Self-assessment and treatment of the Pelvic Cross Syndrome
The Pelvic Cross Syndrome according to Professor Janda is one of the most commonly seen muscle imbalances causing lower back pain.
The Pelvic Cross Syndrome is characterised by a tightness of the hip flexors and back muscles and a weakness (inhibition) of the Gluteal muscles, abdominals and the hamstrings.
Signs of a Pelvic Cross Syndrome are:
- Symptoms are often pain and tightness of the bottom of the lower back.
- A forward tilt of the Pelvis (duck bum) with a sharp lumbar lordosis. (Check the belt line)
- Flat or hanging gluteal muscles (the buttocks should be firm and round) Professor Janda described the faulty look as “bags of water”.
- Over-developed hamstrings in relation to Gluteal muscles. Hamstrings are often perceived as tight because they are over-loaded attempting to compensate for the inhibited gluteals.
- The syndrome is often accompanied by a tight kyphosis at the Thoraco/lumbar junction
- Often the neck is involved with a forward head posture and an increased curve.
Test yourself for a Pelvic Cross Syndrome:
- Stand with the back against a wall with the heels touching the wall. Try to flatten the lumbar spine out to touch the wall without letting the pelvis or thoracic spine lose contact with the wall.
- In the same position try to lift the arms all the way to touch the wall above your head without increasing the lumbar curve or letting the pelvis or the thoracic spine lose contact with the wall.
- Sit at the end of a table or a bed. Lift one leg up against the chest and hold on tight with the arms. In a slow controlled movement roll back onto the back without losing the grip of the knee as it would affect the result of the tests. Laying on the back the other leg should be hanging in a horizontal position, and it should be possible to push it down below horizontal without too much discomfort. If the leg is elevated above horizontal the hip flexors are too tight. Extend the knee to see if the leg can be lowered further, if that occurs the main tightness is probably in the Rectus Femoris (thigh muscle). If the knee position does not affect the thigh position the Ilio-psoas is probably too tight. With the leg hanging in horizontal the knee should be vertical (80-90 degrees of knee flexion) and you should be able to bend it further in without the thigh moving up or feeling any excessive resistance at the front of the thigh.
- Repeat with the other side.
- If the Iliopsoas or the Rectus Femoris are too tight the testing positions can be used as the initial stretching positions. Simply lie on the back with one leg pulled tight towards the chest and use muscle force to slowly push the leg down past horizontal and maintain that position for 30 seconds whilst breathing calmly and slowly. Repeat 2-3 times. To stretch the Rectus Femoris keep the thigh in a horizontal position and slowly bend the knee. Hold the stretched position for 30 seconds and repeat the procedure 2-3 times. Stretching of the short muscles should always precede attempts to strengthen the weak muscles involved. Progression of stretches may include:
- After 2-3 weeks of daily stretching of the Rectus Femoris and Iliopsoas you are ready to start activating the inhibited Gluteal muscles. Lying on the stomach with the knee bent slowly lift the leg up without excessive movement of the pelvis and the lower back. Maintain that position for 10 seconds and repeat 10 times, before switching to the opposite leg.
- Once the muscles are activated (1-2 weeks) the muscle is ready to be further challenged. Bridge exercises are a viable next step. Lay on the back and bend the knees so that the feet have a flat contact with the ground. Slowly lift the buttock area off the floor with the trunk braced as one solid unit. The hip joint should be the only joint moving in this exercise.
- When the gluteal muscles have started to perform their normal duties they can slowly be introduced into more advanced exercises.
- Keep in mind what the imbalance is and focus on stretching of the Rectus Femoris and Iliopsoas whilst concentrating on strengthening the gluteal , hamstrings and abdominal muscles.
Slight limitation of hip movement (mainly extension) is a common examination finding caused by the Pelvic Cross Syndrome and significantly the main symptomatic complaint is back pain not hip pain
Most people I examine have varying degrees of the Pelvic Cross syndrome, and I have still today never come across an individual where the Gluteal, hamstrings and Abdominal muscles are too strong.