Influence of muscular imbalances on pelvic position and lumbar lordosis: a theoretical basis

Eva Buchtelová, Miroslav Tichý, Kateřina Vaníková
University, Faculty of Health Studies, Department of Physiotherapy and Occupational Therapy

Korespondenční autor: Eva Buchtelová (

ISSN 1804-7181 (On-line)

Full verze:
Full version

Submitted:25. 3. 2013
Accepted: 7. 5. 2013
Published online: 28. 6. 2013


This body of research originated as the theoretical basis for part of a dissertation. The aim of this literature review was to obtain a clear picture of the relationships between individual systems which contribute to the development of muscle imbalances. In particular the relationships involved in activation of muscles located in the abdominal wall and back, the position of the pelvis and spine, the associated skeletal muscles found in these areas, as well as the behavior of abdominal muscles in relation to breathing. Based on an analysis of the literature, it was possible to make some generalizations that should be taken into account during the planning of scientific experiments, as well as the planning of preventive or therapeutic strengthening exercises:

  1. There is a mutual relationship between the position of the pelvis and

the shape of the spine, as well as the function of the abdominal and back muscles.

  1. The position of the pelvis and the shape of the lumbar spine are subject

to influence from other parts of the musculoskeletal system. These influences come from both the lower limbs and the upper regions of the torso.

  1. Skeletal muscle structure, pelvic position and the shape of the spine vary

with age. There is a relative increase in the number of slow-twitch fibres within the muscles, which leads to changes in postural functionality. The pelvis gradually tilts forward and results in horizontalization of the sacrum and a deepening of lumbar lordosis.

  1. Previously noted age-related changes can exacerbate pathological

conditions of the lower back.

  1. Muscles can generally be divided into two groups: those muscles

which are primarily involved in local stabilization and those primarily involved in movement and coordination of multiple sections of the musculoskeletal system.

Keywords: abdominal muscles; breathing; pelvic position; skeletal muscle structure; muscular imbalance


1. Abe T, Yamada T, Tomita T, Easton PA (1999). Posture effects on timing of abdominal muscle activity during stimulated ventilation. Journal of Applied Physiology. 86/6: 1994–2000. ISSN 87507587.

2. Allison GT, Morris SL, Lay B (2008). Feedforward responses of transversus abdominis are directionally specific and act asymmetrically: implications for core stability theories. Journal of Orthopaedic and Sports Physical Therapy. 38/5: 228–237. ISSN 01906011.

3. Alvim FC, Peixoto JG, Vicente EJ, Chagas PS, Fonseca DS (2010). Influence of the extensor portion of the gluteus maximus muscle on pelvic tilt before and after the performance of a fatigue protocol. Revista Brasileira de Fisioterapia. 14/3: 206–213. ISSN 14133555.

4. Barrey C, Jund J, Noseda O, Roussouly P (2007). Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. European Spine Journal. 16/9: 1459–1467. ISSN 09406719.

5. Caix M, Outrequin G, Descottes B, Kalfon M, Pouqet X (1984). The muscles of the abdominal wall: a new functional approach with anatomoclinical deductions. Anatomica Clinica. 6/2: 101–108. ISSN 03436098.

6. Cibulka MT, Sinacore DR, Cromer GS, Delitto A (1998). Unilateral Hip Rotation Range of Motion Asymmetry in Patients with Sacroiliac Joint Regional Pain. Spine. 23/9: 1009–1015. ISSN 03622436.

7. Claus AP, Hides JA, Moseley GL, Hodges PW (2009). Different ways to balance the spine: subtle changes in sagittal spinal curves affect regional muscle activity. Spine. 34/6: E208–214. ISSN 03622436.

8. Congdon R, Bohannon R, Tiberio D (2005). Intrinsic and imposed hamstring length influence posterior pelvic station during hip flexion. Clinical Biomechanice. 20/9: 947–951. ISSN 02680033.

9. Cummings G, Scholz JP, Barnes K (1993). The Effect of imposed leg length difference on pelvic bone asymmetry. Spine. 18/3: 386–373. ISSN 03622436.

10. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Stevens VK, De Cuyper HJ (2001). A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting. Spine. 26/6: E114–121. ISSN 03622436.

11. De Troyer A (1983). Mechanical role of the abdominal muscles in relation to posture. Respiration Physiology. 53/3: 341–353. ISSN 00345687.

12. Demoulin C, Crielaard JM, Vanderthommen M (2007). Spinal muscles evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine. 74/1: 9–13. ISSN 1297– 319X.

13. Evcik D, Yücel A (2003). Lumbar lordosis in acute and chronic low back pain patients. Rheumatology International. 23/4: 163–165. ISSN 01728172.

14. Freburger JK, Riddle DL (1999). Measurement of Sacroiliac Joint Dysfunction: A Multicenter Intertester Reliability Study. Physical Therapy. 79/12: 1134–1141. ISSN 00319023.

15. Gajdosik RL, Albert CR, Mitman JJ (1994). Influence of hamstring length on the standing position and flexion range of motion of the pelvic angle, lumbar angle, and thoracic angle. Journal of Orthopaedic and Sports Physical Therapy. 20/4: 213–219. ISSN 01906011.

16. Gandevia SC, Butler JE, Hodges PW, Taylor JL (2002). Balancing acts: Respiratory sensations, motor control and human posture. Clinical and Experimental Pharmacology and Physiology. 29/1–2: 118– 121. ISSN 1440–1681.

17. Gierada DS, Curtin JJ, Erickson SJ, Prost RW, Strandt JA, Goodman LR (1995). Diaphragmatic motion: fast gradient – recalled – echo MR imaging in healthy subjects. Radiology. 194/3: 879–884. ISSN 00338419.

