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Assessment of the degree of pelvic tilt within a normal asymptomatic population
Abstract
In clinical practice the degree of pelvic tilt is commonly assessed because of its reported relationship to pelvic, spinal and lower limb pathologies. There is little normative data presented within the literature establishing typical findings within an asymptomatic population from which to make comparisons in pathological populations. The aim of this study was to report typical pelvic angle in an asymptomatic populations and also the degree of side-to-side asymmetry which might exist within the pelvis. Pelvic angle was measured by finding the angle from horizontal of a line between the anterior superior and posterior superior iliac spines of the ilium using a PALM palpation meter in 120 healthy subjects (65 males, 55 females) with a mean age of 23.8(2.1) years. 85% of males and 75% of females presented with an anterior pelvic tilt, 6% of males and 7% of females with a posterior tilt and 9% of males and 18% of females presented as neutral. There was significant difference in pelvic angle between sides for males (p = 0.002) but a non-significant difference between sides for females (p = 0.314). But the difference in angle for males between sides was less than the smallest detectable difference statistic found in the reliability study, so most likely to be due to measurement error.
... 47 Normative values for pelvic tilt using the palpation meter show a significant degree of variance among asymptomatic populations with the majority of individuals presenting with some degree of anterior pelvic tilt. 20,21,46 DISCUSSION Laboratory-based studies describe alterations in pelvic tilt associated with several common musculoskeletal conditions during a variety of functional and athletic movements. There are comparatively much fewer attempts to identify differences in clinical measures of pelvic tilt when comparing symptomatic to asymptomatic individuals, despite the historical usage of such measurements. ...
... Visual assessment of pelvic tilt is typically subjectively interpreted on a three-point categorical scale: "posterior pelvic tilt," "neutral," or "anterior pelvic tilt." Because of the variance among normal asymptomatic populations, with the majority of asymptomatic individuals presenting with some degree of anterior pelvic tilt, [19][20][21]46 use of this rudimentary scale may lead to misguided clinical decisions. This is further confounded by the fact that kinematic assessment of functional movements shows a precise quantifiable difference in the quantity of pelvic tilt (example: a 5 degree difference in the amount of anterior pelvic tilt between symptomatic and asymptomatic populations). ...
... In addition to using an interval scale, this also reduces the subjectivity of the measurement and may be more sensitive to measure change over a treatment plan. 46 These measurements have shown moderate-to-excellent reliability. 45,46,51 Caliper-based inclinometers have established validity for assessing the degree of anterior pelvic tilt and the total amount of pelvic tilt. ...
Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.
Level of evidence:
5.
... En conséquence et afin d'identifier de potentiels facteurs de risques en lien avec des pathologies du rachis, du bassin ou des articulations périphériques, la posture pelvienne en position debout est régulièrement évaluée en pratique clinique. Une asymétrie marquée au niveau de l'équilibre du bassin induirait des compensations posturales ayant pour effet des souffrances d'ordre musculosquelettique (8,9) , par exemple au niveau sacro-iliaque (10) ou des dommages lombo-pelviens (11) . ...
... Le principal compas-inclinomètre de ce type sur le marché et le plus utilisé dans les études standardisées est le PALM (pour Palpation Meter, Performance Attainment Associates, St. Paul Minnesota, USA) (8,10,17) . De précédentes recherches portant sur l'évaluation de la bascule du bassin ont eu recours au même type de compas-inclinomètre. ...
... Pour s'assurer que la mesure était cliniquement valide, les EIAS et EIPS ont été palpées et marquées avec de petits autocollants ronds amovibles (0.3 cm 2 ) quand les amplitudes finales d'AntévMax et RétrovMax ont été atteintes à chaque test (et également pour la mesure de la Bascule Neutre). Chaque sujet devait se tenir debout avec les pieds écartés d'une largeur de 30 cm et regarder un point fixe devant lui afin de limiter les oscillations posturales (8) . Les sujets devaient répartir au mieux leur poids uniformément entre les deux membres inférieurs et les bras étaient croisés sur leur poitrine avec la main sur l'épaule opposée pendant que l'investigateur repérait l'EIAS et l'EIPS. ...
ENGLISH
Introduction: Standing sagittal pelvic tilt (SSPT) is frequently quantified using the palpation technique, which assesses the relative position of the iliac spines. However,
the reliability of this approach in adolescents remains unknown. This study examines the inter- and intra-investigator reliability of measurements using a compass inclinometer to assess SSPT in young male athletes.
Method: In total, 75 adolescent athletes (age = 14.9 ± 1.7 years) were evaluated on two occasions. Two investigators evaluated SSPT in neutral, anterior, and posterior positions using a compass inclinometer. An average of three measurements was calculated by each investigator, alternately and bilaterally. The reliability was assessed by intra-class correlations, and the differences between sessions and investigators expressed in Cohen’s d were treated statistically as well as several measures of agreement.
Results: Intra-class correlations between sessions and investigators were 0.89–1.00 and 0.70–0.99, respectively, with Cohen’s d <0.2 in all configurations. The coefficients of variation for neutral and anterior SSPT were <15.8% and <8.8%, respectively, between investigators and <14.0% and <7.3%, respectively, between sessions, but those for poste‑
rior SSPT were >38.9% and >24.8% between investigators and sessions, respectively.
Discussion/Conclusion: In adolescent athletes, the manual method using a compass inclinometer demonstrated a good reliability for neutral and anterior SSPT measurements but not for posterior SSPT measurements; therefore, the findings should be cautiously interpreted.
FRANÇAIS
Introduction : La technique palpatoire évaluant la position relative des épines iliaques est fréquemment utilisée pour quantifier la bascule pelvienne sagittale debout (BPSD).
Cependant la fiabilité de cette approche chez les adolescents demeure inconnue. Cette étude examine la fiabilité inter- et intra-investigateur des mesures utilisant un
compas-inclinomètre (PALM) pour évaluer la BPSD chez de jeunes athlètes masculins.
Méthode : 75 athlètes adolescents (âge = 14,9 ± 1,7 ans) ont été testés à deux reprises. Deux investigateurs ont évalué la BPSD en positions neutre, antérieure et postérieure à l’aide du PALM. Une moyenne de trois mesures a été calculée par chaque investigateur, alternativement et bilatéralement. La fiabilité a été évaluée par corrélations intra-classes (ICC) et les différences entre les séances et les investigateurs exprimées en Cohen’s d ont été traitées statistiquement ainsi que différentes mesures d’agrément.
Résultats : Les ICC s’échelonnaient de 0,89 à 1,00 entre les sessions et 0,70 à 0,99 entre les investigateurs, avec Cohen’s d < 0,2 dans toutes les configurations. Les coefficients de
variation relatifs aux BPSD neutre et antérieure étaient inférieurs à 15,8 % et 8,8 % entre les investigateurs respectivement et inférieurs à 14,0 % et 7,3 % entre les séances
respectivement, mais ceux relatifs à la BPSD postérieure étaient supérieurs à 38,9 % et 24,8 % entre les investigateurs et les séances respectivement.
Discussion/Conclusion : Cette méthode manuelle utilisant un compas-inclinomètre démontrait une bonne fiabilité pour les mesures de BPSD neutre et antérieure chez des
athlètes adolescents, mais pas pour les mesures de BPSD postérieure, dont les résultats doivent être interprétés avec précaution.
... In two other studies cited by Herrington (2011), the interrater reliability (r) and standard error of measurement (SEM) were assessed. In both studies r = 0.98-0.99 and SEM = 0.44º -0.47º. ...
... In both studies r = 0.98-0.99 and SEM = 0.44º -0.47º. Both studies concluded that the device was valid and reliable at measuring pelvic inclination (Herrington 2011). ...
... The examiner located the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) via static bony palpation and marked them with a skin marker. Once the appropriate anatomical landmarks were located and marked, the calliper arms of the PPM were aligned to these marks and the angle of inclination was measured (Herrington 2011). ...
Aim:
The aim of this study was to determine whether or not a measurable change in the angle of the innominate bone could be identified after a chiropractic sacroiliac adjustment using a 'PALM PALpation Meter'. Secondly, if a change in the angle of the innominate bone was identified, what was the degree of change in the angle of the innominate bone, induced by the sacroiliac joint (SIJ) adjustment.
Method:
This was a true experimental study that consisted of 100 participants who met the inclusion criteria. The participants were randomly allocated to either the treatment or control group. Each group had 50 participants: 25 females and 25 males. Informed consent was obtained from participants prior to commencement of treatment. The treatment group received a chiropractic adjustment based on their specific SIJ dysfunction. The control group was treated with detuned ultrasound therapy (sham treatment).
Procedure:
Treatment consisted of a once-off treatment. The angles of the innominate bones were measured bilaterally pre- and post-treatment in both groups. Objective data were collected using the PALM PALpation Meter. Once the dysfunctional SIJ was identified, participants in group 1 were treated with specific chiropractic adjustment techniques based on the restriction. Group 2 participants were treated with detuned ultrasound only.
Results:
The results of this study showed that a specific chiropractic adjustment resulted in a measurable change in the angle of the innominate bone (p ≤ 0.001). The change in angle was evident bilaterally; however, the side that was adjusted shows the greatest degree of change. The mean change in angle for the treatment group was 2.25° on the side of dysfunction.
Conclusion:
The results of this study showed that a specific chiropractic adjustment can have a positive effect on the angles of the innominate bone, resulting in the tilt of the pelvis levelling into what is considered to be its correct anatomical alignment.
... Subjects were instructed to look straight ahead during standing measures with equal weight over both feet and arms crossed over their chest while the examiner palpated the anterior superior iliac spine ASIS and PSIS. (Nguyen and Shultz, 2009;Herrington, 2011). ...
... Once palpated the calliper tips established position over the marked landmarks and were compressed to a firm resistance as suggested by Gajdosik et al. 1985. The angle of inclination was directly read from the inclinometer by the examiner (Herrington, 2011). ...
... A study by Herrington (2011) showed that 85% of males and 75% of females have an anteriorly rotated pelvis as measured by the PALM which was on average in the range of 6-7° for both sexes. The study also found that overall there was no significant difference in pelvic angle in standing between the sexes. ...
