OCS - Pelvis 1

Most superficial SIJ ligament and is a common area of tenderness in peripartum femalrs

long dorsal ligament

Prognosis of poor pelvic girdle rehab

Prior hx of pregnancy, orthopedic dysfunction, high BMI, smoking, and lack of belief in improvement

Order of Pelvic girdle objective examination:

symptom provoking functional activities, gait, lumbar and hip ROM screen, SIJ pain provocation cluster, MMT, palpation

SIJ Special Test Cluster

Thigh thrust, compression, distraction, sacral thrust, Gaenslen

What is the preferred order of SIJ Special Tests

Distraction, thigh thrust, compression, sacral thrust, and then Gaenslen

How to perform Mennell’s Test

prone, grab extended leg and raise into hyperextension while immobilizing the pelvic with other other hand. Then immobilize sacrum and repeat. Then immobilize 5th lumbar vertebra. Mennell’s sign is when immobilizing the sacrum.

What causes Fatigue fractures in the pelvic region? how do you treat it?

Gradual. over training and poor nutrition. reduce load

What causes Insuffiency fractures in the pelvic region? how do you treat it?

age and osteoporosis related. off load them completely

Special Tests for Axial Spondyloarthritis:

FABER, blood tests - increased ESR, CRPTr

Treatment for Axial Spondyloarthritis

Extension exercises, Cardiovascular and strengthening exercises, and high intensity exercise

Pregnancy related Pelvic Girdle Pain:

Pain in both SIJ and Pubic symphesis

• Pain with FABER and thigh thrust

• Poor prognsis, can be chronic

Pelvic Girdle Syndrome

Pregnancy related Pelvic Girdle Pain:

What SxS do you see with Pelvic Girdlge Syndrome

Pain in both SIJ and pubic symphysis, (+) FABER and thigh trust

Pregnancy related Pelvic Girdle Pain:

• Pain with palpation of symphysis pubis

• Pain with Trendelenburg test

  • Good prognosis and full resolution in 6 months

Symphysiolysis

Pregnancy related Pelvic Girdle Pain:

What sxs do you see with Symphysiolysis

Pain with palpation of symphysis pubis and trendelenburg test

Pregnancy related Pelvic Girdle Pain:

Pain from one SIJ

Pain with symptomatic side thigh thrust

One sided sacroiliac syndrome

Pregnancy related Pelvic Girdle Pain:

Pain in both SIJ

Reproduced by thigh thrust applied bilaterlly

Double sided sacroiliac syndrome

Treatment of PRPGP

Combination of education, exercise, and stabilization belts.

What muscles are most important to target in PRPGP?

G max, G med, TA, erector spinae, multifidus, hip adductors and lats.

Treatment for PRPGP

Level C

Manipulations, no technique is better than other, use muscle activation techniques or mobs but if that doesn’t work use stabilization belt.

Treatment for Nonspecific Pelvic girdle pain

A Level evidence

thrust manipulation, keep exercise function, G max (step ups, followed by hip thrusts, lunges, squats), educate people to remain active.

It is caused by augmented CNS and sensory

processing.The symptoms are more intense, widespread and can be seen with other CNS

problems such as fatigue, sleep, memory and CNS problems. Commonly seen with chronic LBP or

PGP

• These patients have mainly a pain dominant presentation, which can be assessed using QST

(Quantitative sensory testing where positive findings may be hyperalgesia, dysesthesia).

Central Nociplastic Pain

Treatment for Central Nociplastic Pain

TENS 50-150 Hz, manual therapy, isometric muscle contractions, graded exposure (ask them what the least scary activity is and start there),

Best outcome measure for Pelvic Girdle Pain

Pelvic girdle Questionnaire. higher the score the worse the outcome

When would you want to give a stabilization belt?

Pt shows instability such as active SLR

PGP in Postpartum Population:

Strong Evidence for predicting pain:

History of of lumbar or PGP, including during pregnancy

CPG for PGP in Postpartum Population:

Moderate Evidence:

pain in the posterior pelvis, pain with rolling in bed and with weight-

bearing, multiparity, C-section, presence of depressive symptoms, higher BMI pre-pregnancy,work factors, and breast-feeding position

Gold Standard for Mood disorders after pregnancy

What is the scoring and red flag question?

Edinburgh Postnatal Depression Scale >10 indicates depression and item #10 is a red flag for suicide

PGP in the Postpartum Population CPG: 

Pain Location

SIJ and pubic symphysis with rolling in bed and LE weight bearing 

PGP in the Postpartum Population CPG: 

Special tests

pain that persists >5 secs after palpation of pubic symphysis, thigh thrust and FABER, active SLR, do NOT perform Gaenslens within first 4 weeks PP.

PGP in the Postpartum population Intervention

Best Practice

Functional Training (gait, double-limb, single limb, transitional movements, and childcare tasks)

PGP in the Postpartum population Intervention

Exercise

pelvic floor, back flexors/extensors, and hip extensors

PGP in Postpartum Clasifications:

• Pain and/or clicking at the region of SIJ

• Pain/difficulty with asymmetrical loading of LE/pelvis during functional activities

SI joint Load Transfer Impairment with or withou Asymmetry (unilateral joint involvement)

PGP in Postpartum Clasifications:

• Pain and/or clicking at the region of 1 SIJ

• Bilateral Pain/difficulty with loading of LE/pelvis during functional activities

Pelvic Girdle Load Transfer Impairment (>2 joints)

PGP in Postpartum Clasifications:

• Pain at the region of the Pubic symphysis that may or may not radiate to the groin

• Urogenital symptoms may be present

• Trauma during delivery, symphysis pubis dysfunction during pregnancy or excessive

unilateral leg loading in postpartum

Pubic Symphysis Load Transfer Impairment

Where should SIJ belts be worn?

worn snugly with the bottom margin of the belt above the greater trochanter.

You are treating a 73 year old female 6 weeks after suffering a left inferior pubic ramus fracture. In the clinic you note that she significantly arches her lumbar spine while in supine. The patient relates that the supine position is uncomfortable and she can’t remember having the problem before her fracture. Her inability to maintain a comfortable supine position is likely due to which of the following?

• Shortened gluteus maximus muscle

• Shortened iliopsoas muscle

• Shortened hamstring muscles

• Shortened piriformis muscle

Shortened iliopsoas muscle