Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations

The effects of stride length and stride frequency on trunk coordination in human walking

In speeding-up normal walking, relative phase between horizontal thorax and pelvis rotations changes from more in-phase (synchronous) to more out-of-phase. In pathology (stroke, Parkinson's disease, low-back pain, pregnancy-related pelvic girdle pain), this often fails to happen. Even in healthy gait, however, these phenomena remain poorly understood. Thorax-pelvis relative phase may increase with either stride length, or stride frequency. Sixteen healthy male subjects walked on a treadmill at 0.5m/s, 1.0m/s, or 1.5m/s, with small, normal, or large steps. Increasing stride length (with lower frequency) led to larger spinal rotations, larger thorax-pelvis relative phase, and lower pelvis-leg relative phase, while the thorax continued to counterrotate with respect to the leg. With small steps, speeding-up hardly affected thorax-pelvis relative phase, and spinal amplitudes remained low. From a certain walking speed onwards, pelvis rotations start to contribute to stride length, and thus to speed (the "pelvic step"). This phenomenon appears to be driven, and the present study suggests, at least for higher speeds, that also thoracic counterrotations are driven, and not determined by the passive dynamics of the system. For patients, several strategies may exist to avoid large thorax-pelvis relative phase, and the concomitant large rotations of the spine: walking slowly, walking with small steps, adapting the timing of thorax rotations to that of the pelvis, or refraining from adapting the timing of pelvis rotations to the movements of the leg.

Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking

Women with pregnancy-related pelvic girdle pain (PPP), or athletes with groin pain, may have trouble with the active straight leg raise (ASLR), for which a pelvic belt can be beneficial. How the problems emerge, or how the belt works, remains insufficiently understood. We assessed muscle activity during ASLR, and how it changes with a pelvic belt. Healthy nulligravidae (N=17) performed the ASLR, and walked on a treadmill at increasing speeds, without and with a belt. Fine-wire electromyography (EMG) was used to record activity of the mm. psoas, iliacus and transversus abdominis, while other hip and trunk muscles were recorded with surface EMG. In ASLR, all muscles were active. In both tasks, transverse and oblique abdominal muscles were less active with the belt. In ASLR, there was more activity of the contralateral m. biceps femoris, and in treadmill walking of the m. gluteus maximus in conditions with a belt. For our interpretation, we take our starting point in the fact that hip flexors exert a forward rotating torque on the ilium. Apparently, the abdominal wall was active to prevent such forward rotation. If transverse and oblique abdominal muscles press the ilia against the sacrum (Snijders' "force closure"), the pelvis may move as one unit in the sagittal plane, and also contralateral hip extensor activity will stabilize the ipsilateral ilium. The fact that transverse and oblique abdominal muscles were less active in conditions with a pelvic belt suggests that the belt provides such "force closure", thus confirming Snijders' theory.