Neurobiomecnica-de-Pelvis-y-

Ar7culaciones-Sacroiliaca-

Profesores:
Angelo Bartsch J.
Cristin Cuadra G.
 Recuerdo-Anatmico-
Aspectos(Osteolgicos(

Vs

3 Grados de Libertad Rgida

Movilidad Estable
Aspectos(Osteolgicos(
Recuerdo-Anatmico-
Aspectos(Osteolgicos(
Recuerdo-Anatmico-
Aspectos(Osteolgicos(
Recuerdo-Anatmico-
 by the sacral promontory and anteriorly by the symphysis loid pelves, while the opposite is true in the anthropoid
pubis. The border of the pelvic outlet is formed anteriorly by pelvis. Gynecoid and android pelves predominate in
the pubic arch, laterally by the ischial tuberosities and Caucasian females, while gynecoid and anthropoid type

Alineacin-de-las-Estructuras-
sacrotuberous ligaments, and in the posterior midline by the
coccyx. The plane of the pelvic inlet is approximately 60 off
Aspectos(Osteolgicos(
the horizontal, while the plane of the outlet is nearly hori-
zontal [135] (Fig. 35.19). Owing to the different orientations
are more common in Negroid females; few females hav
platypelloid pelves [8,147]. All pelvic types except the
gynecoid type hamper engagement of the fetal head
during labor [135].

A Android (male) B Gynecoid (female)

Platypelloid Anthropoid
C D
Figure 35.22: Shapes of four major types of pelves are based on the ratio between the transverse and conjugate diameters.
AC. The transverse diameter is greater than the conjugate. D. The opposite is true.
 Oatis_CH35_620-653.qxd 4/15/07 2:06 PM Page 637

Alineacin-de-las-Estructuras-
Aspectos(Osteolgicos(
Chapter 35 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE PELVIS 637

Body weight force W

140

30

Figure 35.26: The lumbosacral angle (a) is formed by the intersec-

Figure 35.25: Medial aspect of the left hemipelvis. In standing,
the sacral promontory tends to tilt down and forward while the
ilia tend to tilt backward because the center of gravity passes
anterior to the sacroiliac joints (SIJs) and posterior to the hip
joints. These tendencies are resisted by the interosseous sacroiliac,
sacrotuberous and sacrospinous ligaments, and the inherent
morphology of the SIJ.
tion of lines drawn between the long axis of the fifth lumbar
vertebra and the sacrum. It results from a forward sacral inclina-
tion (b) and wedge-shaped lower lumbar intervertebral discs and
bodies. As the sacral inclination and lumbar lordosis increase, the
lumbosacral angle decreases, and vice versa. The sacral inclina-
tion is greater in the female, while the lumbosacral angle is
greater in the male. W, superincumbent weight.

scientific studies has found its way into clinical and basic sci- inclination thus formed consists of the base of the sacrum
ygapophyseal capsular ele- to internal derangement [33], Kapandji refers to it as the
addition, the iliolumbar weak link [81]. As a result of the body weight bearing down
aterally (Fig. 35.27). Each on L5 and the anterior inclination of the sacrum, an anteroin-
rse process of L5 (and fre- ferior shear stress is produced at the L5S1 junction; the

Alineacin-de-las-Estructuras-
o connect to the pelvis by resultant force vector, acting through the pars interarticularis,
ass anterior to the SIJ. An is an anterior one [81] (Fig. 35.28). Subsequently, L5 tends to
est, where it is continuous slide forward on the sacral promontory. This tendency is resis-
Aspectos(Osteolgicos(
cia; a lower band (some- ted, and L5 is restrained, however, by the vertebras bony
cral ligament, though not hook, formed by its pedicles, pars interarticulares, and inferior
to the upper surface of the articular processes, fitting over the superior articular processes
Chapter 35 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE PELVIS 639
he anterior sacroiliac liga- of the sacrum below [59] (Fig. 35.28).

