Pelvis and SIJ

Question 1

Signs and symptoms of pelvic dysfxn:

Answer 1

localized pain 
SI displacement
abnormal motor pattern with SI motion
\+ ASLR test
pain with SI provocation
painful to stand on one leg
pain with sitting
pain with sit > stand

Question 2

When descending stairs, how does the SI move?

Answer 2

stance side: anterior to neutral

Question 3

When ascending stairs, how does the SI move?

Answer 3

stance side: posterior rotation

Question 4

SIJ motion at initial contact on R:

Answer 4

R ilium rotates posterior

Question 5

SIJ motion at midstance on R:

Answer 5

R ilium rotates anteriorly but not past neutral

Question 6

SIJ motion at pressing on R:

Answer 6

R ilium rotates anteriorly past neutral

Question 7

Unilateral ilial torsion can be caused by:

Answer 7

trauma
hormonal induced laxity
overuse

Question 8

Unilateral ilial torsion is demonstrated by:

Answer 8

asymmetry of ASIS and PSIS

Question 9

Describe normal lumbopelvic rhythm:

Answer 9

hips, pelvis, and l-spine

in flexion: 70 degrees hips, 40 degrees l-spine

Question 10

Describe how the multifidus stabilizes the sacrum/SIJ:

Answer 10

co-contraction with transversus and pelvic floor muscles

Question 11

Define Upslip:

Answer 11

One ilia has higher ASIS and PSIS

can occur with upward jar to leg

Question 12

Define Downslip:

Answer 12

One ilia has lower ASIS and PSIS

can occur with childbirth

Question 13

Need to differentiate ilial upslips and downslips from:

Answer 13

LLD

Question 14

What is an ilial inflare?

Answer 14

ASIS on one side is closer to midline than the other

Question 15

What is an ilial outflare?

Answer 15

ASIS on one side is farther from midline than the other

Question 16

Ilial inflares/outflares are usually secondary to:

Answer 16

ant/post torsion

unlikely to see true inflares/outflares

Question 17

Pubic ramus upslip/downslip may be associated with

Answer 17

ilial torsion

Question 18

Pubic ramus downslip may be associated with

Answer 18

childbirth

Question 19

Sprain of SI ligaments is usually a result of:

Answer 19

acute injury secondary to trauma

Question 20

Spymphyseal strains are usually related to:

Answer 20

inflammation secondary to mechanical stress

may be seen with pregnancy due to weight of fetus on pubis

Question 21

Osteotis Pubis = symphysitis; usually related to:

Answer 21

overuse injury secondary to repetitive activities placing strain on pubic symphysis
(running, kicking, abdominal sit-ups)

Question 22

Pubic symphysis diastasis is treated conservatively with ____ mm gap.

Answer 22

< 25 mm

Question 23

____ mm gap is called pubic symphysis diastasis.

Answer 23

> 13 mm

Question 24

Normal pubic symphesis gap is:

Answer 24

4 mm

Question 25

What is the normal amount of gapping with pregnancy?

Answer 25

increases by 2-3 mm

Question 26

Define pubic symphysis diastasis:

Answer 26

separation usually during childbirth that creates significant instability (can also happen with trauma)

Question 27

While most pelvis and SIJ conditions are more prevalent in women, what flag should be considered for men?

Answer 27

consider AS 1st sign is often bilateral SI pain unrelated to activity refer to rheumatologist

Question 28

The lumbosacral joint is made up of:

Answer 28

L5-S1 facet joints

Question 29

Describe the composition of the SIJ:

Answer 29

Part synovial and part fibrocartilaginous sacrum: hyaline articular cartilage ilia: fibrocartilage

Question 30

SIJ nerve receptors are located in:

Answer 30

joint capsule and ligaments

Question 31

What level is the sacral axis of motion?

Answer 31

S2

Question 32

Describe nutuation:

Answer 32

sacral flexion base of sacrum tilts forward relative to ilium l-spine extension

Question 33

Describe counternutation:

Answer 33

sacral extension base of sacrum tilts posteriorly relative to ilium l-spine flexion

Question 34

What breath cycle corresponds to nutation and counternutuation?

Answer 34

nutation: exhalation counternutation: inhalation

Question 35

What gravitation forces act on the pelvis?

Answer 35

GFR through LE and hip create posterior and superior sheer Trunk creates sacral nutation moment and inferior sheer stress

Question 36

Passive and dynamic stability elements of the pelvis include:

Answer 36

form closure and force closure

Question 37

Define force closure

Answer 37

dynamic stability from myofascial structures for SIJ

Question 38

Define form closure

Answer 38

passive stability of SIJ from joint surfaces and ligaments

Question 39

The loading force of the body is transmitted through the spine to the sacrum which is wedged between the ilia by:

Answer 39

form closure

Question 40

Compressive forces are needed to resist shear of SIJ surfaces with heavy, abrupt loading and prolonged loading (creep). These forces are provided by:

Answer 40

muscles (force closure) Posteriorly: Lat dorsi, TL fascia, glut. max. and ITB Anteriorly: Obliques, transverse and rectus abdominus

Question 41

How is the CPP of the SIJ obtained?

Answer 41

force closure | Transversus abdominis and obliques pull ilia toward midline