The Pelvic Girdle Is Responsible for the Anatomic Connection and Transmission of Forces

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The Pelvic Girdle Is Responsible for the Anatomic Connection and Transmission of Forces

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME AND ADDRESS OF THE SUSHMA KRISHNA

CANDIDATE Department of Physiotherapy

M.S.RamaiahMedicalCollege,

M.S.R.I.T Post

Bangalore - 560054

2. NAME OF THE INSTITUTION Department of Physiotherapy

M.S.RamaiahMedicalCollege

M.S.R.I.T Post, Bangalore-54

3. COURSE OF STUDY ANDSUBJECT Masters in Physiotherapy

(Musculoskeletal Disorders

And Sports)

4. DATE OF ADMISSION TO COURSE 20th June 2009

5. TITLE OF THE TOPIC “Immediate effect of low dye

calcaneal taping on

pelvic tilt in individuals

with excessivecalcaneal

eversion”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

The pelvic girdle forms a closed kinematic chain with the upper and lower quadrants of the musculoskeletal system and thus is affected by the alignment of lower limb segments. According to this principle, the subtalar joint motion in a closed kinematic chain is said to influence the pelvic alignment.[1]

According to the biomechanical principles, individuals with normal calcaneal eversion have a slight internal rotation of the tibia and femur. With the normal calcaneal eversion angle ranging from 0-60, the presence of an excessive calcaneal eversion, has been shown to cause an increase in internal rotation of the tibia which in turn causes a significant increase in internal rotation of the femur [2]. This further leads to posterior location of the femoral head and thus, causes a posterior shift of the pelvis. These postural modifications causethe individual to bring the trunk anteriorly, in order to regain postural balance relative to gravity which is achieved through a pelvic anteversion.In addition, the tension developed in the iliopsoas muscle and the ligaments due to the internal rotation of the hip will further give a pelvic anteversion torque.[3]

Thus, an excessive calcaneal eversion in standing position leads to an increase in pelvic anteversion which in turn increases the lumbar lordosis.This hyperlordosis further increases the tension in the paraspinal muscles and loads the facet joints.Furthermore, unilateral calcaneal eversion in addition to anterior pelvic tilt may also produce a lateral pelvic tilt [3].These biomechanical changes have been found to contribute towards low back pain. Therefore correction of anterior pelvic tilt is essential in the treatment of patients with low back pain[4].It is hypothesized that correction of excessive calcaneal eversion will reduce the anterior pelvic tilt. Among the various techniques used to correct calcaneal eversion low dye calcaneal taping is found to be the most effective one [5]. Therefore, this study is undertaken to determine if correction of calcaneal eversion through low dye calcaneal taping will help in reducing the anterior pelvic tilt.

NULL HYPOTHESIS

Low dyecalcaneal taping does not change the angle of pelvic tiltinindividuals with excessivecalcaneal eversion.

RESEARCH HYPOTHESIS

Low dyecalcaneal taping changes the angle of pelvic tiltin individuals with excessivecalcaneal eversion.

6.2 REVIEW OF LITERATURE

Levine D and Whittle MW conducted a study on normal individuals.They found that alterations in the pelvic tilt angle causes increase in lumbar lordosis. [5]

Delisle A and Gagnon M studied the effect of pelvic tilt on lumbar spine geometry (severity of lordosis, pelvis and lumbar vertebrae orientation)in normal individuals. They found that anterior pelvic tiltincreasedthe lumbar lordosis and posterior pelvic tilt decreased the lumbar lordosis.Also,both the pelvic tilts were found to change the absolute and relative orientations of the lumbar vertebrae.[6]

Rafael Z.A.Pinto et al assessed the pelvic posture in sagittal and frontal plane by inducing unilateral and bilateral hyperpronation of the foot .They concluded that bilateral hyperpronation of the foot causes an anterior tilt of the pelvis and unilateral hyperpronation causes a lateral pelvic tilt in addition to ananterior pelvic tilt. [3]

Sam Khamis et al, in their study, induced hyper-pronation in normal individuals and found that hyper-pronation of the foot causes internal rotation of the femur and thus causes anterior tilt of the pelvis.[2]

In a study conducted by Jeffery M Whitaker et al proved that Low dye taping technique is effective in reducing calcaneal eversion, increasing first metatarsophalengeal range of motion and increasing medial arch height. [7]

B Vicenzino et al investigated the effect of two antipronation taping techniques namely low dye taping and low dye calcaneal taping, on vertical navicular height. They found that theaddition of calcaneal slings and reverse sixes to low dye taping controlled pronation of the calcaneum to a greater extent than low dye taping in itself. [8]

B Vicenzino et al compared the effects of antipronation taping and temporary orthoses in controlling tibial rotation position after exercise and supported that antipronation taping was superior to orthoses in controlling tibial rotation after exercise. [9]

Therefore, the literature review shows that unilateral or bilateral increase in calcaneal eversion causes an increase in anterior tilt of the pelvis which in turn leads to increase in lumbar lordosis. Low dye calcaneal taping is found to be one of the techniques to correct excessive calcaneal eversion. However, there is lack of evidenceto show that correction of excessive calcaneal eversion through taping will change the angle of pelvic tilt.

OBJECTIVES OF THE STUDY

  1. To measurethe angle of pelvic tiltin individuals with excessive calcaneal eversion before low dye calcaneal taping.
  2. To measure the angle of pelvic tilt in individuals with excessive calcaneal eversion after low dye calcaneal taping.
  3. To compare the angles of pelvic tiltin individuals with excessive calcaneal eversionbefore and after Low dye calcaneal taping.

