Lumbopelvic Hip Complex Dysfunction (LPHCD)

“Lumbopelvic Hip Complex Dysfunction (LPHCd)" is an edit and update of previous postural dysfunction models (e.g. lower body posture, lower-crossed syndrome, sway back posture, anterior pelvic tilt, etc.). It is important to recognize that in these models the term "posture" is being used as an analogy for "ideal alignment". Similarly, when movement professionals refer to pelvic posture, low back posture, good posture, poor posture, better posture, etc. they are referring to this analogy of ideal alignment; not the rigid positioning implied by the colloquial use of the term "posture."

Postural dysfunction and movement impairment syndromes are likely the beginning of "modeling". Modeling has significant potential to aid in refining clinical decision-making, intervention selection, and program design, and improve the reliability and effect size of outcomes. Models are especially conducive for assisting in interpreting multi-variant problems, which is how all clients and patients present. The Brookbush Institute recommends that all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) consider these models as an aid in refining decision-making in practice.

Additional Models:

• Upper Body Dysfunction (UBD)
• Lower Extremity Dysfunction (LED)

Definitions:

• Posture: Arthro- and osteo-kinematics alignment maintained by optimal myofascial activity and length, as a result of sensation, integration, and activation by the nervous system - both statically and dynamically.
• Postural Dysfunction: The absence of ideal posture as a result of maladaptation by one or multiple tissues within the human movement system.
  • Brookbush Institute Modern Definition: Modeling patterns of movement impairment correlated with orthopedic dysfunction, based on all available evidence, with the intent of predicting best-practice assessments and techniques, to optimize measured outcomes.

Summary:

Fascia (Reduction in Extensibility)

Myofascial Synergies (Altered Recruitment)

Arthorkinematics

Signs of Dysfunction

Overhead Squat Assessment :

• Feet flatten
• Feet turn-out
• Knees bow-in
• Knees bow-out
• Excessive lordosis (Anterior pelvic tilt)
• Excessive forward lean
• Asymmetrical Weight Shift

Goniometric Assessment

• Hip Internal Rotation at 90 Degrees of Hip Flexion < 35-45°
• Hip External Rotation at 90 Degrees of Hip Flexion < 35-45°
• Hip Extension < 0-10°
• Knee Extension with Hip Flexion (Hamstring Length  Test ) < 0-20°
• Dorsiflexion < 15-20°

Muscle Length Tests

• Ely's Test (Rectus Femoris )
• Ober's Test (Tensor Fasciae Latae )
• Thomas' Test (Iliacus/Psoas )
• Hamstring Length Test
• Gastroc/Soleus Length Test

Manual Muscle Tests

• Gluteus Medius
• Gluteus Maximus
• Tibial Internal Rotators
• Tibialis Posterior
• Tibialis Anterior

Correlated Injuries, Pathologies, and Pain

The Lumbo Pelvic Hip Complex Dysfunction (LPHCD) model is constructed based on research demonstrating the maladaptive alterations of tissues and motion associated with common impairments of the human movement system. If we create a list of these impairments, this adds to the definition of the LPHCD model, as the model itself could be defined as the expected maladaptive changes to arise from those impairments.

• Low Back Pain (24, 26-27, 30-31, 33-35, 37, 39-58, 65, 71, 95, 97-100, 110, 116, 131-132, 134, 144, 147-160, 166-170, 172, 203-206, 208-210, 212, 214, 218-219, 221-222, 224-225, 228, 229-231, 249-250, 256, 264, 276-277, 280, 290-293, 298-302, 314-315, 339-353, 357, 360, 388, 392-393, 418, 421, 422, 437, 438, 440-441, 445-446, 455-456, 458, 460, 465-466, 475-477, 485-487, 494, 499, 500-505)
  • Disk Herniation (133, 136-143, 444)
  • Spondylolisthesis (29, 32, 428)
  • Instability/Hypermobility (146, 175, 426, 429-435, 462, 478)
  • Sacroiliac Joint Pain (36, 38, 74, 174, 194, 275, 368-369, 389, 488-493, 500, 507, 515, 525-527, 529-530, 535, 544-546, 549)
  • Sciatica (94, 96, 135)
  • Peripartum Pelvic Pain (496-497, 511, 513-514, 532-534, 537-542)
• Knee Pain and Medial Knee Displacement (59-64, 66-70, 82, 303, 305-308, 310-312, 381-385, 396-408, 518-520)
• Hamstring Strain (521)
• Hip Pathology (180, 410-411)
  • Snapping Iliopsoas Tendon (102-109)
  • Adductor and Groin (77, 78, 211)
  • Piriformis Trigger-point (182)
  • Chronic Pelvic Pain (284)