The aim of this study was to compare the effect of gluteus medius strengthening exercises versus sacroiliac joint mobilization in anterior sacroiliac joint dysfunction. Comparative study. Thirty adult patients with pain, tenderness on posterior superior iliac spine and chronic low back pain from both genders participated in this study, their age was ranging from 25 to 40 years old, their body mass index was ranging from 20 to 25 (kg/m 2). The thirty patients were randomly divided into 2 equal groups with 15 patients each. Both groups were given conventional physiotherapy which included ultrasound and corrective exercises as a baseline treatment. Along with conventional physiotherapy Group A received strengthening exercises for gluteus medius subdivisions while Group B received mobilization techniques. The treatment duration was for 3 weeks. Provocation tests, pelvic tilt angle and pain were measured for evaluation before starting the treatment and then after 3 weeks. There was no significant difference in pain and pelvic tilt between both groups post-treatment (p > 0.05). There was a significant decrease in pain and pelvic tilt angle post treatment in group A and B compared with that pre-treatment (p > 0.001). There was no significant difference in the results of provocation tests between group A and B at pre and post treatment (p > 0.05). There was a significant decrease in the number of patients who had positive provocation tests post-treatment compared with that pre-treatment (p < 0.05) in both groups. Both the gluteus medius strengthening exercises and the sacroiliac joint mobilization techniques were effective in treatment of anterior sacroiliac joint dysfunction.
... [7] Pelvic position in the sagittal plane was assessed in standing position, with and without hip flexion 90°using PALM palpation meter (Performance Attainment Associates, St. Paul MN) on both sides. [13] A single experienced sports physician took all the measurements in all children. ...
... [12] In previous studies, it was indicated that the PALM palpation meter was a reliable tool for assessing sagittal pelvic position in standing, sitting and hip flexion (45°and 90°). [13][14][15][16] Assessment of the pelvic position in 20 healthy participants was done [13] and it was concluded that the difference in pelvic position in healthy subjects in the sagittal plane (in standing position), with and without hip flexion 90°was in average around 9.5°. In the control group of children in our study, the average difference in pelvic position in children without scoliosis was 8.42 ± 2.34, which was compatible with previous findings. ...
... [12] In previous studies, it was indicated that the PALM palpation meter was a reliable tool for assessing sagittal pelvic position in standing, sitting and hip flexion (45°and 90°). [13][14][15][16] Assessment of the pelvic position in 20 healthy participants was done [13] and it was concluded that the difference in pelvic position in healthy subjects in the sagittal plane (in standing position), with and without hip flexion 90°was in average around 9.5°. In the control group of children in our study, the average difference in pelvic position in children without scoliosis was 8.42 ± 2.34, which was compatible with previous findings. ...
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.
This case–control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.
The scoliosis was diagnosed with Adams’ forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann–Whitney U test, contingency coefficients, and logistic regression.
The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).
The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).
There was a strong positive association between SIJ dysfunction and AIS in young athletes.
... In a previous study, it was suggested that an anterior pelvic tilt up to a certain degree could be a typical finding in asymptomatic subjects [43]. They reported mean degrees of the anterior pelvic tilt as 6.74 • and 6.23 • for the left and right sides, respectively, in males. ...
... They reported mean degrees of the anterior pelvic tilt as 6.74 • and 6.23 • for the left and right sides, respectively, in males. For females, the values were reported as 6.93 • for the left side and 6.63 • for the right side [43]. In another study conducted on healthy adults and athletes, the mean values of the anterior pelvic tilt were reported as 9.6 • and 11.7 • for males and females, respectively [44]. ...
(1) Background: The aim of the present study is to analyze the instant postural changes and changes in the dystonic contractions among patients with dystonia following the use of an intraoral device called a key integrative dynamic TMJ treatment appliance (KIDTA). (2) Methods: Twelve subjects, previously diagnosed with dystonia were enrolled. Their existing records were utilized to assess the changes in their posture and dystonic contractions. The posture analysis was conducted using a mobile application (APECS). The initial records (T0) and records acquired after the delivery of the KIDTA (T1) were utilized in the analysis. The Wilcoxon signed-rank test was performed to compare parameters between T0 and T1, with a significance level set at p < 0.05. (3) Results: Based on the Wilcoxon signed-rank test, statistically significant differences in T1 compared to T0 were observed in the severity of dystonic spasms, body alignment, head shift, head tilt, shoulder alignment, shoulder angle, axillae alignment, ribcage tilt, pelvic tilt, knee angle, and tibia angle (p < 0.05). (4) Conclusions: Within the limitations of the present pilot study, an intervention to the TMJ through a KIDTA appliance seems to mitigate the severity of dystonic contractions and improve the posture with respect to certain postural parameters.
... Studies have retrospectively connected greater anterior standing PT to ACL injury 23,24 and to dynamic valgus in drop landing tasks. 9 A value for increased or excessive anterior standing PT has not been established; however, during standing, the average runner will have approximately 7°of anterior standing PT. 25 The pelvis stays in anterior PT during running and will typically range from approximately 10°to 15° (Figure 1) with the extremes occurring around the beginning and end of stance. 26,27 Increased anterior PT during running has been exhibited as a compensatory movement for limited hip extension in terminal stance and is thought to allow for an increase in stride length typically displayed by rearfoot strike runners. ...
... The PALM has high intertester and intratester reliability of .89 and .98, respectively, and has been used in many studies to measure standing PT. 2,9,25,38,39 However, to our knowledge no studies have reported the criterion validity of the PALM against the gold standard 3D motion analysis. Therefore, using 3D motion analysis to evaluate the criterion validity of the PALM is needed to further confirm the appropriateness of the use of this measurement tool in clinical settings and whether it can accurately identify standing PT. ...
Standing pelvic tilt (PT) is related to biomechanics linked with increased risk of injury such as dynamic knee valgus. However, there is limited evidence on how standing PT relates to dynamic PT and whether the palpation meter (PALM), a tool to measure standing PT, is valid against 3-dimensional (3D) motion analysis. The purposes of this study were to (1) determine the criterion validity of the PALM for measuring standing PT and (2) identify the relationship between standing PT and dynamic PT during running. Participants (n = 25; 10 males and 15 females) had their standing PT measured by the PALM and 3D motion analysis. Dynamic PT variables were defined at initial contact and toe off. No relationship between the 2 tools was found. Significant large positive relationships between standing PT and PT at initial contact ( r = .751, N = 25, P < .001) and PT at toe off ( r = .761, N = 25, P < .001) were found. Since no relationship was found between standing PT measured by the PALM and 3D motion analysis, the PALM is not a valid alternative to 3D motion analysis. Clinicians may be able to measure standing PT and gain valuable information on dynamic PT, allowing clinicians to quickly assess whether further biomechanical testing is needed.
... The assessor was the same throughout all data collection. To assure the inter-rater reliability, the PT of 20 participants had been measured at two separate times, 1 week apart and with the same setting (25). Statistical Analysis. ...
... There is a lack of standard normative data on pelvic inclination or asymmetry. Moreover, the literature has shown variations in PT among the asymptomatic population and different pelvic morphology between individuals and within the same subjects that may explain the non-normal distribution of PT and dispersion within the groups (25). The flowing sections discuss each outcome interpretation, possible explanations, and how it would affect the CAI continuum. ...
... The Palpation Metre (Performance Attainment Associates, US Patent 5327907) used for angle measuring has been claimed to be a reliable tool, with high intra-tester reliability (ICC¼ 0.87) (Herrington 2011). Both the anterior and posterior superior iliac spines were determined by initial palpation, then two small removable adhesive stickers were put on both landmarks. ...
... Calliper tips were positioned over them, and the inclination angle was directly read from the inclinometer and recorded. Positive degrees represented anterior inclination, while negative degrees represent posterior inclination (Herrington 2011). ...
This was a randomised trial aimed to determine squatting exercises’ effects on menstruation, pelvic mechanics, and uterine circulation in primary dysmenorrhoea. A total of 120 females with primary dysmenorrhoea were assigned into group (A), receiving yoga protocol, or groups (B, C & D), receiving yoga protocol added to modified wall squat, sumo squat, or deep squat, respectively. Menstrual pain and distress, pelvic inclination, and uterine circulation were measured before and after interventions using a pain scale, a questionnaire, palpation metre, and Doppler ultrasonography, respectively. There was a significant reduction in pain intensity in groups B & C (effect size = 3.97 & 5.89, respectively), compared to group A (effect size = 3.68), and in group C (effect size = 5.89) compared to group D (effect size = 3.94), pain subscale in the groups B, C & D (effect size = 1.69, 3.3 & 3.41, respectively), compared to group A (effect size= 2.47), water retention subscale in group D effect size 0.90 compared to group A (effect size =0.41) and in the questionnaire total scores in the groups C &D (effect size = 2.3 & 2.46, respectively) when compared to group A (effect size =1.94). Adding squatting exercises to yoga is more effective than yoga alone in reducing menstrual pain and distress.
• IMPACT STATEMENT
• What is already known on this subject? Physical exercises positively affect primary dysmenorrhoea in terms of decreased pain and distress, possibly through altering faulty posture. Squatting exercises affect lumbopelvic mechanics.
• What do the results of this study add? This study explores the effect of squatting exercises on pelvic inclination, menstrual aspects, and circulation.
• What are the implications of these findings for clinical practice and/or further research? Squatting exercises can be utilised to affect pelvic mechanics leading to decreased menstrual pain and distress, because of decreased pelvic congestion.
... The coordinates of the vertices of the A n D n E n triangle A n (-AD/2, 0, 0) and D n (AD/2, 0, 0) on the x-axis and E n (AD/2-MD, 0, -EM) on the z-axis were calculated based on the coordinates of the A a D a E a triangle using the following expressions Eq. 3 -(6) (6) where, AD, AE and DE the lengths of the sides, EM the length of the perpendicular to the side AD of the triangle A a D a E a and ϕ = acos ...
... The position of the pelvis in the relaxed upright posture has been assessed by many clinical therapists and researchers who aimed to investigate (i) its anatomical and kinesiological relationship with the head-trunk-upper extremities complex and/or the lower extremities [4][5][6][7] , (ii) its response or adaptation to skeletal asymmetries (e.g. leg length discrepancy, scoliosis) and the tensions exerted by the musculoligamentous structures under weight-bearing conditions [ 8 , 9 ] and (iii) its contribution to painful musculoskeletal syndromes [10][11][12] or other clinical conditions [13] . ...
