Pelvis region

Question 1

Describe the function of the pelvis:

Answer 1

• hold a central role in coupling btw mechanical force of the lower limb and the axial skeleton.
• support locomotion
• alterations of pelvis function create effect on vertebral function, thoracic-abdominal diaphragm and the urogenital diaphragm and associated functioning.

Question 2

What are the consequences of pelvis dysfunction?

Answer 2

• alterations in the biomedical function of the pelvis girdle can also influence the cervicocranial elements.
• Somatic dysfunction of the pelvis girdle may be causative of mechanical, visceral complaints.
• The pelvis organs function in reproduction and elimination of wastes and is the site of parasympathetic innervation to the left colon and pelvic organs.

Question 3

What is the role of manual medicine?

Answer 3

Ward: restoration of functional symmetry between the arthrodial, vascular, lymphatic and myofascial/ligamentous elements.

Question 4

Named all the ligaments of the pelvis region

Answer 4

• iliolumbar
• supraspinous
• SIJ ant/post
• Sacrospinous
• Sacrotuberous
• Sacro-coccygeal ant/post/lat
• Anterior longitudinal

Question 5

What are the consequences of pubic symphysis dysfunction?

Answer 5

SD of PS or ilioilial mechanics (asymmetry btw innominate) can place asymmetric tensions on pelvic and urogenital diaphragms. Tensions can result in tension myalgia of the pelvic floor, low back pain, dyspareunia, and painful evacuation of the bowel with associated constipation.

Question 6

Why is the pelvis and its muscles and skeletal integrity important ?

Answer 6

Appropriate musculoskeletal performance is necessary for adequate bladder functioning and prostate health in males.
Ward states that tension on the pubovesicular and puboprotatic fascia and pelvic floor mm may produce urinary tracts symptoms such as burning, frequency, fullness and a weak stream.

Question 7

What are the consequences of abdominal dysfunctions on the pelvis?

Answer 7

• may disturb respiratory excursions, compromising the intra-abdominal pressure changes that promote lymphatic and venous return.
• myofascial restrictions in lumbopelvic region may restrict both thoracolumbar and sacral motion and function.

Question 8

What are the consequences of rectus femurs and adductor dysfunction on the pelvis?

Answer 8

• may cause ant rot. of the innominate and inf. shear at the pubes.
• may generate reflex changes at the ipsilateral iliolumbar ligament, while a pubic shear may affect the pelvic and urogenital diaphragms.

Question 9

Pelvis imbalances may affect GAIT by…………………

Answer 9

the limbo-sacral, iliosacral and SIJ, creating dysfunctions, affecting superior gluteal nerve (L4-S1) and the gluteus medium and minimus. Piriformis hypertonicity related to sacral SD can produce sciatica.

Question 10

Named the muscles of the pelvic floor and give their function:

Answer 10

• mm anchors and elevates the pelvic viscera and maintains closure of the urethral and anal sphincters and aids effective functioning of the pelvic viscera: bladder, bowel control and sexual functioning.
• Coccygeus: flexes coccyx inward towards pelvis and exerts rot. tension on SIJ. Can create dysfunction.
• Pubococcygeus and iliococcygeus: Levator ani. supportive mm for the midline organs. Weakness = clinical problems such as incontinence.

Question 11

What is postpartum pelvic dysfunction?

Answer 11

• create ongoing low back, pelvic and leg pain as well as functional disability of the urogenital and sexual organs for many women. It is a cumulative insult to the pelvis that dysfunctions through functional abnormalities, visceral diseases or activities related injuries.

Question 12

Give a example of:

1. structural or functional abnormalities of pelvis:
2. visceral abnormalities
3. activities related injuries

Answer 12

1. Scoliosis, leg discrepancies, SIJ or spine dysfunction, joint hyper mobility or hypo mobility, mm hypertonicity or hypotonicity, mm weakness or imbalance, postural abnormalities.
2. myofascial hypertonus or abdominal wall and adductor SD can cause bladder dysfunction:urinary frequency/urgency. IBS, endometriosis, hormonales changes, bacterial infection can cause pelvic pain, inflammation and dysfunction on the musculoskeletal system that can continue to mimic the original infection long after the infection or problem has been solved.
3. sport, fall, car accident, surgery.

Question 13

SIJ: explain the CoG transfer during walking:

Answer 13

• Left leg lift = weight transferred to right to maintain balance during the step = Cog shift from one side to the other creating closure of SIJ, side bending right and rotation left of the lumbar spine.
• This shift lock the right articulation of the sacrum at the lumbosacral junction.
• Left quads mm contracts to lift the leg which builds tension at the lower right oblique axis of the sacrum. The slight anterior rotation of the left innominate occurs during the movement of the left leg.
• Tension increase in the right hamstring when the body is ready to move the switch leg during walking, shifting the Cog forward and back left.
• During the hamstring activation the right innominate rotate posteriorly, which stabilise the pubic symphysis.
• Mitchell considered the transverse axis of the pubic symphysis as a postural axis of rotation for the entire pelvis.