present in the newborn; it

s by metaplasia of fibers of
ergoes degeneration from Clinical Relevance
Pars interarticularis
hers theorize that the liga- fracture
cral junction is stressed by
PARS INTERARTICULARIS DEFECTS: Various anom-
e [27,94] and suggest that
alies and
t serve different pathological or congenital conditions, over time and
functions
ned in theunder
coronalstress,
plane; itmay weaken or destroy the integrity of the resist- 1 2
m and thus control lateral 3
ing hook mechanism; such defects include congenital aplasia 4 L5
(or dysplasia) of the sacral facets, near-sagittal orientation of
h vertebra
one or both of the lumbosacral facet joints (Fig. 35.9), exces-
sive anterior
Iliolumbar ligaments tilt of the sacrum resulting in increased lum-

bosacral shear, and spondylolysis. Disruption of the pars

interarticularis (spondylolysis) can occur unilaterally (up to
Pars interarticularis
fracture
30%), with or without slipping (olisthesis), and although it
has been observed at L3, L4, and L5, it is most frequent at L5
[59,60,100,136]. Although 5% of individuals with this condi-
tion are asymptomatic [100], spondylolisthesis can be a seri-
Ventral
ous consequence
sacroiliac of spondylolysis. The Belgian obstetrician
A
ligaments
Herbineaux [72] is credited with describing B the first cases of
spondylolisthesis when he noted that, on occasion, a bony
Figure 35.28: The bony hook of L5 consists of its pedicle, pars
prominence on the anteriorand
interarticularis, surface
inferior of the process;
articular sacrum interfered
it fits over the
Figure 35.29: Spondylolistheses is graded on the basis of the
superior articular process of the sacrum below. A. Disruption of
oth passing with labor.
anterior to theBecause of the
the bony hooklocation of the L5
mechanism between spondylolytic defect,
and S1 can be caused by amount of forward movement of L5 on the sacrum. In grades 1,
both the fourth and fifth fracture of the pars interarticularis (spondylolysis) and can result
the body,
ugh not recognized by the
pedicles, and superior articular processes slip
in spondylolisthesis. B. Pars interarticularis defect seen from
for- 2, 3, and 4, some 25, 50, 75, and 100% of the body of L5 is posi-
ward, leaving theabove
ament is shown. inferior
L5. articular processes, laminae, and tioned anterior to the sacral promontory, respectively.
spinous process in their normal position.
Spondylolisthesis is diagnosed on the oblique radi-
ographic projection; the disrupted pars interarticularis (isth-
 Relacin-mecnica-
Aspectos(Osteolgicos(
Part III I KINESIOLOGY OF THE HEAD AND SPINE

PERIARTICULAR Standing
transfer

rincumbent weight of the head,

transmitted onto the sacrum
tebra and its disc. Weight is
e paired SIJs and distributed to
ing or the femora in standing.
e union of the pubic bodies at
eoligamentous ring is subdi-
d functional arches to describe
n the standing posture [3,9,
passing through the acetabula
anterior and posterior arches
e segments of the sacrum and Sitting
sing from both SIJs to the pos- transfer
he posterior arch, which serves
m above to the lower limbs. The
counter arch and consists of the Figure 35.24: Bony trabecular system of the right innominate
bodies, and interpubic disc; it bone and proximal femur. The transfer of weight via the SIJ is
onnecting the anterior ends of through the arcuate line to the acetabulum in standing, and
aration of the posterior arch at through the arcuate line to the ischial tuberosities when sitting.
a compression strut against the
the femora below. The sitting
Aspectos(Osteolgicos(
Relacin-mecnica-
 Cpsula-Ar7cular>-Ligamentos-
Aspectos(Artrolgicos(
 Cpsula-Ar7cular>-Ligamentos-
Aspectos(Artrolgicos(
 ticular fibrosis of joint surfaces and, in a few individuals, total
the joint, and the interosseous sacroiliac ligament (ISIL)
ankylosis. The degenerative changes that develop on the iliac
connects the sacral and iliac tuberosities (Figs. 35.31, 35.32).
side appear first and are more severe than those on the sacral
The VSIL is little more than a thickening of the anterior joint
side [19,20,168]; furthermore, they appear at an earlier
capsule; the cranial part is thin and reinforced by iliolumbar
age and advance more rapidly in males than females
ligament fibers, while the caudal half is well developed below

Cpsula-Ar7cular>-Ligamentos-
[20,21,29,96,131,151,168]. One author [138] reports severe,
only as far as the iliac arcuate line [147,159]. It assists the sym-
advanced degenerative changes in over 90% of the SIJs from
physis pubis in resisting separation or horizontal movement of
aged males (over 80 years old).
the innominate bones at the SIJs. The DSIL is heavier and
Aspectos(Artrolgicos(