Determining the pelvis position remains a challenge for clinical therapists and researchers mainly due to the difficulty in assessing its potential triaxial rotations in the upright standing posture. The method described in this study aims to determine the position of the pelvis in the upright standing posture by calculating the Euler/Cardan angles of pelvic rotations based on the triaxial coordinates of the anterior superior iliac spines and the pubic symphysis. The coordinates of these bony landmarks were determined with two laser distance meters and a standard metric ruler, all mounted on a custom-made structure. The calculations of all Euler/Cardan angle rotation sequences for both the internal and external rotations of the pelvis were performed by developing an algorithm that executed via a computer program specifically designed for the purpose of this study. The validity of the algorithm was tested by comparing the actual angles of known positions at which an anatomical model of the pelvis was placed with the calculated angles. Our findings revealed <1° differences between the actual and the calculated angles of pelvis rotations regardless of the axis around which it was rotated suggesting that the proposed method can be used for clinical and research purposes.
•The triaxial coordinates of pelvis bony landmarks can be measured anthropometrically using simple measuring instruments
•Pelvis posture can be determined in 3D space with great accuracy by means of the Euler/Cardan angles
... They associated faulty posture with several musculoskeletal disorders, and it connected this to the pelvic position. A study [7] observes the incidence in the population who are completely healthy and do not show any symptoms with an absence of pain; a huge 80% of the population has one. We also identified the existence of asymmetry as a sign of pelvic and lumbar spine tension [7] correlated with LBP. ...
... A study [7] observes the incidence in the population who are completely healthy and do not show any symptoms with an absence of pain; a huge 80% of the population has one. We also identified the existence of asymmetry as a sign of pelvic and lumbar spine tension [7] correlated with LBP. However, in both these articles, they observed the relationship was possibly weak. ...
Posture is a “body’s attitude or the positioning of the limbs when standing or sitting.” There are many examples of different postures which include lordotic posture, swayback posture, flat back, and anterior pelvic tilt. Everyone in some of the other parts of their life considers pain as an unpleasant feeling or sensation that is experienced. Specifically, low back pain can be relentless and daunting to many people who often recovered without the need of a health care professional or any treatment by changing their posture or performing the movement. Various factors are leading to low back pain other than the postural fault, for instance, age, sedentary lifestyle, anxiety, and sleep. However, for back pain, posture has become deep-rooted in people’s thoughts. Health care professionals have instructed people to correct their posture to fight back pain. As people become older, the posture becomes worse, but this does not appear to cause pain. If any person cannot move his/her body, that does not mean that they are having a problem involving posture; that is actually because of a problem relating to movement. A study proved that there is no difference in the lordotic angle of the populace having an issue with LBP. There is a decrease in the range and speed of the movement performed. What matters is the movement rather than the appearance of standing or sitting. The primary aim of this paper is to improve knowledge and understanding of the association between posture and LBP, as, speaking about recent researches, they have observed no association between posture and LBP. There are many studies published to support this evidence. People call the importance of posture and alignment for while performing a heavy deadlift, land a jump, or any strenuous activity. Therefore, an urge to write a paper on this topic is to change the mindset of many people worrying out there about their postural faults or their appearances by providing information about varying their static posture to conform to some ideal and keep moving to improve their function.
... Thus, the therapist placed the PALM inclinometer at ASIS with one end arm and at PSIS with the other end arm. The angle of pelvis inclination was the angle between the horizontal line and the line that crossed ASIS and PSIS, calculated by the PALM inclinometer bubble level [9]. The previous measurement was performed on both sides of the pelvis. ...
... The previous measurement was performed on both sides of the pelvis. The accuracy and validity of this method exhibit high intra-tester reliability (intraclass correlation coefficient [ICC] = 0.87) [9]. The mean pelvic tilt angle value was 13 ± 6° [8]. ...
... We measured sagittal tilt per the standard protocol, which is considered to be reliable. 20,21 Intraclass correlation coefficient (ICCs) for sagittal plane measurements were reported to be high for both intratester (0.98) and intertester (0.89) reliability. 21 Readings were recorded for both sides of the body. ...
... A BMI between 18.5 and 24.9 is considered to be ideal. In our study, population, BMI was 19 (19)(20)(21)(22). A high BMI is associated with hyperlordosis, but results conflict regarding association between BMI and lordosis. ...
Bharatanatyam is a popular classical and traditional dance of India. The dance’s
postures and repetitive movements may affect loading on the spine. This study was undertaken
to establish the relationship between the lumbar spine and pelvic tilt on abdominal muscle endurance
in Bharatanatyam dancers. A secondary aim was to determine the effect of other recreational
activities on these variables. We assessed 35 trained Bharatanatyam dancers, aged between 18 to
35 yr, who had at least 3 yr of training. Lumbar curvature and pelvic tilt were measured using a
bubble inclinometer and palpation meter (PALM), respectively, and abdominal muscle endurance
was tested using McGill’s core-endurance test. Spearman’s coefficient of correlation was used to
determine relationships between variables. Mean lumbar curvature measured 48.00 ± 8.5, right
pelvic tilt 10.83 ± 4.9, and left pelvic tilt 11.20 ± 4.8 degrees. The hold time that dancers could
perform in McGill’s core-endurance test was 360 (225–257), 33 (16–55), 21 (18–34), and 24 (17–
34) s for flexor, extensor, right lateral, and left lateral test, respectively. No significant correlation
was found between the three variables tested: lumbar curvature, pelvic tilt, and abdominal muscle
endurance. The left lateral endurance test was significantly different (p = 0.04) in Bharatanatyam
dancers who were involved in other recreational
... Care was taken to keep the sacroiliac ligaments and pubic symphysis intact. Each ischium of the specimen was subsequently potted in fast-curing resin (Smooth-Cast 300Q, Smooth-On, Inc., Easton, Pennsylvania, USA) and aligned to fit the physiological pelvic orientation [28]. Alignment was done under fluoroscopy using Jamshidi bone biopsy needles and steel wires. ...
Background
Posterior and lateral techniques have been described as approaches to sacroiliac joint arthrodesis. The purpose of this study was to compare the stabilizing effects of a novel posterior stabilization implant and technique to a previously published lateral approach in a cadaveric multidirectional bending model. We hypothesized that both approaches would have an equivalent stabilizing effect in flexion–extension and that the posterior approach would exhibit better performance in lateral bending and axial rotation. We further hypothesized that unilateral and bilateral posterior fixation would stabilize both the primary and secondary joints.
Methods
Ranges of motion (RoMs) of six cadaveric sacroiliac joints were evaluated by an optical tracking system, in a multidirectional flexibility pure moment model, between ± 7.5 N-m applied moment in flexion–extension, lateral bending, and axial rotation under intact, unilateral fixation, and bilateral fixation conditions.
Results
Intact RoMs were equivalent between both samples. For the posterior intra-articular technique, unilateral fixation reduced the RoMs of both primary and secondary joints in all loading planes (flexion–extension RoM by 45%, lateral bending RoM by 47%, and axial RoM by 33%), and bilateral fixation maintained this stabilizing effect in both joints (flexion–extension at 48%, lateral bending at 53%, and axial rotation at 42%). For the lateral trans-articular technique, only bilateral fixation reduced mean RoM of both primary and secondary sacroiliac joints, and only under flexion–extension loads (60%).
Conclusion
During flexion–extension, the posterior approach is equivalent to the lateral approach, while producing superior stabilization during lateral bend and axial rotation.
... Each ischium of the specimen was subsequently potted in fast-curing resin (Smooth-Cast 300Q, Smooth-On, Inc, Easton, Pennsylvania, USA) and aligned to t the physiological pelvic orientation. [22] Alignment was done under uoroscopy using Jamshidi bone biopsy needles and steel wires. The L4 vertebrae was potted after being rigidly a xed to the L5 using wood screws. ...
Background
Posterior and lateral techniques have been described as approaches to sacroiliac joint arthrodesis. The purpose of this study was to compare the stabilizing effects of a novel posterior stabilization implant and technique to a previously published lateral approach in a cadaveric multidirectional bending model. We hypothesized that both approaches would have an equivalent stabilizing effect in flexion-extension, and that the posterior approach would exhibit better performance in lateral bending and axial rotation. We further hypothesized that unilateral and bilateral posterior fixation would stabilize both the primary and secondary joints.
Methods
Ranges of Motion (RoMs) of six cadaveric sacroiliac joints were evaluated by an optical tracking system, in a multidirectional flexibility pure moment model, between ± 7.5 Nm applied moment in flexion-extension, lateral bending, and axial rotation under intact, unilateral fixation, and bilateral fixation conditions.
Results
Intact RoMs were equivalent between both samples. Unilateral posterior intra-articular fixation reduced the RoMs of both primary and secondary joints in all loading planes (flexion-extension RoM by 45%, lateral bending RoM by 47%, and axial RoM by 33%), and bilateral fixation maintained this stabilizing effect in both joints (flexion-extension at 48%, in lateral bending at 53%, and in axial rotation at 42%). Only bilateral lateral trans-articular fixation reduced mean RoM of both primary and secondary sacroiliac joints, and only under flexion-extension loads (60%).
Conclusion
During flexion-extension, the posterior approach is equivalent to the lateral approach; while producing superior stabilization during lateral bend, and axial rotation.
... In a study of healthy adults measuring the pelvic angle with a palpation meter, 85% of males and 75% of females showed an anterior pelvic tilt (mean 6-7 degrees), and the rest showed a posterior pelvic tilt or a neutral posture. Therefore, a single pelvic tilt angle could not be the sole cause of the pathology, and the MDC was reported to be 2.5 degrees [42]. Based on these studies' results, it is difficult to define the normal range for a pelvic tilt, and it is thought that it should be evaluated in relation to functional ability. ...
Background:
This study was aimed at investigating the effect of pelvic tilt taping on muscle strength, pelvic inclination, and gait function in patients with stroke.
Methods:
A total of 60 patients with stroke were included in our study and randomly divided into three groups: the posterior pelvic tilt taping (PPTT, n = 20), the lateral pelvic tilt taping (LPPP) with PPTT (LPPP+PPTT, n = 20), and the control (n = 20) groups. All participants performed pelvic stabilization exercises consisting of 6 movements: supine, side lying, quadruped, sitting, squatting, and standing (30 min/day, five days/week, for six weeks). PPTT to correct anterior pelvic tilt was applied to the LPTT+PPTT and PPTT groups, and lateral pelvic tilt taping was additionally applied to the LPTT+PPTT group. LPTT was performed to correct the pelvis tilted to the affected side, and PPTT was performed to correct the anterior pelvic tilt. The control group did not undergo taping. A hand-held dynamometer was used to measure the hip abductor muscle strength. In addition, a palpation meter and 10-meter walk test were used to assess pelvic inclination and gait function.
