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Movements
• SI: nutation/contra nutation
• Pelvico-lumbo-hip complex: forward backward tilt (pelvis lumbar spine-hip are one unit; one affects the other!)
Ligaments
• Lig. sacroiliaca anterior, posterior
• Interosseus sacroiliac ligament
• Sacrotuberal ligament
• Sacrospinous ligament
• Inguinal ligament
• Iliolumbar ligament
SI Joint pain
initially local, after radiating- dull pain
constant pain, not related to movement, turning in bed, getting up, walking
Symphysis pain
hurts in case of movements, not in case of rest
adductor muscle group and rectus femoris function increases; hormonal changes; gait
Inflammatory pain
constant pain- in case of acute phase; cold is good
Degenerative issue
Hurts on certain movements (arthrosis)
Pathological issues in bony structures
1. Developmental disorders: congenital hip disorder
2. Traumatic injuries: fracture of a bone due to injury to other structures
Pathological issues in SI-Joint
1. Inflammation (sacroiliitis): joint instability; hypo/hypermobility (depending on the inflammation) pain, antalgic constraint, change in pelvic position
2. Arthrosis: joint dysfunction (in elderly patient: dehydration, overuse
3. Traumatic injury
Pathological issues in Symphysis
1. Inflammation
2. Instability (pregnancy, delivery): hormonal changes → more elastic tissues + ligament system
Pelvis torsion
displaced, rotated (RTG required)
1. Anterior direction: acetabulum is in a lower position, in standing position the limb is longer
2. Posterior direction: acetabulum is in a higher position, in standing/lying position the limb is shorter
Pathological problems in ligaments
1. Inflammation: that can comes from overusing (lig. sacrotuberale, sacroiliaca ant/post)
2. Traumatic injury: strain, tear (for example: motorcycle/car accidents)
Pathology in muscles
Muscle imbalance (muscle weakness and/or contracture): change in pelvic position → bad posture → pain → joints, ligaments are overloaded → joint dysfunction + pain → contracture is increased
Pathology in Ischiadic nerve
It comes from the L5-S1 nerve roots
If the m. piriformis is shortened, it can cause pressure on it (radiating, numbing pain from the thigh to the toes)
Pathology in femoral nerve
It comes from the L2-L4 nerve roots
• Runs out between the two fibres of the iliopsoas muscle (it can be shortened)
• It may come under pressure of the lig. inguinale
• Radiating pain from compression distally to the knee joint
neurological symptoms
pain, loss of sensation, muscle weakness, loss of reflexes through motor innervation
Lumbar spine pathology
• Frontal plane: scoliosis
• Sagittal plane: bad posture
Lower limb pathology
Limb length difference: pelvis position also changed
Gapping test
- anterior sacroiliacal ligament inflammation
- posterior joint surface problem
Approximation test
- posterior sacroiliacal ligament problem
- anterior joint surface problem
Sacral apex pressure test
- examination of the anterior ligament system
Knee to shoulder test
- sacrotuberal ligament problem
- m. piriformis problem
Femoral Shear test
- hip and SI joint examination (degeneration)
- sacroiliacal ligament (inflammation)
- posterior articular surface problem
Patrick Faber Test
- adductor muscle group contracture
- hip joint problem
- anterior ligament problem
- posterior articular surface problem
Gaenslen test
- examination of the pelvico-lumbo-hip complex
Flamingo/Trendelenburg test
- examination of the symphysis
- examination of the integrity of m. gluteus Medius
Supine to Long sit Up test
- examination of the pelvic torsion
Actual/apparent limb length difference