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https://t.me/med1917

Academy of Orthopaedic Physical erapy, APTA.

For personal use only. No other uses without permission.

The Pelvic Girdle:

https://t.me/med1917

Evidence-Informed Physical

Therapy Patient Management

Independent Study

Course 31.2.9

Kathleen Chizewski Cauleld,

PT, DPT, OCS, FAAOMPT

University of Minnesota

Minneapolis, Minnesota

Leanna Blanchard,

PT, DPT, CLT, OCS, FAAOMPT

University of Illinois Hospital &

Health Sciences System

Chicago, Illinois

Michael O’Hearn,

PT, MHS, OCS, FAAOMPT

Spectrum Health Lakeland

St. Joseph, Michigan

Carol A. Courtney,

PT, PhD, ATC, FAAOMPT

Northwestern University

Chicago, Illinois

The Pelvic Girdle:

https://t.me/med1917

Evidence-Informed Physical

Therapy Patient Management

Guy G. Simoneau, PT, PhD, FAPTA—Editor

Gordon Riddle, PT, DPT, ATC, OCS, SCS, CSCS—Associate Editor

Cover Illustration by Joseph Kinstler

Dear Colleagues,

I am pleased to welcome you to e Pelvic Girdle: Evidence-Informed Physical erapy Patient Management monograph written by Kathleen Chizewski Caulﬁeld, PT, DPT, OCS, FAAOMPT, Leanna Blanchard, PT, DPT, CLT, OCS, FAAOMPT, Michael O’Hearn, PT, MHS, OCS, FAAOMPT, and Carol A. Courtney, PT, PhD, ATC, FAAOMPT. is work is part of the Academy of Orthopaedic Physical erapy Independent Study Course series 31.2, Current Concepts of Orthopaedic Physical erapy, 5th Edition.

Dr. Kathleen Chizewski Caulﬁeld received her Bachelor of Science in Kinesiology from the University of Illinois Urbana Champaign in 2012 and her Doctorate of Physical erapy from the University of Illinois Chicago in 2015. She then completed an orthopaedic physical therapy residency at UW Hospitals and Clinics and lowship in Orthopedic Manual Physical erapy in 2017 at University of Illinois Chicago. She is a Board Certiﬁed Orthopaedic Clinical Specialist and a Fellow of the American Academy of Orthopaedic Manual Physical erapists. She currently participates in patient care at Park Nicollet Clinics in Minneapolis, MN where she has the opportunity to mentor both residents and fellows. She is adjunct faculty in the Doctor of Physical erapy program at the University of Minnesota. Her practice is focused on the spine and chronic pain.

Dr. Leanna Blanchard received her Bachelor of Science in Kinesiology from the University of Michigan in 2012 and her Doctorate of Physical erapy from e George Washington University in 2015. She completed her residency in orthopaedic physical therapy through the joint program at e Johns Hopkins Hospital and e George Washington University, and received board certiﬁcation in orthopaedic physical therapy through the American Physical erapy Association in 2017. Dr Blanchard completed a fellowship in orthopaedic manual physical therapy at e University of Illinois at Chicago and was recognized as a Fellow of the American Academy of Orthopaedic Manual Physical erapy in 2018. Dr. Blanchard has lectured and provided mentorship at the DPT, residency, and fellowship levels, and published case reports in CRANIO and the Journal of Orthopaedic & Sports Physical erapy.

Unity Point Health – Meriter in 2016. Following her residency, she completed a Fel-

Michael O’Hearn is Chief of Physical erapy for Lakeland Regional Health System in St Joseph, Michigan. Michael is senior faculty for Maitland Australian Physiotherapy Seminars. Michael has received board certiﬁcation in orthopaedic physical therapy through the American Physical erapy Association. He is also recognized as a Fellow of the American Academy of Orthopaedic Manual Physical erapists. In addition to his clinical and teaching responsibilities, he has research interest in the quantitative sensory testing and classiﬁcation of spinal pain.

Dr. Carol A. Courtney is Professor at Northwestern University. She received a Bachelor of Science in Physical erapy from Washington University in St Louis, Master of Science from the University of South Australia and Louisiana State University, and a PhD from the University of Miami. Dr. Courtney is a licensed physical therapist and athletic trainer and has been recognized as a Fellow of the American Academy of Orthopaedic Manual Physical erapists. In 1991 and 1992, she was chosen to serve on the USA medical staﬀs for the Pan American Games in Havana, Cuba, and the Olympic Games in Barcelona, Spain. Dr. Courtney has clinical expertise in the management of chronic musculoskeletal pain and sports injury. Her research investigates the eﬀects of knee joint injury and osteoarthritis on pain processing and joint function, as well as modulation of pain mechanisms through manual therapy interventions. She has more than 100 peer-reviewed publications, book chapters, and conference presentations and has presented both nationally and internationally.

In this monograph, the authors provide a comprehensive, contemporary, and pragmatic approach to the evaluation and treatment of pelvic girdle pain.

My sincere thanks to the authors for their contribution to the Current Concepts series.

