Pelvis

Question 1

• pelvic floor innervation

Answer 1

Pudendal nerve
- From portions of the S2–4

Question 2

levator ani muscles innervation

Answer 2

levator ani nerve, originating from the S3–5 foramina

Question 3

Osteitis condensans ilii

Answer 3

non-inflammatory condition characterized by sclerotic bone lesions affecting the iliac surfaces of the SIJs

• Different from axSpA, no joint space narrowing or eventual joint ankylosis

impairment-based approach is recommended

Question 4

Assessment for pregnancy related pelvic girdle pain

Answer 4

• resisted hip adduction test (performed with a hand-held dynamometer at the medial aspect of the knee with patient in a hook lying position being asking to squeeze the device),
• standard lunge
• ASLR test
• pain on palpation of the long dorsal SIJ ligament

Question 5

• Planks variation for highest lumbar paraspinal activity:

Answer 5

side planks on feet

Question 6

• Planks variation for less lat involvement

Answer 6

on knees have less Lat activation and agood variation for those who dont tolerate plank

Question 7

Plank variation for maximum glute med activation

Answer 7

Side plank

Question 8

• Maximum glute max activation with TRA activation exercise :

Answer 8

Bird dog

Question 9

Recommendation for exercise and education for pregnancy

Answer 9

exercise alone or in combination with education was effective for preventing LBP; however, no other tool such as education, stabilization belt, etc was successful by itself

Question 10

Treatments rec’d for PR PGP

Answer 10

Manual therapy, exercise, stability belt

Question 11

Stability belts for SI pain, how do they help

Answer 11

Stabilization belts
- shown to increase stability of the joint due to decreased biceps femoris muscle activity and decrease activation time of the gluteus maximus muscle

Question 11

Manual therapy recs as treatment for PR PGP

Answer 11

• C evidence for high-velocity, low amplitude manipulations
• enhancing nutation of the sacrum
  for posterior mobilization on the ilium (relative anterior movement of the sacrum)
  
  • Mobilize the sacrum anteriorly (relative posterior ilium movement)
  • If this does not relive pain, moving the sacrum posteriorly can be considered
  • If still no relief, then use of a pelvic stabilization belt may help to modulate pain can be considered

Question 12

Exercise prescription for non specific SIJ pain

Answer 12

Exercise
-stabilization exercises are not more effective than any other form of exercise
- gluteus maximus muscle has been found to increase force closure of the SIJ

Question 13

• Highest levels of gluteus maximus muscle activation

Answer 13

1. Step-up
   
   • followed by several loaded exercises and their variations, such as deadlifts, hip thrusts, lunges, and squats

Question 14

Central Nociplastic Pelvic Girdle Pain treatment

Answer 14

Manual therapy
Education; sleep, nutrition, graded exposure
TENS 1-10hz

Question 14

steps per day had significantly lower all-cause mortality

Answer 14

taking 8000 or more

Question 15

common area of tenderness in peripartum females

Answer 15

• long dorsal SIJ ligament
• most superficial SIJ ligament
• common area of tenderness in peripartum females
• palpable just inferior to the PSIS

Question 16

• Physical Activity Guidelines for Americans

Answer 16

• recommend 150 to 300 minutes of moderate intensity
  
  • 75 to 150 minutes of vigorous intensity exercise weekly for adult

Question 17

sacrotuberous ligament soft tissue connections

Answer 17

-Sacrotuberous has direct integration with the lumbar extensors, piriformis, gluteus maximus, and the biceps femoris

blends with the long dorsal (posterior) SIJ ligament
- inserts at the inferior aspect of the ischial tuberosity
- connected directly to the biceps femoris, and at times can be completely fused to the muscle
- direct integration with the lumbar extensors, piriformis, gluteus maximus, and the biceps femoris

Question 18

does SIJ joint movement decrease or increase in those with pain

Answer 18

neither
sacral nutation tends to occur with transfers from supine to sitting or standing, and that SIJ movement does not differ between symptomatic and asymptomatic sides

normal: SIJ movement decreases as joint load increases.

