FILEX 2012
2 A CCEPTED S TRUCTURAL
VARIATIONS
A SSESSING H IP POSTURE
1.
Low position of ASIS in women often misinterpreted as anterior pelvic tilt
2.
Flat back in men with a tall pelvis misinterpreted as posterior tilt when ASIS is higher than belt line

Horizontal angle of up to 150 difference between ASIS and PSIS when ASIS and Symphisus Pubis aligned vertically has been found.
‘2 O UT OF 3’ R ULE FOR
P ELVIC T ILT
2 OUT OF 3 RULE

Because of these potential sources of error in assessing pelvic tilt, you should use the 2 out of 3 rule.

You need to find at least 2 of these 3 conditions present before you can say that the pelvic tilt is acquired and not structural


An increase or decrease in ‘normal’ depth of lumbar curve

An angle greater than 200 between the ASIS and PSIS

An increase or decrease in the hip joint angle as long as knees remain neutrally aligned
Another option is to return the pelvis to what you consider to be its correct alignment and see if overall alignment improves the affected joints. If incorrect changes occur as a result of the pelvic correction, the problem could be structural and not acquired.
L UMBAR CURVE
L UMBAR C URVE

Anterior curve


Normal curve is slight curve not too deep and not too flat
An increase in ‘normal’ depth of lumbar curve – ANTERIOR TILT

‘Normal’ depth of lumbar curve ‐
NEUTRAL

Decrease in ‘normal’ depth of lumbar curve – POSTERIOR TILT
Dr Mark McKean Fitness Research USC
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FILEX 2012
P ELVIC A NGLE
P ELVIC A NGLE

ASIS aligned with Pubic bone

PSIS greater than 200 above horizontal line of ASIS – ANTERIOR TILT

PSIS between 0o‐20o above horizontal line to ASIS

PSIS between 0o‐20o above horizontal line of ASIS ‐ NEUTRAL

PSIS below horizontal line from ASIS –
POSTERIOR TILT
H IP J OINTS

Hip and knee aligned vertically with trunk

180o at hip joint
A NTERIOR T ILT (2 OF 3)
H IP J OINT ANGLE

Increase in hip joint angle with neutral knees – ANTERIOR TILT

Hip and knee aligned vertically with trunk ‐
NEUTRAL

Decrease in hip angle through to extension – POSTERIOR TILT
P OSTERIOR T ILT (2 OF 3)

Increase in normal lumbar curve


more than 200 angle between PSIS‐ ASIS
Decrease in lumbar curve

PSIS is lower than ASIS

Flexion of hip joint angle with neutral knees


Short hip flexors, long hamstrings, long external oblique, short low back extensors
Extension of hip joint angle with neutral knees

Short hamstrings, long hip flexors, Dr Mark McKean Fitness Research USC
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FILEX 2012
T HINGS TO LOOK FOR

Typically seen from people with F EMORAL ANTERIOR GLIDE WITH

posterior tilt, OR WITHOUT MEDIAL ROTATION

hip extended, 
knees hyperextended, 
possible medial rotation and 
poor glutes and 
weak iliopsoas, T ESTS TO PERFORM

When stand on one leg may see medial rotation

Short dominant hamstrings over glute max, 
Short dominant ITB/TFL over iliopsoas

Seen sitting with legs crossed.
Tests to perform
What to look for
Supine hip flexion
Anterior movement of greater
trochanter can be painful with or
without excessive medial rotation
Prone hip extension
Anterior movement of greater
trochanter with or without
excessive medial rotation (possibly
due to dominance of hamstrings in
hip extension)
C ORRECTING

Aim to improve posterior glide of femoral head, correct dominance behaviour of hamstrings and TFL

Stretch iliopsoas starting with very light pain free movements and loads

Rocking back on hands and knees to stretch posterior capsule

Side lying lateral hip rotation with slight abduction to recruit posterior glute medius (knees flexed 90)

Stretch lateral hip rotators via medial rotation
Dr Mark McKean Fitness Research USC
F EMORAL ANTERIOR GLIDE WITH
LATERAL ROTATION
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T HINGS TO LOOK FOR


Typically see posterior tilt, hips extended, lateral rotation, knees hyperextended. May also see short hamstrings and weak glutes.
In supine position will show lateral rotation, tight glutes
and weak iliopsoas