Pre-approved credits for:

• Human Movement Specialist (HMS) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Group Exercise Instructors
• Massage Therapists
• Occupational Therapists - Advanced
• Personal Trainers
• Physical Therapists
• Physical Therapy Assistants
• Yoga Instructors

This Course Includes:

• AI Tutor
• Text and Illustrations
• Research Review
• Practice Exam
• Pre-approved Final Exam

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    • Hip Range of Motion and Low Back Pain
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    • and 35
    • More external range of motion than internal range of motion
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    • Citation 39 - 41 demonstrate similar findings to this category
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    • Knees Bow Out
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    • Hip Extension
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    • Tensor Fascia Latae
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94. Dangaria, T. R., & Naesh, O. (1998). Changes in Cross‐Sectional Area of Psoas Major Muscle in Unilateral Sciatica Caused by Disc Herniation. Spine, 23(8), 928-931.
95. Barker, K. L., Shamley, D. R., & Jackson, D. (2004). Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine, 29(22), E515-E519.
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     • Iliacus
     • Citation 93 (Anderson et al.)
101. Zahran, S. S., & Fiyaz, N. A. A. Iliopsoas Flexibility in Subjects with Bilateral Flexible Flatfoot
102. Jacobson, T., & Allen, W. C. (1990). Surgical correction of the snapping iliopsoas tendon. The American journal of sports medicine, 18(5), 470-474.
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105. Janzen, D. L., Partridge, E., Logan, P. M., Connell, D. G., & Duncan, C. P. (1996). The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Canadian Association of Radiologists journal= Journal l'Association canadienne des radiologistes, 47(3), 202-208.
106. Taylor, G. R., & Clarke, N. M. (1995). Surgical release of the'snapping iliopsoas tendon'. Bone & Joint Journal, 77(6), 881-883.
107. Byrd, J. W. T. (2005). Evaluation and management of the snapping iliopsoas tendon. Techniques in Orthopaedics, 20(1), 45-51.
108. Deslandes, M., Guillin, R., Cardinal, É., Hobden, R., & Bureau, N. J. (2008). The snapping iliopsoas tendon: new mechanisms using dynamic sonography. American Journal of Roentgenology, 190(3), 576-581.
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     • Quadratus Lumborum
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     • Multifidus
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120. Crisco Iii, J. J., & Panjabi, M. M. (1991). The intersegmental and multisegmental muscles of the lumbar spine: a biomechanical model comparing lateral stabilizing potential. Spine, 16(7), 793-799
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125. Cholewicki, J., Panjabi, M. M., & Khachatryan, A. (1997). Stabilizing function of trunk flexor‐extensor muscles around a neutral spine posture. Spine, 22(19), 2207-2212.
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127. Ng, J. K., Richardson, C. A., & Jull, G. A. (1997). Electromyographic amplitude and frequency changes in the iliocostalis lumborum and multifidus muscles during a trunk holding test. Physical Therapy, 77(9), 954-961.
128. O’sullivan, P. B., Grahamslaw, K. M., Kendell, M., Lapenskie, S. C., Möller, N. E., & Richards, K. V. (2002). The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. Spine, 27(11), 1238-1244.
129. Dofferhof, A. S., & Vink, P. (1985). The stabilising function of the mm. iliocostales and the mm. multifidi during walking. Journal of anatomy, 140(Pt 2), 329.
130. Moseley, G. L., Hodges, P. W., & Gandevia, S. C. (2002). Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine, 27(2), E29-E36.
131. Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., De Cuyper, H. J., & Danneels, L. (2000). CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. European Spine Journal, 9(4), 266-272.
132. Hides, J., Gilmore, C., Stanton, W., & Bohlscheid, E. (2008). Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Manual therapy, 13(1), 43-49.
133. Yoshihara, K., Shirai, Y., Nakayama, Y., & Uesaka, S. (2001). Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine, 26(6), 622-626.
