Clinical Measures of Pelvic Tilt in Physical Therapy

Abstract

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.

Level of evidence: 5.

Keywords: groin; hip; injury assessment; movement system; pelvic tilt.

Figure 1A and 1B.. Assessment of active pelvic tilt in a standing position. First, the caliper-based inclinometer is aligned with the subject’s ASIS and PSIS. Then, the subject is instructed to first anteriorly tilt (Figure 1A) and then posteriorly tilt (Figure 1B). The sum of the absolute values of these two measurements is the total active pelvic tilt. ASIS: Anterior Superior Iliac Spine; PSIS: Posterior Superior Iliac Spine.

Figure 2A and 2B.. Assessment of active pelvic tilt in a split stance position. First, the caliper-based inclinometer is aligned with the subject’s ASIS and PSIS on the side of the posterior limb. Then, the subject is instructed to first anteriorly tilt (Figure 1A) and then posteriorly tilt (Figure 1B). The sum of the absolute values of these two measurements is the total active pelvic tilt. ASIS: Anterior Superior Iliac Spine; PSIS: Posterior Superior Iliac Spine.

Figure 3.. Assessment of pelvic tilt during a step-down maneuver. A smartphone with an application that can assess change in spatial angulation (such as iHandy Level) is secured onto the subject’s sacrum via a running belt. The initial angle is recorded, and the change in angle at the lowest point of the step-down is recorded. The difference between the two angles is the change in pelvic tilt during the stepdown.