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Relation of Anterior Pelvic Tilt During Running to Clinical and Kinematic

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Relation of Anterior Pelvic Tilt During Running to Clinical and Kinematic Br J Sports Med 2000;34:279–283 279 Relation of anterior pelvic tilt during running to Br J Sports Med: first published as 10.1136/bjsm.34.4.279 on 1 August 2000. Downloaded from clinical and kinematic measures of hip extension Anthony G Schache, Peter D Blanch, Anna T Murphy Abstract position of the pelvis is associated with an Background—Limited hip extension flex- increase in the degree of lumbar lordosis ibility due to tight hip flexor musculature during running.78 The resulting repetitive or anterior hip capsular and ligamentous impingement of the vertebral facets from the structures is a possible cause of increased hyperextension of the lumbar spine is then anterior tilt of the pelvis during running. thought to be related to the onset of low back However, to date, research exploring this pain in runners.89 relation, as well as the kinematic relation Tightness of the hip flexor musculature—for between anterior tilt of the pelvis and peak example, iliopsoas, tensor fascia lata, rectus hip extension range of motion during run- femoris—hip joint capsule, or surrounding ning, is not available. anterior hip ligamentous and fascial structures Objective—To assess the relation of ante- in runners may reduce hip extension flexibility. rior pelvic tilt during running to peak hip This is commonly assessed clinically using the extension range of motion measured dur- Thomas test (or modifications of it). Limited ing running and hip extension flexibility hip extension flexibility has been proposed as measured clinically. one possible cause of increased anterior pelvic Methods—Hip extension flexibility was tilt and lumbar lordosis during running.5–7 assessed using the Thomas test, and the Given the proposed implications of increased three dimensional kinematic motion of the anterior pelvic tilt and lumbar lordosis during pelvis and hips were recorded using a running, it would be of interest to explore the VICON motion analysis system with 14 relation between hip extension flexibility and elite athletes running on a treadmill at 20 dynamic measures of anterior pelvic tilt and km/h. peak hip extension range of motion (ROM) Results—Anterior pelvic tilt displayed a during running. Published research into the significant (p<0.01) correlation with peak relations between these three variables is not hip extension range of motion during run- currently available. Therefore the purpose of ning. Anterior pelvic tilt tended to be this research project was to assess the relation increased in runners who displayed re- of anterior pelvic tilt during running to peak duced absolute peak hip extension range hip extension ROM measured during running of motion during terminal stance. No sig- and hip extension flexibility measured clini- http://bjsm.bmj.com/ nificant correlation was shown for hip cally. School of extension flexibility with either anterior pelvic tilt or peak hip extension range of Physiotherapy, Methods motion during running. University of Fourteen (10 male, 4 female) elite track and Melbourne, Conclusions—The outcomes of this study Melbourne, Australia field athletes, who were not suVering from any indicate that anterior pelvic tilt and hip musculoskeletal injuries, volunteered as sub- A G Schache extension are coordinated movements jects for this study. All were experienced tread- on October 2, 2021 by guest. Protected copyright. Physiotherapy during running. Static hip extension flex- mill runners. They had a mean age of 23.6 Department, ibility measured using the modified Tho- years (range 18–29 years). Male subjects had a Australian Institute of mas test does not appear to be reflective of mean height of 177.1 cm (range 167.4–192.0 Sport, Canberra, ACT, these dynamic movements. cm), and female subjects had a mean height of Australia (Br J Sports Med 2000;34:279–283) P D Blanch 167.8 cm (range 163.6–174.5 cm). The study Keywords: running; kinematics; pelvis; hip; flexibility was conducted in accordance with the guide- Paediatric and Child lines of the Australian Institute of Sport ethics Health/Human committee. Movement Studies Injuries to the lumbo-pelvic-hip complex Hip extension flexibility was measured using Departments, University of account for about 14% of all injuries sustained the Thomas test. For this test, each subject sat Queensland, Brisbane, by distance runners and sprinters of varying on the end of a plinth and rolled backwards on Qld, Australia levels of ability.1 Although at first this injury to the plinth while holding both knees to the A T Murphy rate appears quite low with respect to the knee chest. This position ensured that the pelvis was and lower leg, injuries to the lumbo-pelvic-hip posteriorly tilted and the lumbar spine flexed Correspondence to: Mr A G Schache, School of complex