Question 14

Give 9 features for the SIJ:

Answer 14

1. Largest axial articulation of the body.
2. Plane synovial joint
3. Limited motion
4. Normal SIJ function = important for shock absorption
5. Prevent impact for walking
6. transfers weight from trunk to ground.
7. Stabilisation comes from activation of deep stabilising muscles of lower back and pelvis, with ligaments and integrity of lumbosacral structures.
8. Multiaxial articulation. Rotate around S2.
9. Wide variability in the adult SIJ joint.

Question 15

Question: is a Lesion in any of the three pelvic joints affects the other two?

Answer 15

Yes

Question 16

Give examples of sacral anomalies:

Answer 16

• Sacralisation of L5.
• Lumbarisation of S1
• Congenital absence of pedicle.
• Unequal heights of two sides of base of sacrum.
• Accessory laminae
• Dysplasia pars articulates.

Question 17

What are the possible causes of SIJ dysfunctions and its risks factors?

Answer 17

Unidirectional pelvic shear stress, repetitive torsional forces, and inflammation can all cause pain. Risk factors include leg length discrepancy, abnormal gait pattern, trauma, scoliosis, lumbar fusion surgery with fixation of the sacrum, heavy physical exertion, and pregnancy.

Question 18

Where can you noticed pain from the SI joint?

Answer 18

Pain from the SI joint is generally localized in the gluteal region (94%). Referred pain may also be perceived in the lower lumbar region (72%), groin (14%), upper lumbar region (6%), or abdomen (2%)

Question 19

Give the 8 most important clinical test for SIJ:

Answer 19

1. Compression test (approximation test): The patient lies on his or her side with the affected side up; the patient’s hips are flexed 45°, and the knees are flexed 90°. The examiner stands behind the patient and places both hands on the front side of the iliac crest and then exerts downward, medial pressure.
2. Distraction test (gapping test): The examiner stands on the affected side of the supine patient and places his/her hands on the ipsilateral spinae iliacae anteriores superiores. The examiner then applies pressure in the dorso-lateral direction.
3. FABER (flexion abduction external rota- tion test): The patient is positioned supine with the examiner standing next to the affected side. The leg of the affected side is bent at the hip and knee, with the foot positioned under the opposite knee. Downward pressure is then applied to the knee of the affected side.
4. Gaenslen test (pelvic torsion test): The patient lies in a supine position with the affected side on the edge of the examination table. The unaffected leg is bent at both the hip and knee, and maxi- mally flexed until the knee is pushed against the abdomen. The contralateral leg (affected side) is brought into hyperextension, and light pressure is applied to that knee.
5. Thigh thrust test (posterior shear test): The patient lies in the supine position with the unaffected leg extended. The examiner stands next to the affected side and flexes the extremity at the hip to an angle of approximately 90° with slight adduction while applying light pressure to the bent knee.
6. Fortin’s finger test: The patient can consistently indicate the location of the pain with 1 finger inferomedially to the spinae iliacae posteriores superiores.
7. Gillet test: The patient stands on one leg and pulls the other leg up to his or her ches
8. Trenderlenburg: The patient is asked to stand on one leg for 30 seconds without leaning to one side. The therapist obsereves the patient to see if the pelvis stays level during the one-leg stance. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side[5].

Question 20

Explain which muscles affect the SIJ and how they do so:

Answer 20

Tension in the muscle sling will stabilise the SI joint in 3 ways:

• Contraction of the low paravertebral muscles will anteriorize the sacrum.
• Contraction of these muscles will also inflate the thoracolumbar fascia leading to more force closure.
• Due to anatomical relation with the sacrotuberous ligament, the contraction of these muscles will increase tension on the ligament.
• The tension can travel up and down, but the force can be locked up in the SIJ joint.
• Tight adductor, weak gluteus and core instability can affect the structure.
• Due to postural change and imbalance, it can switch off the multifidus and transfer the load on the psoas muscle which is not a static muscle.
• Transversus abdominis and pelvic floor muscles compress the SI joint
• Contraction of pelvic floor muscles rotates sacrum posteriorly (counternutates)
• Counteracted by multifidus and posterior sling muscles (gluteus maximus and latissimus dorsi – attach to thoracolumbar fascia)

Question 21

Explain the force of closure of the SIJ:

Answer 21

Compression or force closure is created by action and reaction between muscle systems, facial and ligamentous connections and gravity

Crucial role of trunk muscles in high load tasks: under gravitational load, the transversely oriented muscles compress the sacrum between ilia to maintain SI joint stability

Particular significance:
transversus abdominis
deep fibres of multifidus
pelvic floor muscles