The pelvis is one of the most important, although sometimes ignored, parts of the skeleton. The pelvis is shaped like a basket with a tip and its cavity contains many vital organs, including the intestines and bladder. In addition, the pelvis is at the center of gravity of the skeleton. If the body is compared to a pencil balanced horizontally on a finger, its point of balance (center of gravity) will be the pelvis.
Therefore, it is obvious that the location of the pelvis greatly affects posture. It's the same as if the central block in the tower is offset, and in this case all the blocks above the offset risk falling. And if you compare the central block with a box, then tilting can lead to the box falling out. Similar mechanisms occur when the pelvis is tilted, and the contents of the pelvis shift forward. The result is a protruding belly and protruding buttocks. Since the pelvis is the junction of the upper and lower torso, it plays a key role in body movement and balance. The pelvic bones provide support to the most important supporting part of the body – the spine. In addition, the pelvis allows the lower limbs and torso to move in a coordinated manner (in tandem). When the pelvis is positioned normally, various movements are possible, twisting and bending and the biomechanics of movements are balanced and the distribution of load vectors is even. Displacement (distortion) of the pelvis from normal positions causes dysfunctional disorders of the spine, as there is a change in the axis of load distribution during movement. For example, if there is a misalignment of the axle in a car, then rapid wear of the wheels occurs. Something similar happens in the spine, lever effects and excess load on certain points occur, which lead to rapid wear and tear of the spinal structures. Therefore, often the main cause of back and neck pain is a change in the position of the pelvis (displacement, distortion). Changing the position changes the biomechanics, which can lead to degenerative changes in the spine, disc herniation, scoliosis, osteoarthritis, spinal canal stenosis, sciatica, etc. Pelvic misalignment also leads to pain and dysfunction in the neck, neck pain radiating to the shoulders and arms, and contributes to the development of carpal tunnel syndrome and other problems in the extremities.
Causes of pelvic distortion (displacement)
First of all, pelvic distortion is caused by normal muscle imbalance. Technology is developing very quickly and a sedentary lifestyle is one of the main reasons for the development of imbalance, because our body requires a certain amount of movement, which it does not receive. Prolonged sitting and low physical activity are sufficient conditions for the development of muscle imbalance, leading to pelvic distortion and, as a result, the appearance of dysfunctional disorders in the spine and back pain.
Accidents and injuries are common causes of pelvic distortion , such as a side impact, lifting heavy objects while twisting, falling to one side, or carrying heavy objects from the side, such as carrying a child on your hip or carrying a heavy bag constantly on one shoulder. In women, the pelvis is less stable from birth than in men, since a certain flexibility and elasticity of the pelvic structures is necessary for normal pregnancy and childbirth. Therefore, pregnancy is often the main cause of pelvic displacement in women.
Damage to the pelvic muscles is the most common cause of misalignment. Injured muscles typically tighten and shift in order to protect surrounding structures. If the muscles in the pelvic area, such as the sacrum, are damaged, then the tightening of the muscles will lead to an impact on the ligaments attached to the pelvis and joints. As a result, structures such as the sacroiliac joints will also have a certain disposition. Muscle tightening after injury persists until the muscle is completely restored and during this period of time the pelvis remains in an abnormal position.
The difference in leg length can also be a cause of pelvic distortion and in such cases the distortion can be from right to left or vice versa. But the displacement may also be forward or backward, or there may be a twisting of the pelvis.
Many conditions can lead to muscle spasms that cause the pelvis to twist. A disc herniation can cause an adaptive muscle spasm and, in turn, antalgic scoliosis with functional pelvic distortion . Active people often experience tension in the calf muscles, which in turn creates tension around the pelvis. Surgeries such as hip replacement can also cause changes in the position of the pelvis.
Because the pelvis is one of the most stressful areas of the body due to movement and weight support, movements that cause pain and stiffness are a strong indicator of problems with the alignment of the pelvis. Back pain in particular is a common indicator of pelvic obliquity . In addition to participating in movement, the pelvic cavity contains: part of the digestive organs, nerves, blood vessels, and reproductive organs. Therefore, in addition to back pain, there may be other symptoms, such as numbness, tingling, bladder and bowel problems, or reproductive problems. Most often, changes in the following muscles lead to pelvic disposition:
M. Psoas major (psoas muscle) anatomically can lead to extension and flexion of the hip, which leads to anterior displacement of the pelvis.
