Neurobiomecnica-de-Pelvis-yAr7culaciones-SacroiliacaProfesores:

Angelo Bartsch J.
Cristin Cuadra G.

Aspectos(Osteolgicos(

Recuerdo-Anatmico-

Vs
3 Grados de Libertad
Movilidad

Rgida
Estable

Aspectos(Osteolgicos(

Recuerdo-Anatmico-

Aspectos(Osteolgicos(

Recuerdo-Anatmico-

Aspectos(Osteolgicos(

Recuerdo-Anatmico-

Aspectos(Osteolgicos(

by the sacral promontory and anteriorly by the symphysis

pubis. The border of the pelvic outlet is formed anteriorly by
the pubic arch, laterally by the ischial tuberosities and
sacrotuberous ligaments, and in the posterior midline by the
coccyx. The plane of the pelvic inlet is approximately 60 off
the horizontal, while the plane of the outlet is nearly horizontal [135] (Fig. 35.19). Owing to the different orientations

loid pelves, while the opposite is true in the anthropoid

pelvis. Gynecoid and android pelves predominate in
Caucasian females, while gynecoid and anthropoid type
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].

Alineacin-de-las-Estructuras-

Android (male)

Platypelloid

Gynecoid (female)

Anthropoid

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.

Aspectos(Osteolgicos(

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637

Chapter 35 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE PELVIS
Body weight force

140
a

b
30

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.

Figure 35.26: The lumbosacral angle (a) is formed by the intersection of lines drawn between the long axis of the fifth lumbar
vertebra and the sacrum. It results from a forward sacral inclination (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 inclination 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

Aspectos(Osteolgicos(

ygapophyseal capsular eleto 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 anteroinrse process of L5 (and freferior shear stress is produced at the L5S1 junction; the
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 resiscia; a lower band (someted, 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
he anterior sacroiliac ligaof the sacrum below [59] (Fig. 35.28).

Alineacin-de-las-Estructuras-

present in the newborn; it

s by metaplasia of fibers of
ergoes degeneration from
Pars interarticularis
fracture
hers theorize that the ligacral junction is stressed by
PARS INTERARTICULARIS DEFECTS: Various anome [27,94] and suggest that
alies and
pathological or congenital conditions, over time and
t serve different
functions
ned in theunder
coronalstress,
plane; itmay weaken or destroy the integrity of the resistm and thus control lateral

639

Clinical Relevance

ing hook mechanism; such defects include congenital aplasia

(or dysplasia) of the sacral facets, near-sagittal orientation of
one or both of the lumbosacral facet joints (Fig. 35.9), excesh vertebra
Iliolumbar
ligaments tilt of the sacrum resulting in increased lumsive anterior
bosacral shear, and spondylolysis. Disruption of the pars
Pars interarticularis
interarticularis (spondylolysis)
can occur unilaterally (up to
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 condition are asymptomatic [100], spondylolisthesis can be a seriVentral
A
ous consequence
of spondylolysis. The Belgian obstetrician
sacroiliac
ligaments
Herbineaux [72] is credited with describing
the first cases of
B
spondylolisthesis when he noted that, on occasion, a bony
Figure 35.28: The bony hook of L5 consists of its pedicle, pars
interarticularis,
inferior of
articular
it fits
over the
prominence on the
anteriorand
surface
the process;
sacrum
interfered
superior articular process of the sacrum below. A. Disruption of
with
labor.
of the
of the L5
spondylolytic
defect,
oth passing
anterior
to theBecause
the bony
hooklocation
mechanism between
and S1 can be caused
by
both the fourth and fifth
fracture of the pars interarticularis (spondylolysis) and can result
the
body,
pedicles,
and
superior
articular
processes
slip
forugh not recognized by the
in spondylolisthesis. B. Pars interarticularis defect seen from
ament is shown.
L5.
ward, leaving theabove
inferior
articular processes, laminae, and
spinous process in their normal position.
Spondylolisthesis is diagnosed on the oblique radiographic projection; the disrupted pars interarticularis (isth-

1 2

L5

Figure 35.29: Spondylolistheses is graded on the basis of the

amount of forward movement of L5 on the sacrum. In grades 1,
2, 3, and 4, some 25, 50, 75, and 100% of the body of L5 is positioned anterior to the sacral promontory, respectively.

