The pelvis: awareness, and movement

About a year ago, I was training a client’s 16 year old son. I was trying to get him to posteriorly tilt his pelvis and feel how that changed his hamstring awareness. “Press into your feet just enough to feel your pelvis tip,” I cued. 

Silence. I could see him thinking really hard. Finally, he looked at me and asked, “what’s your pelvis?”

Fast forward 8 months. I was training a 65 year old man with good body awareness, and a penchant for overthinking things. I was trying to get him to rotate around his hip joint in standing. He was in a staggered stance, weight primarily loaded on his front leg. “Keep your front leg where it’s at and rotate your entire body towards me,” I cued. Just his upper thoracic spine moved. “Let your pelvis rotate as well. Imagine your are rotating around your hip joint.”

Eyes narrowed. Some really odd movement ensued at his pelvis. There was obviously confusion regarding what I was asking. I re-routed, and we moved onto something else. The next week, he came in and said, “I was really frustrated I didn’t understand what you were asking. I realized driving home I thought my hip joint was on the outside of my pelvis. When I looked at an anatomy chart later, I realized the hip isn’t where I thought it was. I would like to try that exercise again, now that I know how that works.”

These two examples illustrate a couple of important points. First, make sure you are using cues relevant to the person in front of you. It occurred to me after the 16 year old left that most 16 years old have no idea where their pelvis is. It was a poor choice of words on my part. Assuming people know where things like the hips are located, for example, is just that- an assumption. Second, there is a lot of confusion regarding how the pelvis and the hips actually work in the average person. If I don’t take time to educate my clients, how can I expect them to understand what I am asking?

The pelvis meets the spine at the sacroiliac joint. “Sacro” refers to the sacrum, a wedge shaped bone consisting of 5 (usually) fused vertebrae (Lierse, 2012). The sacrum and L5, the most bottom part of the lumbar spine, are important load bearing structures. “Ilio” refers to the ilium, which along with the ischium and pubis make up the pelvis. The place where these three bones intersect is the acetabulum (Letournel, et.al, 1990). The pelvis is shaped in such a way so that the acetabulum is an intersection of the upper and lower portions of the pelvis, making it well placed to transfer load from the lower extremity to the torso. It looks a little bit like a cup. The head of the femur sits inside the acetabulum to make up the hip joint. 

Many people when asked to identify their hip joint will gesture to the outside, lower portion of their bottoms. When you move your leg, you will feel movement in this area because muscles contract. However, this isn’t actually where the hip joint is located. If you look at the way the pelvis is shaped, the hip joint is oriented a little bit more to the front, and not so far down. One of the common indicators of hip pathology is groin pain (Lanting & MacDonald, 2013). If you work with clients over the age of 60, chances are high that at some point, someone will come in convinced he needs a hip replacement. If you ask where the pain is located and the person gestures to the middle of his behind, you can explain a pain in the bottom is different than a pain in the hip. (Butt pain can be caused by several different factors, including lumbar spine issues and plain old muscular soreness). As we have discussed in other blogs, we can’t know what is causing discomfort and we shouldn’t even speculate, but understanding anatomy can be quite useful. 

Hopefully, what the above anatomy review provided was an understanding of a) where the pelvis is located and b) a glimpse into why it might be important based on its location. (All body parts are important, but I would argue you might be able to adapt to, say, a missing toe a little better than a missing pelvis). What does this have to do with training and movement?

One of the concepts that floats around the movement world and is beginning to make an impact in the training world is body schema. Your body schema is your internal map. It’s the image you have in your head of what your body looks like and how it moves. When we begin learning any sort of new movement skill in any environment, our ability to perform the skill successfully is based on a dance between the neuromotor system, coordinating sensory information from the environment (both internal and external), and conscious intention (Karin, 2016). By asking my clients to access an area they didn’t have a clear internal representation of the quality of the movement was awkward, over effortful, and inefficient. 

Think back just a moment ago when I argued the pelvis was important. Many people are unclear about the hips and the pelvis. As a result, when you are asking someone to move at the hip joint, it’s not uncommon to see movement either at the pelvis or at the lumbar spine. It is also not uncommon to ask for movement at the pelvis only to have the person move the lumbar spine. 

Examples: 
Let’s pretend you want someone to stand on his left leg. As he lifts his right leg, his right pelvis hikes up. Traditional training text books (and research articles) would tell you his gluteus medius is dysfunctional on the left, his obliques aren’t firing properly, and his right quadratus lumborum is over active. Maybe. But maybe he doesn’t even realize his pelvis is moving. Before jumping to assumptions about dysfunction or muscular weakness, take a moment to teach the person where his pelvis is and what it feels like when it’s moving versus when it’s not moving.

Now let’s pretend you put someone into a plank position. Her pelvis is sagging a little bit. When you ask her to get strong through her legs and keep her rib position, she arches her back and lifts her butt towards the air. You immediately assume her core is weak. Again, maybe this is what’s happening, but maybe she simply doesn’t know how to move her thighs around her pelvis.

How do we solve these dilemmas? Teaching simple exercises such as pelvic tilts and clocks (to male and female clients), having people place their hands on their ASIS as they take a foot forward to feel where they are in space, and teaching leg exercises in a supine position while cueing awareness of the pelvis against the floor are all excellent ways to begin creating an accurate internal map of how the hips and pelvis work. Don’t ask people to “activate” specific muscles- that will only lead to bracing and locking things down in an ineffective way. The amazing thing about getting movement and control in this area is often muscular tightness and discomfort will lessen. This isn’t to say corrective exercises and stretching/mobilizing an area aren’t useful tools. Rather, it’s advocating an environment that sets the client up for success. Teach the client how the pelvis moves and where the hip joint is located before assuming something isn’t working properly or a muscle is tight. The most profound changes happen when you master the basics. In this case, the basics are a fundamental understanding of how the body moves.

*For a examples of pelvis awareness exercises, check out the accompanying video: https://vimeo.com/171324393

References:
Lierse, W., (1987). Applied Anatomy of the Pelvis. Springer: Berlin.
Letournel, E., Judet, R., & Elson, R.A., (1990). Fractures of the Acetabulum. Handspring Press: Berlin. DOI: 10.1007/978-3-642-75435-7_2
Lanting, B.A., & MacDonald, S.J., (2013). The painful total hip replacement. The Bone & Joint Journal, 95, 70-73. DOI: 10.1302/0301-620X.95B11.
Karin, J., (2016). Recontextualizing dance skills: overcoming impediments to motor learning and expressivity in ballet dancers. Frontiers in Psychology, 7, 431.