Is Pelvic Symmetry Possible? (From a bone perspective)
My last blog talked about anterior pelvic tilt and it’s connection (or lack of connection) to lower back pain, you can check that blog out here - Anterior Pelvic Tilt, Is It A Porblem?
However today I want to purely talk about pelvic symmetry, is it achievable? Let me get straight to the point - yes I believe it is achievable in a percentage of the population. When I refer to symmetry I’m referring to balanced movement and strength from the right side of the pelvis and left side of the pelvis. Although it is possible to achieve ‘optimal pelvic alignment’ there are many questions that should naturally arise from this statement…
What are the goals in wanting to achieve ‘pelvic symmetry?’
Will this prevent the risk of pain?
Will this prevent the risk of injury?
Will everyone’s ‘optimal alignment’ look the same?
Will promoting ‘pelvic symmetry’ improve sporting performance?
Will promoting ‘pelvic symmetry’ hinder sporting performance?
Will promoting ‘pelvic symmetry’ increase body confidence?
Will promoting ‘pelvic symmetry’ create unintended nocebo effects? (negative placebo) Afraid of being ‘out of alignment’ in the future?
These are genuine questions that deserve our consideration as health professionals. My intention with blog isn’t to answer all of these questions today but to pose the question, is it even possible for a percentage of the population to achieve ‘pelvic symmetry’?
A study (1), measured 30 cadaver pelvic girdles to see if there was a significant difference in anatomical landmarks that may influence the accuracy of pelvic posture assessments.
Each pelvic cadaver were fixed in the anatomical reference position and the angle of the ASIS and PSIS were measured bilaterally. In addition, the differences in the side to side height of the innominate bones was also recorded. The study concluded:
'The study found a range of values for the ASIS-PSIS of 0–23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height.'
What this study suggests is that due to the variation in bony pelvic anatomy (in the same person), genetically not everyone are able to create or achieve symmetry at the pelvis. This isn’t to imply that these individuals have a problem that can’t be corrected but as health professionals, we should update our understanding of the pelvis and how it can present in individuals.
It’s also important to consider that the lack of symmetry at the bones doesn’t immediately imply that there is a lack of natural symmetry at the joints. The arthrokinematics may still have the potential to be symmetrical from side to side despite the overall structure not being symmetrical naturally. More research needs to be done in this area to clarify if this is the case or not.
Is it possible that we can palpate ‘asymmetry’ at a pelvic girdle and the side to side differences are a result of natural bony landmarks being different? Not necessarily ‘pelvic dysfunction’ being present? Bearing these questions in mind, do we focus on symmetry?
If an individual is moving without pain, doesn’t have an injury history, performs well in their activity and displays strength and good conditioning in their training/exercise routine, do we have to be obsessed about symmetry? - Perhaps not.
If an individual is in pain, isn’t conditioned and has an injury history, is it beneficial to focus on balanced movement and strength at the pelvis? - Potentially yes but it ALWAYS depends on the individual and we should focus on many things not just symmetry.
Although ‘pelvic symmetry’ may be achievable for some, it may not be achievable for others…
Do you want to learn new exercises and techniques to improve the health of the lower back based off the latest research on the fascia of the spine?
Become a Franklin Method Lower Back Fascia Trainer (online certification). Click the link below to find out more:
Lower Back Fascia Certification, 9th-11th October
Movement is medicine.
Tom
References:
Variation in Pelvic Morphology May Prevent Identification of Anterior Pelvic Tilt . SJ Preece. 2008.