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Corrective Exercise - Part 2: The

Lumbo-Pelvic Hip Girdle
By Justin Price
Date Released : 17 Jul 2008

In the first article of this two part series, you learned how to assess the
structures of the foot, ankle and knee. Their interrelatedness to the rest of the
lower kinetic chain was explained and some examples of corrective exercises
to help address the most common imbalances were given. In this article, you
will learn how to assess the lumbo-pelvic hip girdle. You will also learn how
the alignment of the structures in the lumbo-pelvic hip girdle affects other
parts in the lower kinetic chain. Finally, you will be given some exercises that
can be used during regular fitness programs to help correct problems,
eliminate pain and improve function.

About the Lumbo-Pelvic Hip Girdle
The lumbo-pelvic hip girdle is the area where the lower spine, pelvis and top
of the legs come together. The lumbo-pelvic hip girdle has two very important
articulations: the sacro-iliac joint and the acetabulum. The sacro-iliac joint is
where the sacrum (base of your spine, just above your tailbone) meets the
back of your pelvis (ilium). The acetabulum is a cup shaped depression in the
pelvis where the end of the femur sits to form the hip socket (see Figure 1).
There are many ligaments that help hold the bones of the pelvis, spine and
femur in place during the complex, multi-dimensional movements that are
possible in the lumbo-pelvic hip region.

Figure 1
The two most common deviations found in the lumbo-pelvic hip girdle are an
anterior pelvic tilt and excessive lumbar lordosis. An anterior pelvic tilt refers
to an excessive forward rotation (downward tilt) of the pelvis in relation to the

"Do you ever experience pain in your hips. "What is your occupation or job and level of physical activity?" This will help you understand any additional stress on the joint. lower back or groin?" This will help you identify a probable cause. "Have you ever been diagnosed with arthritis of the hips or spine?" This will help you understand the integrity of the joints of the lumbopelvic hip girdle. Note: An anterior pelvic tilt is almost always accompanied by excessive lumbar lordosis and visa versa. 3. Males should remove their shirt. buttocks. It is normal to have a slight (approximately 10 degrees) anterior pelvic tilt. . However. "What aggravates the condition. 2. lift their shirt above their waistline or be asked to tuck their shirt into their shorts.back of the pelvis. The assessment process includes a verbal. you must be able to see the area clearly. and what makes it feel better? Does the pain coincide with other pains in the body?" This will help you and your client understand the cause of the pain. Inform clients prior to their visit that they should wear shorts or form fitting workout pants. Excessive lumbar lordosis refers to an excessive curvature in the arch of the lower back. Verbal Assessment Conduct a verbal assessment first to gain insight from clients into their interpretation of the pain and function of the body parts you are assessing. Assessing the Lumbo-Pelvic Hip Girdle In order to assess the lumbo-pelvic hip girdle. Always write down or make note of your assessment findings. When viewed from the side. The lumbar spine naturally curves inward to form a concavity. Females should wear a sports bra or form fitting t-shirt. the pelvis is rotated anteriorly (forward) around the acetabulum. Ask the following questions: 1. 4. visual and hands-on evaluation. an excessive lordotic curve can cause pain and dysfunction.

Figure 2 Excessive Lumbar Lordosis To check for excessive lumbar curvature. palm down. shoulders and head touching the wall.Visual and Hands On Assessments Excessive Anterior Pelvic Tilt Look at your client’s pelvis from the side.e. Slide your hand. If the back of the pelvis appears to be much higher than the front. then they have excessive lumbar lordosis. If you can slide your entire hand under your client’s back. this will help confirm your finding from the previous assessment that he also has an anterior pelvic tilt . However. You should only be able to slide your fingers under the lower back (see Figure 3). this indicates an excessive anterior tilt (see Figure 2). The way the waistband sits on your client's hips can also help you to assess the position of the pelvis (i. behind the lower back. high at back. low at front). If your client has an excessive curvature of the lumbar spine. ask your client to stand against a wall with the heels. A posterior pelvic tilt would be indicated by the front of the pelvis appearing higher than the back. Evaluate the space between the lumbar spine and the wall.. a posterior pelvic tilt is not common. buttocks.