SIJ hypermobility or hypomobility shouldn’t guide Dx, or be provided as education

Question 19

Fortin area =

Answer 19

Finger Ponting size to inferior to the PSIS
Location of TRUE SI joint pain, although SI joint can refer to

Question 20

Outcome tool for those with complex histories where psychological, social, and biophysical factors, comorbidities, and altered pain processing impact both the pain experience and the associated self-reported disability

Answer 20

OSPROYF

Optimal Screening for Prediction of Referral and Outcome-Yellow Flag

Multidimensional yellow flag assessment tool is inclusive of both vulnerability and resilience factors for application in orthopaedic physical therapy clinical practice

Question 21

Before considering pelvic girdle pain (PGP) what should be ruled out

Answer 21

Diagnosis of PGP can be reached after exclusion of the lumbar spine and hip joint as a source of symptoms

Question 22

Utility of of clinical tests for SI pain and gold standard diagnostic

Answer 22

tissue sensitization provoke symptoms and does not always imply structural fault

Reproduction of pain at least 3/6+
Thigh thrust, compression, distraction, sacral thrust, Gaenslen right, Gaenslen left)

Or any 2 of 4 selected tests:
Thigh thrust, compression, distraction, sacral thrust

found when using Intra-articular anesthetic block injections are the gold standard

Question 23

Axial spondyloarthritis

Answer 23

inflammatory diseases that affect the spine and are often associated with additional extra-articular conditions (perhaps tendonitis or inflamation elsewhere to rule up systemic) can progress to ankylosing spondy Eye irrtation Gut irrtation Long lasting symptoms, esp in butt Joint and pine stiffness UNDER 40 Tx: extension based exercise, cardio and HITT for symptom mgmt and QoL will have elevated ESR values an managed with NSAIDS

Question 24

4 types of PGP

Answer 24

Specific pelvic girdle pathology (AS types, Fxs, OCI) Pregnancy related pelvic girdle pain Nonspecific pelvic girdle pain Nociplastic pelvic girdle pain

Question 25

Types of Pregnancy related pelvic girdle pain

Answer 25

- pelvic girdle syndrome - symphysiolysis - one-sided sacroiliac syndrome - double-sided sacroiliac syndrome - miscellaneous.

Question 26

pelvic girdle syndrome description

Answer 26

- Pain in both SIJ areas as well as in the symphysis pubis. - Test: FABER and thigh thrust

Question 27

One-sided sacroiliac syndrome vs Double-sided sacroiliac syndrome PR PGP

Answer 27

Pain from one SIJ confirmed by thigh thrust to the symptomatic side. - Double-sided sacroiliac syndrome: Pain in both SIJs with pain being reproduced by the thigh thrust test applied bilaterally.

Question 28

-Symphysiolysis

Answer 28

- pain in the symphysis pubis - Test: palpation of the symphysis pubis and reproduction of pelvic pain with the Trendelenburg test

Question 29

miscellaneous PR- PGP examples

Answer 29

daily pain in 1 or more pelvic joints with inconsistent findings from clinical examination

Question 30

Attachemtns to sacrotuberous ligament

Answer 30

Thoracolumbar fascia, such as the latissimus dorsi, gluteus medius, and transverse abdominis muscles

Question 31

Nonspecific Pelvic Girdle Pain

Answer 31

can look like LBP but shouldnt be irritated with Lumbar ROM - Positive findings on 3 of the 5 following tests: - distraction, compression, thigh thrust, Gaenslen, and sacral thrust

Question 32

Active straight leg raise

Answer 32

Active straight leg raise on both sides and rated on a 0-5 scale of difficulty (0 = not difficult at all, 5 = unable). - strongest predictor of a higher ODI score at 1-year post-partum - ASLR test score greater than 0 had a significantly higher DRI score - greater difficulty with the ASLR test during pregnancy was associated with lower post-partum health-related quality of life scores