1. Demystifying the Pelvis

2. 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

3. 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

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

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

6. Thoracolumbar fascia – Transverse Section

7. Thoracolumbar fascia – Transverse Section

8. 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

9. Assessment
Observation

10. Assessment
Palpation
Red dots in standing
All in prone lying

11. 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

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

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

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

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

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

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

18. 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

19. 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

20. Taping techniques for pelvic dysfunction

21. 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.

22. Stages of rehab for pelvic dysfunction