Pelvic Tilt & Lower Crossed Syndrome

Hips and Pelvis   Structural core of the body Contains center of gravity  Innominate Bone = Ilium/Ischium/Pubis  Sacroiliac Joints - moveable eg. walking, running, breathing - supported by strong ant./post. ligaments

Sacroiliac Region and Ligaments

Anterior Posterior

Pelvic Tilting  Common causes: - acquired postural distortions - muscle imbalances (weak/tight) - leg length inequality

Pelvic Tilt Assessment  Anatomical Landmarks ◦ ASIS, PSIS, Iliac Crest  Normal posture = No tilting  Innominate bones rotate:   PSIS > ASIS anterior rotation ASIS > PSIS posterior rotation

ANTERIOR PELVIC TILT

Anterior Pelvic Tilt     Forward/Anterior rotation of the pelvis PSIS higher than ASIS Most common type of tilt Corresponding hyperlordosis

Anterior Pelvic Tilt    ASIS lower than PSIS by >= ½” Contributes to: - SI joint dysfunction - vertebral dysfunction - decreased spinal shock absorption - altered biomechanics Causes hyperlordosis

Anterior Pelvic Tilt   May be asymptomatic due to compensation or may cause symptoms elsewhere Unilateral (one sided tilt) = R or L anterior tilt

Anterior Pelvic Tilt Muscular Causes Short &Tight 1.

Rectus femoris 2.

Iliopsoas 3.

Erector spinae Lengthened & Weak 1.

Rectus Abdominus 2.

Biceps Femoris

Anterior Pelvic Tilt Muscular Attachments      Rectus femoris – AIIS Iliopsoas – lesser trochanter Erector spinae – indirectly into pelvis Rectus abdominis – pubic bone Biceps femoris – ischial tuberosity

Anterior Pelvic Tilt - Assessment   ASIS vs. PSIS height LBP due to - muscle hypertonicity - facet joint compression Hyperlordosis / prominent gluteals Hypertonic QL, RF, ES AROM: trunk flexion hip extension (tight psoas)

Anterior Pelvic Tilt - Assessment Anterior Innominate Rotation Test - positive if ASIS > I cm lower than PSIS

Anterior Pelvic Tilt - Assessment Modified Thomas Test Hip flexed 45 degrees.

Observe opposite thigh.

- hip flexion = tight psoas - knee extension = tight rectus femoris

Anterior Pelvic Tilt - Treatment     Massage, Stretching & Postural reeducation Manually release hypertonic muscles Stretch tight muscles Strengthen weak muscles

 Pic of three sacral angles and corresponding lordosis

POSTERIOR PELVIC TILT

Posterior Pelvic Tilt    Backward/Posterior rotation of the pelvis ASIS higher than PSIS Corresponding hyporlordosis