Assessment of Hip Lumbo-Pelvic Girdle

The lumbo-pelvic hip girdle is where the lumbar spine, pelvis, and hips come together. The lumbo-pelvic hip girdle is one of the most important features of the body because it provides the structure and support needed to maintain an upright posture. balance. Several large muscle groups in the lumbo-pelvic hip region work together to help move the lumbar spine, pelvis, and hips in all three planes of motion with great amounts of freedom. But as we all Know, Nothing comes for free. we got mobility As a cost of Stability. and puts them at risk of developing compensation patterns, movement dysfunctions, and musculoskeletal imbalances in this area of the body.

COMMON DEVIATIONS

1. An Anterior pelvic tilt 
2. Excessive Lumbar Lordosis

• Anterior pelvic Tilt when Person is Standing  in perfect alignment, the pelvis is naturally rotated anteriorly about 10 degrees. This Means ASIS is slightly Lower then the PSIS.  if the pelvis is tilted more than this when standing, the ASIS is too far forward and down, and the PSIS rises too far upward. This excessive forward and downward tilt of the pelvis is called an anterior pelvic tilt.

And, if the ASIS is too high at the front, then the PSIS will drop. A backward tilt of the pelvis is called a posterior pelvic tilt. Since the purpose of this Blog is to cover the most common deviations, will not talk in Details.. if you want in Details let me know in Comments below..

• Excessive lumbar lordosis refers to an excessive curvature (or overarching) of the lumbar spine (see figure Below). Excessive lumbar lordosis is problematic because it can lead to movement dysfunction and eventually pain. 

• Anterior pelvic tilt is almost always accompanied by excessive lumbar lordosis, Because The lumbar spine, sacrum, and pelvis are linked by the sacroiliac joint and the many strong ligaments that cross and support this joint. Therefore, the position of the pelvis directly affects the position of the sacrum and lumbar spine. Conversely, the position of the lumbar spine and sacrum directly affects the position of the pelvis.

ASSESSMENT PROCESS

• VERBAL ASSESSMENT Ask about the following Questions.

1. Ask if the client has ever experienced pain in the hips, groin, buttocks, or lower back. (Encourage for exact site of pain. this can help  guide you toward further examination of the alignment of the leg, hip, and pelvis)
2. Ask about the client’s past injuries and surgeries. For example, a hip replacement or a lumbar fusion will affect both movement and function.
3. Ask about the client’s level of physical activity. For example, it would be important to know if a person plays sports or engages in activities such as golf and tennis that put a lot of stress on the hips and spine.
4. Ask about the client’s occupation. For example, if a person spends much of the day seated in hip flexion with his lower back rounded, this may adversely affect the m function of his lumbo-pelvic hip girdle.
5. Ask the client whether his back or hip problems ever prevent him from engaging in an activity or limit what he can do. This will help you to understand his underlying motivation for coming to see you and Help to Plan Rehab according to Patient's Goal,
6. Ask whether the client’s pain coincides with any other pains or symptoms in other areas of the body. This will help the client to under-stand the body’s interconnectedness and may point to possible causes, compensations, and corrections. For example, a client with  lower back pain who spends a lot of time at the computer may reveal that when her lower back hurts, her neck also hurts. You can take this  opportunity to highlight how her head and neck position directly affects the position of her lumbar spine . 
7. Ask the client what aggravates the pain and what makes it feel better For example, if a client indicates that sitting at work exacerbates his back pain, you can coach him on how to improve his sitting posture 
8. Ask the client if the pain ever wakes him up  at night or if he has trouble sleeping because  of it. This is important because many lumbo-pelvic hip girdle issues are exacerbated by poor sleeping posture.

VISUAL ASSESSMENT FOR ANTERIOR PELVIC TILT AND EXCESSIVE LUMBAR LORDOSIS

1. Ask Patient to stand and observe from Lateral aspect. 
2. Note how pants or shorts of patient's sit on  hips, and note That if the front of the waistband is lower than the back. (The front of the waistband typically rests on the bony protuberance at the front of the pelvis, the anterior superior iliac spine (ASIS). The back of the waistband typically rests on the bony protuberance at the back, the posterior superior iliac spine (PSIS). As such, visually inspecting the client’s waistband can provide insight into the position of the pelvis. If the back of the pelvis appears much higher than the front, this may suggest an anterior pelvic tilt. On the other hand, if the back of the pelvis appears lower than the front, this indicates that the pelvis has rotated backward. However, most people will have an anterior pelvic tilt.
3. While the client is still standing side-on, look at the curvature of the lumbar spine to evaluate for excessive lumbar lordosis. You should see a slight curve, or concavity, in the lower back. However, if the curve of the lower back looks markedly arched then the client is considered to have excessive lumbar lordosis.

• HANDS-ON ASSESSMENT To manually assess for the presence of excessive lumbar lordosis, ask the client to stand barefoot with his back, buttocks, heels, shoulders, and head against a wall. Before you begin the assessment, you must confirm that all of these structures are touching the wall. 
• Then place your hand, palm down, on the wall and slide it behind the client’s lower back (see figure Below).Now evaluate the space between the lower back and the wall. With an acceptable degree of lumbar lordosis, 
• you should only be able to slide your fingers behind the lower back up to and in line with about your second knuckle. 
• If the space between the back and the wall is large enough for you to slide your whole hand or arm through, then the client has excessive lumbar lordosis. The greater the space is between the wall and the lower back, the more extreme the deviation or imbalance. The presence of excessive lumbar lordosis will also indicate an anterior pelvic tilt.

Note that if someone has very well developed gluteal muscles and the base of her spine is not in contact with the wall during the assessment, it will be necessary to make an allowance for the additional space you will find. Use your best judgment to determine whether the lumbar curvature is excessive.

• You can also assess for excessive lumbar lordosis with the client in a supine position. Ask the Patient to lie on the floor on his back with his legs straight. Instruct him to keep his knees and toes pointed toward the ceiling. Evaluate the arch in the lumbar spine by sliding your hand under his lower back (see figure Below). If you can slide all your fingers or your entire hand into the space between his lower back and the floor, this indicates he has excessive lumbar lordosis.

Note - It may be difficult to conduct this assessment accurately if the client has an excessive amount of body fat around the midsection. In such cases the excess flesh will fall toward the floor and may prevent you from being able to slide your hand under  the lower back. Similarly, if you use a soft assessment surface such as a massage table, the accuracy of the assessment may be affected.

• Precaution -  If a Patient has severe lower back pain, you should not ask her to lie on her back with her legs straight because this may aggravate the condition. 

HOW THE LUMBO-PELVIC HIP GIRDLE RELATES TO THE FEET, ANKLES, KNEES

• In the Previous Blog We learned that overpronation of the foot and ankle causes these structures to Rotate inward with the lower leg toward the midline of the body. 

• The movement of these structures, in turn, also causes the knee to move toward the midline and the Femur to rotate inward. 

• These positional changes in the feet, knees, and legs cause the top of the upper leg to shift backward where it attaches to the hip socket (see figure Below). 

• Since the pelvis houses the hip socket, it must also shift out of alignment that is, it rotates anteriorly. This causes the lumbar spine to arch excessively. 

• These compensatory shifts in the lower kinetic chain also affect the position of the thoracic spine and shoulder girdle That we Will learn In Next Blog.

Thanks for Reading.