03-09: The Pelvic Girdle

Question 1

Joints of the pelvis (3)

Answer 1

Sacroiliac Joint, Pubic Symphysis, Lumbrosacral Joint

Question 2

Pelvic Motions (4)

Answer 2

Anterior Tilt, Posterior Tilt, Lateral Tilt, Rotation

Question 3

Anterior Tilt (re: Lordosis)

Answer 3

Increased Lordosis, lumbar back-bending

Question 4

Anterior Tilt (re: ASIS-PSIS, Pelvis Positioning)

Answer 4

• Pelvis moves anteriorly
• ASIS inferior, PSIS superior
• “Donald Duck”

Question 5

Anterior Tilt (re: Deficiencies, Dysfunctions)

Answer 5

• Weakened abs (lengthened), restricted ES (shortened)

- May lead to stenosis of lateral foramen, which may impinge nerves

Question 6

Posterior Tilt (re: Lordosis)

Answer 6

Decreased Lordosis, lumbar goes into flexion (forward bend, flat back)

Question 7

Posterior Tilt (re: ASIS-PSIS, Pelvis Positioning)

Answer 7

• Pelvis moves posteriorly
• ASIS superior, PSIS inferior
• “PInk Panther”

Question 8

Posterior Tilt (re: Deficiencies, Dysfunctions)

Answer 8

• Weakened ES (lengthened), restricted abs (shortened)
• History of disk herniation
• FHP

Question 9

ASIS-PSIS positioning (degrees)

Answer 9

• ASIS should sit inferiorly to PSIS by 8-10˚
• Greater than 10˚ = anterior tilt
• Less than 8˚ = posterior tilt

Question 10

Anterior/Posterior Tilt - Planes of motion

Answer 10

• Motion occurs at lumbarsacral joint (L5-S1)

- Sagittal plane about a frontal axis

Question 11

Lateral Tilt - Definition

Answer 11

• Ability of pelvis to drop down or elevate on one side
• Lateral Tilt = Drop down
• Hip Hike = Rise

Question 12

Lateral Tilt - Osteokinematic Motion

Answer 12

• ABD on one side, ADD on the other side

Question 13

Lateral Tilt - Planes of Motion

Answer 13

• Side to Side

- Frontal plane about sagittal axis

Question 14

Pelvic Rotation - Description

Answer 14

• Pelvis moves as a whole

- Only occurs with single leg standing

Question 15

Pelvic Rotation - Planes of motion

Answer 15

• Motion occurs at iliofemoral joint

- Tranverse plane about a vertical axis

Question 16

Iliorotation - Planes of motion

Answer 16

• Motion occurs at pubic symphysis, SI joint
• Unilateral
• Sagittal plane about a frontal axis

Question 17

Anterior iliorotation (re: ASIS-PSIS)

Answer 17

ASIS inferior, PSIS superior

Question 18

Posterior iliorotation (re: ASIS-PSIS)

Answer 18

ASIS superior, PSIS inferior

Question 19

Anterior Rotation during gait

Answer 19

Internal rotation at hip joint

Question 20

Posterior rotation during gait

Answer 20

External rotation at hip joint

Question 21

Sacrotuberous and sacrospinous ligaments

Answer 21

Prevents rotation

- Limits excessive posterior rotation

Question 22

Interosseous Membranes (Anterior/Posterior SI)

Answer 22

• Prevents flaring
• Anterior SI prevents ASIS outflare
• Posterior SI prevents ASIS inflare

Question 23

Iliolumbar Ligaments

Answer 23

• Anterior ilial rotation = pulls L4

- Posterior ilial rotation = pulls L5

Question 24

Pelvic joint locks up…(results)

Answer 24

…other movable areas move more to compensate

Question 25

Male vs. Female = Males are...

Answer 25

- Sturdier - Pubic symphysis is taller - Ischial tuberosities less far apart - Iliac wings less flared

Question 26

Male vs. Female (Sacral surface, stability)

Answer 26

- Females = S1-S2 - Males = S1-S3 - Greater surface area = more stability

Question 27

Sacrum (Joint Types)

Answer 27

- Sacrum lined with Hyaline cartilage (synovial) - Ilium lined with Fibrocartilage (Amphiarthrodial) - Sacrum also lined with ligaments (synarthrodial) - Cornerstone of pelvic girdle = wider anterior and narrow posterior

Question 28

Transverse Axis Movement

Answer 28

- Really movement of sacrum around frontal axis | - Refers to flexion/extension motion of sacrum

Question 29

Nutation of sacrum

Answer 29

- Resting position is 30˚ - Sacrum nods forward (flex) - Anterior and inferior - Back moves into increased lordosis (extension)

Question 30

Counter nutation of sacrum

Answer 30

- Sacrum nods backward (extension) - Posterior and Superior - Back moves into decreased lordosis (flexion)

Question 31

Nutation-Counter nutation relationship

Answer 31

Inverse relationship between spine and pelvis

Question 32

Muscles that move the pelvis

Answer 32

- Erector Spinae = Anterior Tilters - Abdominals = Posterior Tilters - QL/Obliques = HIp Hikers/Lateral Tilters - Multifidi = Nutators - Piriformis = Counter Nutators

Question 33

Piriformis

Answer 33

O: Anterior aspect of sacrum at S1-S2 I: Superior aspect of the greater trochanter A: Lateral rotation, UL = contralateral rotator of sacrum, BL = counter nutation of sacrum N: Nerve to the piriformis ***Beyond 90˚, piriformis becomes internal rotator (see piriformis stretch)

Question 34

Multifidi (re: sacrum and nutation)

Answer 34

- Forms into one big muscle chunk at L3; anchors to posterior proximal aspect of sacrum - Becomes sacral nutator when multifidi contracts bilaterally (pulls sacrum anteriorly)

Question 35

Sciatic Nerve

Answer 35

- Emerges directly under piriformis and above superior gemellus - Impingement = sciatica - If SN comes through piriformis = piriformis syndrome

Question 36

Ilial Movements

Answer 36

- Primary: Anterior/Posterior Rotation - Accessory: Superior/Inferior (upslip/downslip); ER/IR (inflare/outflare) - Displacement will be greater anteriorly than posteriorly

Question 37

Evaluation of SI Joint (Test for Position)

Answer 37

- Iliac Crest Height - Trochanter Height - ASIS/PSIS positions - Gluteal mass - Pelvic inclination (Normal is 8-10˚) - Pubic position

Question 38

Evaluation of SI Joint (Test for Mobility)

Answer 38

- Forward Bend Test | - Gillet's Test

Question 39

Forward Bend Test

Answer 39

Side that moves first and most is dysfunctional

Question 40

GIllet's Test

Answer 40

Dysfunctional PSIS will rise, not drop down