Upon completion of this chapter, the student should be able to demonstrate the following competencies and proficiencies concerning the pelvis and groin:
Have a basic knowledge and understanding of the anatomy of the pelvis
Understand normal kinematics and biomechanics of the sacroiliac joint
Understand kinematics of the pelvis with gait
Understand how leg-length discrepancy affects the pelvis
Have knowledge of pain referral patterns about the pelvis
Have an understanding of pelvic and groin injuries
Implement a rehabilitation plan including proper stretching, strengthening, and exercise technique in accordance with principles of basic exercise
Perform manual treatment techniques including basic stretching, joint mobilization, and soft tissue mobilization
Utilize adjunct treatment interventions such as pain control modalities, bracing, taping, and neuromuscular electrical stimulation
Injuries to the pelvic region are common in all athletic populations. For the purpose of study, this area can be divided into four specific regions: groin, pelvis, sacroiliac joint, and hip joints. When assessing each one of these regions, careful attention must be paid to the individual structures of tendon, muscle, ligaments, and bones. Injury to one of these areas can affect the others because of their anatomical and kinematic relationships. Stress to individual structures will cause joint and movement pathology. This stress and abnormal movement can translate forces throughout the body, continuing a pattern of dysfunction and pain. Treating injuries to the pelvis can be complicated because of its integral relationship with the lower extremity and spine. The pelvis helps transmit, absorb, and moderate forces transferred from the lower body to the upper body and vice versa. Many large and powerful muscles are attached and rely on the pelvis for stability. These muscles produce large torques and stresses through the pelvis, which can lead to injury and dysfunction. This chapter will cover pelvic anatomy, pelvic movement, and injuries to the pelvis and sacroiliac region along with rehabilitation programs to treat these injuries.
The pelvis is a bony ring made up of the ilium, ischium pubis, and sacrum (Fig. 18-1). The pelvic ring has three joints: the two sacroiliac (SI) joints and the pubic symphysis.1,2 The SI joints are C-shaped amphiarthrodial joints that are formed from the articulations between the sacrum and ileum. The ileum are the two large bones that make up the sides of the pelvis. As a result, the SI joints connect the spine to the pelvis. The SI joints are covered by two different kinds of cartilage; hyaline cartilage covers the anterior sacral edge, and fibrocartilage covers the anterior edge of the ilium.
Bony anatomy of the pelvis.
The pubic bones meet in the anterior region to form the symphysis pubis. This is a nonsynovial amphiarthrodial joint (a joint ...