his lumbar spine will appear further away from the wall. Teaching Neutral Position of the Pelvis While your client is standing against the wall. coach him into a neutral foot and ankle position (see “Teaching Neutral Foot and Ankle Position” in Part 1 of this series). ask your client to step away from the wall. Ask the client to look down at his hands and coach him to posteriorly tilt his pelvis until he can see both the index and the second fingers of both hands (see Figure 4).Figure 3 Note: If your client has excessive body fat or muscle on the buttocks. Now. instruct him to tilt his pelvis posteriorly. Figure 4 When your client has achieved a neutral pelvic position. This should cause his knees to correctly align over the center of the foot. Now. engaging the abdominals to assist with the movement. coach your client to keep his spine erect without overarching the . This is a neutral position for the pelvis. His index fingers should touch and be parallel to the ground. You should feel the space between the wall and his lumbar spine decrease. Instruct your client to place the palms of each hand on the bony protuberance on the front of each hip (ASIS). This is a neutral position for the entire lower body.

To accommodate the movement of the femur in the acetabulum. the pelvis must rotate forward. lumbar spine flexion will become restricted due to the restriction of the muscles. tendons and fascia of the lower back. . Additionally. For example. However. Ankles and Feet The first article in this series explained how foot and ankle pronation causes the knee to move medially (i. ankles and feet. an excessive anterior tilt and excessive lumbar lordosis will affect the body’s ability to effectively rotate the pelvis posteriorly. it is imperative to strengthen the structures of the lower leg as well as the hips. toward the center line of the body). Therefore. which directly affects the alignment and movement capabilities of the lumbo-pelvic hip girdle. it will impair movements required for daily activities and/or exercise. Exercise Recommendations Walking.. imbalances in the lumbo-pelvic hip girdle will lead to a disruption of movement in the knees.lower back. This displacement at the knee causes the tibia and femur to rotate inward. Moreover. which causes the lordotic curve of the lumbar spine to increase. but it is very important to help him attain a kinesthetic awareness of these positions so he can replicate the movement when asked during training sessions.e. It may be difficult for your client to maintain these postures. If an excessive anterior pelvic tilt and excessive lumbar lordosis persists. Relationship Between the Lumbo-Pelvic Hip Girdle and the Knees. which is necessary to correctly move the legs forward in front of the body. The inward rotation of the femur affects the way the head of the femur sits into the hip socket (acetabulum). range of movement into hip/leg flexion may also be inhibited as the pelvis loses its ability to posteriorly rotate. These imbalances can make simple tasks like bending over or lifting the leg to tie one's shoe laces very difficult. sacro-iliac joint dysfunction and hip bursitis. This type of musculoskeletal imbalance will result in compensation patterns that may lead to problems like lumbar disc degeneration. running and all forms of cardiovascular exercise that work the large muscles of the lower kinetic chain involve hip/leg flexion and extension.

Instruct your client to stand on a BOSU ball and use the wall to aid with balance. frontal and transverse plane. Now he will feel a stretch on the muscles on the inside of the calf (medial part of the gastrocnemius and posterior tibialis). all the muscles of the lower leg must be stretched in the sagittal. If it is practical.Here are three possible exercises to help your clients correct the structural deviations discussed herein. 1. To increase flexibility of the muscles that cross the ankle joint and foot. Repeat three times each position and for each leg. Calf Stretch on BOSU (see Figures 5-6) . if he is a chronic over pronator. have your client perform this stretch in bare feet so that the foot and ankle complex can move freely. strengthen the muscles and mobilize the ankle joint so that forces can be shared throughout the foot and ankle complex. However. Figure 5 Figure 6 It might seem counterintuitive to stretch your client into overpronation. . Ask your client to place one foot behind him on the ball and push his heel down into the BOSU ball. In doing this. many of the soft tissues that aid in slowing the foot down into pronation will probably lack flexibility and eccentric control into an over pronated position. Therefore.The lack of dorsal flexion and overpronation that are common in most clients is usually the result of the muscles of the lower leg not being able to move through all three planes of motion. Then coach your client to overpronate. he should feel a stretch on the outside of the calf (poreneal muscle group). by controlling pronation through the stretch. Teach your client to oversupinate by rotating his standing leg out. you can help rejuvenate the soft tissues. Hold each position for one to two seconds.