The M.Quadriceps (quadriceps), especially the rectus muscle, can cause hip flexion.
M.Lumbar erectors can cause lumbar extension.
M. Guadratus lumborum with bilateral compaction can cause an increase in lumbar extension.
M.Hip adductors can cause anterior pelvic tilt as a result of internal rotation of the hip. This leads to shortening of the adductor muscles.
M.Gluteus maximus (gluteus maximus) is responsible for hip extension and is an antagonist of the psoas major muscle.
M.Hamstrings The muscle of the back of the thigh, this muscle can be tightened. The muscle can be weak, but at the same time thicken due to the fact that it is a synergist of the gluteus maximus muscle and this can be of a compensatory nature. The deep abdominal muscles, including the transverse abdominis and internal obliques, may become tight due to weakened lumbar erectors.
Hip, hip joint and pelvis[edit | edit code]
The head of the femur and the acetabulum of the pelvis form a very strong hip joint. The pelvic bones consist of the ilium, pubis and ischium; connecting to the sacrum and each other, they form the pelvis. The pelvis protects the abdominal organs and serves as the attachment point for many of the muscles of the thigh and trunk.
The hip joint allows flexion and extension, abduction and adduction, outward and inward rotation (Fig. 4.1), as well as circular motion.
Figure 4.1.
Range of motion in the hip joint.
A-B.
Flexion and extension of a straight leg and a leg bent at the knee.
Figure 4.1.
(ending).
B.
Abduction and adduction of the leg.
D.
Rotation of the leg outward and inward.
Circular movement is a sequential change of flexion, abduction, extension and adduction.
The hip joint is strengthened by a thick capsule and three large ligaments. In front is the iliofemoral ligament, which prevents hyperextension of the hip joint. The medial pubofemoral ligament limits abduction, and the posterior ischiofemoral ligament prevents excessive flexion.
The depth of the acetabulum, strong joint capsule and large ligaments provide high stability of the hip joint.
Movements in the hip joint are carried out by several muscle groups. The iliopsoas and rectus femoris (part of the quadriceps femoris) are responsible for flexion; gluteus maximus and posterior thigh muscles - for extension; gluteus medius and tensor fasciae lata - for abduction; adductor major, longus and brevis muscles - for adduction. A group of muscles including the piriformis, superior and inferior gemellus, obturator externus and internus, and quadratus femoris muscles externally rotate the hip; The tensor fascia lata internally rotates the thigh.
Symptoms
Symptoms of displacement (distortion) of the pelvis can be either moderate or severe and significantly impair the functionality of the body. With moderate misalignment, a person may feel unsteady when walking or may experience frequent falls.
The most common symptoms such as pain are:
- In the lower back (with irradiation to the leg)
- Pain in the hip, sacroiliac joints, or groin
- Pain in the knee, ankle or foot Achilles tendon
- Pain in shoulders, neck
If the pelvis is misaligned for a long time, the body will correct and compensate for biomechanical imbalances and asymmetries and corresponding adaptations of muscles, tendons and ligaments will occur. Therefore, treatment may require some time. In addition, pelvic distortion can be difficult to correct, since over time a pathological pattern of movements is formed. The longer the period of pelvic distortion, the longer it takes to restore normal muscle balance.
Palpable anatomical landmarks[edit | edit code]
Front surface
- Rectus femoris muscle
- Vastus medialis muscle
- Vastus lateralis muscle
- Superior anterior iliac spine
Medial surface
- Adductor longus muscle
- Thin muscle
- Adductor magnus muscle
Lateral surface
- Iliac crest
Rear surface
- Superior posterior iliac spine
- Ischial tuberosity
- Gluteus maximus muscle
- Biceps femoris
- Semitendinosus muscle
- Semimembranosus muscle
Diagnosis and treatment
Pelvic distortion , as a rule, is easily diagnosed during a physical examination of the patient. If it is necessary to diagnose changes in the spine or hip joints, instrumental examination methods such as radiography or MRI (CT) are prescribed.
