Lumbopelvic and SI Joint AEP Flashcards
(32 cards)
primary functions of the pelvis
bear weight
transfer loads from axial skeleton to appendicular skeleton
provide stable base with limited mobility –> more efficient transfer of loads
muscle attachment
male pelvis structure
prominent bony features narrow, heart shaped inlet narrow distance between ASIS and ischial tuberosities laterally facing acetabulum narrow pubic arch (70 degrees)
female pelvis structure
less prominent bony features wide, oval pelvic inlet wide distance between ASIS and ischial tuberosities anteriorly facing acetabulum wide pubic arch (90-100)
implications of pelvis gender differences
different mechanics in gain (acetabulum orientation)
small base of support for males in sitting
different moment arm, length-tension relationships for musculature
impact on pelvis muscle attachments on its function
pelvis has large influece on trunk, hip and knee
transmission of loads
position influences length/tension relationships of muscles
unilateral stance - frontal plane
-primary muscles
right hip abductors (gluteus medius)
-action on the pelvis to pull into ipsilateral lateral tilt
left lumbar erector spinal
-acting on pelvis to pull into ipsilateral lateral tilt
lumbopelvic rhythm
- what
- function
- observe in…
coupled motion between pelvis and lumbar spine
can increase overall trunk motion for function
observe in standing flexion and extension
L/hip ratio during extension phase
- 1st 25%
- last 25%
- how are patients with LBP different than normal patients
1st -dominated by hip motion last -dominated by lumbar motion LBP patients moved earlier from the lumbar spine early on (1st 25% of movement)
LBP patients hamstring length compared to normal patients
tighter
-no correlation to LP rhythm
L/hip ratio during forward bending
- 0-30 degrees
- 60-90 degrees
0-30
-dominated by lumbar spine
60-90
-dominated by hip motion
muscle recruitment during extension
caudal to cephalic in healthy people
muscle recruitment in healthy vs. non-healthy individuals
opposite recruitment strategies
evidence for altered movement prior to pain development
potential for altered loading at the vertebral joint level with early activation of lumbar erector spinae
what are we looking for at the lumbar spine during posture and movement assessment
quantity
quality and willingness to move
-aberrant movement patterns (sagittal plane)
Gower sign
- aka
- procedure
- positive test
“thigh climbing”
patient asked to bend forward as far as they can and then return to upright
positive sign if they use their hands to return to standing
-usually due to pain, not weakness
instability catch sign
- procedure
- positive sign
- thought to indicate…
patient asked to bend forward as far as they can and then return to standing
sign is positive if they cannot return to erect posture due to suppen painful “catch” in their low back
thought to indicate spinal instability
interrater reliability of
- reversal of LP rhythm
- Gower sign
- instability catch
- aberrant movement patterns in general
reversal -very poor Gower -98% agreement among clinicians instability catch -poor general patterns -a little better than reversal and instability
sacrul
- shape
- what is sacral base (promontory)
- sacral apex formed by
- what is the ala
triangular shape
sacral base formed by the 1st sacral vertebra
sacral apex formed by 5th sacral vertebra
ala
-lateral region of sacrum
-
osteology of SI joint
rigid articulation - boomerang shape
SI joint function
weight bearing joint relieve stress -pelvis region load transfer stability
SI joint ligaments
anterior SI ligament
iliolumbar ligament
interosseous ligament
posterior SI ligament
primary SI anterior ligaments
anterior SI ligament
interosseous ligament
secondary SI ligaments
sacrotuberous ligament
sacrospinous ligament
kinematics of the SI joint
-how much rotation and translation
1-4 degrees of rotation
1-2 mm of translation
terms used to describe rotational and translational movements at the SI joint
nutation
counternutation
