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Pelvic Tilt and Coxarthrosis

Pages: 20-21
Dr. Ida Rolf Institute

Bulletin of Structural Integration Ida P. Rolf


I want to tell you of a booklet that has only appeared in German but could be of interest to all Rolfers. Its title is “Das Aufrechte Stehen” – “Standing Upright”. It is by two manual therapists who have worked to make these techniques acceptable to traditional medicine: Dr. med. Gottfried Gutmann and Dr. med. Franta Vele.

They systematically x-rayed healthy and coxarthrotic people in the following way for comparison: the people had their normal walking shoes on and were told to stand upright with arms folded comfortably before their breasts, to look straight ahead and stand easy. Then the x-rays were taken of their pelvic and lumbar area from the side.

Then they measured the angle of the posterior facet of the first two sacral vertebrae to the horizontal, the angle d°. It is very interesting to note the distribution on this angle in healthy and coxarthrotic persons:

<img src=’https://novo.pedroprado.com.br/imgs/1987/706-1.jpg’>

So obviously pelvic tilt has a very close relationship to the occurance of coxarthrosis. This fits very well with Ida Rolf’s assumption that human anatomy and physiology is designed for the “Line” and that any prolonged deviation from the “Line” causes serious trouble.

The two doctors also found that person with a low d° (strong anterior tilt, in Rolfing lingo) had much more strongly developed postural musculature in the area of lumbars, pelvis, and hip. The closer the sacrum comes to the horizontal, the more regularly they found painful reactions when manipulating the tendinous insertions for the following muscles: iliopsoas, adductors, tensor fasciae latae, rectus abdominisfirst on the symphysis, then on its abdominal insertions, gluteus medius in its middle and ventral portion, which become flexors instead of abductors when the pelvis tilts forward very much, and finally the piriformis. In the clinical experience of these doctors, such painful tendons are sure signs of impending coxarthrosis. This is something we Rolfers might take a closer look at in our work and in future research.

They conducted another interesting piece of research. After x-rays, all persons were asked to stand on a double scale, forefeet on one scale, heels on the other, and to look straight ahead. Of the 280 persons, 151 had their weight more on the heel; sixty-five on the forefoot; sixty-four were in balance. I would have expected that more people would have their weight on their forefeet as I experience it in my practice.

But the interesting part is still to come: the two doctors found that many of their patients simply weren’t able to get the scales to stop changing; they couldn’t find stability.

The graph shows the relationship of this instability (the number of Kg the scales swayed back and forth) and the pelvic tilt. The more upright the sacrum was, the more stability the people had on the double scale.

<img src=’https://novo.pedroprado.com.br/imgs/1987/706-2.jpg’>

A most interesting insight for Rolfers and very much in tune with our contentions. I think we should consider using such measurements in our practice, supplementary to photographs, especially since pelvic tilt and coxarthrosis are closely related.

The authors then took electromygraphic measurements of their clients in standing upright and related these to the pelvic tilt (d°) and the incidence of coxarthrosis. In persons with arthrosis in both hip joints, a d° smaller than 30° (a very anterior pelvis) is five times as frequent as with healthy persons. In persons with arthrosis in only one hip joint, it is three times as frequent. Electromygraphic measurements of the erector spinae group related to d° was such:

<img src=’https://novo.pedroprado.com.br/imgs/1987/706-3.jpg’>

This implies that a strong anterior pelvic tilt not only causes instability in the whole structure, but addtionally forces the postural exensor-muscles into strong and constant activity. And there seems to be a close relationship between this degree of activity and the incidence of coxarthrosis.

Electromygraphic measurements also showed that the left side was used much more extensively than the right side to keep up the upright posture, probably a result of most people being right-handed. Here again coxarthrotic persons showed higher activity than healthy persons, especially in the adductor group and the iliopsoas. Their tenderness precedes all other clinical signs of coxarthrosis.

Up to now I have presented results that are very much supportive of the Rolfing theory. Let me now present two findings that may be hard for us to digest.

<img src=’https://novo.pedroprado.com.br/imgs/1987/706-4.jpg’>

There were no persons above 70°. If you look (on) p. 149 or p. 102 of Ida Rolf’s book, you can measure the angle d° for the pelvis which is “horizontal” in Ida Rolf’s terms. In my measurement, it is above 60° – closer to 70 than to 60. That would then mean there is no such thing as a “posterior pelvis”—or very rarely ever!

The second point is more serious. The authors had a steel line in the x-rays suspended from the point of the external ear hole. Additionally they had a steel line indicating the position of the head of the talus (joint of Chopart). The distance of these lines was measured in relation to the midpoint of the acetabula.

In Rolfing theory, the outer ear should be in the same line as the midpoint of the hip joint (trochanter major). The study shows that this is rarely the case. Hardly ever is the head-line in front of the midhip. Normally it is far back – and surprisingly enough – in healthy people it is much further back than in coxarthrotic persons: 80% of the healthy persons had their ear-line 20-70 mm behind mid-hip (one to three inches); 90% of the coxarthrotic had it 1-30 mm behind mid-hip (up to one inch). Coxarthrotic persons were bettter “in line” than healthy persons.

<img src=’https://novo.pedroprado.com.br/imgs/1987/706-5.jpg’>

According to Rolfing, the line up from the head of the talus should be in front of the midhip. But if you look at the column (above) for “Footline”, this true for none. And again the coxarthrotic people come much closer to the Rolfing ideal than the healthy ones.

Finally the authors measured the distance of the most anterior tip of the sacrum, the promotory, to the perpendicular line going through the middle of the acetabula. Here the results are again what Rolfers would like to see: the spine should definitely be behind the “line” of gravity. In 100% of the coxarthorotic the distance is below 30 mm, i.e. the spine is behind the support-line. In the overall view, however, even here the promotory tends to be anterior to both the Headline and the Footline in healthy and coxarthrotic persons.

In short, the findings of the two authors proclaim the famous banana to be in the healthy form, the ideal line: pelvis shoved forward, legs, head and thorax back behind the pelvis. It could be that these results are due to asking the persons to have their arms folded in front of their breasts which tends to put people into the banana-position. But it could also be that the authors are correct in their own interpretation of the data. To them it proves that those who can lean or recline into the ligaments without having to use muscles to keep upright, can attain a higher degree of stability, can do without muscular contraction and, therefore, can live without the risk of coxarthrosis.

I think it is a questions worth looking into more closely.

P.S. Just a thought on Stanley Rosenberg’s article in the February issue: I use the exhale and the relaxation to get into the tissue and the inhale with its stretching to do the work. I can think of no situation where I would try for a change on the exhale. But I would very much like to read what others think of the question.Pelvic Tilt and Coxarthrosis

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