Pelvic structure & Motion & Evaluation 과목 : 임상 생체 역학 실습 발표일 : 2008. 3. 20 발표자 : 오종남
Function of the pelvis To link the lower extremity with the trunk To transmit the load of the trunk to the lower extremity To absorb the shock from the ground To protect the internal organ
Osteology consist Sacrum Coccyx Innominate Joint relate with pelvis Sacroiliac joint Pubic symphysis Sacrococcyseal joint Lumbosacral junction Hip joint
Osteology
Osteology 여성과 남성의 골반 입구 : 원형/삼각형 천골 : 평균/전방형 하치골궁 : 경사가 곡선 / 경사가 곧음 천좌결흔 : 보통크기 / 좁다
Joint of pelvis Sacroiliac joint Pubic symphysis Coccygeal joint The first three sacral 부분과 ilium Pubic symphysis non-synovial amphiarthrodial joint Fibrocartilage Hyaline cartilage Coccygeal joint Sacrum : convex / coccyx:concave ant, post gliding 임신시에 증가
Joint of pelvis(sacroiliac joint)
Ligaments of Pelvis Sacroiliac joint lliolumbar ligament Aterior sacroiliac ligament Posterior sacroiliac ligament Sacrotuberous ligament Sacrospinous ligament
Ligament of pelvis Pubic symphysis Sacrococcygeal joint Inguinal ligament Superior pubic ligament Inferior pubic ligament Sacrococcygeal joint Ant sacrococcygeal ligament Post sacrococcygeal ligament Lateral sacrococcygeal ligament
Ligament of pelvis
Muscular of pelvis Trunk muscles Hip muscle Abdominalis Quadratus lumborum Erector spinae Hip muscle Iliopsoas Sartorious Tensor fasciae lataes Gluteus maximus Hip adductor Hip abductor External rotator & piriformis Rectus femoris Hamstring
Muscular of pelvis
Motion of pelvis Occurring between the lumbar spine and pelvic and hip joint as a result of coordination Tilting : sagital plan Anterior tilting/Posterior tilting Lateral tilting : frontal plan Pelvic elecation/Pelvic drop Rotation : transeverse plan Forward rotation Backward rotation
Motion of pelvis
Anatomy of pelvis Anterior surface Iliac crest Ant. Superior iliac spine(ASIS) Pubic symphysis Greater trochanter Inguinal lig Mcburney point Baer’s point Femoral triangle
Anatomy of pelvis Posterior surface Ilica crest post. Superior iliac spine(PSIS) Lumbosacral junction Sacral sulcus Sacral cornea Inferior lateral angle(ILA) Ischial tuberosity
Anatomy of pelvis
Anatomy of pelvis
1. Sacroiliac joint Nutation and Counternutation
Motion of pelvic girdle Sacroiliac joint Sacroiliac sacrum과 2개의 innominate Spinal의 움직임에 의해 나타남 Iliosacral Innominate on the sacrum Lower limbs의 움직에 의해 나타남 Pubic symphysis Innominate의 움직임을 축으로 약간움직임
1. Sacroiliac joint Sacroiliac movement Flexion & Extention(=nutation & counter nutation = Ant.nutation & post.nutation) Symmetrical(bilateral) Flexion Extention Asymmetrical(unilateral) Flxion
1. Sacroiliac joint
1. Sacroiliac joint Torsions Opposite side at oblique axis으로 움직임이 일어남. Forward(anterior)sacral torsion(FST) RT LT Backward(posterior)sacral torsion(BST)
Torsions Forward(anterior)sacral torsion(FST) Lt on Lt FST : sacral for ward torsion to Lt on Lt oblique axis Rt on Rt FST Backward(posterior)sacral torsion(BST) Rt on Lt BST : sacral backward torsion to Rt on Lt oblique axis Lt on Rt BST Plan on Axis : 축을 먼저 만들고 면으로 움직이면서 연습해 보세요.
1. Sacroiliac joint Iliosacral movrment Rotation : ant. / post. Flare : Inflare(med rotation)/Outflare(lat. Rotation) Slip : Upslip/downslip Shear : Ant. Shear / post. shear
2. Pubic Symphysis movement Superior / Inferior : 보행시 one legged stnading때 움직임이 나타나고 혼자가끔 움직일 수 있다. Anterior / Posterior : 보행시 swing phase때 나타날 수 있다.
Lumbo Pelvic Rhythm
Lumbo Pelvic Rhythm 시상면에서 움직임이 수행되는 동안, 요추와 고관절 사이의 운동형상학적 상호관계를 요추 골반 리듬이라 한다. Trunk의 Forward Bending Lumber : lodosis 감소 Pelvic girdle Ilium의 PSIS superior(hip jt에서 pelvic girle의 flex이고 ant. Tilting은 아니다. Sacrum: 초기 60도까지 nutation이 증가 하지만 그후는 Counter nutation(lumbar와 sacrum은 처음엔 같은 방향으로 움직임) hamatring의 tight, facet의 제한으로 영향을 받음
Lumbo Pelvic Rhythm Trunk Backward bending Lumbar : lordosis 증가 Pelvic girdle Ilium : PSIS inferior(hip jt에서 pelvic girle의 extends이고 post. Tilting은 아니다.) Sacrum: innominnutes 비례하게 nutated상태로 있음.
Evaluation Observation Posture Weight bearing Spine Pelvis Gait/leg Level test(iliac crest, spine scoliosis, shoulder, greater trochanter, PSIS, ASIS등의 의치를 확인)
Evaluation Active movement test PSIS palpation Sacral nutation palpation SI joint의 운동성 저하 검사 Sacrum base palpation 기타 TEST
Evaluation(active movement)
Evaluation(active movement)
Evaluation(active movement)
Evaluation Passive movement test Provocation test Joint play Gapping test Approximation test Hibb’s test(pron gapping test) Squish test Sacroiliac rocking test Joint play
Evaluation (Passive movement test)
Evaluation (Passive movement test)
Evaluation Resistive test Trunk muscle Hip muscle Muscle은 손상시 힘을 주기 어렵지만 joint는 힘을 주면서 pain을 있기때문에 isometric으로도 통증의 유무를 확인할 수 있다.
Evaluation Supine to Sit Test
참고문헌 정형도수치료 진단학/David J. Magee/현문사 Joint Structure and function/Levangie Norkin/F.A.Davis Kinesiology go the musculosleletal system/Donald A. Neumann/정담미디어 척추와 사진의 검진/Stanley hoppenfeld.MD/대학서림
감사합니다.