Lumbo Pelvic Hip Complex Dysfunction (LPHCD) has been previously described as “lower crossed syndrome” or an “anterior pelvic tilt”. is likely similar to, or includes the dysfunction described as kyphotic lordotic-posture, sway back posture and is correlated with many low back and lumbosacral dysfunctions.  

LPHCD is limited to common impairments of the lumbar spine, sacroiliac joint, hip and knee.

The Mechanism of Muscle Imbalance :

In Lower limb dysfunction, the hip flexors become tight (due to poor posture). As a result of the automatic reflex inhibition by the brain, the abdominals and gluteals on the opposite side of the body weaken. Consequently, this muscle strength imbalance leads to an exaggerated curve in the lower spine which in turn causes low back pain. Because the gluteals are weak, its function is compromised and muscles such as the hamstrings act as synergistically. This leads to overuse and tightness of the hamstrings, which ultimately weaken the abdominals, and further increases the curve of the lower spine.

 

Clinically Relevant Anatomy

The pelvic crossed syndrome involves weakness of the trunk muscles; Rectus abdominus, Obliques internus abdominis, Obliques externus abdominis and transversus abdominis; alongwith the weakness of the gluteal muscles: Gluteus maximus, Gluteus medius and Gluteus minimus. These muscles are inhibited and substituted by activation of the superficial muscles.

There is co-existing over activity and tightness of the thoracolumbar extensors: Erector spinae, Multifidus, Quadratus lumborum and Lattisimus dorsi; and that of the hip flexors: Iliopsoas and Tensor fasciae latae.

The hamstrings compensate for anterior pelvic tilt or an inhibited gluteus maximus.

 

Common Muscular Dysfunction

Short/Over-active :

  • Lumbar Extensors

    • Erector Spinae

    • Multifidus

    • Latissimus Dorsi

  • Hip Flexors

    • Psoas

    • ILiacus

    • Rectus Femoris

    • TFL

    • Vastus lateralis

    • Gluteus minimus

    • Adductor magnus

    • Sartorious

Short/Under-active : Prime mover inhibition

  • Lumbar Satbilizer

    • Psoas

Long/Under-active  should be activated

Lumbar Flexors

    • Transveres Abdominus (not a true lumber flexor)

    • Internal oblique

    • Diaphragm

    • Pelvic Floor

    • Intercostals?

  • Hip Extensors

    • Gluteus Medius

    • Gluteus maximus

    • Semitendinosus and Semimembranosus

Long/Over-active : require released only

  • Synegistists of hip External Rotation

    • Piriformis and Deep ROtators

    • Adductor magnus

    • Biceps femoris

  • Lumbar Flexors

    • Rectus Abdominus

    • External oblique

Why the cervical spine address?

In, lower crossed syndrome posture will predispose the patient to develop the upper crossed syndrome. Lordosis is a curve of extension. Therefore, if the lumbar spine is hyperlordotic, the center of weight of the trunk shifts posteriorly. To compensate, the thoracic spine often increases kyphosis (curve of flexion) to bring the center of the weight back anteriorly.

Increased thoracic kyphosis then predisposes both hyperlordosis of the lower cervical spine with concomitant hyperlordosis of the upper cervical spine and protracted head posture, and protracted shoulder girdles with medially (internally) rotated arms; in other words, upper crossed syndrome.

 

Here is link to follow the exercises to correct Lower cross syndrome.

 

Referances :

  1.  Janda V. Muscles and motor control in low back pain: Assessment and management. In: Twomey Lt. Physical therapy of the low back. New York, Edinburgh, London: Churchill Livingston, 1987;253-87
  2.  Ishida, H., Hirose, R., Watanabe, S., 2012. Comparison of changes in the contraction of the lateral abdominal muscles between the abdominal drawing-in maneuver and breathe held at the maximum expiratory level. Man. Ther. 17 (5), 427- 431. Level of Evidence: 2C
  3. The Pelvic Crossed Syndromes: A reflection of imbalanced function in the myofascial envelope; a further exploration of Janda’s work. Journal of bodywork and movement therapies. 2010 July;14:299-301

 

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