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Pelvis assessment
1) Are the iliac crests level?
Lower yourself to the level of the crests, get hands horizontal to them. Slide them
backwards/forewords to see if one side is held anteriorly/posteriorly
2) Is there Lsp involvement? (iliolumbar ligament, thoracolumbar fascia)
90o from iliac crests, thumb onto inferior aspect of PSIS (half on half off), light
contact, ask pt to flex forward: is the skin being dragged with the Lsp?
3) Is there weakness in the hip abductors?
Trendelenburgs test – make sure eyes are at the level, can be a very subtle drop
in the contralateral side of the leg that is picked up
4) Is there inominate or sacral dysfunction?
Stork test – pt stabilises against wall/plinth, thumb on PSIS (R), thumb on S2,
ask pt to lift knee (R) as far as comfortable, if thumb moves superiorly there is
right (R) inominate dysfunction/involvement. Then ask pt to lift (L) knee, if thumb
moves superiorly there is (L) sacral dysfunction/involvement. Do the same on the
other side. During these movements the inominate should posteriorly rotate and
the sacrum counternutate – the superior thumb movement shows that this is not
the case.
Can test the inferior pole – PIIS and S4 as pelvic floor dynamics can affect the
lower pole of SIJ.
5) Is the sacrum being dragged with the Lsp?
Seated (the sacrum is supported, counternutated and pelvic floor relaxed), pt feet
on floor, thumbs on PSISs, pt flexes, is the thumb dragged in the same way as
standing? If yes L/S involvement.
6) General feel of legs
Supine – pick up legs and get a feel of weight, contour, position, apply traction to
feel any blockages – are there problems in ankle/knee/hip?
7) Are ASIS level?
Dominant hand away, hands on lateral glutes, 90o thumbs to inferior ASIS, move
body so that it is right above your hands and assess level, if different assess leg
length (medial malleoli) if anteriorly rotated leg appears longer.
8) Are the hip flexors causing rotation of the pelvis?
Thomas test – supine pull one knee to chest, does the other knee rise off of the
table, if so how much? Compare sides.
Have to get pelvis level before you can truly assess leg length difference.
9) Is there dysfunction at the pubic symphysis?
Supine – explain what you’re going to do – show picture/model. With fingers
pointing towards head start at the umbilicus and move hand inferiorly until on
bone, put pressure down on either side and see whether it is tender, feels raised
or ‘harder’, if yes then dysfunction on that side.
10) Is there restriction at the SIJ?
Supine SIJ exam tests posterior SI ligaments. Prone – hands on lateral glutes,
90o to PSIS, replace thumbs with index then thumbs to inferior angle of sacrum
(inferior, medial), get over your hands and get idea of shape/orientation of
sacrum. To test anterior SI ligament compress through sacrum asking if tender
and feel for ‘hardness’, then test nutation/counternutation and work out if the
sacrum prefers to go one way (is held) rather than the other
11) Assess piriformis
If the sacrum is rotated to one side then piriformis may be pulling it, assess its
tone compared to the other side
Then try and make sense of your findings!!!!