Sincerely,

Guy Simoneau, PT, PhD, FAPTA Editor

2920 East Avenue South, Suite 200 | La Crosse, WI 54601 | Oﬃce 608-788-3982 | Toll Free 800-444-3982 | Fax 608-788-3965

TABLE OF CONTENTS

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ACRONYM LIST ................................................................................................................................................................................................................5

ABSTRACT

LEARNING OBJECTIVES

..........................................................................................................................................................................................................................7

..............................................................................................................................................................................................7

PRE-LEARNING ASSESSMENT..................................................................................................................................................................................7

INTRODUCTION

CLINICAL ANATOMY, KINESIOLOGY, AND BIOMECHANICS

...................................................................................................................9

Anatomy ....................................................................................................................................................................................... 9

Joints ...................................................................................................................................................................................10

Capsuloligamentous tissues .................................................................................................................................................. 10

Muscles ................................................................................................................................................................................ 11

Innervation .......................................................................................................................................................................... 12

Vasculature .......................................................................................................................................................................... 13

Kinesiology and Biomechanics .................................................................................................................................................... 13

MECHANISMS OF CHRONIC PELVIC GIRDLE PAIN

CLINICAL EXAMINATION AND DECISION-MAKING PROCEDURES

...................................................................................................................................14

................................................................................................. 14

History and Interview ................................................................................................................................................................. 14

Pain diagram ........................................................................................................................................................................14

History and behavior of symptoms ...................................................................................................................................... 15

Diﬀerential diagnosis ........................................................................................................................................................... 15

Examination and Assessment ...................................................................................................................................................... 17

Clinical decision-making process ......................................................................................................................................... 17

Palpation-based mobility tests .............................................................................................................................................. 18

Pain provocation tests ..........................................................................................................................................................18

Abdominal examination ....................................................................................................................................................... 19

Neurological examination .................................................................................................................................................... 19

CONDITION-SPECIFIC EVIDENCE-BASED REHABILITATION CONCEPTS

Speciﬁc Pathologies ..................................................................................................................................................................... 23

Sacral stress fractures ............................................................................................................................................................ 23

Axial spondyloarthritis ......................................................................................................................................................... 23

Osteitis condensans ilii ......................................................................................................................................................... 24

Pregnancy-related Pelvic Girdle Pain ........................................................................................................................................... 24

Assessment ........................................................................................................................................................................... 24

Treatment ............................................................................................................................................................................ 24

Prognosis .............................................................................................................................................................................26

Nonspeciﬁc Pelvic Girdle Pain..................................................................................................................................................... 26

Assessment ........................................................................................................................................................................... 26

....................................................................................23

Treatment ............................................................................................................................................................................ 26

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Central Nociplastic Pelvic Girdle Pain ......................................................................................................................................... 27

Assessment ........................................................................................................................................................................... 27

Treatment ............................................................................................................................................................................ 27

OUTCOME MEASURES AND RETURN TO FUNCTION

.............................................................................................................................. 29

Patient-reported Outcome Measures ........................................................................................................................................... 29

Pelvic Girdle Questionnaire .................................................................................................................................................29

Oswestry Disability Index .................................................................................................................................................... 29

Roland Morris Disability Questionnaire ..............................................................................................................................29

Quebec Back Pain Disability Scale ....................................................................................................................................... 29

Disability Rating Index ........................................................................................................................................................ 29

Fear-Avoidance Beliefs Questionnaire and Pain Catastrophizing Scale .................................................................................. 29

Optimal Screening for Prediction of Referral and Outcome-Yellow Flag Tool ...................................................................... 30

e Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs and painDETECT .....................................30

Other Outcome Measures ........................................................................................................................................................... 30

Timed Up and Go ...............................................................................................................................................................30

Active straight leg raise ......................................................................................................................................................... 30

Summary of Outcome Measures ................................................................................................................................................. 30

Return to Function ..................................................................................................................................................................... 30

CONCLUSION ................................................................................................................................................................................................................ 31

CASE SCENARIOS ....................................................................................................................................................................................................... 32

Case Scenario 1 ........................................................................................................................................................................... 32

Case Scenario 2 ........................................................................................................................................................................... 33

Case Scenario 3 ........................................................................................................................................................................... 34

Case Scenario 4 ........................................................................................................................................................................... 34

APPENDICES .................................................................................................................................................................................................................. 36

Appendix A. Lumbar Screen ....................................................................................................................................................... 36

Appendix B. Exercises for Pelvic Girdle Pain ............................................................................................................................... 37

Appendix C. Manual erapy Techniques for Pelvic Girdle Pain ................................................................................................ 41

REFERENCES..................................................................................................................................................................................................................45

Opinions expressed by the authors are their own and do not necessarily reﬂect the view of the

Academy of Orthopaedic Physical erapy. e authors declare no conﬂict of interest.

e publishers have made every eﬀort to trace the copyright holders for borrowed material.

If we have inadvertently overlooked any, we would be willing to correct the situation at the ﬁrst opportunity.

Course content is not intended for use by participants outside the scope of their license or regulations.

Academy of Orthopaedic Physical erapy, APTA.

For personal use only. No other uses without permission.

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