Lumbo Pelvic Hip Complex Dysfunction (LPHCD):

Predictive Model of Lumbo Pelvic Hip Complex Dysfunction

By Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, H/FS

For an introduction to Postural Dysfunction and Movement Impairment please refer to:

  • Introduction to Postural Dysfunction and Movement Impairment

 

By any other name:

Lumbo Pelvic Hip Complex Dysfunction (LPHCD) has been previously described as "lower crossed syndrome" or an "anterior pelvic tilt"(1, 3), is likely similar to, or includes the dysfunctions described as kyphotic lordotic-posture, sway back posture (4), and is correlated with many low back and lumbosacral dysfunctions (4, 6-9).  Lumbosacral Dysfunction (LSD) will be addressed in a separate article, as a "variation" of the LPHCD model. To our knowledge, the first organization to refer to the integrated system of joints of the lumbar spine, sacrum, pelvis and hips as the "lumbopelvic-hip complex" was the National Academy of Sports Medicine (3), with the intent of better defining the term "core." We have chosen to use the same segment-descriptive label for this model. Again, labeling by segment allows the model to evolve with ever increasing detail and accuracy as new theories, research, techniques and outcome measures increase our knowledge of impairment. Further, the risk is reduced that the title itself will imply a certain set of altered motions, muscle activity, fascial dysfunctions, changes in sensation, perception, motor unit recruitment, limit the tissues included, or limit the movement related hypotheses used to construct the model.

LPHCD is limited to common impairments of the lumbar spine, sacroiliac joint, hip and knee. This definition is not intended to exclude the possibility that more distal structures may impact motion of the LPHC; it is simply a border for the purposes of analysis.  These borders were influenced by:

  • Practice - considering a minimum number of joints that should be assessed in those with complaints related to the LPHC.
  • Education - considering the minimum number of joints that would be included in describing all of the muscles and fascial structures with attachments to the pelvis.

 

 

Summary of Model:

Recommended Assessments and Techniques

Common Osteokinematic Dysfunction:

Commonly observed/studied impairments:
  • Excessive Lordosis (a.k.a. anterior pelvic tilt, sway back, etc.)
  • Knees Bow In (a.k.a. functional knee valgus, medial knee displacement, hip adduction, etc.)
  • Knees bow out (a.k.a. functional varus, lateral knee displacement, hip abduction, etc.)
  • Arms Fall (loss of shoulder flexion)
  • Goniometry:
    • More hip external rotation than internal rotation
    • Loss of hip flexion/knee extension (biceps femoris extensibility)
    • Loss of hip extension
Recommended Assessment:
  • Overhead Squat Assessment (OHSA):
    • Knees bow in
    • Knees bow out
    • Excessive lordosis (Anterior pelvic tilt)
    • Arms Fall
  • Goniometry
    • Shoulder Flexion Goniometry
    • Lower Body Goniometry

Common Muscular Dysfunction

Short/Over-active
  • Lumbar Extensors

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