Healthcare and Medicine Reference
In-Depth Information
Fig. 11.5 In (A), the pelvis is
tilted left, due to a short left
leg. This has resulted in a
compensatory right bend of the
spine, right tilt of the shoulder
girdle, and left shift of the rib
cage relative to the pelvis.
In (B), we see an anterior tilt
of the pelvis, with a posterior
bend of the lumbars and an
anterior shift of the head due
to an anterior bend in the
upper thoracic spine. The neck
is thus anteriorly tilted, and
only by a sharp posterior bend
in the upper cervicals can this
fellow keep his eyes looking
forward horizontally - compare
to Figure 11.3B.
A
B
C
A
B
Fig. 11.4 In (A), 'neutral' posture, more or less, is depicted
diagrammatically. If for a few pages we accept the convention of
these diagrams, we can see that in (B), the pelvis is anteriorly
tilted - the top of the pelvis tilts toward the front - relative to both
the femur and the ground. In (C), we see the common but
commonly mis-assessed situation of the pelvis being anteriorly
tilted relative to the ground but posteriorly tilted relative to the
femur. 'Compared to what?' is a meaningful question.
Tilt is commonly applied to the head, shoulder
girdle, rib cage, pelvis, and tarsi of the feet. Tilt can
be used broadly, such as 'a right side tilt of the
torso relative to gravity', or very specifically, such
as 'an anterior tilt of the left scapula relative to the
right' or 'a posterior tilt of the right innominate
bone relative to the sacrum' or 'a medial tilt of the
navicular relative to the talus'. Once again, for
clarity in communication and accuracy in
translating this language into soft-tissue strategy, it
is very important to understand to what the term
being used is related: an 'anterior pelvic tilt relative
to the femur' is a useful observation, a simple
'anterior pelvic tilt' opens the door to confusion.
Bend. A 'bend' is a series of tilts resulting in a curve,
usually applied to the spine. If the lumbar spine
is side bent, this could be described as a series of
tilts between each of the lumbar vertebrae, which
we usually summarize as a bend - either side,
forward, or back (in the right bend in Fig. 11.5A, the
top of LI faces more the client's right than the top
of L5).
The normal lumbar curve thus has a back bend,
and the normal thoracic spine a forward bend. A
lordotic spine could be generally described as an
'excess posterior bend in the lower lumbars', or
could be specified in more detail. A low but strong
lumbar curvature might parse out on investigation
as: 'the lumbars have a strong posterior bend from
L5-S1 to about L3, but have an anterior bend from
L3-T12.'
In the spine, the essential difference between a tilt
and a bend is whether the deviation from 'normal'
runs off in a straight line or a curve. If the rib cage
is tilted off to the right, we can presume that either
the pelvis is likewise right tilted so the lumbars run
straight, or more likely, as in Figure 11.6A, the
lumbar spine has a right side bend. Further, spinal
mechanics dictates that the left bend in the lumbars
very likely involves the tendency toward a right
pared to the femur (Fig. 11.4C). Both descriptions
are accurate as long as the point of reference is
agreed.
Definitions: Tilt, Bend, Shift, and Rotation
• Tilt. 'Tilt' describes simple deviations from the
vertical or horizontal, in other words, a body part
or skeletal element that is higher on one side than
on another. Although tilt could be described as a
rotation of a body part around a horizontal axis
(left-right or A-P), 'tilt' has a readily understood
common meaning, as in the Tower of Pisa.
'Tilt' is modified by the direction to which the top
of the structure is tilted. Thus, in a left side tilt of
the pelvic girdle, the client's right hip bone would
be higher than the left, and the top of the pelvis
would lean toward the client's left (Fig. 11.5A). An
anterior tilt of the pelvic girdle would involve the
pubic bone going inferior relative to the posterior
iliac spines, and a posterior tilt would imply the
opposite (Fig. 11.5B). In a right side tilt of the head,
the left ear would be higher than the right, and the
planes of the face would tilt to the right (Fig. 11.5A).
In a posterior tilt of the head, the eyes would look
up, the back of the head approaches the spinous
processes of the neck, and the top of the head
moves posteriorly (Fig. 11.5B).
In Figure 11 AC, the leg as a whole is anteriorly
tilted, and the pelvis is posteriorly tilted relative to
it. The head in this diagram is anteriorly tilted -
looking down - which is an equivalent position to
the pelvis in Figure 11.4B. The terminology is
applied consistently throughout the entire body.
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