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Why Can’t I Hold a Neutral Pelvis?

A ‘neutral pelvis’ is one of the goals of physical therapy. A patient cannot hold a neutral pelvis statically and is unable to move distal joints dynamically. This means that the patient requires muscle strengthening and re-education to perform a neutral pelvis. Listed below are the main reasons why a patient can’t hold a neutral pelvis. Let’s take a closer look at each.

Anatomy

The pelvis is composed of four bones. The sacrum, the largest bone, is wedge-shaped and lies posteriorly between the pubis and the ischium. The innominate bones connect to each other at the sacroiliac joint, and the coccyx, a small bone attached to the underside of the sacrum, forms the pelvic rim. Various important joints and ligaments support and maintain the pelvic shape.

The pelvic artery lies just below the uterus. This arterial branch supplies the uterus with blood. The pelvic plexus has several specialized regions. The mesometrium is the main sheet of tissue on either side of the uterus. It divides the posterior and anterior peritoneum. The cardinal ligaments lie below the mesometrium. The mesovarium and mesosalpinx lie on the upper edge of the mesometrium.

Development

Pelvis development begins with a series of events during early fetal development. The pelvic region is marked by the ischial tuberosity, pubic symphysis, and sacroiliac joint. These events highlight the importance of chondrogenesis, a process that specifies the future morphology of bones. Pelvic morphology develops into a distinct functional pattern by the time the person reaches adulthood.

In order to understand the mechanics of the pelvis, researchers have studied the structure of the pelvis. To achieve this, a musculoskeletal model was used, with a set of trusses and shell elements to represent the pelvic girdle. These models differed in how they represent cortical and trabecular bone, which may impact their shape and architecture. This study is the first to examine how the FE models and the structural model compare.

Function

During normal gait, the pelvis moves into an asymmetric position, and the IL and CI work together to rotate the pelvis to the right. These muscle actions are influenced by pelvis motion and are not resolved by EMG data. The pelvic motion is the main driver of the counter-rotation of the trunk, and therefore, these muscles are involved in a variety of movements. However, the mechanism of pelvic rotation is not well understood.

The pelvis is part of the abdominal cavity, and is separated from the perineum by the pelvic diaphragm. The greater and lesser ischiadic foramina provide access to the pelvic structures. The peritoneum and the subserous fascia attach to the pelvic bones and form the visceral ligaments. As a result, the pelvis is an essential organ for human reproduction and development.

Fractures

Symptoms of a pelvic fracture include pain in the groin, hip, and lower back. It can also be accompanied by numbness and tingling in the legs and lower back. Patients may have difficulty walking and standing. Pelvic fractures can also occur after high-impact events, such as a fall. In addition to pain, patients may experience sexual dysfunction or an inability to perform daily activities.

X-linked hypophosphatemic osteomalacia is present in this 40-year-old male. A frontal pelvic radiograph shows flared iliac wings with a high degree of sclerosis around the SI joints and prominent ossification at the periarticular ligament. The patient is referred to a radiologist for further evaluation. If the patient fails to respond to conservative treatment, fractures of the pelvic bone are likely to be the cause.

Anatomical landmarks

The recognition of bony landmarks of the pelvis is a crucial operation in subject-specific biomechanics, orthopedics, and morphometrics. It is preferable to use an automatic approach rather than subjective manual identification. This article proposes an iterative tangential plane method for fully automatic landmark identification on pelvic surface models. This method is robust against initial pelvic alignment in space.

One approach to anatomical landmark detection is an atlas-based approach. In this approach, a pelvis-specific atlas is developed based on gray-value data, which are then used to label anatomical areas on a surface model of the pelvis. These surfaces are non-rigidly registered to computed tomography data. They use Euclidean distance to determine landmark locations.