134. Hides, J. A., Stokes, M. J., Saide, M. J. G. A., Jull, G. A., & Cooper, D. H. (1994). Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine, 19(2), 165-172.
135. Kader, D. F., Wardlaw, D., & Smith, F. W. (2000). Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clinical radiology, 55(2), 145-149.
136. Zhao, W. P., Kawaguchi, Y., Matsui, H., Kanamori, M., & Kimura, T. (2000). Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine, 25(17), 2191-2199.
137. Bajek, S., Bobinac, D., Bajek, G., Vranic, T. S., Lah, B., & Dragojevic, D. M. (2000). Muscle fiber type distribution in multifidus muscle in cases of lumbar disc herniation. Acta Medica Okayama, 54(6), 235-242.
138. Rantanen, J., Hurme, M., Falck, B., Alaranta, H., Nykvist, F., Lehto, M., … & Kalimo, H. (1993). The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine, 18(5), 568-574.
139. Ford, D., Bagnall, K. M., McFadden, K. D., Greenhill, B., & Raso, J. (1983). Analysis of vertebral muscle obtained during surgery for correction of a lumbar disc disorder. Cells Tissues Organs, 116(2), 152-157.
140. Fidler, M. W., Jowett, R. L., & Troup, J. D. G. (1975). Myosin ATPase activity in multifidus muscle from cases of lumbar spinal derangement. Bone & Joint Journal, 57(2), 220-227.
141. Lehto, M., Hurme, M., Alaranta, H., Einola, S., Falck, B., JÄrvinen, M., … & PaljÄrvi, L. (1989). Connective Tissue Changes of the Multifidus Muscle in Patients with Lumbar Disc Herniation An Immunohistologic Study of Collagen Types I and III and Fibronectin. Spine, 14(3), 302-309.
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143. Yoshihara, K., Nakayama, Y., Fujii, N., Aoki, T., & Ito, H. (2003). Atrophy of the multifidus muscle in patients with lumbar disk herniation: histochemical and electromyographic study. Orthopedics, 26(5), 493.
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145. Cassisi, J. E., Robinson, M. E., O'conner, P., & MacMillan, M. (1993). Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls. Spine, 18(2), 245-251.
146. Sihvonen, T., & Partanen, J. (1989). Segmental hypermobility in lumbar spine and entrapment of dorsal rami. Electromyography and clinical neurophysiology, 30(3), 175-180.
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153. Grabiner, M. D., Koh, T. J., & El Ghazawi, A. (1992). Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine, 17(10), 1219-1223. Decoupled bilateral excitation
154. Janda, V. (1986). Muscle weakness and inhibition (pseudoparesis) in back pain syndromes. Modern manual therapy of the vertebral column
155. Hides, J., Stanton, W., McMahon, S., Sims, K., & Richardson, C. (2008). Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. journal of orthopaedic & sports physical therapy, 38(3), 101-108.
156. Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., Bourgois, J. D. W. D. C. H. J., Dankaerts, W., & De Cuyper, H. J. (2001). Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. British journal of sports medicine, 35(3), 186-191.
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     • Latissimus Dorsi
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162. Barker, P. J., Briggs, C. A., & Bogeski, G. (2004). Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments. Spine, 29(2), 129-138.
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     • Erector Spinae
     • Citations 119-120, 122-124, 126-129, 139, 145, 147, 152, 159-160, 163, 165
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171. McGill, S. M., Hughson, R. L., & Parks, K. (2000). Changes in lumbar lordosis modify the role of the extensor muscles. Clinical Biomechanics, 15(10), 777-780.
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     • Biceps Femoris
173. Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) Journal of Electromyography and Kinesiology 22 (3). 391-397
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     • Piriformis
178. Giphart, J. E., Stull, J. D., LaPrade, R. F., Wahoff, M. S., & Philippon, M. J. (2012). Recruitment and activity of the pectineus and piriformis muscles during hip rehabilitation exercises: an electromyography study. The American journal of sports medicine, 40(7), 1654-1663.
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182. Baker, B. A. (1986). The muscle trigger: evidence of overload injury. J Neurol Orthop Med Surg, 7(5), 35-44.
