Pelvic instability A significant percentage of the stress-related musculoskeletal pathology of the trunk occurs at the lumbopelvic region. This region includes the lumbar spine, lumbosacral junction, and the sacroiliac joints. The term lumbopelvic instability has evolved to describe a painful, usually nonspecific, condition that is associated with hypermobility at one or more of the articulated segments. The amount of hypermobility may be slight and difficult to quantify through routine clinical assessment. This condition, nevertheless, is believed capable of generating excessive stress on spinal related structures, including the interbody, apophyseal joint and sacroiliac joints, spinal ligaments, and neural tissues. Persons often seek medical attention when pain occurs with movement in the region. The clinical picture of this condition is often complicated by the uncertainty regarding whether lumbopelvic instability is the cause or the effect of other impairments in the low back, such as degenerative disc disease
Therapeutic Exercise including Pilates as a Way to Improve Lumbopelvic Stability Weakness, fatigue, or the inability to specifically control the timing or magnitude of forces produced by the trunk muscles has long been suspected as a potential cause, or at least an associated factor, in the pathogenesis of lumbopelvic instability. For this reason, specific muscular-based exercises are often considered an essential component of conservative treatment for this condition The following lists four themes that tend to be emphasized with this therapeutic approach. 1. Train persons how to selectively activate deeper stabilizers of the trunk, most notably the lumbar multifidi, transversus abdominis, and internal oblique. Activation of these muscles appears particularly important for establishing a baseline stability of the lumbopelvic region, especially in advance of unexpected or sudden movements of the trunk or extremities.
The literature suggests that some persons with low-back pain have difficulty selectively activating these muscles, especially while maintaining a neutral position of the lumbar spine. As a part of the initial treatment, some clinicians attempt to instruct persons to “draw in” (or hollow) the abdomen, an action performed almost exclusively by bilateral contraction of the transversus abdominis and internal oblique. Teaching subjects to selectively activate these deeper muscles can be enhanced by using feedback supplied by rehabilitation real-time ultrasound imaging. Once a subject has learned to selectively activate these muscles, the next step is to maintain the activation during the performance of other abdominal exercises or during activities of daily living —a concept referred to as “core awareness.” Such awareness needs to be maintained as more challenging resistive exercises are applied to the other important stabilizing muscles of the trunk and lower extremities.