on palpation of the long dorsal SIJ ligament
- Planks variation for highest lumbar paraspinal activity:
side planks on feet
- Planks variation for less lat involvement
on knees have less Lat activation and agood variation for those who dont tolerate plank
Plank variation for maximum glute med activation
Side plank
- Maximum glute max activation with TRA activation exercise :
Bird dog
Recommendation for exercise and education for pregnancy
exercise alone or in combination with education was effective for preventing LBP; however, no other tool such as education, stabilization belt, etc was successful by itself
Treatments rec’d for PR PGP
Manual therapy, exercise, stability belt
Stability belts for SI pain, how do they help
Stabilization belts
- shown to increase stability of the joint due to decreased biceps femoris muscle activity and decrease activation time of the gluteus maximus muscle
Manual therapy recs as treatment for PR PGP
- C evidence for high-velocity, low amplitude manipulations
- enhancing nutation of the sacrum
for posterior mobilization on the ilium (relative anterior movement of the sacrum)- Mobilize the sacrum anteriorly (relative posterior ilium movement)
- If this does not relive pain, moving the sacrum posteriorly can be considered
- If still no relief, then use of a pelvic stabilization belt may help to modulate pain can be considered
Exercise prescription for non specific SIJ pain
Exercise
-stabilization exercises are not more effective than any other form of exercise
- gluteus maximus muscle has been found to increase force closure of the SIJ
- Highest levels of gluteus maximus muscle activation
- Step-up
- followed by several loaded exercises and their variations, such as deadlifts, hip thrusts, lunges, and squats
Central Nociplastic Pelvic Girdle Pain treatment
Manual therapy
Education; sleep, nutrition, graded exposure
TENS 1-10hz
steps per day had significantly lower all-cause mortality
taking 8000 or more
common area of tenderness in peripartum females
- long dorsal SIJ ligament
- most superficial SIJ ligament
- common area of tenderness in peripartum females
- palpable just inferior to the PSIS
- Physical Activity Guidelines for Americans
- recommend 150 to 300 minutes of moderate intensity
- 75 to 150 minutes of vigorous intensity exercise weekly for adult
sacrotuberous ligament soft tissue connections
-Sacrotuberous has direct integration with the lumbar extensors, piriformis, gluteus maximus, and the biceps femoris
blends with the long dorsal (posterior) SIJ ligament
- inserts at the inferior aspect of the ischial tuberosity
- connected directly to the biceps femoris, and at times can be completely fused to the muscle
- direct integration with the lumbar extensors, piriformis, gluteus maximus, and the biceps femoris
does SIJ joint movement decrease or increase in those with pain
neither
sacral nutation tends to occur with transfers from supine to sitting or standing, and that SIJ movement does not differ between symptomatic and asymptomatic sides
normal: SIJ movement decreases as joint load increases.
SIJ hypermobility or hypomobility shouldn’t guide Dx, or be provided as education
Fortin area =
Finger Ponting size to inferior to the PSIS
Location of TRUE SI joint pain, although SI joint can refer to
Outcome tool for those with complex histories where psychological, social, and biophysical factors, comorbidities, and altered pain processing impact both the pain experience and the associated self-reported disability
OSPROYF
Optimal Screening for Prediction of Referral and Outcome-Yellow Flag
Multidimensional yellow flag assessment tool is inclusive of both vulnerability and resilience factors for application in orthopaedic physical therapy clinical practice
Before considering pelvic girdle pain (PGP) what should be ruled out
Diagnosis of PGP can be reached after exclusion of the lumbar spine and hip joint as a source of symptoms
Utility of of clinical tests for SI pain and gold standard diagnostic
tissue sensitization provoke symptoms and does not always imply structural fault
Reproduction of pain at least 3/6+
Thigh thrust, compression, distraction, sacral thrust, Gaenslen right, Gaenslen left)
Or any 2 of 4 selected tests:
Thigh thrust, compression, distraction, sacral thrust
found when using Intra-articular anesthetic block injections are the gold standard
Axial spondyloarthritis
inflammatory diseases that affect the spine and are often associated with additional extra-articular conditions (perhaps tendonitis or inflamation elsewhere to rule up systemic)
can progress to ankylosing spondy
Eye irrtation
Gut irrtation
Long lasting symptoms, esp in butt
Joint and pine stiffness
UNDER 40
Tx: extension based exercise, cardio and HITT for symptom mgmt and QoL
will have elevated ESR values an managed with NSAIDS
4 types of PGP
Specific pelvic girdle pathology (AS types, Fxs, OCI)
Pregnancy related pelvic girdle pain Nonspecific pelvic girdle pain
Nociplastic pelvic girdle pain
Types of Pregnancy related pelvic girdle pain
- pelvic girdle syndrome
- symphysiolysis
- one-sided sacroiliac syndrome
- double-sided sacroiliac syndrome
- miscellaneous.
pelvic girdle syndrome description
- Pain in both SIJ areas as well as in the symphysis pubis.
- Test: FABER and thigh thrust
One-sided sacroiliac syndrome vs Double-sided sacroiliac syndrome
PR PGP
Pain from one SIJ confirmed by thigh thrust to the symptomatic side.
- Double-sided sacroiliac syndrome:
Pain in both SIJs with pain being reproduced by the thigh thrust test applied bilaterally.
-Symphysiolysis
- pain in the symphysis pubis
- Test: palpation of the symphysis pubis and reproduction of pelvic pain with the Trendelenburg test
miscellaneous PR- PGP examples
daily pain in 1 or more pelvic joints with inconsistent findings from clinical examination
Attachemtns to sacrotuberous ligament
Thoracolumbar fascia, such as the latissimus dorsi, gluteus medius, and transverse abdominis muscles
Nonspecific Pelvic Girdle Pain
can look like LBP but shouldnt be irritated with Lumbar ROM
- Positive findings on 3 of the 5 following tests:
- distraction, compression, thigh thrust, Gaenslen, and sacral thrust
Active straight leg raise
Active straight leg raise on both sides and rated on a 0-5 scale of difficulty (0 = not difficult at all, 5 = unable).
- strongest predictor of a higher ODI score at 1-year post-partum
- ASLR test score greater than 0 had a significantly higher DRI score
- greater difficulty with the ASLR test during pregnancy was associated with lower post-partum health-related quality of life scores
