Lumbopelvic Rhythm

Original Editor - Chelsea Mclene


Top Contributors - Chelsea Mclene and Kim Jackson  

Introduction

Lumbar joint is formed by wedge shaped intervertebral disc anteriorly and posteriorly by L5-S1 facet.

Cailliet described a specific instance of coordinated, simultaneous activity of lumbar flexion and anterior tilting of pelvis in sagittal plane during trunk flexion and extension. He combined lumbar and pelvic motion.[1]When femur, pelvis and spine move in combined coordinated manner, it produces a larger ROM than what might be available to one segment alone.It is an open kinematic chain and is analogous to Scapulo-Humeral Rhythm.

What is lumbopelvic rhythm

The activity of bending over to touch one's toes with knees straight depends on lumbopelvic rhythm.

Lumbopelvic rhythm or the hip-spine coordination[4] refers to the way in which the lumbar spine, moves in combination with the pelvis. It is the kinematic relationship between lumbar spine and hip joints during sagittal plane movement.

According to Cailliet[1], the first part of bending forward consists of lumbosacral flexion followed by anterior tilting of pelvis at hip joints . The muscles in the lower back namely erector spinae, contract eccentrically to control the movement against gravity while trunk flexes and pelvis tilts anteriorly. The muscles that flex the hip contract concentrically and this motion is balanced by eccentric contraction of muscles that extend the hip.

When return to the erect posture, this rhythm is reversed. It is initiated by posterior tilting of pelvis at the hip, followed by extension of lumbar spine.[5] The hip extensors initiate the posterior rotation of the pelvis until it is in a better position for spinal extensors to concentrically contract without too much stress being put on them. As these muscles contract concentrically, the hip flexors contract eccentrically to help control the movement.The aspect of motion of interest include timing, as well as magnitude related characteristics.[6]

[7]
[8]


Lumbopelvic rhythm contribution to low back pain

Lumbopelvic rhythm while bending forward and returning to initial position has been investigated and better understanding of trunk motion pattern was achieved as used on research on low back disorders[9]. During forward bending, the eccentric contractions of the lumbar and hip extensors help to lower the body in a controlled motion against gravity. If the muscles are weak or fatigued, the weight of the body is enough to overload the muscles and this causes strain. When the body is returning to the erect position, if the hip flexors are tight or the extensors are too weak to initiate posterior pelvic rotation, the spinal extensors can get overloaded, causing injury and pain.[10](fig.4)

Improvement of lumbopelvic rhythm by correction of forward head posture

Research[13] was done on the improvement of lumbopelvic rhythm by correction of forward head posture which concluded that the study showed clinical significance in the improvement of lumbopelvic rhythm by forward head correction given for 4 weeks of treatment.

This included cervicothoracic fascia release, Maitland mobilisation, stretching of trapezius, pectorals, levator scapulae and neck exercise like chin tuck and chin drop.

Implications

  1. It is used to identify 'Pelvic cross syndrome' in gymnasts.[14]
  2. It is used to identify weakness, inflexibilities or muscles imbalance which contribute to low back pain.
[15]

Further Reading

Lumbosacral Biomechanics

Lumbo-Pelvic Stability

Pelvic tilt

References

  1. 1.0 1.1 Cailliet R: Soft Tissue Pain and Disability(ed. 3) ,Philadelphia F.A. Davis,1996
  2. basics of lumbar spine. source: pixy.org.CCO public domain, No attribution required. Available from https://pixy.org/1364428/ [last accessed 23/9/2020]
  3. Bob holzer. Uttanasana yoga icon. Lisensed under creative common. Available from https://thenounproject.com/term/uttanasana/107998/ , [last accessed 23/9/2020]
  4. Tojima M, Ogata N, Nakahara Y, Haga n. Three-dimensional motion analysis of lumbopelvic rhythm during trunk extension. Journal of Human Kinetics 2016 Apr 1;50(1):53-62.
  5. Norkin, C. C., Levangie, P. K. Joint Structure and Function: A Comprehensive Analysis. United States: F.A. Davis Company,2011
  6. Zhou J, Ning X, Fathallah F. Difference in lumbopelvic rhythm between trunk flexion and extension. Clinical Biomechanics. 2016;32:274-279. doi:10.1016/j.clinbiomech.2015.10.012.
  7. Alexandra Kopelovich . Lumbopelvic rhythm . Available from : http://youtu.be/yvVbwcv_sVQ [last accessed 15/9/2020]
  8. Vanessa Yingling . PelvicLumbarMotion . Available from : https://youtu.be/KQgp_dtXm7Q [last accessed 15/9/2020]
  9. Vazirian M, Van Dillen L, Bazrgari B. Lumbopelvic rhythm during trunk motion in the sagittal plane: A review of the kinematic measurement methods and characterization approaches. Physical therapy and rehabilitation. 2016;3.
  10. Lowe W:The lumbopelvic rhythm. Academy of clinical massage, published july 1,2015. Accessed Sept 2020
  11. lumbar joint - anterior. sorce: anatomography. Available from https://commons.wikimedia.org/wiki/File:Lumbar_vertebrae_anterior.png [last accessed 23/9/2020]
  12. lumbar joint - anterior. sorce: anatomography. Available from https://commons.wikimedia.org/wiki/File:Lumbar_vertebrae_anterior.png [last accessed 23/9/2020]
  13. Dass B, Shinde D, Kala S et.al. Improvement in the lumbo-pelvic rhythm by correction of forward head posture. Int J Health Sci Res. 2020; 10(9):69-75.
  14. Kruse D, Lemmen B. Spine Injuries in sport of Gymnastics. Current Sports Medicine Reports. 2009;8(1):20-28
  15. NESTA & Spencer Institute . Integrated motion of lumbar spine . Available from : https://youtu.be/qbjiXos89Dc [last accessed 15/9/2020]