Aspectos(Osteolgicos(

PERIARTICULAR

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 subdid functional arches to describe
n the standing posture [3,9,
passing through the acetabula
anterior and posterior arches
e segments of the sacrum and
sing from both SIJs to the poshe posterior arch, which serves
m above to the lower limbs. The
counter arch and consists of the
bodies, and interpubic disc; it
onnecting the anterior ends of
aration of the posterior arch at
a compression strut against the
the femora below. The sitting

Relacin-mecnicaPart III I KINESIOLOGY OF THE HEAD AND SPINE

Standing
transfer

Sitting
transfer

Figure 35.24: Bony trabecular system of the right innominate

bone and proximal femur. The transfer of weight via the SIJ is
through the arcuate line to the acetabulum in standing, and
through the arcuate line to the ischial tuberosities when sitting.

Aspectos(Osteolgicos(

Relacin-mecnica-

Aspectos(Artrolgicos(

Cpsula-Ar7cular>-Ligamentos-

Aspectos(Artrolgicos(

Cpsula-Ar7cular>-Ligamentos-

Aspectos(Artrolgicos(

ticular fibrosis of joint surfaces and, in a few individuals, total

ankylosis. The degenerative changes that develop on the iliac
side appear first and are more severe than those on the sacral
side [19,20,168]; furthermore, they appear at an earlier
age and advance more rapidly in males than females
[20,21,29,96,131,151,168]. One author [138] reports severe,
advanced degenerative changes in over 90% of the SIJs from
aged males (over 80 years old).

the joint, and the interosseous sacroiliac ligament (ISIL)

connects the sacral and iliac tuberosities (Figs. 35.31, 35.32).
The VSIL is little more than a thickening of the anterior joint
capsule; the cranial part is thin and reinforced by iliolumbar
ligament fibers, while the caudal half is well developed below
only as far as the iliac arcuate line [147,159]. It assists the symphysis pubis in resisting separation or horizontal movement of
the innominate bones at the SIJs. The DSIL is heavier and

Cpsula-Ar7cular>-LigamentosDorsal sacroiliac
ligament

Sacrospinous
ligament

Sacrotuberous
ligament
Iliolumbar
ligament

Sacrospinous
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.

Aspectos(Artrolgicos(

Cpsula-Ar7cular>-Ligamentos-

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Osteocinem2ca(

Chapter 35 | STRUCTURE AND FUNCTION OF THE BONES AND JOINTS OF THE PELVIS
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 extension and bilateral hip extension, when it counternutates.

opposite direction, during trunk extension or bilateral hip

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.

torsion. These movements are always accompanied by

Osteocinem2ca(

Ejes-y-Planos-de-Movimiento-

end) moves anteriorly and inferiorly. This causes the

inferior portion of the sacrum and the coccyx to move
posteriorly. The pelvic outlet becomes larger and can be
visualized by drawing a line from the tip of the coccyx
to the bottom surface of the pubic symphysis.

Osteocinem2ca(

Simtricos-

pelvic outlet, it is important that t

has increased. Putting the SI joi
increases the A-P diameter.

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
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

Nutation

Counternutation

A
B
Figure 17-4. Sacroiliac joint motions. (A) Nutation occurs
when the sacral promontory moves anteriorly and inferiorly
while the tip of the coccyx moves in the opposite direction.
(B) Counternutation occurs when the sacral promontory
moves posteriorly and superiorly while the tip of the coccyx
moves in the opposite direction.

Ala
Lateral flared wings that are actual
transverse processes.

Foramina
Located on the anterior (pelvic) a
surfaces are four pair of foram
serve as the exit for the anterio
divisions of the sacral nerves. T
foramina are larger.

Asimtricos-

Part III I KINESIOLOGY OF THE HEAD AND SPINE

Osteocinem2ca(

innominate bone relative to the other

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 sym5], though this remains equivocal.
or instability in either the SIJ or symis accompanied, however, by a secondthe 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
d rotation of the pelvis on the fixed femora
turbances in the lumbopelvic rhythm can
o low back pain [3,121,139].

Figure 35.37: Application of unbalanced forces on the pelvis, as

in static one-legged stance on the left, results in asymmetrical,
antagonistic movement at the SIJs along with movement at the
symphysis pubis. This type of movement can be assessed clinically
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
with forward rotation of the pelvis on the fixed femora
[3,139]. Disturbances in the lumbopelvic rhythm can
2
contribute to low back pain [3,121,139].

Figure 35.37: Application of unbalanced forces on the pelvis, as

in static one-legged stance on the left, results in asymmetrical,
antagonistic movement at the SIJs along with movement at the
symphysis pubis. This type of movement can be assessed clinically
by palpating movement of the ASIS and PSIS.

