Assessing the Pelvic Alignment

[neuromuscular]

Neuromuscular,

I have never heard of this assessment tool - its certainly not in common use in Aus. By the sounds of it you have some demographic data behind it use. Can you please post the reference that cites this tool and the data you quoted (inter/intra reliability would also be useful to know). As far as knew the use of positional fault theories to re-assess effectiveness of treatment is shaky as best. To state that you use this tool to compare effectiveness of different Rx techniques suggests that there is tight correlation between the test results and the cause of back pain - as far as I knew this is something we still don't know in >85% of cases. I would (as would the whole medical community) be very interested in this test if this was the case.

From this then, what is the rationale behind this tool in the context of NSLBP/back pain. It sounds as if it may be sensitive in this population but not very specific as it would be very susceptible to false positives arising from hip/SIJ dysfunction and anatomical variants etc. On the surface it sounds like it may be more useful as a functional/WB test in hip/SIJ pathology.

Also how do the results guide treatment choice as you eluded to?

Your response will be appreciated.

Dear Physio Dace:

The measuring of pelvic angles is not totally new. There have been several uses of the test at anatomical neutral. The new feature of the test that I am putting forth is to to the four sided pelvic angle assessment with hip abduction directly lateral in the coronal plane. This is the ASIS to ASIS , PSIS to PSIS, and the ASIS to PSIS (R&L). The most efficient foot postions are closed, 1 foot or 30 cm, 18 inches or 45 cm, 2 feet or 60- cm, 30 inches or 75 cm etc by 6 inch or 15 cm increments.

This makes the pelvic angles differ as the foot width position increases due to hip abduction.

If you want to be very accurate, you may use a set of lasers mounted to the wall with measuring marks and levels to compare the relative position of the landmarks to each other. However, the difference of pelvic angles and landmark positions is very obvious and the need for special equipment is not a priority. Some have suggested that a transit such as used by a surveyor would be of benefit, but the entire patient position moves inferior as the hip abduction occurs and the need to consult a landmark such as the umbilicus to compare the positions of the landmarks would be too much of a problem to work with it.

The differences of the ASIS to ASIS is often 1 cm to 4 cm This is readily discernable by the eye without aid. The increase of pelvic angle can be from neutral to over 20 degrees which you can measure with a goniometer.

Yes this test is not "mainline", but the trial of the test is being done by the OGI of the USA. The research paper should be out in the near future. the research person is having similar success that I had although he is over 1,000 kms away and I have not had collusion with him other than the putting forth of the test.

Patients can be taught to look in the mirror and compare their ASIS to ASIS to see if they are moving off line. They will often come in before pain as the positional change is obvious to them. These are patients where ergonomic factors affects their back pain. Most patients need little or no follow up after 3 to 6 treatments.

I do use this to compare pre and post therapy at seminars. I find that thepatient may have "less pain" than prior to the therapy, but that the bone positions have not been corrected to antomical neutral. It has probably been a proprioceptive sense change or nociceptor change that has brought a temproary pain reduction. However, I have found that long term pain reduction is obtained best when the pelvic angles remain stable throughout hte hip abduction.

This is new and I do not know what the statistics would be in Australia, since driver position is differenct and the dirver tends to lean on the right arm rest in the automobile, while here, the driver rests on the left arm rest. Would this have a difference/ I do not know.

Statistics obtained in Canada:

Patients with no back pain have no or lttle difference in pelvic angles from neutral.

!0% of all patients have bilateral pelvic angles which move either into anterior or posterior rotations as hip abduction increases. The angle remain bilateral, but are greater. These are such as the flat back or lordosis kyphosis type of postures.


90% of patients with back pain have differeing pelvic angels. The break down of the percentages has been posted.

Simply try the test and give me feedback.

I no longer look for SIJ dysfunction as the test of the standing SIJ with leg raise or torso flexion has been disproved by landmarking the PSIS to sacrum aand have the patient do hip abduction, In every case, the PSIS has moved superior to the sacrum. How can a supposed fixed or stuck joint move apart on its own? This test and others has wrongly concentrated our focus on the SIJ when there is a larger more global problem.

Hope that you have found this helpful.

Best regards,

Neuromuscular.