There are various treatment options for pelvic distortion , and these methods depend on the cause that led to the pelvic distortion. When treating pelvic torsion, for example, it is necessary to reduce muscle damage. For this, various physiotherapy techniques and NSAIDs can be used. If the pelvic distortion is caused by a difference in the length of the limbs, then the use of individual insoles or surgical treatment methods is necessary.
But, in any case, treatment of pelvic distortion is effective only in combination with the influence on the pathogenetic links that led to a change in the position of the pelvis and disruption of biomechanics (physiotherapy, massage, manual therapy and exercise therapy). Exercise therapy is the leading method of treating pelvic disposition, especially when the cause of pelvic distortion is muscle problems.
Pelvic fractures
When choosing treatment tactics, we proceed from the following factors:
- nature of the fracture;
- degree of displacement of bone fragments;
- the patient's overall health condition.
Conservative treatment
Conservative treatment may be recommended for stable fractures without displacement or with minimal displacement of bone fragments.
Conservative treatment includes:
- Use of support aids . To eliminate stress on the injured limb, the doctor may recommend using crutches or a walker for up to 3 months or until the fracture heals. If the patient has injuries to both lower extremities, a wheelchair is used for mobility until weight bearing on at least one extremity is allowed.
- Drug therapy . Your doctor may recommend medications such as painkillers and anticoagulants. The latter are prescribed to prevent thrombosis of the veins of the lower extremities.
Surgery
Patients with unstable pelvic fractures may require one or more surgical procedures.
External fixation . External fixation is used to stabilize the pelvic ring. The operation involves inserting metal rods or screws through small incisions in the skin and muscles into the pelvic bones. The ends of these rods and screws remain above the surface of the skin on either side of the pelvis and are fixed to carbon fiber connecting beams. The external fixator acts as a stabilizing frame that holds the pelvic bones in the correct position.
In some cases, an external fixator is used for stabilization until fracture healing occurs. In patients who are currently medically unable to undergo the longer, more complex surgical procedure that is indicated for them, an external fixator may be used as a temporary measure until the patient's condition is stabilized and definitive fixation of the fracture is achieved.
In this case, an external fixator was used to stabilize the pelvic bones.
Skeletal traction . Skeletal traction is a system of blocks, weights and counterweights that are used to reposition bone fragments. Skeletal traction is often applied shortly after injury and removed after surgery. Sometimes some acetabular fractures are treated using skeletal traction alone. However, this method is used quite rarely, and if the need arises, the decision about this will be made directly by you and your doctor.
When applying skeletal traction, a metal wire is passed through the femur or tibia. A load is fixed to the spoke, which, due to traction, helps to hold the fragments as close as possible to the anatomical position. In many patients, skeletal traction also allows one to reduce the severity of pain to one degree or another.
Open reduction and internal fixation . During the operation, the bone fragments are first returned to their normal anatomical position (reduced). Metal plates and screws are used to hold the fragments in this position until fusion occurs.
In this case, plates and screws were used to stabilize the pelvic fracture.
Risks of complications accompany any operation, regardless of its complexity. Before surgery, your doctor will discuss each of these risks with you and take all necessary measures to avoid them.
Possible complications include:
- problems with wound healing, including due to the development of infection;
- damage to nerves or blood vessels;
- vein thrombosis;
- Pulmonary embolism - the entry of blood clots into the blood vessels of the lungs.
Rehabilitation procedure
Due to the nature of their age, older people require long-term recovery. Therefore, doctors recommend rehabilitation after a stroke, heart attack and other complex diseases. A femoral neck fracture also applies to them. During this period, the patient needs careful and professional care to ensure proper bone healing and return to active movement.
Of course, a familiar home environment and the absence of stress and anxiety are recommended for the patient. But not every family has the opportunity to provide the patient with adequate maintenance. For this purpose, we offer you the services of caregivers and nurses, and round-the-clock care will be provided in specialized care centers for the elderly.
“Home Care Center” offers you these services: for many years we have been providing reliable and effective support, providing a comfortable environment and quick recovery for our clients. Our range of services includes:
- 24-hour stay;
- organization of leisure;
- provision of nutritious and dietary nutrition;
- performing necessary medical procedures;
- maintaining hygiene;
- conservative treatment;
- massage and physiotherapy.