Dorsal sacroiliac
ligament

Sacrospinous
ligament

A Sacrotuberous
ligament Sacrospinous
ligament
Iliolumbar B
ligament Sacrotuberous
ligament

Lumbosacral
ligament

Ventral
sacroiliac
ligament

C
Figure 35.32: Ligaments of the sacroiliac joint. A. Dorsal view. B. Medial view. C. Ventral view.
 Cpsula-Ar7cular>-Ligamentos-
Aspectos(Artrolgicos(
 Oatis_CH35_620-653.qxd 4/15/07 2:06 PM Page 645

Ejes-y-Planos-de-Movimiento-
Chapter 35 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE PELVIS 645
Osteocinem2ca(

Farabeuf

Bonnaire

Weisl

Figure 35.34: Sagittal plane motion of the sacrum. In nutation,

the base of the sacrum moves ventrocaudally and its apex moves
dorsocranially; this occurs when the sacrum is loaded from
above, in trunk flexion, or in bilateral hip flexion. The base of
the sacrum moves in the opposite direction during trunk exten-
sion and bilateral hip extension, when it counternutates.
Figure 35.35: Medial view of the innominate bone shows three
primary sites proposed as the location of the axis of rotation
between the sacrum and the ilium.

opposite direction, during trunk extension or bilateral hip torsion. These movements are always accompanied by
 Ejes-y-Planos-de-Movimiento-
Osteocinem2ca(
 end) moves anteriorly and inferiorly. This causes the pelvic outlet, it is important that t
inferior portion of the sacrum and the coccyx to move has increased. Putting the SI joi
posteriorly. The pelvic outlet becomes larger and can be increases the A-P diameter.

Simtricos-
visualized by drawing a line from the tip of the coccyx
to the bottom surface of the pubic symphysis. Bones and Landmarks
The two bones of the SI joint are th
ilium, the latter of which is the super
hip bone. The sacrum is wedge-shape
Osteocinem2ca(

five fused sacral vertebrae. It is located

hip bones and makes up the poster
bony pelvis. Its anterior surface, ofte
surface, is concave (Fig. 17-5). Becaus
sacrum articulates with the fifth lum
angle referred to as the lumbosacral ang
landmarks are as follows (Figs. 17-5 a
Base
Superior surface of S1.
Promontory
Ridge projecting along the anterior e
body of S1.
Superior Articular Process
Located posteriorly on the base, it
the inferior articular process of L
Ala
Counternutation
Lateral flared wings that are actual
Nutation
transverse processes.
A B
Foramina
Figure 17-4. Sacroiliac joint motions. (A) Nutation occurs
when the sacral promontory moves anteriorly and inferiorly Located on the anterior (pelvic) a
while the tip of the coccyx moves in the opposite direction. surfaces are four pair of foram
(B) Counternutation occurs when the sacral promontory serve as the exit for the anterio
moves posteriorly and superiorly while the tip of the coccyx divisions of the sacral nerves. T
moves in the opposite direction. foramina are larger.
 Asimtricos-
Part III I KINESIOLOGY OF THE HEAD AND SPINE

innominate bone relative to the other

Osteocinem2ca(

relative prominence of the right and

SISs [33,39,58,90,99,104,152,179]. For
t ASIS moves upward, the right ASIS
become more prominent while the left
IS become less prominent (Fig. 35.37).
metrical forces are applied transiently to
each gait cycle [20]. The proposed axis
transverse and passes through the sym-
5], though this remains equivocal.
or instability in either the SIJ or sym-
is accompanied, however, by a second-
the other [69].

ythm
and innominate bones can also move as a
movements of the spine are coupled with
, a lumbopelvic rhythm (discussed in
r to the scapulothoracic rhythm, has been
. 35.38). The specific rhythm varies among
ion of the trunk from standing combines
r vertebrae and at the lumbosacral junction Figure 35.37: Application of unbalanced forces on the pelvis, as
d rotation of the pelvis on the fixed femora in static one-legged stance on the left, results in asymmetrical,
turbances in the lumbopelvic rhythm can antagonistic movement at the SIJs along with movement at the
symphysis pubis. This type of movement can be assessed clinically
o low back pain [3,121,139].
by palpating movement of the ASIS and PSIS.
 postulated [22] (Fig. 35.38). The specific rhythm varies among
individuals, but flexion of the trunk from standing combines
flexion of the lumbar vertebrae and at the lumbosacral junction Figure 35.37: Application of unbalanced forces on the pelvis, as
with forward rotation of the pelvis on the fixed femora in static one-legged stance on the left, results in asymmetrical,