Results:
Muscle strength was significantly stronger in the LPTT+PPTT group than in the other two groups (p = 0.01). The anterior pelvic tilt was significantly improved in the taping group compared to the control group (p < 0.001), and the lateral pelvic tilt was significantly improved in the LPTT+PPTT group compared to the other two groups (p < 0.001). Significantly greater improvements in gait speed were observed in the LPTT+PPTT group than in the other two groups (p = 0.02).
Conclusions:
PPPT can significantly affect pelvic alignment and walking speed in patients with stroke, and the additional application of LPTT can further strengthen these effects. Therefore, we suggest using taping as an auxiliary therapeutic-intervention method in postural control training.
... The right and left PT angles were measured using a palpation meter (Varzeshpajohane Emruz Co., Iran) in standing position with legs parallel to each other and shoulder-width apart. The palpation meter arms were placed between the anterior superior iliac spine and the posterior superior iliac spine to measure the PT angle [26]. This measurement was performed three times, and the average degree was considered as the PT angle. ...
Introduction: This study aimed to investigate the immediate effect of kinesio taping (KT) over abdominal muscles with different tensions on the components of the lumbopelvic complex.
Materials and Methods: This is a single-blind randomized controlled clinical trial. Participants were 44 healthy male athletes aged 18-30 years with increased anterior pelvic tilt (PT). Three intervention groups underwent 15 minutes of KT over rectus abdominis and external oblique muscles with tensions of 100, 115, and 140%, respectively, and one group was considered as the control group with no KT. The PT and lumbar lordosis angles and iliopsoas and hamstring muscle lengths were measured before and after the KT. Repeated measures ANOVA was used to compare the means in the study groups before and after the intervention.
Results: The mean of right and left PT and lumbar lordosis angles in groups with 115 and 140% tensions before and after the intervention were statistically different (P
... In a normal, asymptomatic population, anterior pelvic tilt was found among 85% of male and 75% of female participants, the tilt degree was in the range of 6°-7° for both sexes. [6] If a patient has a pelvic tilt, the anterior pelvic plane cannot be aligned parallel to the table on which the patient is lying. ...
... Compared to the previously published studies [28][29][30], the results obtained in the studied population are higher than the ranges of the pelvic tilt as well as its average values. This may indicate differences in pelvic tilt values; differences which depend on the place of living of the respondents, their lifestyles and attitude towards widely understood physical activity, and possible generational changes taking place during the last decades and resulting in secular changes in the body height and proportions [32,33]. There were also differences in pelvic tilt in women and men, although different to what was reported by Herrington [34]. ...
Background:
Disturbances in pelvic girdle tilt can cause compensatory changes affecting postural dysfunctions, and can lead to hip and groin strain changes and back pain. However, we still have no clear information on the normative values of pelvic girdle tilt and mobility.
Objective:
The study aimed to (1) evaluate the position and mobility of the pelvic girdle in the sagittal and frontal planes in asymptomatic adults aged 19-30, (2) evaluate the possible variation of results according to gender and to develop a proposal for normative values, and (3) evaluate whether body mass, height and BMI are related to the magnitude of hip girdle position and mobility.
Methods:
The research was conducted in a sample group consisting of 346 men and women using the scaled form of the anthropometric level of the Duometr® The values of position and mobility of the pelvic girdle in the sagittal and frontal planes were analyzed.
Results:
Differences were noted in the values of the pelvic tilt (p= 0.033) between the men and women. The women showed slightly higher values of posterior range of motion (p= 0.0002) and total range of motion (p= 0.002). The other parameters did not show any significant variation. There was no clear association between body weight, height and BMI and the study variables, except for a small, significant correlation between BMI and posterior pelvic tilt in women (r= 0.175, p= 0.005). In the frontal plane there were no differences in the analyzed variables in terms of gender or side of the body measured.
Conclusions:
There was no association between the anthropometric variables and the pelvic girdle tilt and mobility. No size variation by gender was observed in the frontal plane. Slight differences were observed in the sagittal plane. Normative values are proposed.
... They associated faulty posture with several musculoskeletal disorders and it connected this to the pelvic position. In a study, [10] when we observe the incidence in the population who are completely healthy and do not show any symptoms with an absence of pain, a huge 80% of the population has one. We also identified the existence of asymmetry as a sign of pelvic and lumbar spine tension (Sahrmann, 2002) and (Levangie, 1999) correlated with LBP. ...
Posture is a “body’s attitude or the positioning of the limbs when standing or sitting.” There are many examples of different postures which include lordotic posture, swayback posture, flat back, and anterior pelvic tilt. Everyone in some of the other parts of their life considers pain as an unpleasant feeling or sensation that is experienced. Specifically, low back pain can be relentless and daunting to many people who often recovered without the need of a health care professional or any treatment by changing their posture or performing the movement. Various factors are leading to low back pain other than the postural fault, for instance, age, sedentary lifestyle, anxiety, and sleep. However, for back pain, posture has become deep-rooted in people’s thoughts. Health care professionals have instructed people to correct their posture to fight back pain. As people become older, the posture becomes worse, but this does not appear to cause pain. If any person cannot move his/her body, that does not mean that they are having a problem involving posture; that is actually because of a problem relating to movement. A study proved that there is no difference in the lordotic angle of the populace having an issue with LBP. There is a decrease in the range and speed of the movement performed. What matters is the movement rather than the appearance of standing or sitting. The primary aim of this paper is to improve knowledge and understanding of the association between posture and LBP, as, speaking about recent researches, they have observed no association between posture and LBP. There are many studies published to support this evidence. People call the importance of posture and alignment for while performing a heavy deadlift, land a jump, or any strenuous activity. Therefore, an urge to write a paper on this topic is to change the mindset of many people worrying out there about their postural faults or their appearances by providing information about varying their static posture to conform to some ideal and keep moving to improve their function.
... Each ischium was potted individually in a fast curing resin (Smooth-Cast 300Q, Smooth-On, Inc, Easton, Pennsylvania) with the superiorinferior axis, defined physiologically, aligned with gravity. 25 Wood screws were inserted through the L4 endplate and into the L5, rigidly fixing both vertebral bodies. The L4 vertebral was then potted in a cylindrical mold with fast curing resin to allow for mounting of a pure moment ring during testing ( Figure 2). ...
Purpose:
The purpose of this study was to assess the stabilizing effect of a posterior joint fixation technique using a novel cortical allograft implant in unilateral and bilateral fixation constructs. We hypothesize that fixation would reduce the joint's range of motion during flexion-extension, axial rotation, and lateral bending loads. We also hypothesize that fixation would shift the center of the instantaneous axis of rotation during the predominant flexion-extension motions towards the implant's location, and that this shift would be correlated with the reduction in flexion-extension range of motion.
Materials and methods:
Six cadaveric sacroiliac joint specimens were tested under intact, unilateral fixation, and bilateral fixation conditions. The total range of motion (ROM) of the sacroiliac joint in flexion-extension, lateral bending, and axial rotation were evaluated by an optical tracking system, in a multidirectional flexibility pure moment model, between ± 7.5 Nm applied moment loads. The centers of the instantaneous axis of rotation (cIAR) of the sacroiliac joint were evaluated during flexion-extension loading. A correlation analysis was performed between the ROM reduction in flexion-extension upon implantation and shift of the cIAR to the graft implantation site.
Results:
Unilateral and bilateral fixations generated sacroiliac joint ROM reductions in flexion-extension, lateral bending, and axial rotation motions. Fixation shifted the cIAR to the graft implantation site. Reduction in the total range of motion had a moderate correlation with the shift of the cIAR.
Conclusion:
Our novel posterior approach presents a multifaceted mechanism for stabilizing the joint: first, by the reduction of the total range of motion in all planes of motion; second, by shifting the centers of the instantaneous axis of rotation towards the implant's location in the predominant plane of motion, ensuring little to no motion at the implantation site, thus promoting fusion in this region.
... Regarding the leg position, when standing, the subjects were asked to widen their stance to approximately shoulder width. Based on the results of previous studies [27,28], using a palpation meter (PALM®; Performance Attainment Associates, St. Paul Minnesota, USA), the anterior and posterior superior iliac spines were marked such that the pelvic anteversion angle between the two points was set between 6 • and 7 • . With the palms of the hands placed on the posterior surfaces of the iliac crests when in a standing position, the starting standing position (pre-Ex) was defined as the 10 s after a 30 s acclimatization period. ...
Background:
In low back pain, multifidus muscle fibers reportedly exhibit increased stiffness. Low back pain was associated with lumbodorsal muscle fatigue. There is no report of using shear modulus to verify the mechanism of an immediate effect of exercise on low back pain. Here, temporary lumbodorsal muscle fatigue was created, simulating fatigue-related nonspecific low back pain.
Objective:
To assess the effect of standing back extension exercise on fatigued lumbodorsal muscle based on the results of multifidus muscle elasticity measured using shear wave elastography.
Methods:
Thirty-three healthy subjects were randomly divided into three groups. The subjects performed the Biering-Sorensen test as the fatigue-task of the lumbodorsal muscle before the standing back extension exercise. The fatigue-exercise group exercised five sets after completing the fatigue-task. The fatigue-non-exercise group remained standing for the same duration as the fatigue-exercise group without doing the exercise after the fatigue-task. The non-fatigue-exercise group exercised five sets of without performing the fatigue-task. As intra-group and inter-group factors, the shear modulus of the multifidus muscle was compared before and after the exercise.
Results:
The shear modulus of the multifidus muscle after the standing back extension exercise was significantly lower in the fatigue-exercise group, and no significant decrease was observed in the fatigue-non-exercise and non-fatigue-exercise group.
Conclusions:
The standing back extension exercise improved the shear modulus of the fatigued multifidus muscle. Therefore, it was suggested that the change in the elasticity of fatigued muscle might lead to the prevention of low back pain caused by muscle fatigue.
