Assessing the Pelvic Alignment

[neuromuscular]

Neuroman,

Thanks for the thorough reply. Just to clarify, its a static weight bearing test right? Also have you found that changes in alignment during the test are linked with the reproduction production of LBP symptoms - I ask this given that a change in alignment post-Rx seems to relate to improvement in symptoms - from what I gather anyway? Or is something that you see over time?

I look forward to reading the paper/s when they come to hand and until then I will trial the Ax tool on my LBP patients - out of interest any subgroups/classifications of NSLBP that you have found this tool to be most useful. e.g. either from McKenzie/O'Sullivan/Lee classifications etc? Or perhaps this will serve as yet another classification system.

Also what is the title of the test as it will be keyworded in upcoming research?

On face value it sounds like it may be useful, though I'm still a little skeptical when it comes to using/relying on alignment/asymmetry in the human body to correlate with musculoskeletal pain - particularly when it relates to non-specific LBP. Skepticism, as you can appreciate comes hand in hand with physio.

Is there a place for the use of a saggital plane LL position/movement within the test to simulate a more functional WB position?

Cheers for your input.

Dear Physio Dace:

The test is with full weight bearing in every position.

A supine and prone assessment are also used.

Since I am semi retired, the research paper will be done by a physio doing his Phd. I do not know the exact title.

The new feature is to use hip abduction in assessing pelvic angles. I have found no information that this has been done, even though there has been some done on just pelvic angles.

I will have to add more later if you are interested, so please contact me again.

Best regards,

Neuromuscular.

[linbin]

hi
i think most of the physios are well aware of the limited evidence supporting inter rater reliability of ASIS,PSIS,Lumbar segments .so how well anyone can determine the faults with the test mentioned here.i feel its more subjective also keeping in mind the structural variations among individuals

[neuromuscular]

hi
i think most of the physios are well aware of the limited evidence supporting inter rater reliability of ASIS,PSIS,Lumbar segments .so how well anyone can determine the faults with the test mentioned here.i feel its more subjective also keeping in mind the structural variations among individuals

Dear linbin:

To my knowledge, no one has tried the pelvic assessment with hip abduction. The hip abduction stresses the pelvis in a predictable way. There will alwauys be apprehension to new ideas.

As I have stated, just try the test. The differences are obvious.

Hope that this is helpful. I will be unavailable for some time.

Best regards,

Neuromuscular

[neuromuscular]

Just an update.

In the research for the abstract, the person doing the search of present papers has found no one who has considered the pelvic angle assessment with hip abduction.

Neither have any of the well respected authorities that I personally contacted in Europe and USA.

It is of note that many top experts are presently looking forward to the research paper due at year end or shortly there after. It will be done by a person from Lincoln Nebraska, USA.

This is a heads up for those who want to be with the latest research.

Best regards,

Neuromuscular

[river]

Thanks to neuromuscular for sharing this new assessment. My concern is the functional angle of the hip. Walking or stair climbing, involved more hip flexion then hip abduction though we can have patients with hip dysfunction in the coronal plan. There is also slight hip rotation (transverse plane). Also, factors like leg length discrepancy would distort the results. But I will be interested to read more about it when the paper is out. Also, what treatment protocols have you used to treat SIJ dysfunction/malalignment? If manipulation is not as effective, any inputs on Muscle energy techniques?

Cheers,
river

[neuromuscular]

Thanks to neuromuscular for sharing this new assessment. My concern is the functional angle of the hip. Walking or stair climbing, involved more hip flexion then hip abduction though we can have patients with hip dysfunction in the coronal plan. There is also slight hip rotation (transverse plane). Also, factors like leg length discrepancy would distort the results. But I will be interested to read more about it when the paper is out. Also, what treatment protocols have you used to treat SIJ dysfunction/malalignment? If manipulation is not as effective, any inputs on Muscle energy techniques?

Cheers,
river

Dear river:

Thank you for your interest.

The use of hip abduction is to see the effect of the adductors to the hip and pelvis. The standing SIJ test does not give accurate information on the SIJ when compared to the same test with hip abduction. The supposed "stuck" or "fixation" of the SIJ disappears as the PSIS moves superior and lateral to the sacrum.

What we see in the standing SIJ test with leg raise or torso flexion is the effect of the adductor longus on the contralateral side and the psoas on the ipsilateral side. This is why the joint moves together.

The hip flexion on stair climbing is not the problem, but the muscular imbalance of the patient.

The concept that this research is showing is that the one test does not give enough accurate information, but was too readily accepted over 100 years ago as showing a "stuck" SIJ and that we have never challenged that idea or concept, but kept building on it. In fact, it gives questionable results at best.

The lateral movement provides a specific measurable distortion. In normal people with no back pain, the pelvis remains level - PSIS TO PSIS, ASIS TO ASIS, AND PSIS TO ASIS (L&R).

In those who have low back pain the measurements are very much off normal to the point of obvious.

Leg length is a concern, but is it functional or anatomical? Anatomical can only be addressed with height adjustments to the shorter leg. Functional are a result of the rotation of the innominate bone and are corrected by the therapy. As the innominate bone rotates, the acetabulum is not in the center of rotation, so it moves superior or inferior and anterior or posterior as the rotation progresses. Depending on the rotation, the leg will appear short or long. In radiographic examination, the head of the femur can be closer or farther from the film plate. Further, in radiographnic examination the shape of the ischial foramen is distorted by the angle of the innominate bone in anterior or posterior rotation.

Hope that this is helpful to you.

Best regards,

Neuromuscular.