Lumbar-Pelvic Instability (Poor Core Control)

Lumbo-pelvic instability is the result of inability for the supporting structures of the trunk to maintain the optimum position of the spine and pelvic girdle.

 

Causes

Common causes for lumbo-pelvic instability include:

  • Acute Low Back Injury
  • Chronic Low Back Pain
  • Post Abdominal or Pelvic Surgery
  • Pregnancy
  • Post Natal

Understanding Lumbar and Pelvic Instability

The stability of the trunk and pelvis is provided by a combination of passive, active and neural control. Instability arises when one or more of these components is not functioning appropriately and support of good skeletal alignment is not provided.

Passive Control of the Trunk

This is provided by the physical structures such as the vertebrae of the spine, the bones of the pelvic girdle, the ligaments between the bones, and the tendons and fascia

Active Control of the Trunk

Active control is provided by the postural and movement muscles around the spine and pelvis. These muscles produce core stability by working to support the bones (postural muscles) and provide appropriate movement (movement muscles)

 

Postural muscles

Moving muscles

Pelvic floor Rectus Abdominus
Transversus abdominus Internal / external oblique
Multifidus Latissimus dorsi
Diaphragm Ilioposas

Neural Control of the Trunk

Neural control of the trunk relies on sensory feedback from the joint receptors, ligament receptors and muscle receptors, and these work simultaneously to stabilise the spine in all positions. The neural control of the spine can be adversely impacted upon by injury, surgery, or pregnancy.

Assessment

Pelvic instability is assessed by a history and physical examination. This can involve assessing:

  • Position of the spine and pelvis in static positions
  • Position of sine and pelvis through movment
  • Palpation of the joint movement in the pelvis and spinal coloumn

Management

Management of lumbo-pelvic instability can occur through a number of stages

Correct Alignment of Skeletal Structure

Pain from instability occurs due to the poor alignment of the pelvic and spinal joints. This can be corrected by joint mobilisation, muscle energy tehcnqies, soft tissue techniques, stretching, dry needling.

Improve the Function of Core Stabilising Muscles

Initially this is done using bio feedback. Here we are working on developing Active and Neural control via the core muscles. Once these muscles are correctly activated, the client is able to progress to an individualised core strengthening program. This program may include Pilates mat exercises, swiss ball, cable, theraband or functional weight training.