... In clinical practice the degree of pelvic tilt is commonly assessed because of its reported relationship to pelvic, spinal and lower limb pathologies. 5) Orientation of acetabulum depends on pelvis tilt. 6) Position of the acetabulum relates to the global sagittal balance of the spino-pelvic unit. ...
... Bei asymptomatischen Personen gibt es häufige Variationen der Beckenpositi-on. Zu dieser Erkenntnis gelangten Herrington et al. [21] in ihrer Studie, in der Messungen des "pelvic tilt" mit einem speziellen Messgerät, dem sog. Palpation Meter (PALM, Performance Attainment Associates, St. Paul, Minnesota, USA), bei 120 beschwerdefreien jungen Erwachsenen durchführten. ...
Zusammenfassung
Pathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie in Verbindung gebracht. Aufgrund dieser Messungen werden therapeutische Wege eingeschlagen. Zu diesem Thema wurden auf der Basis einer systematischen Literatursuche in zwei maßgeblichen Datenbanken 28 Artikel ermittelt. Die inhaltliche Analyse beschäftigt sich v. a. mit der Variationsanatomie des Beckens sowie der Reliabilität palpatorischer und apparativer Bestimmungen von knöchernen Referenzpunkten am Becken. Hieraus ergeben sich maßgebliche Erkenntnisse: Eine Variationsanatomie des Beckens ist häufig und kommt auch bei nichtsymptomatischen Personen vor. Die palpatorische und apparative Bestimmungen der knöchernen Referenzpunkte sind gering bis moderat reliabel. Der Rückschluss von einer festgestellten Beckenasymmetrie auf den Einfluss bestehender oder noch zu erwartender Rücken‑, Hüft- oder Beckengelenkbeschwerden ist nach derzeitiger Studienlage zumindest umstritten und daher nicht empfehlenswert.
... Pelvic angle was measured using a PALM palpation meter (Performance Attainment Associates, St. Paul, MN, USA), a pelvic-leveling device that combines the features of a measurement caliper and an inclinometer. The PALM palpation meter" has been validated in several previous studies [9][10][11][12]. The subjects stood with legs aligned with their shoulders, positioned their arms by the side of their body and looked at a fixed point ahead to control for posture sway. ...
Background:
LBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people's lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania.
Methods:
Following signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants' height, weight, curvature of the spine, and pelvic angle were obtained.
Results:
A Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups.
Conclusions:
A person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.
... 30 Finalmente, los hallazgos posturales en pacientes sintomáticos no difieren de los asintomáticos, motivo por el cual, la relación entre la alteración postural y el dolor lumbar termina siendo inconsistente. [31][32][33] Uso de imágenes ...
Resumen
Objetivo: Conocer los pensamientos, actitudes y abordajes terapéuticos utilizados por kinesiólogos argentinos en la rehabilitación de los pacientes con dolor lumbar.
Materiales y método: Se realizó un estudio descriptivo, transversal tipo encuesta entre marzo y mayo de 2018. Se incluyeron kinesiólogos argentinos, mediante un muestreo no probabilístico. Se los invitó a completar la encuesta mediante la plataforma online Survey Monkey®. La misma constaba de 21 preguntas de tipo elección múltiple y con respuestas abiertas con el objetivo de darle la posibilidad a los encuestados de desarrollar sus ideas.
Resultados: 159 kinesiólogos completaron la encuesta. De ellos, 129 (81,5%) refirió haber padecido dolor lumbar en algún momento de su vida. Ciento treinta y cuatro respondieron en cuanto al abordaje terapéutico, siendo 11 (8,2%) los profesionales que indicaban reposo y 80 (60,4%) los que sugerían limitar algún movimiento. Ciento cincuenta y cuatro (96,8%) refirieron educar a sus pacientes. La actividad laboral y los factores psicosociales fueron las variables consideradas más relevantes en la cronificación del dolor lumbar. Ciento treinta y uno (82,3%) destacan la importancia de la evaluación postural y 105 (66,1%) de ellos consideran que su modificación es parte del éxito del tratamiento. La resonancia magnética nuclear y la radiografía son los estudios complementarios más utilizados.
Conclusión: el 82,5% de los kinesiólogos encuestados considera importante valorar la postura. Casi el total utiliza tiempo de su sesión para educar a sus pacientes y sólo el 8,2% indica reposo. Entre el 12% y 21% administra cuestionarios de discapacidad, miedo al movimiento o catastrofismo.
Palabras clave: dolor lumbar, kinesiología, encuesta, tratamiento.
... The anterior pelvic tilts were measured bilaterally by placing the PALM caliper tips in contact with the ipsilateral anterior and posterior superior iliac spines (Fig. 2). This method is valid, reliable, and cost-effective for calculating any discrepancies between the patients' landmarks [18]. During the pelvic alignment measurements, the participants took off their shoes and stood with their hands crossed in front of their chests. ...
Background:
Pelvic alignment changes during pregnancy and post-childbirth. Pelvic belts exert external forces that compress and stabilize the joints, and therefore, could influence pelvic alignment. However, limited information is available regarding this potential effect. Therefore, the purpose of this study is to investigate the influence of pelvic belt use on pelvic alignment during and after pregnancy.
Methods:
Data of 201 pregnant women in late pregnancy and 1 month after childbirth were used. Pelvic alignment measurements, including anterior and posterior pelvic width, pelvic asymmetry, and pelvic belt use during and after pregnancy were investigated. Participants were divided into four groups according to pelvic belt use: before and after childbirth (BAC), before childbirth only (BC), after childbirth only (AC), and non-use (NU). Then, an initial one-way ANOVA was conducted to compare the amount of change in pelvic alignment from late pregnancy to post-childbirth between the groups. After the initial analysis, a multivariate regression analysis was performed to determine the statistically significant differences between the groups to consider other factors that influenced pelvic alignment such as age, BMI, number of previous childbirths, vaginal delivery and pelvic asymmetry in late pregnancy. Next, a cutoff point for subgroup stratification based on the weekly duration of pelvic belt use and inter-group changes in pelvic alignment were compared.
Results:
As the result of the initial one-way ANOVA, the decrease in pelvic asymmetry from during pregnancy to postpartum for BAC was greater than that for AC. Moreover, multiple regression analysis showed that the effect of pelvic belt that was revealed in the initial analysis was statistical significance even after adjustment for other factors. Moreover, pelvic asymmetry in the BAC group decreased, compared to being increased or unchanged in the NU and AC groups when the group cutoff time was 7 h per week.
Conclusions:
Continuous and extended use of pelvic belts during and after pregnancy might be related to modifications of pelvic asymmetry in the perinatal period. Therefore, the instruction of correct and comfortable usage and the recommendation of continuous use of pelvic belt especially during pregnancy are required for prevention of some discomforts related to pelvic malalignment.
... Pelvic tilt, an angle between anterior-superior iliac spine (ASIS) and the posterior-superior iliac spine (PSIS) was measured with a digital pelvic inclinometer (Sub4 Technologies, Staffordshire, UK) in standing position. Normal/neutral angle was considered between 0-5 degrees in males, and 7-10 degrees in females (Herrington, 2011). ...
With high rates of active population experiencing undiagnosed, nonspecific
low back pain, a new approach is needed with consideration of
dysfunctional movement patters that may lead to chronic back pain. Active straight leg raise (ASLR) is widely used diagnostic tests for LBP, but there is a lack of evidence of association with other clinical parameters and functional analyses used in evaluation of LBP. Hence, the primary aim of this study is to investigate association of ASLR test with the movement deficiencies in muscles and joints responsible for lumbo-pelvic stability in populations with and without low back pain. 100 physically active participants with (n=50) and without LBP (n=50) volunteered for the study. One-way ANOVA was used to examine for
potential differences between two groups, and multiple correspondence analysis (MCA) to examine the pattern of relationships between the measured variables. Participants without pain had significantly higher ASLR score (p < 0.001), demonstrated better hamstring flexibility (p < 0.001) and better gluteal activation
pattern (p < 0.01). On the other hand, participants with LBP had greater incidence of pelvic rotation during knee flexion, and hip internal rotation, relative to participants without LBP (p < 0.001). Results also demonstrate that participants with pain scored largely 1 on the ASLR which was also associated with hamstring tightness, calf tightness, limited trunk flexion, hypo-mobility of the trunk, and
posterior pelvic tilt. These findings indicate a strong association of low back pain with functional movement impairment and weakness in movement motor control. ASLR test should be used conjunction with other functional evolution tests to isolate the cause of LBP in physically active individuals.
... Existem na literatura diversos métodos disponíveis para avaliação da posição da pelve. Comumente a avaliação pélvica é realizada com os indivíduos em ortostatismo, incluindo fotogrametria, uso de inclinômetros, radiografias e medidores de palpação (PALM) 12 . Um estudo japonês com mulheres jovens utilizou fotogrametria para avaliação do formato e inclinação da pelve 13 . ...
Introdução: O câncer tem sido um crescente problema de saúde pública no Brasil. Comumente, a pessoa com câncer pode apresentar diversas alterações posturais, como a rotação da pelve, ocasionadas pela doença e por efeitos adversos secundários às formas de tratamento. Objetivo: Analisar a influência do posicionamento rotacional da pelve de pessoas com câncer por meio da baropodometria. Métodos: Foram incluídos 45 indivíduos, divididos em: Grupo Quimioterapia e/ou Radioterapia (GQR), Grupo Câncer em Acompanhamento (GCA) e Grupo Controle sem Câncer (GCS). Todos os voluntários foram avaliados quanto ao posicionamento da pelve por meio da baropodometria. Resultados: Não foram encontradas alterações significativas no posicionamento rotacional da pelve nas comparações entre os grupos com câncer e grupo controle (p: 0,112; Poder: 0,838; f2: 1,121). Conclusão: Os resultados sugerem que o câncer e suas formas de tratamento não exerceram influência sobre a postura rotacional da pelve.
... In clinical practice the degree of pelvic tilt is commonly assessed because of its reported relationship to pelvic, spinal and lower limb pathologies. 5) Orientation of acetabulum depends on pelvis tilt. 6) Position of the acetabulum relates to the global sagittal balance of the spino-pelvic unit. ...
