Part 4 in our video series Performing the Mat Evaluation with blog content by Ana Endsjo, MOTR/L, CLT and video by Stacey Mullis, OTR/L, ATP. See Part 1, Part 2, and Part 3.
An anterior pelvic tilt frequently occurs when a client lacks trunk and pelvic stability and attempts to accommodate by “stacking the spine.” This is often seen in progressive disorders such as muscular dystrophy or with spina bifida. The anterior superior iliac spine (ASIS) is lower than the posterior superior iliac spine (PSIS), causing the client to push the pelvis forward.
To palpate for an anterior pelvic tilt, much like a posterior pelvic tilt, you must be able to locate both the ASIS and the PSIS on the client’s body. Recall the little tricks we provided in the first blog of this series to make finding those bony landmarks a little easier:
ASIS: known as the “hip bones.” These are the bones that stick out in the front of our pelvis and where we often rest our hands.
PSIS: Look for the “dimples” or indentations in the lower back and then push deep into that area to palpate the PSISs.
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With an anterior pelvic tilt, the trunk presents with an excessive lumbar lordosis or “sway back.” It is also common to see an excessive hyperextension in the thoracic region of the spine.
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The head and neck position will result in a flattening of the natural cervical curvature, and the head will often present with a hyperextension as well with an upward eye gaze toward the ceiling.
View this week’s short video clip of the live mat evaluation palpating for anterior pelvic tilt. Stacey Mullis does a great job showing you not only the position of the pelvis but of the spine and head as well. Pelvic rotation will be discussed in next week’s blog. See you then!
Transcript (edited for clarity):
Another abnormal posture that you might see is an anterior pelvic tilt. We’re going to go back to our landmarks, and we’ll start with the ASIS and let’s just see where it is with an anterior pelvic tilt. You’re going in again and palpating.
I can tell already that the ASIS in this posture is lower than it was in the posterior pelvic tilt. From here I would go around to the back, and I would check the PSIS. I find the dimple again and I place my hands there, and sure enough the PSIS is actually higher than the ASIS. Jamie is now in an anterior pelvic tilt. Another thing to notice with this is the lordotic posture in the lower spine here, and then you can see that her eyes are facing upwards and her neck is extended back.
Ana Endsjo, MOTR/L, CLT
Clinical Education Manager LTC Division
Ana Endsjo has worked as an occupational therapist since 2001 in a variety of treatment settings. She has mainly worked with the geriatric population, dedicated to the betterment of the treatment of the elderly in LTC centers. Her focus has been on seating and positioning and contracture management of the nursing home resident. With this experience, her hope is to guide other therapists, rehab directors, nurses, and administrators through educational guides, blogs, webinars, and live courses in her role as Clinical Education Manager for the long term care division.