Osteocinem2ca(

Ritmo-Lumboplvico-

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.

Osteocinem2ca(

254

PART III

Movimiento-Plvico-

Clinical Kinesiology and Anatomy of the Trunk

ASIS

Pubic symphysis

Pubic symphysis

Pubic symphysis

Neutral
A

ASIS

ASIS

Anterior tilt
B

Posterior tilt
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

Movimiento-Plvico-

gy and Anatomy of the Trunk

Osteocinem2ca(

the right leg is swingpported 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.
cause the pelvis moves
f there is right forward
hip medial rotation (see
medial rotation occurs
moral head rather than,
ound. With right backleft hip lateral rotation
ns of joint motions that
bed in greater detail in
of some of the associate 17-1.

d by groups of muscles
elvis tilts in the antering muscle groups prog. 17-19). To tilt the
nk extensors, primarily
orly while the hip flexrsely, to tilt the pelvis
up anteriorly while the
s pull down posteriorly
muscle groups are actin opposite directions

he force of gravity can

CH

Pelvis remains
fairly level
Right hip abductors
Back extensors

Pelvis tilts anteriorly

Hip flexors

Pelvis tilts posteriorly

Trunk flexors

Hip extensors

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
(lateral view). The trunk extensors pulling up (posteriorly)
and the hip flexors anterior pulling down (anteriorly) cause
the pelvis to tilt anteriorly.

pelvis, while the right hip abductors (gluteus medius

Figure 17-20. Force couple causing posterior pelvic tilt

(lateral view). The trunk flexors pulling up (anteriorly) and
the hip extensors pulling down (posteriorly) cause the pelvis
to tilt posteriorly.

Rangos-de-Movimiento-Normal-

644

Part III I KINESIOLOGY OF THE HEAD AND SPINE

Osteocinem2ca(

TABLE 35.6: Movement of Sacroiliac Joint

Author(s)

Method(s)

Subjects

Joint Motion Conclusions

Pitkin and
Pheasant
1936

Inclinometry

Living subjects

Unilateral antagonistic movement of the ilium around

transverse axis through the symphysis pubis averaged
11 (319), or 5.5 on each side

Strachan et al.
1938

Mechanical testing of sacral

rotation

Cadavers

During trunk movements, sacral rotation was 15

when one ilium was immobilized and the other was
fixed to the sacrum

Weisl 1955

Movement of sacral
promontory via radiography

Living subjects

Max ventral movement of the sacral promontory was

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

PSISs via palpation

Living subjects

PSISs came 0.5 in. closer in horizontal plane

Colachis et al.
1963

Measured distance between

Kirschner wires implanted in PSISs

Living subjects

Maximum movement of PSISs was 5 mm with flexion

from standing
The axis was not fixed

Kapandji 1974

Theorized based on writings of

Farabeuf and Bonnaire

None

In nutation the ilia approximate and the iliac

tuberosities separate
Opposite in counternutation

Frigerio 1974

Biplanar radiography

Cadavers and
living subjects

Maximum movement between ilium and sacrum was

12 mm (mean ~2.7 mm)
Maximum movement between innominates was 15.5 mm

Egund et al.
1978

Roentgen stereophotogrammetry

Living subjects
with hypoor hypermobile SIJs

Maximum rotation was 2

Axis of sacral rotation was through the iliac tuberosities
at the level of S2
Translations were ~2 mm

Wilder et al.
1980

Theoretical best-fit axes of

rotation based on topographic
analysis of joint surfaces

Dried bony
specimens

Joint rotation cannot occur exclusively about any

previously proposed axis
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
3" greater

Scholten et al.
1988

Biomechanical model

Model

Model relative pelvic motions rarely exceeded 12

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)

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
and 5 ! 3.9 in transverse plane

Smidt et al.
1997

Computed tomography

Cadavers

Sagittal plane sacral rotation was 78

Translation was 48 mm

PSISs, posterior superior iliac spines; SIJ, sacroiliac joint.

En el plano sagital
entre 1 a 8, con
la media de 2 y 3.
Traslacin caudal
del sacro entre 0,5
y 8mm, con media
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,
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

Probably these movements around the Y- and Zaxes 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.

Rangos-de-Movimiento-Normal-

Osteocinem2ca(

Supine to sitting

X
Z

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
inward movement of the iliac crests, noted as
positive values around the Z-axis for the left side
and negative values for the right (Table 23.2).