... Our study reported only 1% of posterior pelvic tilt occurrence among the male students whereas the findings from a previous study showed the presence of posterior pelvic tilt among 6% of males and 7% of females. [18] A typical muscle imbalance scenario that causes posterior pelvic tilt involves tight hamstrings, gluteus and lower abdominal muscles coupled with weak quadriceps, psoas and lower back muscles. Tight muscles exert a pull on body structures that is not counterbalanced by the pull of weak muscles. ...
A good stance and posture reflect a proper state of mind. A human posture goes through a series of changes in the course of body growth and development. Postural defects are very common among high school students. Posture screening during the schooling year's helps to discover the spinal deviations, especially those related to the use of backpacks and poor sitting postures. At the later stage spinal deviations progress to spinal deformities. This study was aimed to detect the prevalence of posture alterations in high school students. We had screened 100 (35 male and 65 females) high school students. A survey questionnaire was administered to identify their posture awareness. Then they were screened for sagittal and frontal alignments using the plumb line test. The results revealed that 86% (n=86) high school students were responsive to the importance of posture and 70% (n=70) were aware about their own posture. From the posture screening, 20% (n=7) of male and 10.8% (n=7) female participants were identified as having faulty posture.
... The intra class correlation coefficient suggests that the intra rater and inter-rater reliability were excellent for sagittal and frontal plane measures i.e. anterior pelvic tilt and lateral pelvic tilt except moderate inter-rater reliability for lateral pelvic tilt. The methodology was adapted from Petrone et al [21]and Herrington et al [23] who performed the limb length discrepancy. In this study, we performed in a way that is suitable to the patients post stroke. ...
Introduction: Palpation meter (PALM TM) device was tested for its reliability to measure the pelvic tilt in musculoskeletal related dysfunctions, but not in stroke. The aim of this study is to find the intra and inter rater reliabilities of the PALM TM device and quantify the pelvic tilt in patients with stroke. Sixty four patients post stroke and age matched 64 healthy individuals participated in the study. Materials and Methods: Sagittal and coronal planar pelvic positions were measured in standing using PALM TM device by two raters blinded for the values at different time point on same day. Results: The mean anterior pelvic tilt (APT) was 5.5 degrees on the most affected side and 5.4 degrees on the least affected side and lateral pelvic tilt (LPT) was 3.03 degrees towards most affected side. The intra-rater reliability (r value) of LPT and APT towards the most and least affected sides was 0.76, 0.91 and 0.90, respectively. The inter-rater reliability was ranging between 0.47-0.80 for the LPT and 0.80-0.92 for the APT. Conclusion: PALM TM device provided excellent inter and intra-rater reliability for sagittal planar pelvic tilt and good intra and inter-rater reliability for coronal planar pelvic tilt in stroke. Clinicians can use PALM TM device to find the treatment efficacy of pelvic control training for patients post stroke.
... The PALpation Meter has been shown to be a reliable tool to measure pelvic position. 2,15,18,27 The validity of the PALpation Meter also has been reported for measuring pelvic crest height differences. 37 The validity of the current method of assessing pelvic rotation with the PALpation Meter device, however, has not been documented. ...
Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with FAI symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to hip-healthy people. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with Femoroacetabular Impingement (FAI) and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 hip-healthy people participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the three groups in all conditions (Ps<0.05). Post-hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and hip-healthy group (mean difference= 1.2° to 1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to the hip-healthy group (mean difference= 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and hip-healthy people. Level of Evidence Symptom prevalence, level 4. J Orthop Sports Phys Ther, Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.
... Further, the definition of neutral position using a reference trial led to greater trunk flexion angles. This difference can be explained by the anterior tilt of the pelvis during standing (Herrington, 2011). Using anatomical landmarks to define trunk angles incorporates the anterior pelvic tilt, leading to negative trunk angles during standing, whereas using a reference trial assumes the pelvis horizontal. ...
Motion capture of the trunk using three-dimensional optoelectronic systems and skin markers placed on anatomical landmarks is prone to error due to marker placement, thus decreasing between-day reliability. The influence of these errors on angular output might be reduced by using an overdetermined number of markers and optimization algorithms, or by defining the neutral position using a reference trial. The purpose of this study was to quantify and compare the between-day reliability of trunk kinematics, when using these methods.
Wenn es in der Hüfte klemmt, kommen viele Ursachen in Frage. Das femoroazetabuläre Impingement ist eine davon. Für Patienten bricht dann oft eine Welt zusammen, aber den Betroffenen kann geholfen werden – mit einer individuell abgestimmten Therapie. Voraussetzung dafür ist eine gute klinische Diagnostik.
Excessive anterior and posterior pelvic tilts (PT) angles are associated with overuse injuries of the lower limbs and of the lumbo-pelvic-hip complex. There is a lack of evidence that correlates anterior and posterior PT angles with limited hip internal rotation (IR) and external rotation (ER), and hip muscles torque ratios. The purpose of this study was to examine the correlation between averaged anterior/posterior PT angle in standing position and hip IR and ER range of motion (ROM), hip adductors and abductors (Add/Abd) torque ratio, and hip flexors and extensors (Flexor/Extensor) torque ratio. Twenty-six healthy participants participated in this study, fifteen females (22.0 ± 2.8 yrs, 163.5 ± 7.5 cm, 65.9 ± 10.4 kg) and eleven males (22.0 ± 2.2 yrs, 178.5 ± 4.5 cm, 78.4 ± 8.7 kg). Hip muscle torques were collected with an isokinetic dynamometer, five trials at 30 degrees per second (deg· s-1) and at 60 deg· s-1. The measurement of PT in standing natural position and hip IR and ER ROM in functional weight-bearing lunge position were recorded, using a 3D Motion Analysis System. There were no significant correlations between PT angle and hip IR and ER (p ≥ 0.05), no significant correlations between PT angle and hip Add/Abd torque ratio (p > 0.05), and no significant correlations between PT angle and hip Flexor/Extensor torque ratio (p > 0.05). The measurement of PT angle in standing natural position was not associated with hip IR and ER ROM and hip Add/Abd and Flexor/Extensor torque ratios, in healthy population.
BACKGROUND: A method of measurement of voluntary activation (VA, percent of full muscle recruitment) during isometric and isokinetic concentric contractions of the quadriceps femoris (QF) at 60∘/s and 120∘/s was previously validated. OBJECTIVE: This study aimed to quantify the test-retest minimal real difference (MRD) of VA during isometric (ISOM) and isokinetic concentric contractions of QF (100∘/s, ISOK) in a sample of healthy individuals. METHODS: VA was measured through the interpolated twitch technique. Pairs of electrical stimuli were delivered to the QF at 40∘ of knee flexion during maximal voluntary contractions. Twenty-five healthy participants (20–38 years, 12 women, 13 men) completed two testing sessions with a 14-day interval. VA values were linearized through logit transformation (VAl). The MRD was estimated from intraclass correlation coefficients (model 2.1). RESULTS: The VA (median, range) was 84.20% (38.2–99.9%) in ISOM and 94.22% (33.8-100%) in ISOK. MRD was 0.78 and 1.12 logit for ISOM and ISOK, respectively. As an example, in terms of percent VA these values correspond to a change from 76% to 95% and from 79% to 98% in ISOM and in ISOK, respectively. CONCLUSIONS: The provided MRD values allow to detect significant individual changes in VA, as expected after training and rehabilitation programs.
BACKGROUND: Pelvic tilt angle is defined as the angle between the horizontal plane and the line passing through the center of the PSIS and center of ASIS. Clinically use of a pelvic inclinometer to measure pelvic inclination angles is a quick, non-invasive, user-friendly method. In the present study we have devised a similar method of measuring pelvic tilts by means of a self-designed pelvic inclinometer.
Background and Aims: Swayback posture is one of the spinal abnormalities and one of the important causes for the pathology of the Lumbo-Pelvic region. However, due to inadequate information about the method of evaluation among researchers, and also lack of agreement about the muscular changes, less attention has been paid to muscle activity in this posture. Therefore, the purpose of the current study was to compare the electromyographic activity of trunk and hip muscles during standing in females with and without swayback posture. Materials and Methods: For this purpose, 30 inactive females selected using purposive sampling method were assigned into two groups of swayback posture and control. Pelvic tilt and sway angles were obtained with camera and electromyography signals from the thoracic and lumbar erector spine, lumbar multifidus, gluteus maximus, medial hamstring, rectus abdominis, external oblique abdominal, and rectus femoris muscles during standing posture. Results: The results of independent t-test demonstrated significant differences between swayback posture and control groups in the pelvic tilt (p ꞊ 0/001) and sway angles (p ꞊ 0/001). Also, no significant differences were shown between the two groups in the electromyographic activity of erector spine, lumbar multifidus, rectus abdominal, external oblique, and hip extensor muscles during standing (p > 0/05). Moreover, there was a significant difference between the two groups in the amounts of activity of the rectus femoris muscle (p ꞊0/012) and internal oblique (p ꞊0/018). Conclusion: The findings of the present study demonstrated that there are similar muscle contractions in the trunk and hip muscles between two groups of sway back posture and control, which contrary to the previous studies, the perception of passive swayback posture has been somewhat violated. Hence, this can provide a better understanding of the sway back posture for trainers and athletes in assessment and rehabilitation. Cite this article as: Zahra Darzi Sheikh, Foad Seidi*, Reza Rajabi, Hooman Minoonejad. Comparison of the electromyographic activity of trunk and hip muscles during standing in females with and without Swayback posture.
Excessive anterior pelvic tilt is suspected of causing femoroacetabular impingement, low back pain, and sacroiliac joint pain. Non-surgical treatment may decrease symptoms and is seen as an alternative to invasive and complicated surgery. However, the effect of non-surgical modalities in adults is unclear. The aim of this review was to investigate patient- and observer-reported outcomes of non-surgical intervention in reducing clinical symptoms and/or potential anterior pelvic tilt in symptomatic and non-symptomatic adults with excessive anterior pelvic tilt, and to evaluate the certainty of evidence. MEDLINE, EMBASE, Web of Science and Cochrane (CENTRAL) databases were searched up to March 2019 for eligible studies. Two reviewers assessed risk of bias independently, using the Cochrane Risk of Bias tool for randomized trials and the ROBINS-I tool for non-randomized studies. Data were synthesized qualitatively. The GRADE approach was used to assess the overall certainty of evidence. Of 2013 citations, two randomized controlled trials (RCTs) (n = 72) and two non-RCTs (n = 23) were included. One RCT reported a small reduction (< 2°) in anterior pelvic tilt in non-symptomatic men. The two non-RCTs reported a statistically significant reduction in anterior pelvic tilt, pain, and disability in symptomatic populations. The present review was based on heterogeneous study populations, interventions, and very low quality of evidence. No overall evidence for the effect of non-surgical treatment in reducing excessive anterior pelvic tilt and potentially related symptoms was found. High-quality studies targeting non-surgical treatment as an evidence-based alternative to surgical interventions for conditions related to excessive anterior pelvic tilt are warranted.
