Better Quarter One Notes

Pelvis

General

Indicators for Pelvis Assessment

  • Pain SI Joint (Forten FInger Test)

  • Coxal Resticions

  • Tibial Dysfunctions

  • Group Dysfunctions in Lumbar

  • Pain on Medial Aspect of Knee

  • Longitudinal/Metatarsal Arch Asymmetry


Screening Tests

Screening Tests

Test

Purpose

Positive Sign

How to Apply

Valsalva

Screen for disc involvement (↑ intrathecal pressure)

Increased lumbar/pelvic pain during bearing down

Ask client if symptoms worsen during bowel-movement-like straining

Slump Test

Assess disc pathology or neural tension

Pain reproduced with slump + knee extension + dorsiflexion

Seated → slump forward → extend knee → dorsiflex → compare bilaterally

Scour Test

Identify hip joint pathology (OA, labrum, capsulitis)

Pain, catching, clicking, grinding

Supine → flex hip to 90° → compress femur into acetabulum → sweep in arc

Patrick/FABER

Differentiate hip vs SI joint pathology

Pain at SI (posterior) = SI lesion; pain anterior = hip pathology

Supine → figure-4 position → stabilize ASIS → press knee toward table


Assessment

General

Pelvis Protocol

  • Rule out anatomical short leg

    • If present, shim up low side until illiac crests are equal

  • Perform standing & seated flexion tests


  • Anatomical Short Leg Findings

Finding

Innominate Crest

Greater Trochanter

Anatomical Short Leg

Low

Low (same side)

Pelvic Imbalance

Low

Equal

Pelvic or Coxa Imbalance

Equal

Low

Pelvic or Coxa Imbalance

Low

Low (opposite side)



Standing Flexion Test

Seated Flexion Test

Interpretation

+ Same

+ Same

Positive Side Dysfunctional

+

Equal (no difference)

Positive Side Dysfunctional (may be influenced by tight hamstrings)

+ Same

+ Different

Possible dysfunction in both pelvis and sacrum


Specific


Following General Assessment

  • Have client square pelvis; assess following landmarks

    • Pubic Tubercles (check for Subluxation)

    • ASIS (checks for Rotations & Flares)


Dysfunctions


Dysfunction Type

Musculature

Relative Location

Key Notes

Inferior Pubic Subluxation

Adductors, Gracilis, Obturators

Same side

Adductors pull pubis inferior

Superior Pubic Subluxation

Rectus abdominis

Same side

RA pulls pubis superior

Anterior Rotation

Rectus femoris, QL, Iliocostalis

Same side

Causes long leg + hip flexor dominance

Posterior Rotation

Hamstrings, Glute Max

Same side

Creates short leg + posterior tilt

Inflare

Iliacus, Obliques, TA

Same side

Pelvis rotates inward

Outflare

TFL, Glute med/min

Same side

Pelvis rotates outward; abductor tension


Associated Conditions


Condition

Associated Conditions

Superior Pubic Subluxation

  • Inhalation Res. Ribs 3-5

Inferior Pubic Subluxation

  • Coxa Abduction

  • Coxa External Rotation

  • Varus Tibia

Anterior Innominate Rotation

  • Coxa Extension

  • Exhalation Res. Ribs 11-12

  • Knee Flexion

  • NSR in Lumbar

  • Anterior Displaced Tibia

Posterior Innominate Rotation

  • Coxa Flexion

  • Knee Extension

  • Posterior Displaced Tibia

  • Medially/Laterally Rotated Tibia

  • Medial/Lateral Rotation Res. Tibia

  • Varus/Valgus Tibia

  • Anterior Fibular Glide

Pelvic Inflare

  • Inhalation Res. Ribs 5-10

  • Inhalation/Exhalation Res. Ribs 11-12

  • Coxa Internal Rot

  • Coxa Extension

Pelvic Outflare

  • Valgus TIbia

  • Coxa External Rot

  • Coxa Abduction

  • IT Band Syndrome


Sacrum

General

Indicators for Sacral Assessment

  • Fortin Finger Test to SI Joint or Sacrum

  • Trauma to Are

  • Pain Radiating Over Top Innominate & Over GT

  • Pain/Tingling Radiating into Glutes & Down Leg


Biomechanics

  • Inhalation: Sacrum counter-mutates (sacral base moves posterior, extends)

  • Exhalation: Sacrum nutates (sacral base moves anterior, flexes)


Non-Neutral Mechanics

  • When spine is fully extended or flexed, tension in multifidi pull on inferior aspect of the sacrum

    • Motion puts tension on the anterior sacral ligature creating a scooping type of motion of the sacrum which moves the base posterior & superior.

      • Breathing then occurs on the middle axis of sacrum & superior axis of the pelvis


Dysfunctional Mechanics

  • On returning to neutral, one sacral base goes back to the middle transverse axis of the pelvis; the other stays fixed on the superior axis

  • The returning side must move anteriorly to reach the middle axis

  • This causes the sacrum to be stuck in flexion, forced to nutate/counternutate on an oblique axis instead of a transverse one

  • Motion is compromised → sacrum becomes fixated in a flexed position

    • Naming the Dysfunction

      • Sacral dysfunctions are named for the position the anterior sacrum is stuck in

      • The right or left designation = whichever sacral base returned to the middle axis (and thus moved anterior)

        • Right sacral base returned → Right Flexed Sacrum

        • Left sacral base returned → Left Flexed Sacrum


Screening Tests

Test

Purpose

Positive Sign

How to Apply

Valsalva

To assess for the possibility of disc pathology

If there is pain when performing said action

Ask client if they have the pain reoccur or increase when bearing down

Slump Test

^

If there is a recreation of pain when performing the test

Have client sit on edge of plinth, flex one hip & dorsi-flex foot, then have client slump forwards

Patrick’s (Faber) Test

  • For general coxa motion

  • To differentiate hip pain & pain referred to hip from pathological condition

  • If there is a ROM difference

  • If there is a recreation of pain

  • Supine have client make “4” shape with legs; for assymetry compare distance from knee to plinth & compare bilaterally

  • To test for SI; place palm on ASIS and press down & monitor for pain


Assessment

General

Test

Finding & Meaning

Gait

During the swing phase the client may tend to take short steps

Standing

  • May favour one side or lean to one side

Standing Flexion Test

Tests for illiosacral motions; if positive, further assess SeFT

Seated Flexion Test

Monitor movement of sacrum, it is positive if one side of sacral base moves deep (anterior)

Specific

Landmark

Finding & Meaning

Sulcus Examination

  • Torsion: Shallow

  • Flexed: Deep

Inferior Lateral Angle

  • Torsion: Posterior

  • Flexed:

Inferior of Inferior Lateral Angle

  • Torsion: N/A

  • Flexed:

Dysfunctions

Associated Conditions






Test

Purpose

Positive Sign

How to Apply









Assessment