When stand on one leg will see lateral rotation

People may sit cross legged with one foot resting on top of other thigh
T ESTS TO PERFORM
Tests to perform
What to look for
Supine hip flexion
Anterior movement of greater
trochanter with excessive lateral
rotation
Posterior movement of greater
trochanter with excessive lateral
rotation (possibly due to
dominance of hamstrings in hip
extension)
Hips rotated laterally
Prone hip extension
Single leg stance
C ORRECTING

Prone medial hip rotation from neutral with knees flexed to 90 stretching lateral rotators

Strengthen and shorten medial hip rotators

Side lying hip abduction with medial rotation and hip flexion

Seated hip flexion holds at 120o limiting abduction and lateral hip rotation 
Forward bends emphasis on hip flexion and glutes only with no lateral rotation.
H IP ADDUCTION WITH MEDIAL
ROTATION
T HINGS TO LOOK FOR

More recruitment of medial rotators than lateral rotators

Lengthened piriformis may compress sciatic nerve and get referred pain

TFL‐ITB over used in abduction/flexion

Dominant adductors to abductors

Will also have weak lateral rotators, and glute medius and maximus, short ITB‐TFL, and short adductors

Generally sleep side lying
Dr Mark McKean Fitness Research USC
T ESTS TO PERFORM
Tests to perform
What to look for
Side lying external rotation
Weakness of lateral rotators
Thomas test
Short ITB
Prone hip extension/trunk hip
extension
Weak glutes
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CORRECTING

Aim to strengthen hip abductor and lateral rotators 
Prone hip abduction with knee flexed to 90 – moving leg to the side with limited pelvic tilting – this reduce use of flexors

Prone glute squeeze and hold isometric contraction

Side lying external rotation of hip

Strengthening of quads with no medial rotation

May require treatment of ITB fascia to reduce recruitment hierarchy
H IP EXTENSION WITH KNEE
EXTENSION
T HINGS TO LOOK FOR

Lack of recruitment of glute max in hip extension or quads in knee extension and over use of hamstrings to perform same movements 
Commonly results in hamstring strains

Hamstring contraction can be painful and muscle painful to touch

Common in athletes with hypertrophied hamstrings

When standing will see hips extended and knees hyperextended

Poor knee control in step up/downs with weak glute max and decreased recruitment of quads

When returning from forward bend will sway hips forward to use the upper body to extend rather than the glutes
T ESTS TO PERFORM
Tests to perform
What to look for
Step ups
Knees move backwards instead of
body moving forwards
Prone hip extension/trunk hip
extension
Full hip extension before glutes used
Single leg raise
Short hamstrings
Forward bend test
Short gastroc, short hamstrings,
forward sway of hips on return to
stand
Side lying lateral rotation of hip
Weak lateral rotators
C ORRECTING

Aim to improve strength of synergist muscles of hip extension and reduce recruitment of hamstrings. 
Hamstring lengthening antigravity and passive

Strengthen glute max

Side lying hip abduction with slight lateral rotation

Forward bend with glute initiation of movement not hamstrings
Dr Mark McKean Fitness Research USC
E XERCISE P RESCRIPTION
A NTERIOR P ELVIC T ILT
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FILEX 2012
M USCLES ARE LENGTHENED
- REQUIRE SHORTENING
Hamstrings Gluteus maximus
 External oblique
 Quadratus lumborum*
M USCLE ARE SHORTENED
– REQUIRE LENGTHENING




Low effort isometric contractions
Build up to 10 x 10 s – low weight bearing
 Maintain good posture in exercises 

Iliopsoas
Quadriceps
Antigravity stretches
Long duration up to 10‐12 min
Light tension stretches
Low balance weight bearing postures




M USCLES ARE WEAK
- REQUIRE STRENGTHENING

VMO
Anterior Glute medius
Lateral hip rotators

General dynamic exercises 
Isolated to integrated approach


E XERCISE P RESCRIPTION
P OSTERIOR P ELVIC T ILT
M USCLES ARE LENGTHENED
- REQUIRE SHORTENING



One joint hip flexors
External obliques
Quadriceps
Dr Mark McKean Fitness Research USC
M USCLE ARE SHORTENED
– REQUIRE LENGTHENING
Hamstrings
Internal oblique
 Rectus abdominis
 Intercostals


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FILEX 2012
M USCLES ARE WEAK
- REQUIRE STRENGTHENING

Medial hip rotators
D R M ARK M C K EAN
P H D CSCS AEP MESSA
Post Doctoral Research Fellow University of Sunshine Coast  Australian Institute of Fitness Research
 mmckean@usc.edu.au


Dr Mark McKean Fitness Research USC
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