Acute Management: Pelvis and Hip

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Acute Management: Pelvis and Hip
2014-02-15 14:38:18
Acute Management Pelvis Hip
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  1. Posterior Oblique Sling
    • Rhomboids
    • Latissimus Dorsi
    • Thoracolumbar Fascia
    • Contralateral Glut Max
  2. Anterior Oblique Sling
    • Pectoralis Major
    • Serratus Anterior
    • External Obliques
    • Anterior Abdominal Fascia
    • Contralateral Internal Obliques
    • Adductor Muscles
  3. Functions of the SI Joints
    • Stability
    • Mobility
  4. Stability of the SI Joint
    Load Transfer (from upper torso --> pelvis --> ground)

    • Supplied by two mechanisms:
    • 1) Form closure
    • 2) Force closure
  5. Form Closure
    • Relates to shape and orientation of articular surfaces
    • Male pelvis less stable than female pelvis (decreased wedge angle --> increased shear forces)
    • In the absence of form closure, it is not possible to stabilize the SIJ w/o invasive procedures
  6. Force Closure
    • Relates to the compressive forces supplied by ligaments and muscles
    • In the absence of force closure, it is possible to stabilize the SIJ by using external compression (SI belt) or by re-training muscles
  7. Mobility of the SIJ
    • Shock absorption
    • Regional biomechanics (regional interdependence)
  8. Sacroiliac Axes of Motion
    • Bilateral (transverse) axis (1) -- nutation/counternutation
    • Longitudinal (vertical) axes (2) -- inflare/outflare
    • Oblique axes (2) -- sacral torsion
  9. Iliosacral Motions
    Coxal bone moves over sacrum 

    • Anterior/posterior coxal rotation
    • Inflare/outflare
  10. Sacroilial Motions
    Sacrum moves over coxal bone

    • Nutation/counternutation (nod forward/backwards)
    • Forward/backward torsionopp (i.e. R on L) are always backwards; same (i.e. R on R) are always forwards)
    • Unilateral flexion/extension
  11. Nutation
    • Sacral base moves forward and down around transverse axis
    • Similar to posterior coxal rotation
    • Occurs w/ small ranges of lumbar extension
    • Stable position for SIJ
  12. Counternutation
    • Sacral base moves backward and down around transverse axis
    • Similar to anterior coxal rotation
    • Occurs w/ small ranges of lumbar flexion 
    • Unstable position for SIJ
  13. Left-On-Left (Forward) Torsion
    • R sacral base moves forward and down around L oblique axis
    • Pelvic surface of sacrum faces left
    • Occurs w/ pelvic rotation in the gait cycle
    • Lumbar spine extends and rotates L
  14. Right-On-Left (Backward) Torsion
    • R sacral base moves backward and down on L oblique axis
    • Pelvic surface of sacrum faces R
    • Non-physiologic motion (not part of gait cycle)
    • Lumbar spine flexes and rotates R
  15. Anterior Coxal Rotation
    • Similar to sacral counternutation
    • Accompanies hip extension
    • Full hip ext also requires lumbar extension
  16. Posterior Coxal Rotation
    • Similar to sacral nutation
    • Accompanies hip flexion
    • Full hip flexion also requires lumbar flexion 
    • Induced by initial contact in gait cycle
  17. Inflare
    • Center of ASIS moved forward and medially
    • PSIS moves backwards and laterally
    • Accompanies hip IR
  18. Outflare
    • PSIS migrates medially
    • ASIS migrates laterally
    • Accompanies hip ER
  19. Sacroiliac Tests: Motion Tests
    • Standing forward bend
    • Seated forward bend

    *Tight hamstrings can make someone appear like they have an ipsilateral hypomobile jt or a contralateral hypermobile jt --> do seated to eliminate hamstring influence
  20. Iliosacral Tests: Motion Tests
    • Gillet
    • Squish (Contralateral, Ipsilateral)
    • ASLR
  21. Provocation Tests
    • Gaenslen
    • Iliac Compression
    • Iliac Gapping
    • Patrick
  22. Active Straight Leg Raise Test (ASLR)
    • Purpose = to assess contribution of force closure to stability in SIJ
    • Examiner applies pressure to pelvis during ALSR to mimic function of transverse abdomens, multifidus, and anterior pelvic floor muscles
    • Pt performance enhanced by PT pressure --> deficit in muscle function presumed