Pelvis Rotation PDF

Pelvis : Rotation INNOMINATE ROTATION NORMAL MECHANICS: In the walking cycle, normally we find the innominates rotate anteriorly or posteriorly, depending upon where in the cycle the respective leg is. The anterior rotation occurs as the leg is being flexed and results from the rectus femoris, quadr...

Pelvis : Rotation INNOMINATE ROTATION NORMAL MECHANICS: In the walking cycle, normally we find the innominates rotate anteriorly or posteriorly, depending upon where in the cycle the respective leg is. The anterior rotation occurs as the leg is being flexed and results from the rectus femoris, quadratus lumborum and illiocostalis contracting. The posterior rotation results as the momentum of the body causes forward motion and the leg becomes more posterior. This rotation results from the hamstrings and gluteals contracting. ANTERIOR INNOMINATE ROTATION Tightness Testing Procedure/Findings G.A (This will be described for a left side dysfunction for ease of understanding) Stand behind client with your eyes at the level of their PSIS Palpate the P.S.I.S then move contact so thumbs are on inferior aspect of P.S.I.S Ask client to flex fully forward as far as comfortable. Monitors to see if one P.S.I.S travels a further distance anterior/superiorly overall. If one side travels a greater distance overall, it is the side of pelvic dysfunction. The standing flexion test gives us the side of dysfunction only. Results: There was a positive standing flexion test on left. S.A ASIS ASSESSMENT for ROTATIONS Palpate A.S.I.S with palms of hands. Lower draping below A.S.I.S. Palpate A.S.I.S with thumbs then lower thumb placement to the inferior aspect (under) of the A.S.I.S. Monitor superioposterior-inferoanterior relationship for asymmetry. Refer finding to the side of dysfunction determined in the standing flexion test. Results: The ASIS on the left is anterior/inferior Results: Because the standing flexion test was positive on the left side, we relate our assessment findings to the left side. In this case the left ASIS was anterior inferior in relation to the right. Therefore, we can assume the condition is an anterior innominate rotation on the left. Cause : This condition is caused by a hypertonicity of the rectus femoris and/or the quadratus lumborum and/or illiocostalis At this point we must isolate the dysfunctional muscle tissue through passive testing and/or palpation to determine the specific causative musculature. Passive test for Rectus femoris Client is in a prone position with their knees flexed Stand at foot of plinth and grasps the distal aspect of the tibias. Passively flex clients’ knee. Monitor for quality and quantity of movement. Compare bilaterally. Decreased ROM on dysfunctional side indicates tightness Palpation of Illiocostalis Client is in a prone position Palpate the lateral aspect of the erector spinae onto the innominate crest Compare bilaterally Increased tone on dysfunctional side indicates tightness Palpation of Quadratus lumborum Client is in a prone position Place fingers at the lateral aspect of the erector spinae Move fingers medial and under the erectors Compare bilaterally Increased tone on dysfunctional side indicates tightness Verification: Now that the causative musculature has been determined, the therapist must verify their findings. To do this, the strength of the hamstings will be tested to rule out their possible involvement. Resisted test of Hamstrings Client is in the prone position with knees flexed to mid range (approximately 90 degrees) Stand at the foot of plinth and grasps posterior aspects of distal tibias. Apply non yielding resistance for 6 seconds as the client attempts to flex their knees (pull heels to gluteals). Compare bilaterally, Results: Symmetrical strength Verification: The Apparent Short Leg Test can also be performed as verification for this dysfunction. Client is in a supine position Stand at the foot of the plinth and grasp clients’ ankles in a “pistol grip” with your thumbs on the calcaneus. Bring medial aspects of clients’ ankles as close together as possible Lean back with your body to create traction and as you do so, dorsi flex the ankles by increasing pressure with your fingers in an inferior direction. Monitor the heights of the medial malleoli. Results: Long leg on the side of the anterior innominate rotation Extrinsic Treatment: Positioning/application Rectus femoris tightness: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Illiocostalis tightness: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Quadratus lumborum tightness: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ MET (Isometric): Tightness Tightness of Rectus Femoris Client is in a prone position. Stand on the side of dysfunction and passively flex clients’ knee to the first barrier Brace clients’ anterior distal aspect of the tibia against their shoulder and grasps the opposite side of the plinth. Provide a non yielding resistance as client attempts to extend their knee for 7-10 seconds. Take up any elongation which has resulted by further flexing the knee to the next barrier. Repeat this protocol 3-5x. Comments _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Upon completion of treatment of the dysfunctional musculature, reassess the bony landmarks to determine if the innominate have become realigned. Exercise Rehabilitation Stretches for the appropriate musculature causing this dysfunction can be found in the Exercise Rehabilitation Manual Unit#2 #3 #4 The following condition may be associated with this dysfunction: - Exhalation restriction of ribs 11-12 on dysfunctional side. - Coxa extension