For us desk jockeys sitting for eight hours a day at work, proper pelvic alignment and overall workplace ergonomics are constantly preached so that we may be kind to our bodies and maintain the integrity of our musculoskeletal system. For those who are permanently wheelchair-bound, on the other hand, proper pelvic alignment is even more serious.
“If the patient’s pelvis is asymmetrical, they’ll initially notice a little bit of discomfort; kind of like when you wake up in the morning and feel like you slept with your neck wrong,” said Dr. Kirsten Davin OTDR/L, ATP, SMS. “But eventually, poor positioning can lead to a lot of life-altering or life-threatening issues. In some asymmetries, the top of the trunk will flex forward. That can impede that respiratory status, digestive capability, field of vision and other much bigger ramifications than just being a little bit uncomfortable.”
The pelvis is the key point of control, and adjustments can dramatically impact a patient’s seating satisfaction. But where should you start? Dr. Davin has been educating occupational therapists and physical therapists about the challenges of wheelchair seating and positioning for years, filling in the gaps that weren’t covered in traditional schooling. Her upcoming free webinar will help healthcare professionals identify problems in a client’s seating system, find the cause and be able to produce a solution that will result in better symmetry and functional outcomes.
Here are some important pieces of information about pelvic asymmetry that will give you a better understanding of the topic before attending the webinar!
How to Identify Four Pelvic Asymmetries
Some misalignments are easier to identify than others, but if a patient’s pelvis is asymmetric, they will usually fall into one of these four diagnoses:
1. Posterior Pelvic Tilt
- Most common posture seen in wheelchair users
- Pelvis tilted back, spine curved forward, sitting on sacrum and coccyx
- Encourages kyphosis
2. Anterior Pelvic Tilt
- Pelvis tilted forward, lower spine curved back
- Usually seated away from the wheelchair’s back support
3. Pelvic Obliquity
- Pelvis tilted to one side, spine curved to the opposite; one side of the pelvis is higher than the other
- Encourages scoliosis
4. Pelvic Rotation
- Pelvis rotated asymmetrically; one half of the pelvis anterior to the other, spine rotating the opposite way
- Can appear as though a leg length discrepancy is present
Where Do Pelvic Asymmetries Come From?
Just as there are a handful of misalignments, there are a handful of causes that drive patients to present with them. One of the main causes that Dr. Davin cites is core and trunk weakness.
In addition to trunk weakness associated with spinal cord injury, “The trunk can weaken from age or illness,” she said. “Once it weakens, it can allow patients to fall into a forward flexed pattern of sitting, and that pushes the top of the pelvis back. That’s when we start to have the posterior pelvic tilt presenting.”
Other causes of pelvic asymmetry that Dr. Davin noted include:
- Stroke (resulting in one side of the body being weaker or stronger than the other)
- Self-propelling their chair (using one side to self-propel, pushing that side forward and the other side backward)
- Leg positioning
Addressing Pelvic Asymmetry in Wheelchair-Bound Patients
No matter what the patient’s condition is, the first item on your treatment to-do list should always be to get him or her out of the wheelchair for an assessment.
“Get the client out of that chair, sit them on a mat or the edge of the bed and see what’s actually going on with the pelvis,” said Dr. Davin. “Put your hands on the client’s pelvis and try to manipulate it. If that pelvis moves around, then we know that it’s flexible. If we have a flexible pelvis, then we can do some exercises to strengthen along with adjustments with the actual cushion itself to push one half of the client up.”
… And if the pelvis is not flexible?
“We can still do some adjustments, but this time we’re going to be accommodating with our seating system,” said Dr. Davin. “So we’re not going to change the client, but we’re going to change the wheelchair seating system to accommodate what’s going on. That can be done via cushion adjustments, seating adjustments or different types of products such as pelvic belts, lateral supports or additions to the wheelchair.”
Get the Full Training for Free
Dr. Davin’s free seating and positioning webinars will help you build the best plans of care to improve and neutralize common conditions in wheelchair –bound patients. Register today to learn from the master herself, and sign up to our email list for additional articles and educational opportunities!