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Principles of Manual Medicine

Functional & Clinical Significance of the Pelvis - Overview

Accurate diagnosis and treatment of dysfunction within the pelvic girdle is of great importance to practitioners of manual medicine. The osseous pelvis has a significant contribution to the functional capacity of the musculoskeletal system and warrants appropriate investigation and management in all patients. The superior surface of the body of the sacrum supports the vertebral column and the sacroiliac joints couple to the lower extremities. Consequently, alterations in normal sacral mechanics can have a significant effect on both body support and locomotion.

The pelvic girdle is important in the respiratory circulatory model because of it's relationship to the pelvic diaphragm. Dysfunction of the osseous pelvis alters the functional capacity of the muscles of the pelvic diaphragm in a similar fashion to thoracic spine and rib dysfunction on the thoracoabdominal diaphragm. All of the viscera and soma below the diaphram receive their preganglionic innervation from fibers at levels T5 and below. The relationship of the thoracic spine to the sympathetic division of the autonomic nervous system is important because visceral afferent pathways usually follow the sympathetic pathways. Visceral disturbances often cause increased musculoskeletal tension in structures innervated from the corresponding spinal level through the viscerosomatic reflexes. Manipulative treatment can be used to reduce afferent input from associated facilitated structures, which reduces somatosympathetic activity to the affected viscus.

The sacral component of the pelvis is of importance within the craniosacral system. The sacrum has inherent mobility between the two innominates as part of craniosacral rhythm. Alterated mechanical function of the pelvic girdle can negatively influence the craniosacral mechanism, and alterated craniosacral mechanics can influence the biomechanical function of the osseous pelvis.

In the structural diagnosis of the pelvic girdle, the examiner is looking for combinations of asymmetry, range of motion, and tissue texture abnormalities that lead to the diagnosis of pelvic girdle dysfunction. The diagnostic process identifies dysfunction at the:

  • Pubic symphysis -- dysfunction between the two pubic bones
  • Sacroiliac joints -- dysfunction between the two inniminates
  • Iliosacral joints -- dysfunction between each innominate and the sacrum
Diagnosis is performed with the patient standing, sitting prone, and supine. Click here to begin the Clinical Pelvis modual.
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