Ensure the hips are extended and the spine is erect. However.Have your client stand on one leg and then instruct him to bend at the hips and squat as he reaches forward and away from the body.2. He should also feel the gluteal muscles contracting and pulling both the lower and upper leg outwards. One Leg Stand (see Figure 7) . if needed. The skills your client learned from the “Big Toe Pushdowns” exercise (in Part 1 of this series) will help him to remain balanced and stable. This will help align the leg in the hip joint. If the muscles of the foot and butt are not slowing down this motion. the key to performing this exercise correctly is having your client use his butt and foot muscles to control this motion. His leg will rotate inward and his foot will pronate. Teach your client to control the inward motion of the foot and leg by trying to slow down this motion with the muscles of the butt and foot. Figure 7 3.Instruct your client to stand on one leg. Coach your client to have his foot straight and his weight centered. (Use a balance aid. The knee should move toward the midline of the body and the foot should pronate. then the joints will take the stress. Single Leg Squat with Reach (see Figures 8-9) .) Coach him to rotate the tibia and femur out by rolling the foot out and raising the arch. Figure 8 Figure 9 . Teach this movement so that the muscles do the work and control joint motion effectively.

Gray’s Anatomy. 5. New York: Barnes & Noble Books. Scott M. 2002. CA: Healthy Learning. Simply conduct your regular exercise programs and incorporate strategies that address any musculoskeletal imbalances you identify during the assessment process. “A Step-by Step Guide to the Fundamentals of Corrective Exercise”. 1997. Awareness Heals: The Feldenkrais Method for Dynamic Health. 2003. how they relate to other structures and some sample corrective exercises you can incorporate into your personal training programs. 1995. 2002. Golding. 2003. Lawrence A. 9. Price.Conclusion Structural assessments and corrective exercises can be integrated into any fitness program. Price. 8. shoulder girdle. Justin. Justin. Additionally. The Malalignment Syndrome: Implications for Medicine and Sport. Part 1: The Foot and Ankle”. Massachusetts: Perseus Books. Henry. Abelson. Steven. Ann. Shafarman. The topic of the third and final article of this series will be the thoracic spine. Wolf. “A Step-by Step Guide to the Fundamentals of Structural Assessment”. Price. Article Archives. Fitness Professionals’ Guide to Musculoskeletal Anatomy and Human Movement. 2006. and Golding. 2. Edinburgh: Churchill Livingstone. 3. “Integrating Corrective Exercise and Personal Training. Neuromusculoskeletal Examination and Assessment: A Handbook for Therapists. Lenny McGill Productions. Personal Training on the Net. Kamali. Brain and Abelson. P. . Nicola and Moore. developing a thorough understanding of the individual structures of the body will help you to understand more complex information on movement and whole body mechanics. Release Your Pain. 2008. Calgary: Rowan Tree Books. Lenny McGill Productions. Petty. neck and head. Gray. Edinburgh: Churchill Livingstone. 7. 2006. Schamberger. References: 1. Justin. 6. Monterey. You will learn how to assess these areas of the body. 4. Dr.

Champaign. William C. . Diane K. Champaign. 1988.). IL: Human Kinetics. (Eds. Whiting. IL: Leisure Press. Biomechanics of Musculoskeletal Injury. and Zernicke. 11. Conquering Athletic Injuries. and Taylor.Taylor. Ronald F.10. 1998. Paul M.