Cite this article: EFORT Open Rev 2020;5:722-730. DOI: 10.1302/2058-5241.5.190017
Context:
Protonics™ knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking.
Objective:
To compare the effect of Protonics™ knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome.
Design:
Randomized controlled trial.
Setting:
Loma Linda University.
Participants:
There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m2 participated in the study.
Intervention:
Subjects were randomized to 1 of 2 treatment groups, the Protonics™ knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks.
Main outcome measures:
Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test.
Results:
Both groups showed significant improvement in the outcome measures. However, the Protonics™ knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics™ brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction.
Conclusions:
Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics™ knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome.
Background:
The optimum repetition number of standing back-extension exercise (SBEE) effective for the prevention and improvement of low back pain (LBP) is unknown.
Objective:
To determine the effect of physiotherapy on LBP by investigating the optimum repetition number of SBEE via optical analysis and electromyographic (EMG) examination of the multifidus muscles.
Methods:
Hemodynamics and multifidus muscle activity were examined in 16 healthy adult men using near-infrared spectroscopy and surface EMG after performing repetitive SBEE.
Results:
Oxidized hemoglobin (Oxy-Hb) levels significantly increased in the second extension phase but decreased in the third and subsequent extension phases; deoxidized hemoglobin (deOxy-Hb) levels increased in the third and subsequent extension phases. In the standing phase, no significant difference was observed; in the third and subsequent phases, Oxy-Hb levels decreased and deOxy-Hb levels increased. Muscular activity significantly decreased in the second standing phase but increased in the third and subsequent phases. No significant difference was observed in the extension phase with respect to the number of SBEE repetitions performed. In healthy individuals, hemodynamics improved up to second repetition of SBEE; subsequent repetitions may decrease hemodynamics because of increased activity of the multifidus muscles.
Conclusions:
In healthy individuals, hemodynamics improved up to second repetition of SBEE.
Background: Assessment of the pelvis is a complex integration with spine and lower extremities and is prone to multiple dysfunctions. Physiotherapists in routine rarely assess pelvis associated musculoskeletal abnormalities. This study was aimed at finding the frequency of pelvic-asymmetry in medical students of Karachi. Methodology: An observational cross-sectional study was conducted from 28th November 2017 to 6th February 2018 to measure asymmetry of the pelvis manually. A sample of 154 medical students was calculated through Open Source Epidemiologic Statistics for Public Health (Open Epi) version 3.0 with a confidence level of 95%. Non-probability purposive sampling technique was used. An informed consent was taken and data was collected from participants aged between 18-25 years through a self-generated questionnaire. Participants with Congenital abnormalities or fracture of lower limb or complain of nerve root pain, any spinal pathology/tumor/surgery of lower limb were excluded from the study sample. Data was analyzed using Statistical Project of Social Science (SPSS) version 20. Results: According to the results 43.5% of the study subjects were observed having pelvic asymmetry. Furthermore, 41.0% participants were spending <3 hours in a constant standing position were observed with the asymmetrical pelvis, while 40.5% participants with pelvic asymmetry work for >3 hours standing constantly. Only 41.5% of participants with low back pain were observed having an asymmetrical pelvis. Conclusion: It can be concluded from the study results that there is a high prevalence of pelvic asymmetry observed among medical students of Karachi. Moreover, knee and ankle joint pain due to constant standing is highly associated with asymmetrical pelvis as compared to hip pain.
[Purpose] This study aimed to clarify the effects of Capacitive and Resistive electric transfer (CRet) on changes in muscle flexibility and lumbopelvic alignment after fatiguing exercise. [Subjects and Methods] Twenty-two healthy males were assigned into either the CRet (n=11) or control (n=11) group. Fatiguing exercise and CRet intervention were applied at the quadriceps muscle of the participants’ dominant legs. The Ely test, pelvic tilt, lumbar lordosis, and superficial temperature were measured before and after exercise and for 30 minutes after intervention. Statistical analysis was performed using one-way analysis of variance, with Tukey’s post-hoc multiple comparison test to clarify within-group changes and Student’s t-test to clarify between-group differences. [Results] The Ely test and pelvic tilt were significantly different in both groups after exercise, but there was no difference in the CRet group after intervention. Superficial temperature significantly increased in the CRet group for 30 minutes after intervention, in contrast to after the exercise and intervention in the control group. There was no significant between-group difference at any timepoint, except in superficial temperature. [Conclusion] CRet could effectively improve muscle flexibility and lumbopelvic alignment after fatiguing exercise.
Objective.
The purpose of this study was to investigate the reliability of a digital pelvic inclinometer (DPI) for measuring sagittal plane pelvic tilt in 18 young, healthy males and females.
Method.
The inter-rater reliability and test–re-test reliabilities of the DPI for measuring pelvic tilt in standing on both the right and left sides of the pelvis were measured by two raters carrying out two rating sessions of the same subjects, three weeks apart.
Results.
For measuring pelvic tilt, inter-rater reliability was designated as good on both sides (ICC = 0.81–0.88), test–re-test reliability within a single rating session was designated as good on both sides (ICC = 0.88–0.95), and test–re-test reliability between two rating sessions was designated as moderate on the left side (ICC = 0.65) and good on the right side (ICC = 0.85).
Conclusion.
Inter-rater reliability and test–re-test reliability within a single rating session of the DPI in measuring pelvic tilt were both good, while test–re-test reliability between rating sessions was moderate-to-good. Caution is required regarding the interpretation of the test–re-test reliability within a single rating session, as the raters were not blinded. Further research is required to establish validity.
Despite 80 years of study, questions of how leg length difference relates to recurrent pain and somatic dysfunction remain controversial. The authors hypothesize that a correlation exists between leg length inequality and back pain. They further hypothesize that if common compensatory patterns described in classic osteopathic medical literature exist, these patterns should interact with the pelvic postural asymmetry patterns of Lloyd and Eimerbrink in a predictable, most probable, and congruent fashion. This article reviews the osteopathic medical, as well as the allopathic medical and chiropractic literature for studies that meet criteria for evidence-based comparison.
Using lumbar radiographic studies produced with subjects standing, the authors examined the prevalence of six types of pelvic postural asymmetry in a consecutive case series of 421 patients with low back pain. Establishing the frequency of pelvic postural asymmetry patterns is a necessary first step in creating an evidence-based foundation to further clarify postural compensatory patterns. Various correlations between and within these patterns are identified.
To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL) ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females) had a history of ACL injury and twenty (10 males, 10 females) had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancies. Statistical analysis was performed to identify differences in these measures in regard to injury history and gender, and to identify if any of these measures were predictive of ACL injury history. Increased navicular drop and anterior pelvic tilt were found to be statistically significant predictors of ACL injury history regardless of gender. Limbs that had previously suffered ACL ruptures were found to have increased navicular drop and anterior pelvic tilt compared to uninjured limbs. Based on the results of this retrospective study, the lower extremity malalignments examined do not appear to predispose females to tearing their ACLs more than males.
Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0-23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height. These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry.
Clinical measurement, intrarater reliability study.
To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM).
Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM.
Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized.
The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain.
Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.
The purpose of this study was to examine intratester reliability of a test designed to measure the standing pelvic-tilt angle, active posterior and anterior pelvic-tilt angles and ranges of motion, and the total pelvic-tilt range of motion (ROM). After an instruction session, the pelvic-tilt angles of the right side of 20 men were calculated using trigonometric functions. Ranges of motion were determined from the pelvic-tilt angles. Intratester reliability coefficients (Pearson r) for test and retest measurements were .88 for the standing pelvic-tilt angle, .88 for the posterior pelvic-tilt angle, .92 for the anterior pelvic-tilt angle, .62 for the posterior pelvic-tilt ROM, .92 for the anterior pelvic-tilt ROM, and .87 for the total ROM. We discuss the factors that may have influenced the reliability of the measurements and the clinical implications and limitations of the test. We suggest additional research to examine intratester reliability of measuring the posterior pelvic-tilt ROM, intertester reliability of measuring all angles and ROM, and the pelvic tilt of many types of subjects.
Statistical methodology for the concurrent assessment of interrater and intrarater reliability is presented. Application of the methodology is illustrated with an example of one therapist using two goniometers repeatedly to measure knee joint angles. Methods for estimating the coefficients, testing hypotheses, constructing confidence intervals, and computing sample size requirements are provided. In addition, the calculation and clinical interpretation of the standard error of measurement (SEM) are discussed. It is recommended that (1) when both interrater and intrarater reliability are being assessed, a repeated-measures design be used to take advantage of the increased precision gained by using all observations in the statistical analysis, and (2) appropriate statistical tests, confidence intervals, and SEMs always be used in conjunction with the estimated reliability coefficients.
We examined the association between pelvic inclination and lumbar lordosis during relaxed standing and eight variables thought to contribute to lordosis.
Ninety subjects (45 men, 45 women) without back pain or a history of surgery were examined. The mean age was 54.8 years (SD = 8.5) for male subjects and 58.9 years (SD = 8.8) for female subjects.
Multiple linear regression modeling was used to assess the association of pelvic inclination and size of lumbar lordosis in a standing position with age, gender, body mass index, physical activity level, back and one-joint hip flexor muscle length, and performance and length of abdominal muscles.
Abdominal muscle performance was associated with angle of pelvic inclination for women (R2 = .23), but not for men. Standing lumbar lordosis was associated with abdominal muscle length in women (R2 = .40), but it was multivariately associated with length of abdominal and one-joint hip flexor muscles and physical activity level in men (R2 = .38). No correlation was found between angle of pelvic inclination and depth of lumbar lordosis in a standing position.
Neither univariate nor multivariate regression models account for variability in the angle of pelvic inclination or size of lumbar lordosis in adults during upright stance; no correlation was found in standing between these two variables. The use of abdominal muscle strengthening exercises or stretching exercises of the back and one-joint hip flexor muscles to correct faulty standing posture should be questioned.
