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 functial activities, gait, lumbar and hip ROM screen, SIJ pain provocation cluster, MMT, palpation

SIJ Special Test Cluster

Thigh thrust, compression, distraction, sacral thrust, 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.

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:

• Pain with palpation of symphysis pubis

• Pain with Trendelenburg test

  • Good prognosis and full resolution in 6 months

Symphysilysis

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