Assessing the Pelvic Alignment

[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.