Pelvic Tilt Lower Crossed Syndrome Hips and Pelvis

Hips and Pelvis Structural core of the body Contains center of gravity Innominate Sacroiliac

Sacroiliac Region and Ligaments Anterior Posterior

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

Pelvic Tilt Assessment Anatomical Landmarks ◦ ASIS, PSIS, Iliac Crest Normal posture = No

Anterior Pelvic Tilt Forward/Anterior rotation of the pelvis PSIS higher than ASIS Most common

Anterior Pelvic Tilt ASIS lower than PSIS by >= ½” Contributes to: - SI

Anterior Pelvic Tilt May be asymptomatic due to compensation or may cause symptoms elsewhere

Anterior Pelvic Tilt Muscular Causes Short &Tight 1. Rectus femoris 2. Iliopsoas 3. Erector

Anterior Pelvic Tilt Muscular Attachments Rectus femoris – AIIS Iliopsoas – lesser trochanter Erector

Anterior Pelvic Tilt - Assessment ASIS vs. PSIS height LBP due to - muscle

Anterior Pelvic Tilt Assessment Anterior Innominate Rotation Test - positive if ASIS > I

Anterior Pelvic Tilt Assessment Modified Thomas Test Hip flexed 45 degrees. Observe opposite thigh.

Anterior Pelvic Tilt Treatment Massage, Stretching & Postural reeducation Manually release hypertonic muscles Stretch

Three sacral angles and corresponding lordosis

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

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Pelvic Tilt & Lower Crossed Syndrome

Hips and Pelvis Structural core of the body Contains center of gravity Innominate Sacroiliac Bone = Ilium/Ischium/Pubis 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

Three sacral angles and corresponding lordosis

POSTERIOR PELVIC TILT

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