Ritmo-Lumboplvico-
2 [3,139]. Disturbances in the lumbopelvic rhythm can antagonistic movement at the SIJs along with movement at the
symphysis pubis. This type of movement can be assessed clinically
contribute to low back pain [3,121,139].
by palpating movement of the ASIS and PSIS.
Osteocinem2ca(

A B C

Figure 35.38: Common lumbopelvic rhythm. A. Normal standing posture. B. During the first 45! of trunk flexion, most motion results
from lumbar and sacral flexion causing the sacrum to nutate and the lumbar curve to flatten. C. In extreme trunk flexion, the lumbar
spine continues to flatten and the pelvis rotates about the femoral heads, while the sacrum paradoxically counternutates.
 Movimiento-Plvico-
254 PART III Clinical Kinesiology and Anatomy of the Trunk
Osteocinem2ca(

ASIS ASIS
ASIS

Pubic symphysis Pubic symphysis

Pubic symphysis

Neutral Anterior tilt Posterior tilt

A B C
Figure 17-13. Pelvic movement in the sagittal plane. (A) The anterior superior iliac spine (ASIS) and the pubic symphysis
should be in the same vertical plane. (B) Anterior tilt occurs when the pelvis tilts forward, moving the ASIS anterior to the
pubic symphysis. (C) Posterior tilt occurs when the pelvis tilts backward, moving the ASIS posterior to the pubic symphysis.

walk, the pelvis is level when both legs are in contact or less supported side, or the side farthest from the
gy and Anatomy of the Trunk
Movimiento-Plvico- CH

the right leg is swing-

Osteocinem2ca(

pported side is the point of

right side of the pelvis
ht ASIS in front of the
ackward (Fig. 17-18C),
. Stated another way, if
nd swing your right leg
elvis rotates backward. Pelvis remains
cause the pelvis moves fairly level
f there is right forward
hip medial rotation (see Right hip abductors
medial rotation occurs
Pelvis tilts posteriorly
moral head rather than, Back extensors Pelvis tilts anteriorly Trunk flexors
ound. With right back-
left hip lateral rotation Hip flexors
Hip extensors
ns of joint motions that
bed in greater detail in
of some of the associat-
e 17-1.

d by groups of muscles
elvis tilts in the anteri-
ng muscle groups pro-
g. 17-19). To tilt the
nk extensors, primarily
orly while the hip flex-
rsely, to tilt the pelvis
up anteriorly while the
s pull down posteriorly
muscle groups are act-
in opposite directions
A
Figure 17-21. Force couple
frontal plane. In a reversal of
lateral benders pull up while
down. This keeps the pelvis f
the pelvis drop on the unsup
Figure 17-19. Force couple causing anterior pelvic tilt Figure 17-20. Force couple causing posterior pelvic tilt
(lateral view). The trunk extensors pulling up (posteriorly) (lateral view). The trunk flexors pulling up (anteriorly) and
and the hip flexors anterior pulling down (anteriorly) cause the hip extensors pulling down (posteriorly) cause the pelvis
the pelvis to tilt anteriorly. to tilt posteriorly.

he force of gravity can pelvis, while the right hip abductors (gluteus medius
 644
Rangos-de-Movimiento-Normal-
TABLE 35.6: Movement of Sacroiliac Joint
Part III I KINESIOLOGY OF THE HEAD AND SPINE

Author(s) Method(s) Subjects Joint Motion Conclusions

Pitkin and Inclinometry Living subjects Unilateral antagonistic movement of the ilium around
Osteocinem2ca(