restriction - Anterior displaced tibia - Knee flexion restriction POSTERIOR INNOMINATE ROTATION: Tightness Testing Procedure/Findings G.A (This will be described for a left side dysfunction for ease of understanding) Stand behind client with your eyes at the level of their PSIS Palpate the P.S.I.S then move contact so thumbs are on inferior aspect of P.S.I.S Ask client to flex fully forward as far as comfortable. Monitors to see if one P.S.I.S travels a further distance anterior/superiorly overall. If one side travels a greater distance overall, it is the side of pelvic dysfunction. The standing flexion test gives us the side of dysfunction only. Results: There was a positive standing flexion test on left. S.A ASIS ASSESSMENT for ROTATIONS Palpate A.S.I.S with palms of hands. Lower draping below A.S.I.S. Palpate A.S.I.S with thumbs then lower thumb placement to the inferior aspect (under) of the A.S.I.S. Monitor superioposterior-inferoanterior relationship for asymmetry. Refer finding to the side of dysfunction determined in the Standing flexion test. Results: The ASIS on the left is posterior/superior Results: Because the standing flexion test was positive on the left side, we relate our assessment findings to the left side. In this case the left ASIS was posterior/superior in relation to the right. Therefore, we can assume the condition is an posterior innominate rotation on the left. Cause: This condition is caused by a hypertonicity of the hamstrings and/or the gluteus maximus. At this point we must isolate the dysfunctional muscle tissue through passive testing and/or palpation to determine the specific causative musculature. Passive test for hamstrings Client is supine, flex their coxa and knee to 90. Stabilize the coxa in this position. Passively extend clients knee. Monitor for quality and quantity of movement Compare bilaterally. Decreased ROM on dysfunctional side indicates tightness Passive test for Gluteus maximus Client is supine on the plinth. Place your hand under the clients’ lumbar spine and with your other hand flex their hip, bringing their thigh up towards their trunk. As you flex the hip, monitor at which point the lumbar spine touches your hand and the angle of the femur. It is this relationship that is monitored. Monitor for quality and quantity of movement. Compare bilaterally. Decreased ROM on dysfunctional side indicates tightness. Verification: Now that the causative musculature has been determined, the therapist must verify their findings. To do this, the strength of the rectus femoris will be tested to rule out its’ possible involvement. Resisted test for the rectus femoris Client is in a prone position with their knee flexed to mid-range (approximately 90 degrees). Stand at foot of plinth and brace clients’ anterior tibias on your shoulders as you grasp the plinth. Apply non yielding resistance for 6 seconds as the client attempts to extend their knees. Compare bilaterally. Results: Symmetrical strength Verification: The Apparent Short Leg Test can also be performed as verification for this dysfunction. Client is in a supine position Stand at the foot of the plinth and grasp clients’ ankles in a “pistol grip” with your thumbs on the calcaneius. Bring medial aspects of clients’ ankles as close together as possible Lean back with your body to create traction and as you do so, dorsi flex the ankles by increasing pressure with your fingers in an inferior direction. Monitor the heights of the medial malleoli. Results: Short leg on the side of the posterior innominate rotation Palpation is our greatest asset as massage therapists and is a very valuable tool when it comes to verification of our findings. Palpation of the hamstrings and/or gluteus maximus is also performed to verify hypertonicity of the dysfunctional tissue. Extrinsic Treatment: Positioning/application Hamstring hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Gluteus maximus hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ MET(Isometric): Tightness Tightness of the Hamstrings Client is supine, flex their coxa and knee to 90 degrees. Stabilize coxa in this position. Passively extend clients’ knee to the first barrier. Brace distal aspect of tibia on your shoulder. Provide a non yielding resistance as the client attempts to flex their knee for 7-10 seconds. Take up any elongation which has resulted by extending the knee to the next barrier. Repeat this protocol 3-5x. Comments _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Tightness of Gluteus Maximus Client is in lateral recumbent position with affected hip superior. Stand in front of the client. Flex the knee, and flex the hip to its first barrier. Brace the anterior aspect of the knee. Provide a non yielding resistance as patient attempts to extend their hip for 7-10 seconds. Take up any elongation which has resulted by further flexing the coxa to the next barrier. Repeat this protocol 3-5x. Comments _________________________________________________________________________________ _________________________________________________________________________________ Upon completion of treatment of the dysfunctional musculature, reassess the bony landmarks to determine if the innominate have become realigned. Exercise Rehabilitation Stretches for the appropriate musculature causing this dysfunction can be found in the Exercise Rehabilitation Manual Unit#2 #3 #4 Any of the following conditions may be associated with this dysfunction: - Posterior tibial displacement - Meniscus tears - Medial or lateral tibial rotation restrictions - Anterior fibular glide restriction - Medially or Laterally rotated tibias