Limited hip extension flexibility due to tight hip flexor musculature or anterior hip capsular and ligamentous structures is a possible cause of increased anterior tilt of the pelvis during running. However, to date, research exploring this relation, as well as the kinematic relation between anterior tilt of the pelvis and peak hip extension range of motion during running, is not available.
To assess the relation of anterior pelvic tilt during running to peak hip extension range of motion measured during running and hip extension flexibility measured clinically.
Hip extension flexibility was assessed using the Thomas test, and the three dimensional kinematic motion of the pelvis and hips were recorded using a VICON motion analysis system with 14 elite athletes running on a treadmill at 20 km/h.
Anterior pelvic tilt displayed a significant (p<0.01) correlation with peak hip extension range of motion during running. Anterior pelvic tilt tended to be increased in runners who displayed reduced absolute peak hip extension range of motion during terminal stance. No significant correlation was shown for hip extension flexibility with either anterior pelvic tilt or peak hip extension range of motion during running.
The outcomes of this study indicate that anterior pelvic tilt and hip extension are coordinated movements during running. Static hip extension flexibility measured using the modified Thomas test does not appear to be reflective of these dynamic movements.
Interpretation of any postural changes over time relies on the knowledge that the person's perception of comfortable erect posture remains sufficiently constant. This study measured the repeatability of sagittal spinal alignment during one day, and the degree of variability in that alignment measured subsequently four, eight and 12 days, and 16 and 24 months later. Normal women, pregnant women and women with low back pain, in the age range of 15 to 34 years, were included in the study. Spinal curvature was determined using a clinometer, while an electro-goniometer attached to callipers determined the degree of pelvic tilt. Results demonstrated that on any one day, a consistent postural alignment is assumed (in terms of spinal curvature and pelvic inclination) when an individual is asked to stand comfortably erect. In addition, in the normal, symptom-free, young adult subject, the perception of posture, and therefore postural alignment remains constant for at least two years.
This study determined the intra- and intertester reliability of the Palpation Meter (PALM) in measuring frontal and sagittal plane pelvic positions among asymptomatic adults during static standing. Four examiners measured 24 physical therapy students in two trials. The sagittal plane measurement was taken as the angle formed by a line connecting the ASIS and PSIS versus the horizontal. The frontal plane measurement was taken as the angle formed by a line connecting the superior border of the iliac crests versus the horizontal. Unlike previous studies, this study attempted to replicate the realities of clinical practice by using the PALM to perform measurements over clothing without applying adhesive markers for landmarks, and without controls for postural sway. Intraclass correlation coefficients suggest intratester reliability was high for both frontal (0.84) and sagittal plane measures (0.98), and intertester reliability was high for sagittal plane measures (0.89) but moderate for frontal plane measures (0.65). Standard error of the means for frontal and sagittal plane measures are presented, and clinicians are cautioned to observe the limitations of precision inherent in this device.
Fluctuating asymmetry (FA), a pattern of bilateral variation that is normally distributed around a mean of zero, appears to correlate inversely with fitness and health. In this study, we compared the FA of asymptomatic control subjects (n = 51) and patients with low back pain (n = 44). We measured eight traits, from the upper and lower limbs, and used them to obtain asymmetry indices for each subject. We also measured pelvic asymmetry in standing subjects. The low back pain (LBP) group showed significantly higher asymmetry in the pelvis, and in ulnar length and bistyloid breadth. Our results demonstrate a link between LBP and asymmetry not only in a weight-bearing trait (i.e., pelvic configuration), but in two traits that are not functionally related to the back (i.e., ulnar length and bistyloid breadth). We can now consider LBP as another health and fitness measure correlated with FA.
The purpose of this study was to examine the intertester reliability of 13 tests for sacroiliac joint (SIJ) dysfunction. Eight therapists examined 17 patients in two clinical settings. In each case, two therapists independently examined the patients and obtained results on all 13 of the SIJ tests. Patients with lumbosacral pain and unilateral lower extremity symptoms of a duration less than one year were examined. All the therapists had specialized in orthopedic physical therapy and had been trained in SIJ examination. Reliability was poor; 11 of the 13 tests resulted in less than 70% agreement. The two tests that relied solely on subjective patient response and imparted no information on SIJ position or mobility were within a range of 70% to 90% agreement. Our findings suggest the necessity of reviewing examination methods for the SIJ and improving reliability of clinical testing of this joint.
Some clinical approaches to the treatment of low back pain evaluate and treat observed asymmetries of pelvic posture and motion. Scientific evidence suggests the motion available between the innominate bones is small and variable in nature. The purposes of this investigation were 1) to determine if interinnominate motion of subjects without low back pain was symmetrical in reciprocal test posture combinations, 2) to assess innominate bone symmetry in standing, and 3) to determine if a difference in the magnitude of interinnominate motion was present between a subject group which performs more frequent flexibility activities compared with a subject group representing the general population. Thirty-four subjects (eight male gymnasts, nine female gymnasts, eight male nongymnasts, and nine female nongymnasts) were evaluated in standing and three other reciprocal postures (modified standing, modified sitting, and half-kneeling). In each posture, the Metrecom Skeletal Analysis System was used to obtain coordinates for the anterior and posterior iliac spines. Projection angles were used to determine the relative positions of the right and left innominate bones. Results suggest that stand to right modified standing and stand to left modified standing oblique sagittal interinnominate composite motions were symmetrical, stand to right modified sitting and stand to left modified sitting oblique sagittal interinnominate composite motions were asymmetrical, and stand to right half-kneel and stand to left half-kneel oblique sagittal interinnominate composite motions' symmetrical properties were mixed depending on the group. Gymnasts as a group were found to have asymmetrically positioned innominate bones while nongymnasts as a group had symmetrically positioned innominate bones.
A cross-sectional case-control approach was used to estimate the association between low back pain of less than 12 months' duration and pelvic asymmetry among 21-50-year-old patients seeking physical therapy services.
To evaluate the premise that asymmetrical positioning of the innominates of the pelvis is a source of low back pain.
No published studies have been conducted to evaluate systematically the association between low back pain and pelvic asymmetry in a clinic-based sample.
Pelvic landmark data were obtained in 144 cases and 138 control subjects. The associations of low back pain with levels of pelvic asymmetry were estimated by use of odds ratios and 95% confidence intervals. Effect modification and confounding of the low back pain-pelvic asymmetry association by several factors was assessed and alternative asymmetry measures considered.
Pelvic asymmetry was not positively associated with low back pain in any way that seemed clinically meaningful. Asymmetry of posterior superior iliac spine landmarks showed some evidence of a weak positive association with low back pain.
In the absence of meaningful positive association between pelvic asymmetry and low back pain, evaluation and treatment strategies based on this premise should be questioned.
Previous research suggests that visual estimates of sacroiliac joint (SIJ) alignment are unreliable. The purpose of this study was to determine whether handheld calipers and an inclinometer could be used to obtain reliable measurements of SIJ alignment in subjects suspected of having SIJ dysfunction.
Seventy-three subjects, evaluated at 1 of 5 outpatient clinics, participated in the study.
A total of 23 therapists, randomly paired for each subject, served as examiners. The angle of inclination of each innominate was measured while the subject was standing. The position of the innominates relative to each other was then derived. An intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and a kappa coefficient were calculated to examine the reliability of the derived measurements.
The ICC was .27, the SEM was 5.4 degrees, and the kappa value was .18.
Measurements of SIJ alignment were unreliable. Therapists should consider procedures other than those that assess SIJ alignment when evaluating the SIJ.
Retrospective review of all CT scans of pelvis and abdomen performed at our institution in October and November 2000.
To determine the prevalence and extent of radiographic pelvic asymmetry in a population of patients not preselected for having low back pain.
Pelvic asymmetry refers to asymmetric positioning of landmarks on the two sides of the pelvis and may have a structural or functional etiology. Pelvic asymmetry can be associated with the presence of true leg length discrepancy, lead to false diagnosis or inaccurate measurement of leg length discrepancy, or itself be independently associated with back pain. Although the prevalence of pelvic asymmetry has been reported in patients with back pain to be 24-91%, its prevalence in the general population is not known.
A total of 323 consecutive CT scans of the pelvis/abdomen were assessed for pelvic asymmetry by one of three examiners. Pelvic asymmetry was defined as an unequal distance from the iliac crests to the acetabuli bilaterally, measured on the anteroposterior scout view of the CT scan. Measurements made on 30 randomly selected scans by the three examiners were used to assess interrater reliability of the measurement method.
Pelvic asymmetry ranged in magnitude from -11 mm to 7 mm [right pelvis (mm) - left pelvis (mm)]. Pelvic asymmetry was >5 mm in 17 of 323 (5.3%) and >10 mm in 2 of 323 (0.6%) of the subjects; 172 of 323 (53.3%) had a smaller right hemipelvis (mean asymmetry = -3.0 mm). A total of 95 of 323 (29.4%) had a smaller left hemipelvis (mean asymmetry = 2.1 mm). The intraclass correlation coefficient [ICC(2,1)] between the three observers was high (0.91).
Pelvic asymmetry of >5 mm was uncommon, with a prevalence of approximately 5% in the population studied. CT scanography was found to be a practical and reliable method for the assessment of suspected pelvic asymmetry.
The objectives of the study were to assess: (1) static innominate asymmetry in the sagittal plane, (2) leg length discrepancy (LLD), and (3) the relationship between static innominate rotation and LLD in asymptomatic collegiate athletes. The study was an observational study by design which took place in a University athletic training research laboratory. The participants were twenty-four male and 20 female asymptomatic intercollegiate athletes who volunteered to take part in the study. Static innominate asymmetry was assessed with a caliper/inclinometer tool and LLD was measured with a tape measure using standard clinical methods. Results showed that forty-two subjects (95%) demonstrated some degree of static innominate asymmetry. In 32 subjects (73%), the right innominate was more anteriorly rotated than the left. Nearly all subjects were determined to have unequal leg lengths with a majority, 30 subjects (68%), showing a slightly longer left leg. Weak correlations (r=0.33 - 0.44) were identified between static innominate asymmetry and LLD. In Conclusion static innominate asymmetry and LLD are common among asymptomatic collegiate athletes. This information provides clinicians with normative data of common clinical measures in a physically active population.
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