Pheasant transverse axis through the symphysis pubis averaged

1936 11 (319), or 5.5 on each side
Strachan et al. Mechanical testing of sacral Cadavers During trunk movements, sacral rotation was 15
1938 rotation when one ilium was immobilized and the other was
fixed to the sacrum
Weisl 1955 Movement of sacral Living subjects Max ventral movement of the sacral promontory was
promontory via radiography 5.6 ! 1.4 mm with standing from recumbent Axis of
angular movement was 510 cm below the sacral
promontory
Mennell 1960 Changes in distance between Living subjects PSISs came 0.5 in. closer in horizontal plane
PSISs via palpation
Colachis et al. Measured distance between Living subjects Maximum movement of PSISs was 5 mm with flexion
1963 Kirschner wires implanted in PSISs from standing
The axis was not fixed
Kapandji 1974 Theorized based on writings of None In nutation the ilia approximate and the iliac
Farabeuf and Bonnaire tuberosities separate
Opposite in counternutation
Frigerio 1974 Biplanar radiography Cadavers and Maximum movement between ilium and sacrum was
living subjects 12 mm (mean ~2.7 mm)
Maximum movement between innominates was 15.5 mm
Egund et al. Roentgen stereophotogrammetry Living subjects Maximum rotation was 2
1978 with hypo- Axis of sacral rotation was through the iliac tuberosities
or hypermobile SIJs at the level of S2
Translations were ~2 mm
Wilder et al.
1980
Theoretical best-fit axes of
rotation based on topographic
Dried bony
specimens
Joint rotation cannot occur exclusively about any
previously proposed axis En el plano sagital
entre 1 a 8, con
analysis of joint surfaces An important function of the SIJ may be to absorb energy
Reynolds 1980 Stereoradiography Cadaver Sacral rotations were 12
Miller et al.
1987
Mechanical testing with one
or both ilia fixed
Cadavers Both ilia fixed: 1.9 rotation, 0.5 mm translation One ilium
fixed: rotation 27.8" greater and translation la media de 2 y 3.
3" greater
Scholten et al. Biomechanical model Model Model relative pelvic motions rarely exceeded 12
1988 rotation and 3 mm translation
Sturesson et al.
1989
Stereoradiography Living subjects Mean rotation 2.5 ! 0.5
Mean translation 0.7 mm (0.11.6 mm)
Traslacin caudal
Smidt et al.
1995
Metrecom skeletal analysis
system
Living subjects Composite sacroiliac motion (relative motion between
R/L innominates) was 9 ! 6.5 in oblique sagittal plane
del sacro entre 0,5
Smidt et al. Computed tomography Cadavers
and 5 ! 3.9 in transverse plane
Sagittal plane sacral rotation was 78
y 8mm, con media
1997
PSISs, posterior superior iliac spines; SIJ, sacroiliac joint.
Translation was 48 mm
2-3mm
 In total, 41 patients (34 women 1945 years of age,
and 7 men aged 1845 years) were included in the
RSA studies by Sturesson et al (1989, 1999a, 2000a,
Rangos-de-Movimiento-Normal-
2000b). The studies were focused on various issues
but the basic movement analysis was used in all
studies to make the groups in the different studies
Y
Osteocinem2ca(
X inward movement of the iliac crests, noted as
Z positive values around the Z-axis for the left side
Fig. 23.2 The pelvis with the rotational axes.
Ch23-F10178.indd 345
Probably these movements around the Y- and Z-
axes reflect the wide variation in the anatomy of
the SIJ (Solonen 1957). The movements around the
X-axis and the helical axis did not show statistical
differences, thus it can be said that the innominates
move around the sacrum as a unit or the sacrum
moves symmetrically between the ilia.
Supine to sitting
Compared with the movement pattern from
supine to standing, the movement from supine
to sitting, both around the helical and the X-axis
shows an increase of about 25%. However, the
most interesting observation is a small but constant
and negative values for the right (Table 23.2).
Standing to prone with
hyperextension
The largest movement in the SIJ was found between
the standing to prone with hyperextension
positions (Tables 23.3 and 23.4). In the prone position
with hyperextension the load on the SIJ is low and
in contrast to the other positions, the movement
0.2- 2 Grados de Rotacin
1-2 mm de traslacin
Movimientos Pasivos de 7 a12/27/06
8 9:35:37 AM
grados
 Sturesson et al (1989, 2000). The average values for
rotation and translation were low, being 1.8 of rota-
tion (coupled with 0.7 mm of translation) for the men
and 1.9 of rotation (coupled with 0.9 mm translation)

