The Pelvic Equilibrium Theory A New Paradigm Clifton Bradeley The - - PowerPoint PPT Presentation
The Pelvic Equilibrium Theory A New Paradigm Clifton Bradeley The IOCP 2018 National Podiatry & Associated Healthcare Conference Introduction to the problem Sites of common overuse Injuries. 1. Foot & ankle. 2. Lower leg shank. 3.
A New Paradigm
Clifton Bradeley The IOCP 2018 National Podiatry & Associated Healthcare Conference
Sites of common overuse Injuries.
The same common injuries. Very little has changed despite advances in technology. The injury patterns are also the same.
u Pain; inflammation;
dysfunction.
u Tissue stress. u Medical & nutritional. u Overuse. u Poor technique. u Poor footwear. u Sports surface issues etc. u Body mass issues. u Body type issues. u Local mechanical factors.
Pain & Dysfunction Tissue Stress Medical & Nutritional 3 Party Factors Body Type Local Mechanical Factors
These do NOT explain the full mechanism of injury!
Tissue Stress Tissue adaptive syndrome (TAS). Overuse. Tissue cell damage. Overload syndrome. Physiological changes etc. Overuse Injury Pain. Inflammation. Dysfunction.
Geophysics
Gravity. Newton’s 3rd; GRF .
Vestibular Balance
Establish the Essential ‘T’. CoM efficiency. Balance. Stable Sinusoidal curves.
Local Mechanical
Foot & Ankle. Lower Shank. Knee & Thigh. Pelvis & SIJ. Lower Lumbar.
End
Start ‘Middle Bit ?’
u Excessive pronation - bilateral or unilateral u Under pronation/supination (bilat/unilat). u Early or delayed heel lift (bilat/unilat). u Excessive internal or external rotations
(bilat/unilat).
u Increased ankle, knee, hip or spinal flexion
(bilat/unilat).
u Increased ankle, knee, hip or spinal extension
(bilat/unilat).
u Pelvic obliquity (frontal plane) & Leg length. u Adduction/abduction. Local Mechanical
Foot & Ankle. Lower Shank. Knee & Thigh. Pelvis & SIJ. Lower Lumbar.
This is taught at undergrad level These are local adaptations
u Pelvic/ sacral torsions (various axes). u Hypo/hyper lordosis/kyphosis/ etc. u Anterior innominate orientation. u Posterior innominate orientations. u Displaced center of mass (CoM). u Sinusoidal curve pattern disturbance. u Sagittal plane facilitations/blockages. u Time:Pressure integral disturbance. u Joint acceleration/decelerations. u Asymmetrical Overload syndrome. u Fascial slings/ form & force closure issues. Local Mechanical
Foot & Ankle. Lower Shank. Knee & Thigh. Pelvis & SIJ. Lower Lumbar.
all created by abnormal loading.
loading starts extrinsic to the lower limb.
There has to be a LINK & a MECHANISM that combines the Geophysics to the local mechanical compensations/adaptations.
Geophysics
Global Adaptation? At Pelvic Level?
Local Mechanical changes Overuse Injury
‘X is the whole body adaptations that include the local mechanical changes .’
u Fascia delivers force throughout the
whole network. These are fascial slings.
u However, they are not the origin of the
force.
u This force is generated by the pelvis
i.e. the fulcrum during adaptation to asymmetry.
u The type of adaptation determines
which structure is over loaded and therefore which overuse injury occurs. Posterior oblique sling & thoracolumbar fascia. These global adaptations around the pelvis can create the local mechanical changes.
u Postural adaptations allowed our ancestors to cope
with the natural world during stand and gait.
u Each of these adaptations were SHORT-LIVED &
CONSTANTLY CHANGING as our ancestors moved around from surface to surface.
u The extrinsic natural environment was the main driver
for these adaptations.
u Their aim was to achieve vestibular balance in the
presence of gravity, GRF and natural asymmetry (internal & external).
u The geophysics has NOT changed. u Our ability to adapt has NOT changed. u The need to establish ‘The Essential T’ has
NOT changed.
G GRF
The asymmetrical load created by adaptation determines the overuse injury depending on:
discussed.
i.e. Muscle-Tendon-Joint Engineering.
A B C D E Etc. B C D E Etc. A
Hypothesis: that all ambulant humans appear to demonstrate one of four adaptations and that they may help to explain how overuse injuries occur throughout the whole kinetic chain.
PI ilium, Long Side.
PI ilium, Both Sides.
Posterior Adaptation Rotation on Long leg side. Posterior Adaptation Rotation on both sides.
AS ilium, Short Side.
PI ilium, Short Side.
Anterior Adaptation Rotation on Short leg side Posterior Rotation adaptation
Short leg side
Facing this way
Understanding this mechanism will be a key advancement to MSK medicine
Sacral base angle almost vertical Sacral base angle 30 to 40°
There are several rules & they are extremely useful clinically. E.g.’s
This should match the numbers gathered from the pelvis. Sample pelvic behaviour as
Cohort
u N=118 consented. u 68m/50f u Age (years) 17 to 76 u Average age = 44 u All presented to an MSK center
with at least one MSK overuse injury.
u Sequential and prospective data
collected after an independent reliability study.
Methodology
u Each patient underwent the same protocol. u Static trial: 8mm board. u Dynamic trial: 8mm in-shoe raise platform. u Innominate inclination was measured after
each trial with a digital pelvic inclinometer.
Beardsley, C., Egerton, T ., & Skinner, B. (2016). Test–re-test reliability and inter-rater reliability of a digital pelvic inclinometer in young, healthy males and females. PeerJ, 4, e1881.
2 10 8 9
10 11 1 13 8 1 10 9 2 8 11 2 1 10 Single Femoral Pathway, PI ilium Long side
Figure 10 – Pelvic Inclination data showing measurements taken at different stages of the assessment grouped by pelvic adaptation
Results
common.
adaptation may to be a significant factor in the formation of overuse injuries.
associated with certain pelvic adaptations.
Conclusion.
have a great effect on the upper and lower kinetic chain.
localized mechanical dysfunction.
beyond the lower limb and old paradigms.
Facebook trolls.