     • Adductor Magnus
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     • Transverse Abdominis
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185. Hodges, P. W., & Richardson, C. A. (1997). Contraction of the abdominal muscles associated with movement of the lower limb. Physical therapy, 77(2), 132-142.
186. Hodges, P. W., & Richardson, C. A. (1999). Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neuroscience letters, 265(2), 91-94.
187. Saunders, S. W., Rath, D., & Hodges, P. W. (2004). Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion. Gait & posture, 20(3), 280-290.
188. Barker, P. J., Briggs, C. A., & Bogeski, G. (2004). Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments. Spine, 29(2), 129-138.
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193. Vleeming A, Pool-Goudzward AL, Stoeckart R, et al. The Posterior Layer of the Thoracolumbar Fascia: Its Function in Load Transfer from Spine to Legs. Spine 20:753-758, 1995
194. Richardson, C., Snijders, C., Hides, J., Damen, L., Pas, M., Storm, J. (2002) The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain. Spine. 27 (4), 399-405
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207. Hodges, P. W., Moseley, G. L., Gabrielsson, A., & Gandevia, S. C. (2003). Experimental muscle pain changes feedforward postural responses of the trunk muscles. Experimental Brain Research, 151(2), 262-271.
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213. Crommert, M. E., Ekblom, M. M., & Thorstensson, A. (2011). Activation of transversus abdominis varies with postural demand in standing. Gait & posture, 33(3), 473-477.
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215. Hodges, P., Richardson, C., & Jull, G. (1996). Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiotherapy Research International, 1(1), 30-40.
216. Bjerkefors, A., Ekblom, M. M., Josefsson, K., & Thorstensson, A. (2010). Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow. Manual Therapy, 15(5), 502-507.
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228. Knee
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281. Critchley, D. (2002). Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low‐abdominal hollowing. Physiotherapy research international, 7(2), 65-75.
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291. Bullock-Saxton, J. E. (1994). Local sensation changes and altered hip muscle function following severe ankle sprain. Physical therapy, 74(1), 17-28.
292. Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994). The influence of ankle sprain injury on muscle activation during hip extension. International journal of sports medicine, 15(06), 330-334.
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303. Bolgla, L. A., & Uhl, T. L. (2005). Electromyographic analysis of hip rehabilitation exercises in a group of healthy subjects. Journal of Orthopaedic & Sports Physical Therapy, 35(8), 487-494.
304. Ramskov, D., Barton, C., Nielsen, R. O., & Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. journal of orthopaedic & sports physical therapy, 45(3), 153-161
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477. Sturesson, B. E. N. G. T., Selvik, G., & UdÉn, A. (1989). Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine, 14(2), 162-165.
478. Sturesson, B., Uden, A., & Onsten, I. (1999). Can an external frame fixation reduce the movements in the sacroiliac joint?: A radiostereometric analysis of 10 patients. Acta Orthopaedica Scandinavica, 70(1), 42-46.
479. Sturesson, B., Uden, A., & Vleeming, A. (2000). A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine, 25(3), 364-368.
480. Sturesson, B., Uden, A., & Vleeming, A. (2000). A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine, 25(2), 214.
481. Bernard, J. T., & Kirkaldy-Willis, W. H. (1987). Recognizing specific characteristics of nonspecific low back pain. Clinical orthopaedics and related research, (217), 266-280.
482. Bogduk N (1995) The anatomical basis for spinal pain syndromes. J Manipulative Physiol Ther 18, 603–605.
483. Borenstein, D. (1996). Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Current opinion in rheumatology, 8(2), 124-129.
484. Fortin, J. D., Dwyer, A. P., West, S., & Pier, J. (1994). Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine, 19(13), 1475-1482.