Traslacin-
for the women. No statistical differences were noted
for either age or gender. They postulated that more
than 6 of rotation and 2 mm of translation should
be considered pathologic (Jacob & Kissling 1995).
Figure 6.7 When the sacrum nutates, its articular surface
In 1995, Buyruk et al (1995a, b) established that glides inferoposteriorly relative to the innominate.
the Doppler imaging system could be used to meas-
Atrocinem2ca(

ure stiffness of the SIJ. This research has recently

nd four men
been repeated and confirmed by Leonie Damen
d only 2.5 of
et al (2002a). Doppler imaging of vibrations across
.51.6 mm of
the SIJSacral
hasNutation
shown (Buyruk et al 1995a, b, 1997, 1999,
ducted in the
Damen et al 2002a) that stiffness of the SIJ is variable
al (2000) felt
between subjects and therefore the range of motion
Inferoposterior Sacral counter-
955, Colachis Glide Nutation
verestimated is potentially variable. This research has also revealed
that stiffness of the SIJ is symmetric when the left and Anterosuperior
f SIJ mobility right sides are compared in subjects without pelvic Glide

ed those of pain and asymmetric in subjects with pelvic pain.

ge values for These studies will be discussed in greater depth
g 1.8 of rota- later. In conclusion, we know that the SIJs are capable
n) for the men of a small amount of both angular (14) and transla-
m translation) toric motion (13 mm), that the amplitude of this
es were noted motion is variable between subjects; however, within
ed that more one subject it should be symmetric between sides.
ation should
sling 1995). NUTATION/COUNTERNUTATION OF THE
Figure 6.7 When the sacrum nutates, its articular surface
ablished that SACRUM
glides inferoposteriorly relative to the innominate.
Figure 6.8 When the sacrum counternutates, its articular
used to meas- surface glides anterosuperiorly relative to the innominate.
has recently Nutation and counternutation are osteokinematic
onie Damen terms that describe how the sacrum moves relative et al 2000). In other words, whenever an individual
ations across to the innominates regardless of how the pelvic girdle is vertical, the sacrum is nutated relative to the
b, 1997, 1999, is moving relative to the lumbar spine and femora. innominates. The amount of sacral nutation
SIJ is variable Nutation of the sacrum occurs when the sacral depends on how the individual is sitting or stand-
 Limitantes-del-Movimiento-
Osteocinem2ca(

Msculos(que(refuerzan(y(estabilizan(la(ar2culacin(
sacroiliaca(
1.>-Erector-Espinal-
2.>-Mul7do-Lumbar-
3.>-Grupo-Muscular-Abdominal-
----a.-Oblicuos-Internos-y-externos-
----b.-Rectos-Abdominal-
----c.-Transverso-abdominal-
4.>-Isquio7biales-
 Patrones-de-Reclutamiento-
Mecnica(Muscular(
 Interaccin-de-Torques-
Mecnica(Muscular(
 Aplicacin-de-Conocimientos-
Adquiridos-
Funcionalidad(

Que aprendimos del Fenmeno o Test de Flexin Relajacin?

Torque(Extensor(Generado( Torque((Nm)(
1.>-Msculos-Extensores- 200-
2.>-Ligamentos- 72-
 Aplicacin-de-Conocimientos-
Adquiridos-
Funcionalidad(

Malas noticias, le toc lavar la loza del Cumpleaero

Usted debe levantar una caja llena de platos, tazas y vasos
para ponerla en el lavaplatos. cmo lo har?

Formas(de(Reducir(la(Fuerza(Requerida(por(los(Msculos(
Extensores(mientras(se(realiza(un(levantamiento(de(carga(
1.>-Reducir-la-velocidad-del-movimiento-
2.>-Reducir-la-magnitud-de-la-carga-externa-
3.>-Reducir-la-longitud-del-momento-externo-
4.>-Aumentar-la-longitud-del-momento-interno-
 Aplicacin-de-Conocimientos-
Adquiridos-
Funcionalidad(

Qu tcnica es mejor?
 Aplicacin-de-Conocimientos-
Adquiridos-
Funcionalidad(
 Lying on the side 0.12
Lying prone 0.11
Lying prone, extended back, supporting on elbows 0.25

Aplicacin-de-Conocimientos- Laughing heartily, lying laterally

Sneezing, lying laterally
Peaks by turning around
0.15
0.38
0.700.80

Measurements
easurements of Pressures
of Pressures
Adquiridos-
in theinIntervertebral
the Intervertebral
Disc Disc Wilke
Wilke et al et757
Relaxed standing
Standing, performing
Measurements of Pressures in the Intervertebral
al Standing,
757
vasalva
Disc Wilke
bent forward
et almaneuver
757
0.50
0.92
1.10

