by Justin Price, MA
The Lumbopelvic Hip Girdle
The second article of a two-part series on the lower kinetic chain.
The first article of this series discussed the structures of the foot, ankle and knee. This article will address the other area of the lower kinetic chain: the lumbopelvic hip girdle. You will learn how to assess the structures in this area, discover how the alignment of these structures affects other parts of the lower kinetic chain and become familiar with some exercises to help correct any deviations. The lumbopelvic hip girdle is the area where the lower spine, pelvis and tops of the legs come together. As the human body evolved from quadrupedal to bipedal, a lumbar curvature developed in the spine to help lift the torso on top of the pelvis. Consequently, the pelvis became wider and more compact to accommodate the increased weight of the torso and provide greater potential for locomotion. The complex array of muscles, tendons, ligaments, fasciae and joints that make up the lumbopelvic hip girdle possesses advanced movement capabilities. However, the potential for increased function brings with it a greater likelihood of muscular imbalances and structural malalignments. The lumbopelvic hip girdle has two very important articulations: the sacroiliac joint and the acetabulum. The sacroiliac joint is where the sacrum (base of the spine, just above the tailbone) meets the ilium (back of the pelvis). The acetabulum is a cup-shaped depression in the pelvis where the end of the femur sits to form the hip socket. pelvis is rotated anteriorly (forward) around the acetabulum. A slight anterior pelvic tilt of 10 degrees is normal. Lumbar lordosis refers to a curvature in the arch of the lower back. The lumbar spine naturally curves inward to form a concavity; however, an excessive lordotic curve can cause pain and dysfunction. Note: Excessive anterior pelvic tilt is always accompanied by excessive lumbar lordosis and vice versa. medical condition. Rather than attempting to make a diagnosis, use your client's responses to your questions to choose exercises that strengthen or balance weak areas or, if the imbalances are severe, to avoid exercises that might be contraindicated.
Visual and Hands-On Assessment
The Assessment Process
To assess the lumbopelvic hip girdle, you must be able to see the area clearly. Instruct clients to wear shorts or formfitting workout pants. Females should wear a sports bra or form-fitting T-shirt. Males should remove their shirt or at least lift it above the waistline or tuck it into their pants. The assessment process includes a verbal, visual and hands-on evaluation. Always make note of your assessment findings.
The two most common deviations found in the lumbopelvic hip girdle are (1) excessive anterior pelvic tilt and (2) excessive lumbar lordosis. Anterior pelvic tilt refers to a forward rotation (downward tilt) of the pelvis. When viewed from the side, the
A verbal assessment can provide some insight into a client's condition. Ask the following questions: 1. Do you ever experience pain in your hips, buttocks, low back or groin? 2. Have you ever been diagnosed with arthritis of the hips or spine? (This helps you gauge the integrity of the joints of the lumbopelvic hip girdle.) 3. What is your occupation? How much physical activity do you get? (This gives you an idea of the daily stress experienced by the structures in this area.) 4. If you are experiencing pain, what aggravates the condition? What makes it feel better? Does the pain coincide with other pains in the body? Remember to stay within your scope of practice; only a physician can diagnose a
February 2007 IDEA Fitness Journal
Use a visual and hands-on assessment to further assess the structures. Excessive Anterior Pelvic Tilt. Look at the client's pelvis from the side. When the back of the pelvis appears to be much higher than the front, an excessive anterior tilt is indicated. The way the waistband sits on the hips (high at the back and low at the front) can also help you assess the position of the pelvis. Posterior Pelvic Tilt. If the front of the pelvis appears higher than the back, a posterior pelvic tilt is indicated. This deviation is not common. Excessive Lumbar Lordosis. To check for excessive lumbar curvature, ask your client to stand with heels, buttocks, shoulders and head touching a wall. Slide your hand, palm toward the wall, behind the client's low back and evaluate the space between the lumbar spine and the wall. You should be able to slide your fingers only up to and in line with the second knuckles. If you can slide your entire hand under the back, the client has excessive lumbar lordosis. Note: If your client has excessive body fat or muscle on the buttocks, the lumbar spine will appear farther away from the wall. Take this into consideration when making your assessment.
Teaching Neutral Position
Use the following technique to teach your client how to achieve neutral pelvic position. While your client is standing
against a wall, instruct him to tilt his pelvis posteriorly, engaging the abdominals to assist with the movement. You should feel the space between the wall and the lumbar spine decrease. Now ask the client to step away from the wall and to place one of his palms on the bony protuberance on the front of each hip. His index fingers should touch and be parallel to the ground. Coach the client to look down at his hands and posteriorly tilt his pelvis until he can see both the index and second fingers of both hands. This is neutral position for the pelvis. When your client has achieved a neutral pelvic position, coach him into a neutral foot and ankle position (see
© 2007 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.