Demystifying the Pelvis

Bony anatomy Made up of 3 fused bones – Pubis, ilium and Ischium Main bony landmarks are ASIS, PSIS, AIIS, Ishial tuberosity, Pubic symphysis and crest

Form vs Force Closure Form closure looks at the passive structures that ‘hold’ the pelvis and SIJ in place Form closure has to do with passive structures that help to stabilise the SIJ and allow for the small degrees of nutation/counternutation that needs to occur to normalise gait and LSp movement and function

Form vs Force closure Force closure looks at the muscles and fascia that cross over the SIJ to dynamically stabilse the core/pelvis

Thoracolumbar fascia Very important in lumbopelvic stabilty and force closure of the SIJ.

Thoracolumbar fascia – Transverse Section

Thoracolumbar fascia – Transverse Section

Tranversus Abdominis/Oblique ratios Allison et al in 2008 has shown that the transversus abdominis IS dependent on which upper limb is moved Hu et al in 2011 has shown that the obliquus externus works with the transversus abdomius to help slow rotational movements in gait Core stability is no longer considered to be solely related to the ‘corset’ type stabilisation of the TrA, but more a combination of force couples between a number of muscles throughout the body After learning all the ‘basic’ anatomy its strange to think that for more than 15 years just drawing belly button in was considered the best way to stabilise the back and pelvis

Assessment Observation

Assessment Palpation Red dots in standing All in prone lying

Assessment Movement - Barbara Hungeford et al 2004 and 2004 showed that we can palpate and detect an innominate side of the pelvis in clinic. Stork/Marching Forward flexion

Pubis symphysis– inferior Affected side below unaffected side Held by adductors

Pubic symphysis – superior Affected PS superior to unaffected PS Maintained by tension or increased activity of rectus abdominis

Innominate shear - Upslip Superior vertical shear of ilium relative to sacrum Glut max/ med are inhibited/ weak on side of upslip Overactive/ tight QL

Innominate shear - Downslip Inferior vertical shear of ilium relative to sacrum Overactive/ tight hamstrings

Compressed innominate dysfunction – Anterior rotation Weak gluteus medius on contralateral side

Compressed innominate dysfunction –Posterior rotation Weak ipsilateral Gmax, Gmed Overactive HS

Common changes in muscle function Decreased activation ? weak Overactive ? tight TrA Iliopsoas Lower fibres IO Piriformis Lumbar multifidius TFL Gluteus max Bicep fem Gluteus med (post fibres) Erector spinae Rectus abdominis Adductors

Manual therapy for correction of pelvic dysfunction Manual techniques Theory Specifics Muscle energy technique (METS) Promote reciprocal inhibition which relaxes muscles. Contract/relax stretch (PNF) Need to be assessed by a physiotherapist Deep tissue release Lengthens appropriate muscle groups to reduce pull on pelvis QL release to correct upslips HS/glute/piriformis release for downslips and posterior rotations Hip flexor release for anterior rotations Dry needling Elicits a local twitch response leading to increase in muscle length and decrease muscle spasm. Piriformis, glutes, ES, H/S, Adductors, TFL

Taping techniques for pelvic dysfunction

RTUS 3 abdominal layers should have a size ratio of 1:1:1. Look for imbalances between obliques and TrA Provides a gold standard objective measure Good visual feedback for patient, can be used as a training tool.

Stages of rehab for pelvic dysfunction