Pathological Trunk & Pelvis Deviations

Question 1

what are possible causes and effects of a trunk backward lean during stance in IC/LR?

Answer 1

Causes:
- purposeful to decrease demand on hip extensors
- countering rigid hip flexion contracture

Effects:
- decreases forward momentum
- may increase energy cost

Question 2

what are possible causes and effects of a trunk backward lean during swing?

Answer 2

Causes:
- purposeful to advance limb

Effects:
- may increase energy cost

Question 3

what are possible causes and effects of a trunk forward lean?

Answer 3

Causes:
- 2° increased hip flexion in IC/LR or stance
- purposeful to decrease demand on quads
- purposeful to advance over rigid PF’d ankle
- purposeful to substitute visual input for impaired proprioception
- use of AD
- decreased available trunk extension ROM
- abdominal pain

Effects:
- increased energy cost and demands on hip/trunk extensors – increased lumbar lordosis
- may improve stability and/or forward progression

Question 4

what are possible causes and effects of a trunk lateral lean?

Answer 4

Causes:
- Ipsi lean 2° weak hip aBductors - decreased MS demand
- Ipsi lean 2° ADductor contraction & contralateral pelvic tilt
- Ipsi lean 2° ABductor or ITB tightness
- Contra lean 2° impaired body image “pusher”
- Ipsi lean with contra hip hike clear swing limb
- Postural response for reference short stance limb
- Purposeful to avoid hip pain
- Use of (A) devices

Effects:
- increases energy cost
- decreases forward momentum

Question 5

what are possible causes and effects for pelvic hiking in swing?

Answer 5

Causes:
- Weak hip or knee flexors
- Weak dorsiflexors
- Leg length discrepancy
- Inability to flex knee (brace, cast)
- Overactive Quadratus Lumborum

Effects:
- Reference side elevates in voluntary coordination with swing limb
- Purposeful to assist foot clearance
- May decrease energy costs
- May be seen with circumduction

Question 6

what are possible causes and effects for posterior pelvic tilts?

Answer 6

Causes:
- Tight hamstrings
- Purposeful to decrease demand on hip extensors in IC/LR
- Purposeful for swing (SLA)
- LBP
- decreased lumbar extension
- Weak hip flexors

Effects:
- With thigh vertical, hip hyperextends on stance limb
- Advances limb in absence of effective hip flexors
- May increase energy cost

Question 7

what are possible causes and effects for anterior pelvic tilts?

Answer 7

Causes:
- weak abdominals
- hip flexion
- 2° forward trunk lean

Effects:
- may increase energy cost
- may increase lordotic curve which may result in LBP
- compensations as seen in with increased hip flexion

Question 8

what are possible causes and effects for decreased anterior pelvic rotation?

Answer 8

Possible Causes:
- 2° Retracted pelvis
- Comp to decreased demand on quads & hip extensors at LR
- 2° decreased backward rotation of opposite limb
- 2° Back pain

Effect:
- decreases ipsilateral step length

Question 9

what are possible causes and effects for decreased posterior pelvic rotation?

Answer 9

Possible Causes:
- 2° decreased motor control trunk & pelvic muscles
- 2° Back pain
- 2° excess hip flexion

Effect:
- decreased Contralateral step length (TSt)

Question 10

what are possible causes and effects for increased anterior pelvic rotation?

Answer 10

Possible Causes:
- 2° Purposeful to advance limb
- 2° Excess backward rotation opposite limb

Effect:
- Increases ipsilateral step length (TSw)

Question 11

what are possible causes and effects for increased posterior pelvic rotation?

Answer 11

Possible Causes:
- 2° inability to dissociate pelvis from limb movement
- 2° excess plantarflexion
- 2° compensation for increased hip flexion in stance
- 2° weak plantarflexors with no heel-off

Effects:
- decreased forward progression & limb advancement in swing
- Used on purpose to increased forward progression in stance

Question 12

what are possible causes and effects for ipsilateral pelvic drop?

Answer 12

**iliac crest is lower on reference limb

Causes:
- Contralateral abductor weakness
- May be present w/ scoliosis
- Compensation for shortened reference limb (LLD)
- Purposeful to lower limb for IC

Effects:
- Increased lateral shift of COM
- May increased energy cost
- May result in back pain

Question 13

what are possible causes and effects for contralateral pelvic drop?

Answer 13

**iliac crest is higher on reference limb

Causes:
Weak hip abductors of reference limb (B & C) w/ & w/o compensation
- Ipsilateral adductor spasticity (D)
- Contralateral abductor spasticity (D)
- Purposeful to lower opposite limb for IC

Effects:
- increased relative length of reference limb
- May decrease opposite limb stability
- May increase energy cost
- May result in back pain

Question 14

what are the causes of Trendelenburg?

Answer 14

weakness of ipsilateral hip abductors
contralateral hip drop

Question 15

what are compensatory techniques for Trendelenburg?

Answer 15

• using a cane
  
  • cane on opposite side decreases joint reaction forces in painful reference hip by 36% and reduces demands/reduced compression force on hip joint
• carrying a load
  
  • holding a load on ipsilateral side decreases joint reaction forces in painful reference hip

Question 16

what are possible causes and effects for Circumduction during Swing?

Answer 16

Causes:
- Compensation for weak hip and/or knee
flexors, DF
- 2° decreased ankle, knee, hip flexion ROM
- 2° extensor pattern
- 2° LLD

Effects:
- Enables limb advancement
- May increase energy cost

Question 17

what are the functional effects of a Leg Length Discrepancy (LLD)?

Answer 17

Due to foot hyperpronation/supination, pelvic obliquity, and/or muscle/joint imbalances.

Question 18

what are LLD compensations on the short side?

Answer 18

• foot inversion
• knee hyperextension
• external rotation
• vaulting

Question 19

what are LLD compensations on the long side?

Answer 19

• foot eversion
• knee flexion
• circumduction
• steppage
• hiking

Question 20

what are overall LLD compensations?

Answer 20

• unequal arm swing
• spinal rotation w/ or w/o lateral flexion
• compensatory scoliosis w/ low shoulder on longer side