Pelvic Tilt & Lower Crossed Syndrome

Hips and PelvisHips and PelvisStructural core of the bodyContains center of gravity

Innominate Bone = Ilium/Ischium/Pubis

Sacroiliac Joints- moveable eg. walking, running, breathing- supported by strong ant./post. ligaments

Sacroiliac Region and Sacroiliac Region and LigamentsLigaments

Anterior Posterior

Pelvic TiltingPelvic TiltingCommon causes:

- acquired postural distortions- muscle imbalances (weak/tight)- leg length inequality

Pelvic Tilt AssessmentPelvic Tilt AssessmentAnatomical Landmarks

◦ASIS, PSIS, Iliac Crest

Normal posture = No tilting

Innominate bones rotate: PSIS > ASIS anterior rotation ASIS > PSIS posterior rotation

ANTERIOR PELVIC ANTERIOR PELVIC TILTTILT

Anterior Pelvic TiltAnterior Pelvic TiltForward/Anterior rotation of the

pelvisPSIS higher than ASISMost common type of tiltCorresponding hyperlordosis

Anterior Pelvic TiltAnterior Pelvic TiltASIS lower than PSIS by >= ½”Contributes to:

- SI joint dysfunction- vertebral dysfunction- decreased spinal shock

absorption- altered biomechanics

Causes hyperlordosis

Anterior Pelvic TiltAnterior Pelvic TiltMay be asymptomatic due to

compensation or may cause symptoms

elsewhereUnilateral (one sided tilt) = R or L anterior tilt

Anterior Pelvic TiltAnterior Pelvic Tilt Muscular Causes Muscular Causes

Short &Tight

1.Rectus femoris2.Iliopsoas3.Erector spinae

Lengthened & Weak

1.Rectus Abdominus2.Biceps Femoris

Anterior Pelvic TiltAnterior Pelvic Tilt Muscular Attachments Muscular Attachments

Rectus femoris – AIISIliopsoas – lesser trochanterErector spinae – indirectly into

pelvisRectus abdominis – pubic boneBiceps femoris – ischial

tuberosity

Anterior Pelvic Tilt - Anterior Pelvic Tilt - AssessmentAssessmentASIS vs. PSIS heightLBP due to - muscle hypertonicity

- facet joint compressionHyperlordosis / prominent glutealsHypertonic QL, RF, ESAROM: trunk flexion hip extension (tight

psoas)

Anterior Pelvic Tilt - Anterior Pelvic Tilt - AssessmentAssessmentAnterior Innominate Rotation Test - positive if ASIS > I cm lower

than PSIS

Anterior Pelvic Tilt - Anterior Pelvic Tilt - AssessmentAssessmentModified Thomas Test

Hip flexed 45 degrees.Observe opposite thigh.- hip flexion = tight psoas - knee extension = tight rectus femoris

Anterior Pelvic Tilt - Anterior Pelvic Tilt - TreatmentTreatmentMassage, Stretching & Postural

reeducationManually release hypertonic

musclesStretch tight musclesStrengthen weak muscles

Pic of three sacral angles and corresponding lordosis

POSTERIOR PELVIC POSTERIOR PELVIC TILTTILT

Posterior Pelvic TiltPosterior Pelvic TiltBackward/Posterior rotation of

the pelvisASIS higher than PSISCorresponding hyporlordosis