7. MATERIALS AND METHODS:

7.1. SOURCE OF COLLECTION OF DATA:

Subjects visiting Physiotherapy OPD of M.S.Ramaiah Medical Teaching

Hospital.

7.2. METHODS OF COLLECTION OF DATA:

Type of study: Interventional study

Sampling procedure: ConvenienceSampling.

Proposed Sample size: 30 Subjects

Procedure of data collection:

An ethical clearance will be obtained from the ethical committee of M.S.RamaiahMedicalCollege.Subjects who fulfill the inclusion criteria will be taken up for thestudy. An informed consent will be obtained from the subjectsselected. A brief lower limb assessment will be performed (Annexure II).

Thecalcaneal eversion angle of the subjects will be measured in a standing position with the help of a goniometer.The individuals will then be asked to stand in a relaxed position with feet apart. Markers will be placed on the ASIS and PSIS, and aphotograph of the pelvis will be taken in the sagittal view to determine the angle of angle tilt using a Digital camera. Low dye calcaneal taping will then be applied to the everted foot in long sitting position with the foot placed out of the couch. The subjectswill then beasked to stand in a relaxed position with the tape onand aphotographof thepelvis will betaken again to determine the angle of pelvic tilt. The two photographs will be analysed using an image analysis software to measure the angle of pelvic tilt.

Inclusion criteria:

1. Asymptomatic individuals with calcaneal eversion > 60

2. Males and females aged between 18-30 yrs

Exclusion criteria:

  1. History of lower limb injuries
  2. Lower limb deformities / spinal deformities
  3. Neurological deficits in the lower limbs
  4. Limb length discrepancies
  5. History of low back pain.

Materials required

  1. Markers
  2. Camera stand
  3. Digital camera
  4. Image tool software

5. Non-Stretchable LeucoplastTape

Statistical analysis:

The angle of pelvic tilt with and without low dye calcaneal taping will be compared using Paired t-test.

7.3. Does the study require any investigation or intervention to be conducted on patients or other human or animals? Yes

7.4. Has ethical clearance been obtained from institution?

Yes (A copy of it has been enclosed)

LIST OF REFERENCES

  1. Snijders CJ, Vleeming A et al. Transfer of lumbosacral load to iliac bones and

legs, biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clinical Biomechanics 1993;8:285-94.

2. Khamis S, Yizhar Z. Effect of feet hyperpronation on pelvic tilt pelvic alignment in a standing position. Gait and Posture 2007; 25(1):127-34.

3.Rafael Z.A. Pinto, Thales R Souza et al. Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position. Manual Therapy 2008; 13: 513-519.

4.Stienberg EL, Luger E, et al. A comparitive roentgenographic analysis of the lumbar spine in male armyrecruits with or without lower back pain. Clinical Radiology 2003;58:985-9.

5.Levine D, Whittle MW. The effects of pelvic movement on lumbar lordosis in the standing position. Journal of Orthopaedic and Sports physical therapy 1996 Sep; 24(3):130-5

6.Delisle A and Gagnon M. Effect of pelvic tilt on lumbar spine geometry. IEEE Trans Rehabilitation Eng.1997 Dec;5(4):360-6.

7.Jeffery M Whitaker et al.Effect of the low dye taping strap on Pronation-sSensitive Mechanical attributes of the Foot. Journal of American Podiatric Medical Association. 2003; Vol 93(2):118-123.

8.B.Vicenzino et al. An investigation of the antipronation effect of two taping methods after application and exercises. Gait and Posture 1997(5):1-5.

9.B.Vicenzino et al. Antipronation taping and Temporary orthoses. Effects of tibial rotation position after exercises. Journal of American Podiatric Medical Association; 1999 Vol 89(3):118-123.

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF

11.1GUIDE: Mrs. JUDITH ROWENA. W

ASSISTANT PROFESSOR

DEPARTMENT OF PHYSIOTHERAPY

M.S.RAMAIAHMEDICALCOLLEGE

11.2SIGNATURE:

11.3 CO-GUIDE: Mrs. SHOBHALAKSHMI

ASSISTANT PROFESSOR

DEPARTMENT OF PHYSIOTHERAPY

M.S.RAMAIAHMEDICALCOLLEGE

11.4 SIGNATURE:

11.5 HEAD OF THE DEPARTMENT: PROF. SAVITA RAVINDRA

PROF AND HOD

DEPT OF PHYSIOTHERAPY

M.S.RAMAIAHMEDICALCOLLEGE

11.6 SIGNATURE:

12.

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:

12.2 SIGNATURE:

13. ANNEXURE I

INFORMED CONSENT

A request for an assessment of pelvic tilt and calcaneal eversion has been made, the information of which will be useful as data for the research study titled “Immediate effect of low dye calcaneal taping on pelvic tilt in individuals with excessive calcaneal eversion” to be done by Ms.Sushma Krishna. I have been explained the entire procedure and I am satisfied with the same.

I hereby give my consent to be included in the study.

SIGNATURE:

NAME:

14. ANNEXURE II

ASSESSMENT PROFORMA

Demographic Data

Name:

Age:

Sex:

Address:

Phone Number:

Occupation:

Height:

Weight:

Lower limb Assessment

Calcaneal Eversion –

Limb length

True length -

Apparent length –

ASIS and PSIS are in level Yes No

Angle of Pelvic Tilt

Angle ofPelvic Tiltpre low dye calcaneal taping (in degrees)-

Angle ofPelvic Tiltpost low dye calcaneal taping (in degrees)-

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