Standing to prone with

hyperextension

Fig. 23.2 The pelvis with the rotational axes.

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
Ch23-F10178.indd 345

Movimientos Pasivos de 7 a12/27/06

8
grados

9:35:37 AM

Sturesson et al (1989, 2000). The average values for

rotation and translation were low, being 1.8 of rotation (coupled with 0.7 mm of translation) for the men
and 1.9 of rotation (coupled with 0.9 mm translation)
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).
In 1995, Buyruk et al (1995a, b) established that
the Doppler imaging system could be used to measure stiffness of the SIJ. This research has recently
been repeated and confirmed by Leonie Damen
et al (2002a). Doppler imaging of vibrations across
the SIJSacral
hasNutation
shown (Buyruk et al 1995a, b, 1997, 1999,
Damen et al 2002a) that stiffness of the SIJ is variable
between
subjects and therefore the range of motion
Inferoposterior
Glide
is potentially variable. This research has also revealed
that stiffness of the SIJ is symmetric when the left and
right sides are compared in subjects without pelvic
pain and asymmetric in subjects with pelvic pain.
These studies will be discussed in greater depth
later. In conclusion, we know that the SIJs are capable
of a small amount of both angular (14) and translatoric motion (13 mm), that the amplitude of this
motion is variable between subjects; however, within
one subject it should be symmetric between sides.

Atrocinem2ca(

Traslacin-

nd four men
d only 2.5 of
.51.6 mm of
ducted in the
al (2000) felt
955, Colachis
verestimated

f SIJ mobility
ed those of
ge values for
g 1.8 of rotan) for the men
m translation)
es were noted
ed that more
ation should
sling 1995).
ablished that
used to meashas recently
onie Damen
ations across
b, 1997, 1999,
SIJ is variable

NUTATION/COUNTERNUTATION OF THE
Figure 6.7 When the sacrum nutates, its articular surface
SACRUM
glides inferoposteriorly relative to the innominate.
Nutation and counternutation are osteokinematic
terms that describe how the sacrum moves relative
to the innominates regardless of how the pelvic girdle
is moving relative to the lumbar spine and femora.
Nutation of the sacrum occurs when the sacral

Figure 6.7 When the sacrum nutates, its articular surface

glides inferoposteriorly relative to the innominate.

Sacral counterNutation
Anterosuperior
Glide

Figure 6.8 When the sacrum counternutates, its articular

surface glides anterosuperiorly relative to the innominate.

et al 2000). In other words, whenever an individual

is vertical, the sacrum is nutated relative to the
innominates. The amount of sacral nutation
depends on how the individual is sitting or stand-

Osteocinem2ca(

Limitantes-del-MovimientoMsculos(que(refuerzan(y(estabilizan(la(ar2culacin(
sacroiliaca(
1.>-Erector-Espinal2.>-Mul7do-Lumbar3.>-Grupo-Muscular-Abdominal----a.-Oblicuos-Internos-y-externos----b.-Rectos-Abdominal----c.-Transverso-abdominal4.>-Isquio7biales-

Mecnica(Muscular(

Patrones-de-Reclutamiento-

Mecnica(Muscular(

Interaccin-de-Torques-

Funcionalidad(

Aplicacin-de-ConocimientosAdquiridosQue aprendimos del Fenmeno o Test de Flexin Relajacin?

Torque(Extensor(Generado(

Torque((Nm)(

1.>-Msculos-Extensores-

200-

2.>-Ligamentos-

72-

Funcionalidad(

Aplicacin-de-ConocimientosAdquiridosMalas 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-movimiento2.>-Reducir-la-magnitud-de-la-carga-externa3.>-Reducir-la-longitud-del-momento-externo4.>-Aumentar-la-longitud-del-momento-interno-

Funcionalidad(

Aplicacin-de-ConocimientosAdquiridosQu tcnica es mejor?