Table 1. Intradiscal Pressure Values forwithout

Different
TableTable 1. Intradiscal
1. Intradiscal Pressure
Pressure Values
Values for Different
for Different Sitting relaxed, backrest 0.46
Funcionalidad(

Positions and Exercises Sitting actively straightening the back 0.55

Positions
Positions and Exercises
and Exercises
Sitting with maximum flexion 0.83
Position Pressure
Sitting bent forward with (MPa)
tight supporting the elbows 0.43
Position
Position Pressure
Pressure (MPa) (MPa)
Sitting slouched into the chair 0.27
Lying supine Standing up from a chair 0.10 1.10
Lying supine
Lying supine Lying on the side 0.10 0.10 0.12
Lying
Lying on theon the side
side Lying prone 0.12 0.12 0.11
Lying prone Walking barefoot 0.530.65
Lying prone Lying prone, extended0.11back,0.11
supporting
Walking with tennis shoes0.25
on elbows 0.530.65
Lying prone,
Lying prone, extendedextended back, supporting
back, supporting on on
elbows elbows 0.25 0.25
Laughing heartily, lying laterally 0.15
Figure 3. Laughing
LaughingRadiograph withlaterally
heartily,
heartily, lying implanted
lying laterallypressure transducer approx-
0.15 0.15
Sneezing, lying laterally 0.38
imately inSneezing,
thelying
Sneezing, centerlyingoflaterally
laterallythe L4 L5 nucleus Peakspulposus. 0.38 0.38 Jogging with hard street shoes
by turning around 0.700.80 0.350.95
Peaks Peaks by turning
by turning aroundaround 0.700.80
0.700.80 Jogging with tennis shoes 0.350.85
Relaxed standing 0.50
Relaxed Relaxed
standingstanding Standing, of
performing 0.50
vasalva 0.50 Climbing
maneuver stairs, one stair at
0.92a time 0.500.70
by muscle spasms
Standing,
Standing, thatvasalva
resolved
performing
performing vasalvawith training
maneuver
maneuver the back mus-
0.92 0.92 Climbing stairs, two stairs
cles.Standing,
TwoStanding,
years the experiment,Standing, bent forward 1.10a time
at 0.301.20
bent after
bent forward
forward the subject reported
1.10 no 1.10 Walking down stairs, one stair at a time 0.380.60
further episodes of back pain, and an MRI investigation did not Walking down stairs, two stairs at a time 0.300.90
Sitting relaxed, without backrest Lifting 20 kg, bent over with 0.46round back 2.30
show anySitting
Sitting change
relaxed, of the
relaxed,
without treated
without
backrest discSitting
backrest in comparison with
0.46 the0.46
actively straightening the back 0.55 school
Sitting Sitting
activelyactively straightening
straightening the back
the back Lifting 20 kg as taught in back 1.70
status before the experiment. Sitting with maximum0.55flexion0.55 Holding 20 kg close to the0.83 body 1.10
SittingSitting with maximum
with maximum flexionflexion Sitting bent forward with 0.83supporting the elbows
0.83 tight 0.43
Results
SittingSitting bent forward
bent forward withsupporting
with tight tight supporting the elbows
the elbows 0.43
0.43chair Holding 20 kg, 60 cm away from the chest 1.80
Sitting slouched into the 0.27
SittingSitting
slouchedslouched
into theinto the chair Standing up from a chair
chair 0.27 0.27 1.10
All positions and activities were achieved or performed
StandingStanding
up fromup afrom
chair a chair 1.10 1.10 Pressure increase during night (over a period of 7 hr) 0.100.24
actively by the volunteer without assistance.
Walking barefoot Position- 0.530.65
Walking barefoot
Walking barefoot 0.530.65
Walking with tennis shoes 0.530.65 0.530.65
Walking with tennis
Walking shoes shoes
with tennis 0.530.65
0.530.65
mplanted pressure transducer approx-
ox-
approx-
L4 L5 nucleus pulposus. Jogging with hard street shoes related measurements were recorded usually
0.350.95 after two
Jogging with hard
Jogging withstreet shoes shoes Jogging with tennis shoes
hard street 0.350.95
0.350.95 0.350.85 some training.
Jogging Measurements
with
Joggingtennis shoes shoes of Pressures in the
with tennis Intervertebral
0.350.85
0.350.85 Disc required
pretrials; activities Wilke et al 757
Ejercicios(
Ejercicios(