Pelvic Girdle

Question 1

What are the 11 joints that make up Pelvic Girdle?

Answer 1

L4-L5 intervertebral
L5-S1 intervertebral
L4-L5 facet joints
L5-S1 facet joints
(R) and (L) SIJ
Pubic-symphasis
2 hip joints

Question 2

True Pelvic Girdle made up of:

Answer 2

2 SIJs

1 PS

Question 3

Innominate formed by?

Answer 3

fusion of ilium, ischium, and pubis

Question 4

Anterior Ilial Rotation

Answer 4

5 degrees
ASIS moves anterior and inferior
PSIS moves superiorly
Occurs during hip extension

Question 5

Posterior Ilial Rotation

Answer 5

5 degrees
ASIS moves posterior and superior
PSIS moves inferior
Occurs during hip flexion > 90 degrees

Question 6

Inflare

Answer 6

ASIS moves anterior and medial

PSIS moves anterior and lateral

Question 7

Outflare

Answer 7

ASIS moves posterior and lateral

PSIS moves posterior and medial

Question 8

Ilial upslip

Answer 8

superior shear

normally occurs during heel strike

Question 9

Ilial downslip

Answer 9

inferior shear

return from upslip during swing phase gait

Question 10

Ilial upslip Injury

Answer 10

Ilium is forced into upslip it will move into either
Upslip with anterior rotation
Upslip with posterior rotation

To realign manipulate with leg pull–correct upslip first.

Question 11

How to notice an upslip?

Answer 11

ASIS look level–it takes a 2cm difference to be worried for PSIS to be uneven= anterior rotation upslip

ASIS uneven, PSIS are level for posterior rotation upslip

Posterior pull leg in supine; Anterior pull leg in prone

Question 12

Sacral Flexion (Nutation)

Answer 12

base moves anterior and inferior
occurs during initiation of spinal extension, exhalation, and completion of spinal flexion

*will feel thumbs on PSIS go in when person extends

Question 13

Sacral Extension (counternutation)

Answer 13

base moves posterior
early spinal flexion
inhalation

Question 14

Sacral Rotation

Answer 14

(R) and (L) rotation around a (R)/(L) oblique axis

SB (R)- sacrum rotates (L)

Think of it as the L6 vertebra…SB (R) it will rotate (L). SB (R) (R) thumb on PSIS should go forward.

Question 15

Treatment of rotated sacrum

Answer 15

Stuck in right rotation= unable to left rotate. Sacral sulcus test reveals that the right joint is not moving. Treat by using isometric contraction of right pirifomis
Stuck in right rotation= unable to rotate left. Sacral sulcus test reveals that the left joint isn’t moving. Treat by contracting the left multifidi.

Question 16

Anterior Sacroiliac ligament

Answer 16

runs from sacrum to ilium laterally and inferiorly
reinforced by ilio-lumbar ligament

stressed during ilial outflare, hyper hip ER
taut in hip flexion and ilial ER

Question 17

Ilio-lumbar

Answer 17

Attaches from TP of L4 and L5 to ilium

Checks posterior ilial rotation and contralateral lumbar SB and rotation

taut in post. rotation, can help prevent lateral shift

Question 18

Short Posterior SI ligament

Answer 18

runs from PSIS promentory to the sacrum. Limits all ilial motion on sacrum mainly anterior ilial rotation

tender with SI malalignment

Question 19

Long Posterior SI ligament

Answer 19

runs from the inferior margin of PSIS to lower 1/2 sacrum

checks anterior ilial rotation

Question 20

Sacrotuberus

Answer 20

runs from the ischial tuberosity to distal 1/3 sacrum

checks:
sacral flexion
ipsilateral sacral rotation
ilial posterior rotation
becomes taut when biceps femoris is stretched

Question 21

Sacrospinous

Answer 21

deep to sacrotuberous (cannot palpate)

Question 22

Pelvic Girdles need for load transfer

Answer 22

Mobility-ilium moves on sacrum AROM hip in OC and sacrum on ilium in spine flexion, extension, SB, and ROT
Stability- static and dynamic stabilizers

Question 23

Self locked/closed pack position of SIJs

Answer 23

full posterior innominate rotation=ideal position for loading tasks
sacral (nutation) during active flexion and extension of the spine the sacrum nutates (flexes)

Question 24

Form Closure-static stabilizers

Answer 24

ability to transfer loads through the PG, while keeping joint surfaces stable.