485. Fortin, J. D., Aprill, C. N., Ponthieux, B., & Pier, J. (1994). Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine, 19(13), 1483-1489.
486. Daum, W. J. (1995). The sacroiliac joint: an underappreciated pain generator. American journal of orthopedics (Belle Mead, NJ), 24(6), 475-478.
487. Schwarzer, A. C., Aprill, C. N., & Bogduk, N. (1995). The sacroiliac joint in chronic low back pain. Spine, 20(1), 31-37.
488. Slipman, C. W., Lipetz, J. S., Plastaras, C. T., Jackson, H. B., Vresilovic, E. J., Lenrow, D. A., & Braverman, D. L. (2001). Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. American journal of physical medicine & rehabilitation, 80(6), 425-432.
489. Maugars, Y., Mathis, C., Berthelot, J. M., Charlier, C., & Prost, A. (1996). Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Rheumatology, 35(8), 767-770.
490. Vleeming, A., Pool-Goudzwaard, A. L., Hammudoghlu, D., Stoeckart, R., Snijders, C. J., & Mens, J. M. (1996). The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain. Spine, 21(5), 556-562.
491. Pool-Goudzwaard, A., van Dijke, G. H., Mulder, P., Spoor, C., Snijders, C., & Stoeckart, R. (2003). The iliolumbar ligament: its influence on stability of the sacroiliac joint. Clinical Biomechanics, 18(2), 99-105.
492. Buyruk, H. M., Stam, H. J., Snijders, C. J., Laméris, J. S., Holland, W. P., & Stijnen, T. H. (1999). Measurement of sacroiliac joint stiffness in peripartum pelvic pain patients with Doppler imaging of vibrations (DIV). European Journal of Obstetrics and Gynecology and Reproductive Biology, 83(2), 159-163.
493. Damen, L., Buyruk, H. M., Güler-Uysal, F., Lotgering, F. K., Snijders, C. J., & Stam, H. J. (2002). The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine, 27(24), 2820-2824.
494. Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., Danneels, L., & Willard, F. H. (2012). The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of anatomy, 221(6), 537-567.
495. Chesworth, B. M., Padfield, B. J., Helewa, A., & Stitt, L. W. (1994). A comparison of hip mobility in patients with low back pain and matched healthy subjects. Physiotherapy Canada, 46(4), 267-274.
496. Cibulka, M. T., Sinacore, D. R., Cromer, G. S., & Delitto, A. (1998). Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine, 23(9), 1009-1015.
497. Cibulka, M. T. (1999). Low back pain and its relation to the hip and foot. Journal of Orthopaedic & Sports Physical Therapy, 29(10), 595-601.
498. Nadler, S. F., Malanga, G. A., Feinberg, J. H., Prybicien, M., Stitik, T. P., & DePrince, M. (2001). Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. American journal of physical medicine & rehabilitation, 80(8), 572-577.
499. Renkawitz, T., Boluki, D., & Grifka, J. (2006). The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. The Spine Journal, 6(6), 673-683.
500. Van Dillen, L. R., Bloom, N. J., Gombatto, S. P., & Susco, T. M. (2008). Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Physical Therapy in Sport, 9(2), 72-81.
501. Murray, E., Birley, E., Twycross-Lewis, R., & Morrissey, D. (2009). The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: an observational study. Physical Therapy in Sport, 10(4), 131-135.
502. Snijders, C. J., Ribbers, M. T., de Bakker, H. V., Stoeckart, R., & Stam, H. J. (1998). EMG recordings of abdominal and back muscles in various standing postures: validation of a biomechanical model on sacroiliac joint stability. Journal of Electromyography and Kinesiology, 8(4), 205-214.
503. MassoudArab, A., RezaNourbakhsh, M., & Mohammadifar, A. (2011). The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. Journal of Manual & Manipulative Therapy, 19(1), 5-10.
504. Snijders, C. J. (1995). Biomechanical modelling of sacroiliac joint stability in different postures. Spine: state of the art reviews, 9, 419-432.
505. Sturesson, B. (2007). Movement of the sacroiliac joint with special reference to the effect of load. In Movement, Stability & Lumbopelvic Pain (Second Edition) (pp. 343-352).
506. Hu, H., Meijer, O. G., Van Dieen, J. H., Hodges, P. W., Bruijn, S. M., Strijers, R. L., … & Xia, C. (2010). Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking. Journal of biomechanics, 43(3), 532-539.
507. Damen, L., Buyruk, H. M., Güler‐Uysal, F., Lotgering, F. K., Snijders, C. J., & Stam, H. J. (2001). Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta obstetricia et gynecologica Scandinavica, 80(11), 1019-1024.