Funcionalidad(

Aplicacin-de-ConocimientosAdquiridos-

Lying on the side

Lying prone
Lying prone, extended back, supporting on elbows
Laughing heartily, lying laterally
Sneezing, lying laterally
Peaks by turning around

Aplicacin-de-ConocimientosAdquiridos-

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

Funcionalidad(

Table 1. Intradiscal Pressure

Values
forwithout
Different
Sitting
relaxed,
backrest
1. Intradiscal
Pressure
Values
for Different
TableTable
1. Intradiscal
Pressure
Values
for Different
Positions and Exercises
Sitting
actively
straightening
the back
Positions
and Exercises
Positions
and Exercises

Sitting with maximum flexion

Pressure
(MPa)
Sitting bent forward with
tight supporting
the elbows
Position
Pressure
Position
Pressure
(MPa) (MPa)
Sitting slouched into the chair
Standing up from a chair 0.10
Lying supine
Lying supine
Lying supine
0.10 0.10
Lying on the side
0.12
Lying
the side
Lying on
theon
side
0.12 0.12
Lying prone
0.11
Walking barefoot
Lying prone
Lying prone
Lying prone, extended0.11
back,0.11
supporting
on
elbows
Walking with tennis shoes0.25
Lying prone,
extended
back, supporting
on
elbows
0.25
Lying prone,
extended
back, supporting
on
elbows
0.25
Laughing heartily, lying laterally
0.15
Figure
3. Laughing
Radiograph
withlaterally
implanted
transducer approxheartily,
lying
laterallypressure
Laughing
heartily,
lying
0.15 0.15
Sneezing, lying laterally
0.38
imately
inSneezing,
thelying
center
the L4 L5 nucleus
lyingoflaterally
Sneezing,
laterally
0.38 0.38 Jogging with hard street shoes
Peakspulposus.
by turning around
0.700.80
by turning
0.700.80
Peaks Peaks
by turning
aroundaround
0.700.80
Jogging with tennis shoes

Position

Relaxed standing
0.50
Relaxed
standing
0.50
Relaxed
standing
0.50
Climbing
stairs,
one
stair
at
a time
Standing, of
performing
vasalva
maneuver
0.92
by muscle
spasms
thatvasalva
resolved
with
training
the back
musStanding,
performing
vasalva
maneuver
0.92
Standing,
performing
maneuver
0.92
Climbing
stairs,
two
stairs
at
bent forward
1.10a time
cles.Standing,
TwoStanding,
years
the experiment,Standing,
the subject
reported
bent forward
1.10 Walking down stairs, one stair at a time
bent after
forward
1.10 no
further episodes of back pain, and an MRI investigation did not
Walking down stairs, two stairs at a time
Sitting relaxed, without backrest Lifting 20 kg, bent over with
0.46round back
show
anySitting
change
of the
treated
discSitting
in comparison
with
the
relaxed,
without
backrest
0.46
Sitting
relaxed,
without
backrest
0.46
actively straightening the back
0.55 school
Lifting 20 kg as taught in back
Sitting
actively
straightening
the back
Sitting
actively
straightening
the back
status
before
the
experiment.
Sitting with maximum0.55
flexion0.55 Holding 20 kg close to the0.83
body
with maximum
0.83supporting the elbows
SittingSitting
with maximum
flexionflexion
0.83 tight
Sitting bent forward with
0.43
Holding
20
kg,
60
cm
away
from the chest
bent forward
withsupporting
tight supporting
the elbows
0.43
SittingSitting
bent forward
with tight
the elbows
0.43chair
Results
Sitting
slouched
into the
0.27
slouched
into
the chair Standing up from a chair
SittingSitting
slouched
into the
chair
0.27 0.27
1.10
Standing
up
from
a
chair
1.10 Pressure increase during night (over a period of 7 hr)
Standing
up
from
a
chair
1.10
All positions and activities were achieved or performed

actively by the volunteer without

assistance.
Walking
barefoot PositionWalking
barefoot
Walking
barefoot
Walking
with tennis
shoes shoes
Walking
with tennis

mplanted pressure transducer approxoxapproxL4 L5 nucleus pulposus.

0.530.65
0.530.65
Walking with tennis shoes
0.530.65
0.530.65

0.12
0.11
0.25
0.15
0.38
0.700.80
0.50
0.92
1.10
0.46
0.55
0.83
0.43
0.27
1.10
0.530.65
0.530.65
0.350.95
0.350.85
0.500.70
0.301.20
0.380.60
0.300.90
2.30
1.70
1.10
1.80
0.100.24

0.530.65
0.530.65

related measurements
were recorded usually
Jogging with hard street shoes
0.350.95
Jogging
with hard
shoes shoes Jogging with tennis shoes
0.350.95
Jogging
withstreet
hard street
0.350.95
0.350.85 some training.
pretrials; activities
Measurements
Intervertebral
Disc required
Wilke et al 757
Jogging
with
tennis
shoes shoes of Pressures in the
0.350.85
Jogging
with tennis
0.350.85

after two

Ejercicios(

Ejercicios(