Pelvis

Question 1

Form vs Force closures

Answer 1

Form Closure:

• Passive stability
• Joint surfaces, shape, ridges and grooves, cartilage
• Wedge/concave shape of the sacrum
• Convex shape of ilium
• Fibrocartilage and hyaline cartilage on joint surfaces
• Interdigitating symmetrical grooves and ridges → highest co-efficient of friction of any diarthrodial joint

Force Closure:

• Dynamic stability
• Muscles acting on SIJ
• When muscles contract they place tension on the fascia
• SIJ stiffness increases even with slight muscle activity - effectiveness of load transfer from spine to legs is improved when muscle forces actively compress the SIJ, preventing shear

Question 2

Pelvic Girdle Pain

Answer 2

Pain experienced between the posterior iliac crest and the gluteal fold particularly in the vicinity of the SIJ

Question 3

Specific vs non-specific PGP

Answer 3

Specific:
-Spondyloarthropathy (sacroiliitis, AS, psoriatic arthritis, Reiter’s syndrome), stress fracture, infection, tumour

Non-Specific
-Everything else e.g. pregnancy

Question 4

PGP diagnosis

Answer 4

• Patient interview and Hx: pregnancy, fall on buttock, reported pain with loading
• Pain palpation tests: Fortin’s area, long dorsal SI ligament and palpation of the symphysis pubis

- Pain provocation tests
o Thigh thrust
o Patrick’s Faber
o Gaenslen’s test (pelvic torsion)
o Modified Trendelenburg’s tests
o Functional test: active straight leg raise test
• Diaphragm/respiration
• Abdominal muscles patterning
• Pelvic floor muscles/continence
• Lumbopelvic motion
• 0-5 of difficulty/heaviness 
o	Distraction/compression tests
o	Sacral thrust test

Question 5

Management and treatment

Answer 5

-Address motor control issues: local and global muscles
-Ensure good pelvic floor muscle control: TA and multifidus
-Strength of glutes
-Check breathing pattern
-No abdominal bracing
-Belts
-NSAIDs
-Manual handling
o Anterior rotation innominate
o Posterior rotation innominate
o Counter nutation sacrum
o Nutation of sacrum
-Mobility exercises
o Pelvic tilt (cat/cow but only moving sacrum)
o Pelvic rotation on a ball