Lumber Movement and Function

Lumber Movement and Function

Relevance of Lumbar and Pelvic Movement

  • Lumbar movement is closely coupled with pelvic movement.
  • This coupling is crucial for activities like sit-to-stand.
  • The action phase of sit-to-stand involves:
    • Hip flexion
    • Trunk extension
  • Pelvic and lumbar movements are important for:
    • Weight lifting
    • Rowing
    • Various high-level functions

Lumbar Movements as Part of the Trunk

  • Lumbar movement is integrated with the entire trunk segment.
  • The trunk consists of approximately 25 moving segments.
  • The lumbar spine comprises five segments.
  • Movement of the upper trunk, lower trunk, and cervical spine can be segmented.

Coupling with Pelvic Tilt

  • Descriptions of trunk movement include:
    • Flexion
    • Extension
    • Side flexion
    • Rotation
  • Lumbar movements are always coupled with pelvic tilt.
  • Types of pelvic tilt:
    • Anterior
    • Posterior
    • Lateral

Physiological Curves of the Spine

  • Thoracic spine:
    • Normal kyphosis: 20-40 degrees
  • Lumbar spine:
    • Normal lordosis: 20-40 degrees

Pelvic Tilt Explained

Anterior Pelvic Tilt

  • Anterior superior iliac spine (ASIS) tilts forward.
  • Lumbar spine extends.

Posterior Pelvic Tilt

  • ASIS tilts backward.
  • Lumbar spine reduces extension or flexes.

Lateral Tilt

  • One ASIS is higher than the other.
  • Rotation occurs in the frontal axis.
  • Example: Right lateral tilt means the right ASIS is lower, and the left ASIS is higher.

Muscles Involved in Pelvic Tilt

Anterior Pelvic Tilt

  • Muscles that shorten or engage:
    • Erector spinae
    • Iliopsoas
    • Sartorius

Posterior Pelvic Tilt

  • Muscles that engage in contraction:
    • Rectus abdominis
    • Hamstrings
    • Gluteus maximus
  • Posture vs. Movement: The discussion focuses on the muscles involved in moving into anterior or posterior tilt, not static posture.

Sustained Posture and Contributing Factors

  • Sustained pelvic tilt in posture may be due to:
    • Habit
    • Pain avoidance
    • Compensation for misalignment elsewhere (SIJ, hip, knee)
    • Muscle stiffness
    • Fear avoidance behavior

Correlation Between Posture and Symptoms

  • Limited evidence linking sustained posture directly to symptomatology (e.g., low back pain).
  • Older studies suggesting a correlation have been contradicted.
  • A sustained posture should be viewed as a contributing factor rather than a direct cause of symptoms.

Implications of Anterior and Posterior Pelvic Tilt

Anterior Pelvic Tilt

  • Potential findings:
    • Shorter/more active hip flexors
    • Shorter/more active lumbar extensors
    • Abdominal weakness
    • Requires case-by-case assessment in static and dynamic activities

Posterior Pelvic Tilt

  • Potential findings:
    • Hip extensor weakness
    • Reliance on passive anterior structures
    • Shorter/more active abdominal muscles

Practical Demonstration and Range of Motion

  • Demonstration of anterior and posterior pelvic tilt in a sitting position.
  • Individuals may exhibit different ranges of motion in anterior vs. posterior rotation.
  • The focus is on exploring movement and appreciating the range of motion, not necessarily correlating it with pain.

Pelvic Tilt and Functional Activities

Lying Down

  • Posterior pelvic tilt facilitates rolling up to a lying position.

Sit to Stand

  • Anterior pelvic tilt and lumbar spine expansion are necessary.

Reaching

  • Anterior pelvic tilt and lumbar extension increase reach.
  • Lateral tilt and lumbar inclination occur when reaching laterally.

Lumbo-Pelvic Rhythm

  • The coordinated movement of the pelvis and lumbar spine.

Ipsi-directional Rhythm

  • The pelvis and lumbar spine move in the same direction (e.g., lifting from the floor).

Counter-directional Rhythm

  • The pelvis and lumbar spine move in opposite directions.
  • This may or may not contribute to symptoms.

Ideal Pelvic Tilt and Posture

  • Normal mobility involves moving through anterior and posterior pelvic tilt in daily activities.
  • Ideally, a middle range or neutral position is maintained in static postures (sitting, standing).
  • Non-neutral posture doesn't automatically indicate pain but could be a contributing factor.

Observations and Assessments

  • Assess for:
    • Reliance on passive structures at the end of the range of movement.
    • Overactivity of specific muscles around the pelvis (abdominals, back, gluteals).

Neutral Posture

  • Characterized by:
    • Balanced muscle activity.
    • A little bit of anterior pelvic tilt.
    • 20-40 degrees of lumbar extension.

Trunk Movements in Function

  • Upper and lower trunk often move separately during activities like throwing or walking.
  • Segmental rotation occurs.

Clinical Relevance of Lumbar and Pelvic Movement Patterns

  • Relevant for patients with symptoms in the lumbar and pelvic regions.
  • Pelvic tilts relate to body function and structures and can be an impairment to address.
  • Assess:
    • Passive range of motion of the hip and lumbar spine.
    • Muscle imbalances (hyperactivation, stiffness, weakness, shortening).
    • Motor learning, habits, and ingrained movement patterns.

Key Points for Pelvic Tilt Observations

  • Assess pelvic movement in static and dynamic activities (standing, sitting, reaching, squatting).
  • Analyze the lumbo-pelvic rhythm.
  • Evaluate the passive range of motion of related segments (sacroiliac joint, lumbar spine, hips).
  • Consider movement patterns and habits.
  • Determine if the person can achieve each movement.
  • Assess the range of motion.
  • Identify where the movement is initiated.
  • Evaluate the ease and gracefulness of the movement.

Examples of Posture

  • Example 1: A person sitting with lumbar flexion and posterior pelvic rotation who doesn't achieve lumbar extension and anterior pelvic rotation when standing.
  • Example 2: A person sitting in a hyper-extended position with an anterior pelvic tilt, who demonstrates excessive extension during sit-to-stand.

Summary

  • Observation of high-level function requires detailed attention to segmental alignment.
  • Functional valgus (if present) may involve movement at the pelvis, hip, ankle, and foot.
  • Lumbar and hip movements coordinate.
  • Assess movement in combination of two segmental movement together.