Question 25

Dynamic Stability-force closure

Answer 25

Optimal muscle fxn provides PG with dynamic stability=force closure

Question 26

Local muscle system

Answer 26

Pelvic floor muscles Diaphragm Transverse Abdominus Lumbo-sacral multifidi

Question 27

Global muscle system

Answer 27

Opposite Latissimus dorsi and glut max abdominal obliques and adductors glut med in weight bearing

Question 28

Diaphragm-local PG

Answer 28

the roof, provides stability by increasing intra-abdominal pressure

Question 29

Pelvic floor muscles-local PG

Answer 29

need to activate for PG stabilization and bladder control. Co-activated with TA contraction

Question 30

Multifidi and TA-Local PG

Answer 30

both put tension on the thoraco-dorsal fascia creating a corset of support for the LB and PG---circle of integrity

Question 31

Posterior Oblique Sling

Answer 31

aides in force closure (L) lats with (R) glut max and intervening thoracodorsal fascia

Question 32

Anterior Oblique Sling

Answer 32

External Oblique and opposite internal oblique and opposite adductor of thigh and intervening abdominal fascia

Question 33

Lateral Sling

Answer 33

Stabilizes body in frontal plane in single limb support Keeps pelvis level--prevents ilial upslip Stance leg glut med and adductors and opposite side Quad Lumb

Question 34

Glute Med in single limb stance

Answer 34

keeps pelvis level, prevents trendelenberg limits unwanted superior shear or upslip forces of the ilium on sacrum

Question 35

Role of Biceps femoris for CC and ECC

Answer 35

It is coupled with erector spinae through sacrotub ligament. At end of swing phase hamstrings eccentrically contract to control hip flexion and knee extension. Contraction of BF pulls sacrotub taut, assists in stabilizing SIJ

Question 36

Motor Control & PG Fxn

Answer 36

In a healthy back and PG CNS anticipates when muscles need to activate to handle an oncoming load and muscle fire before the load or required motion occurs.

Question 37

Integrated model of function

Answer 37

Form Closures-Bones, Jts, Ligs Force Closure-Muscle, Fascia Motor Control-Neural patterning Emotions-Awaremess

Question 38

MOI to PG

Answer 38

``` LLD Superior shearing force-causes innominate upslip weak lateral sling and jump landing hormonal influence-relaxin systemic hypermobility ```

Question 39

Hyperabduction force to hip

Answer 39

Separation force to PS

Question 40

Hyperflexion force of hip

Answer 40

excessive posterior ilial rotation, stresses sacrotub and ilio-lumbar ligs

Question 41

Hyperextension force of hip

Answer 41

excessive anterior rotation of ilium, stresses short and long SI ligs

Question 42

Hyper ER of hip

Answer 42

possible damage to anterior SI ligament and possible PS separation

Question 43

Common PG S&S

Answer 43

Local SI joint pain and tender palpation Local PS pain and tender palpation Unilateral complaint Pain with stairclimbing, gait, standing, sitting **Referred pain buttock to posterior thigh with SI involvement **Referred pain to adductors with PS involvement Painful palpation of one or more SI ligaments Painful palpation of hip adductors and lower RA with pubic problem Active SLR sign

Question 44

PG Assessment

Answer 44

``` S&S Posture/LLD Palpate Special tests Core and sling fxn Muscle length ** No one test proves anything in this area of the body mulitple tests showing it will ```

Question 45

Restricted SIJ

Answer 45

(+) March and/or flare test Local ligament tenderness Referred pain buttock/thigh (+) pain provocation tests such as Squish ASIS or PSIS asymmetry (B) hip ROM asymmetry (-) hypermobility tests such as ASLR and posterior ilial translation.

Question 46

Hypermobile PS

Answer 46

MOI=childbirth or forced hip abduction or ER Hypermobility Hormonal influences Poor tolerance to sitting standing or walking (+) pain over pubic tube, adductors or RA (+) ASIS gapping test (+) FABER

Question 47

Hypermobile SIJ

Answer 47

Hx of hypermobility Hormonal influences Local SIJ pain and referred pain buttock and thigh Local ligament tenderness Difficulty holding stable pelvic posture in stork standing (+) pain on squish, ASIS gapping, FABERs (+) ASLR (+) Sidelying posterior ilial translation test (B) hip ROM asymmetry

Question 48

PG Treatments

Answer 48

Direct mobilization-upslip correction (leg pull) Isometric mobilization "muscle energy" Soft tissue mobilization- massage hypertonic muscles Lumbopelvic taping/strapping Core stabilizing-improves force closure Improve motor control-muscle fire sequencing deal with emotional compoinent prolotherapy

Question 49

Upslip treatment

Answer 49

Upslip with anterior rotation - Prone leg pull-manipulation Upslip with posterior rotation -Supine leg pull-manipulation

Question 50

Anterior Ilial Rotation

Answer 50

Direct mobilization into posterior rotation | Isometric contraction of gluteus maximus or RA; opposite limb gives a counterforce

Question 51

Posterior Ilial Rotation

Answer 51

Direct mobilization into anterior rotation | Isometric contraction of hip flexors, hip adductors, opposite limb gives counterforce

Question 52

Ilial inflare

Answer 52

isometric mobilization using gluteus medius and minimus

Question 53

Ilial outflare

Answer 53

isometric mobilization using iliacus

Question 54

Prolotherapy

Answer 54

intraligamentous or intratendinous injection at a fibro-osseous jxn (SI or PS) of a solution induces temporary inflammatory reaction.

Question 55

How does prolotherapy work?

Answer 55

6-10 treatments at 1-2 week intervals | activity limited

Question 56

Who is a candidate for prolo?

Answer 56

patient with disabling joint pain and instability that has lasted greater than 6 months demonstrates significant joint instability (+) hypermobile tests cannot tolerate prolonged sitting or standing