508. Damen, L., Spoor, C. W., Snijders, C. J., & Stam, H. J. (2002). Does a pelvic belt influence sacroiliac joint laxity?. Clinical Biomechanics, 17(7), 495-498.
509. Vleeming, A., Buyruk, H. M., Stoeckart, R., Karamursel, S., & Snijders, C. J. (1992). An integrated therapy for peripartum pelvic instability: a study of the biomechanical effects of pelvic belts. American Journal of Obstetrics & Gynecology, 166(4), 1243-1247.
510. Mens, J. M., Damen, L., Snijders, C. J., & Stam, H. J. (2006). The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain. Clinical biomechanics, 21(2), 122-127.
511. Marshall, P., & Murphy, B. (2006). The effect of sacroiliac joint manipulation on feed-forward activation times of the deep abdominal musculature. Journal of Manipulative & Physiological Therapeutics, 29(3), 196-202.
512. Fox, M. (2006). Effect on hamstring flexibility of hamstring stretching compared to hamstring stretching and sacroiliac joint manipulation. Clinical Chiropractic, 9(1), 21-32.
513. Méndez-Sánchez, R., González-Iglesias, J., Sánchez-Sánchez, J. L., & Puente-González, A. S. (2014). Immediate effects of bilateral sacroiliac joint manipulation on plantar pressure distribution in asymptomatic participants. The Journal of Alternative and Complementary Medicine, 20(4), 251-257.
514. Suter, E., McMorland, G., Herzog, W., & Bray, R. (1999). Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain. Journal of Manipulative and Physiological Therapeutics, 3(22), 149-153.
515. Suter, E., McMorland, G., Herzog, W., & Bray, R. (2000). Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 23(2), 76-80.
516. Grindstaff, T. L., Hertel, J., Beazell, J. R., Magrum, E. M., Kerrigan, D. C., Fan, X., & Ingersoll, C. D. (2012). Lumbopelvic joint manipulation and quadriceps activation of people with patellofemoral pain syndrome. Journal of athletic training, 47(1), 24-31.
517. Cibulka, M. T., Rose, S. J., Delitto, A., & Sinacore, D. R. (1986). Hamstring muscle strain treated by mobilizing the sacroiliac joint. Physical Therapy, 66(8), 1220-1223.
518. Murphy BA, Dawson NJ, Slack JR. Sacroiliac joint manipulation decreases the H-reflex. Electromyogr Clin Neurophysiol. 1995; 35: 87– 94.
519. Murphy BA, Dawson NJ, Slack JR. Sacroiliac joint manipulation decreases the H-reflex. Electromyogr Clin Neurophysiol. 1995; 35: 87– 94.
520. Dishman, J. D., & Bulbulian, R. (2000). Spinal reflex attenuation associated with spinal manipulation. Spine, 25(19), 2519-2525.
521. Son, J. H., Park, G. D., & Park, H. S. (2014). The effect of sacroiliac joint mobilization on pelvic deformation and the static balance ability of female university students with SI joint dysfunction. Journal of physical therapy science, 26(6), 845-848.
522. Foley, B. S., & Buschbacher, R. M. (2006). Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. American journal of physical medicine & rehabilitation, 85(12), 997-1006.
523. Kamali, F., & Shokri, E. (2012). The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of bodywork and movement therapies, 16(1), 29-35.
524. Tullberg, T., Blomberg, S., Branth, B., & Johnsson, R. (1998). Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 23(10), 1124-1128.
525. Shearar, K. A., Colloca, C. J., & White, H. L. (2005). A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. Journal of Manipulative & Physiological Therapeutics, 28(7), 493-501.
526. Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual & Manipulative Therapy, 16(3), 142-152.
527. de Oliveira Grassi, D., de Souza, M. Z., Ferrareto, S. B., de Lima Montebelo, M. I., & de Oliveira Guirro, E. C. (2011). Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint. Manual therapy, 16(5), 495-500.
528. Kluge, J., Hall, D., Louw, Q., Theron, G., & Grové, D. (2011). Specific exercises to treat pregnancy‐related low back pain in a South African population. International Journal of Gynecology & Obstetrics, 113(3), 187-191.
529. Stuge, B., Lærum, E., Kirkesola, G., & Vøllestad, N. (2004). The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine, 29(4), 351-359.
530. Stuge, B., Veierød, M. B., Lærum, E., & Vøllestad, N. (2004). The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine, 29(10), E197-E203.