from a clinical point of view are often on the plinth. Tester one held one hip in maxi- Physiotherapy, University of quite debilitating and demand prolonged peri- mal flexion to maintain this pelvic position, Melbourne, 200 Berkeley St, ods of rehabilitation. This is evident from sev- while the limb to be measured was lowered Carlton, Victoria 3053, Australia eral case studies describing running injuries to towards the floor with the knee in a relaxed 2–4 email: a.schache@ this region. One factor that has been anecdo- position. The head and shoulders of each sub- pgrad.unimelb.edu.au tally linked to running related injuries of the ject remained in a flat position on the plinth Accepted for publication lumbo-pelvic-hip complex is increased anterior throughout the test. Tester two used a goniom- 29 February 2000 pelvic tilt.56 It has been suggested that such a eter with a spirit level attached to the arm to www.bjsportmed.com 280 Schache, Blanch, Murphy Br J Sports Med: first published as 10.1136/bjsm.34.4.279 on 1 August 2000. Downloaded from PSIS ASIS Horizontal Anterior pelvic tilt (+ve) Hip extension Hip flexion Hip extension angle (–ve) Figure 1 Measurement of hip extension flexibility using the Thomas test. measure the angle formed between a horizontal reference line and a line connecting the greater Figure 2 Diagrammatic representation of the trochanter to the lateral femoral epicondyle (fig measurement of anterior pelvic tilt and peak hip extension range of motion during running. PSIS, posterior superior 1). A positive value was assigned to the iliac spine; ASIS, anterior superior iliac spine. situation where the thigh was extended below the horizontal reference line. This test has been Table 1 Group means and ranges for measured variables previously found to be adequately reliable Variable Mean Range when measuring normal subjects.10 All running sessions were performed on a Anterior pelvic tilt (°) 22.1 13.6–37.0 Peak hip extension ROM (°) −11.7 −27.1–7.5 treadmill (Sportech Gymnasium and Elec- Hip extension flexibility (°) 17.4 7.5–25.0 tronic Sports Equipment, Jamison, ACT, Aus- Relative stride length (%) 206.3 186.8–216.4 tralia) custom made for the Australian Institute Relative leg length (%) 53.5 51.1–56.1 of Sport biomechanics laboratory. The tread- ROM, range of motion. mill was set with no incline. To measure the motion of the pelvis and hips during running, tem (rotation occurring in the sagittal plane of small reflective markers were positioned on the global coordinate system). Hip flexion and both anterior superior iliac spines, the mid- extension was defined as a rotation of the thigh point between the two posterior superior iliac segment about the medial-lateral axis of the spines and both lateral femoral condyles. In local coordinate system in the pelvic segment addition, two markers mounted on small (rotation in the sagittal plane of the pelvic wands were positioned on the lateral aspect of coordinate system). Anterior pelvic tilt was the distal third of the right and left thighs on a assigned a positive value, and true hip joint line connecting the lateral projection of the hip extension was assigned a negative value in this joint centre (greater trochanter) to the lateral study. http://bjsm.bmj.com/ projection of the knee joint centre (lateral femoral condyle). All markers were positioned DATA ANALYSIS according to the VICON Clinical Manager Anterior pelvic tilt was measured as the angle (Oxford Metrics Ltd, Oxford, UK) protocol. of the pelvis at the time of terminal hip exten- Each subject performed a five minute warm sion. The magnitude of terminal hip extension up running on the treadmill at the test speed of was used to represent peak hip extension 20 km/h. After this period, the three dimen- ROM. Stride time, based on the information sional trajectories of the markers were collected from the load cell, represented the time on October 2, 2021 by guest. Protected copyright. using a VICON motion analysis system between two foot strikes on the same side of the (Oxford Metrics Ltd) with six cameras (NAC body. Stride length was calculated by multiply- Inc, Yokohama, Japan) operating at a sampling ing the known stride time by the belt speed of rate of 200 Hz. Foot strike and foot oV were the treadmill. Relative stride length and relative detected using a load cell (Applied Measure- leg length for each subject were then obtained ment Australia Pty Ltd, Jamison, ACT, Aus- by expressing the values as a percentage of the tralia) attached to the treadmill. respective height. Immediately after the five minute warm up, Data for the left and right sides were five seconds of data were captured for each compared using a two tailed paired t test. For subject, and a single representative cycle was each subject, data for the left and right sides chosen for analysis. The three dimensional were combined, and average values were used angular rotations of the pelvis and hips were in analyses.
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