1. PMG NTE 2009 Parallel Session Posterior pelvic tilt (in sitting) Pat Postill, Physiotherapist David Long, Clinical Scientist both from Oxford Centre for Enablement, Nuffield Orthopaedic Centre NHS Trust

2. Is posterior tilt of the pelvis inevitable in the non ambulant population? Are we as service providers exacerbating the problem? Do we expect too much?

3. Aims of the session To describe why posterior tilt is potentially destructive and dysfunctional To explore potential “benefits” of posterior pelvic tilt

4. Aims of the session To highlight that if postural limitations are not accommodated there will be a tendency for the pelvis to become posteriorly tilted Raise awareness that ramped seating can lead to a posteriorly tilted pelvis rather than provide a stable base Provide potential clinical solutions including a case study example

5. Posture is what? The constant struggle to remain erect against the forces of gravity A series of positions that we use from which to function

6. Posture - ‘a constant struggle against the force of gravity’ (Hare, 1987)

7. In pairs……... Identify the three elements of ‘good’ posture

8. “That body attitude which facilitates maximum performance for minimum energy consumption and without causing damage to the body system.” (Pope, 2007)

9. So what are the ……... Three elements of ‘bad’ posture

10. “That which results in less accuracy, is carried out with increased effort and leads to damage to the body.” (Pope, 2007)

11. Assessment Full assessment of physical and personal profile is vital including functional and lifestyle aspects Lack of knowledge of a fixed postural asymmetry can lead to inappropriate prescription and thus give people no option but to sit with a posteriorly tilted pelvis

12. Consequences of sitting with a posteriorly tilted pelvis Lack of lumbar lordosis (loss or not developed) Reduces the ability to extend the spine Resulting postural kyphosis –Spine more prone to scoliosis due to opened facet joints Neck flexed or hyper extended (poking chin)

13. Consequences of sitting with a posteriorly tilted pelvis Likelihood of sliding forward on seat (shear forces – tissue damage) Loss of stability possibly leading to increased tone Not energy efficient What functions does this impact?

14. Functions compromised by kyphotic posture Breathing Swallowing Digestion Communication

15. Assessment wAnalyse. Identify what can and what cannot be corrected (from your assessment) Accommodate accordingly

16. What physical limitations can lead to a posteriorly tilted pelvis? Hip flexion Knee extension with hip flexed Leg length discrepancy Lack of lumbar lordosis Fixed kyphosis

17. Clinical suggestions for the following limitations: Hip flexion Knee extension with hip flexed Leg length discrepancy Lack of lumbar lordosis Fixed kyphosis

18. “Benefits” of posterior pelvic tilt Energy efficiency Stability What are the issues related to sitting with a neutral pelvis in neutral tilt in space?

19. How can we augment postural stability and provide an energy efficient seated position? Tilt in space Forward lean e. g. SAM seating system

20. Pot holes Riser / recliner chairs Elevating leg rests on wheelchairs Excessive ramping Overly long seat depth (measurement)

21. Aims of the session To describe why posterior tilt is potentially destructive and dysfunctional To explore potential “benefits” of posterior pelvic tilt

22. Aims of the session To highlight that if postural limitations are not accommodated there will be a tendency for the pelvis to become posteriorly tilted Raise awareness that ramped seating can lead to a posteriorly tilted pelvis rather than provide a stable base Provide potential clinical solutions including a case study example

23. Is posterior tilt of the pelvis inevitable in the non ambulant population? Are we as service providers exacerbating the problem? Do we expect too much?

24. Health warning! Equipment can create more problems through inappropriate recommendation due to lack of thorough assessment

25. References / Resources Pope PM 2007 Severe and Complex Neurological Disability Elsevier Hare N, 1987 The Human Sandwich Factor Congress Lecture, Chartered Society of Physiotherapy, Oxford Details of further courses available: –pat.postill@noc.nhs.ukpat.postill@noc.nhs.uk –dave.long@noc.nhs.ukdave.long@noc.nhs.uk www.posture24.com