531. Monticone, M., Barbarino, A., Testi, C., Arzano, S., Moschi, A., & Negrini, S. (2004). Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow-up. Europa Medicophysica, 40(4), 263-268.
532. Herzog, W., Conway, P. J., & Willcox, B. J. (1991). Effects of different treatment modalities on gait symmetry and clinical measures for sacroiliac joint patients. Journal of manipulative and physiological therapeutics, 14(2), 104-109.
533. Elden, H., Ladfors, L., Olsen, M. F., Ostgaard, H. C., & Hagberg, H. (2005). Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. Bmj, 330(7494), 761.
534. Mens, J. M., Snijders, C. J., & Stam, H. J. (2000). Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Physical Therapy, 80(12), 1164-1173.
535. Nilsson-Wikmar, L., Holm, K., Öijerstedt, R., & Harms-Ringdahl, K. (2005). Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine, 30(8), 850-856.
536. Mens, J. M., Snijders, C. J., & Stam, H. J. (2000). Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Physical Therapy, 80(12), 1164-1173.
537. Nilsson-Wikmar, L., Holm, K., Öijerstedt, R., & Harms-Ringdahl, K. (2005). Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine, 30(8), 850-856.
538. Smith, R. L., Sebastian, B. A., & Gajdosik, R. L. (1988). Effect of sacroiliac joint mobilization on the standing position of the pelvis in healthy men. Journal of Orthopaedic & Sports Physical Therapy, 10(3), 77-84.
539. Levangie, P. K. (1999). Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Physical Therapy, 79(11), 1043-1057.
540. Cibulka, M. T., & Koldehoff, R. (1999). Clinical usefulness of a cluster of sacroiliac joint tests in patients with and without low back pain. Journal of Orthopaedic & Sports Physical Therapy, 29(2), 83-92.
541. Szadek, K. M., van der Wurff, P., van Tulder, M. W., Zuurmond, W. W., & Perez, R. S. (2009). Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of pain, 10(4), 354-368.
542. Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.
543. Freburger, J. K., & Riddle, D. L. (2001). Using published evidence to guide the examination of the sacroiliac joint region. Physical therapy, 81(5), 1135-1143.
544. Smith, R. L., Sebastian, B. A., & Gajdosik, R. L. (1988). Effect of sacroiliac joint mobilization on the standing position of the pelvis in healthy men. Journal of Orthopaedic & Sports Physical Therapy, 10(3), 77-84.
545. Elgafy, H., Semaan, H. B., Ebraheim, N. A., & Coombs, R. J. (2001). Computed tomography findings in patients with sacroiliac pain. Clinical orthopaedics and related research, 382, 112-118.
     • Additional Research
546. Snijders, C. J., Hermans, P. F., Niesing, R., Spoor, C. W., & Stoeckart, R. (2004). The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clinical Biomechanics, 19(4), 323-329.
547. Graber, D. I. (1997). Muscle dysfunction as a contributor to low back pain: A case study. Journal Of Sports Chiropractic & Rehabilitation, 11(1), 21-24.
     • Rotatores, Interspinalis and Intertransversarii
548. Cornwall, J., Stringer, M. D., & Duxson, M. (2011). Functional morphology of the thoracolumbar transversospinal muscles. Spine, 36(16), E1053-E1061.
549. Peck, D., Buxton, D. F., & Nitz, A. (1984). A comparison of spindle concentrations in large and small muscles acting in parallel combinations. Journal of Morphology, 180(3), 243-252.
550. Nitz, A. J., & Peck, D. (1986). Comparison of muscle spindle concentrations in large and small human epaxial muscles acting in parallel combinations. The American Surgeon, 52(5), 273-277.
551. Morris, J. M., Benner, G., & Lucas, D. B. (1962). An electromyographic study of the intrinsic muscles of the back in man. Journal of anatomy, 96(Pt 4), 509.
552. Schuenke, M. D., Vleeming, A., Van Hoof, T., & Willard, F. H. (2012). A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. Journal of anatomy, 221(6), 568-576.
553. Schilder, A., Hoheisel, U., Magerl, W., Benrath, J., Klein, T., & Treede, R. D. (2014). Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain. PAIN®, 155(2), 222-231.
554. Schilder, A., Magerl, W., Hoheisel, U., Klein, T., & Treede, R. D. (2016). Electrical high-frequency stimulation of the human thoracolumbar fascia evokes long-term potentiation-like pain amplification. Pain, 157(10), 2309-2317.
555. Wilke, J., Schleip, R., Klingler, W., & Stecco, C. (2017). The lumbodorsal fascia as a potential source of low back pain: a narrative review. BioMed research international, 2017.