18. Greenman PE (1986). Innominate shear dysfunction in the sacroiliac syndrome. Journal of Manual Medicine. 2: 114–121. ISSN 0935–6339.

19. Häggmark T, Thorstensson A (1979). Fibre types in human abdominal muscles. Acta Physiologica Scandinavica. 107/4: 319–325. ISSN 1365–201X.

20. Harrison DE, Cailliet R, Harrison DD, Janik TJ (2002). How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt and thoracic kyphosis? European Spine Journal. 11/3: 287–293. ISSN 09406719.

21. Hashemirad F, Talebian S, Hatef B, Kahlaee AH (2009). The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion-extension. Journal of Electromyography Kinesiology. 19/5: 746–753. ISSN 1050–6411.

22. Hodges PW, Richardson CA (1996). Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain: A motor control evaluation of transverses abdominis. Spine. 21/22: 2640–2650. ISSN 03622436.

23. Hodges PW, Heijnen I, Gandevia SC (2001). Postural activity of the diaphragm is reduced in humans when respiratory demand increases. The Journal of Physiology. 537/3: 999–1008. ISSN 00223751.

24. Hodges PW, Eriksson AEM, Shirley D, Gandevia SC (2005). Intra-abdominal pressure increases stiffness of the lumbar spine. Journal of Biomechanics. 38/9: 1873–1880. ISSN 00219290.

25. Kalimo H, Rantanen J, Viljanen T, Einola S (1989). Lumbar muscles: structure and function. Annals of Medicine. 21/5: 353–359. ISSN 07853890.

26. Kera TA, Maruyama H (2005). The effect of posture on respiratory activity of the abdominal muscles. Journal of Physiological Anthropology and Applied Human Science. 24/4: 259–265. ISSN 13453475.

27. Kiryu S, Loring SH, Mori Y, Rofsky NM, Hatabu H, Takahashi M (2006). Quantitative analysis of the velocity and synchronicity of diaphragmatic motion: dynamic MRI in different postures. Magnetic Resonance Imaging. 24: 1325–1332. ISSN 1522–2586.

28. Kolář P (2007). Vertebrogenní obtíže a stabilizační funkce páteře – terapie [Vertebral difficulties and stabilizing function of the spine – therapy]. Rehabilitace a fyzikální lékařství. 14/1: 3–17. ISSN 12112658 (Czech).

29. Kolář P (2009). Analýza zobrazení pohybu bránice magnetickou rezonancí v kombinaci se spirometrickým vyšetřením. Autoreferát disertační práce [Analysis of motion display the diaphragm magnetic resonance imaging in combination with spirometry. Summary of dissertation]. 2. LF UK, Univerzita Karlova Praha (Czech).

30. Kolář P, Šulc J, Kyncl M, Sanda J, Čakrt O, Anděl R, Kumagai K, Kobesova A (2012). Postural function of the diaphragm in persons with and without chronic low back pain. Journal of Orthopaedic and Sports Physical Therapy. 42/4: 352–362. ISSN 01906011.

31. Kondo T, Kobayashi I, Taguchi Y, Hayama N, Tajiri S, Yanagimachi N (2005). An analysis of the chest wall motions using the dynamic MRI in healthy elder subjects. Tokai Journal Experimental and Clinical Medicine. 30/1: 15–20. ISSN 03850005.

32. Korovessis P, Stamatakis M, Baikousis A (1999). Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients. Journal of Spinal Disorders. 12/2: 131–137. ISSN 08950385.

33. Kovanen V (1989). Effects of ageing and physical training on rat skeletal muscle. An experimental study on the properties of collagen, laminin, and fibre types in muscles serving different functions. Acta Physiologica Scandinavica. Suppl. 577: 1–56. ISSN 03022994.

34. Kovanen V, Suominen H, Heikkinen E (1984). Collagen of slow twitch and fast twitch muscle fibres in different types of rat skeletal muscle. European Journal of Applied Physiology and Occupational Physiology. 52/2: 235–242. ISSN 03015548.

35. Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O’Brien M (2005). The importace of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 30/6: S27–34. ISSN 03622436.

36. Lewit K (2003). Manipulační léčba v myoskeletální medicíně [Handling therapy in musculoskeletal medicine]. 5. zcela přeprac. vyd. Praha: Sdělovací technika, 424 s. ISBN 80–86645–04–5 (Czech).

37. Lexell J (1995). Human aging, muscle mass, and fibre type composition. Journal of Gerentology and Biological Science and Medical Science. 50: 11–16. ISSN 1758–535X.

38. Loring SH, Mead J (1982). Abdominal muscle use during quiet breathing and hyperpnea in uninformed subjects. Journal of Applied Physiology Respiratory Environmental and Exercise Physiology. 52/3: 700–704. ISSN 01617567.

39. Mac-Thiong JM, Berthonnaud E, Dimar JR II., Betz RR, Labelle H (2004). Sagittal alignment of the spine and pelvis during growth. Spine. 29/15: 1642–1647. ISSN 03622436.

40. Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P (2007). Sagittal spinopelvic balance in normal children and adolescents. European Spine Journal. 16/2: 227–234. ISSN 09406719.

41. Mac-Thiong JM, Wang Z, De Guise JA, Labelle H (2008). Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine. 33/21: 2316– 2325. ISSN 03622436.

42. Mannion AF, Dumas GA, Cooper RG, Espinosa FJ, Faris MW, Stevenson JM (1997a). Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences. Journal of Anatomy. 190/4: 505–513. ISSN 00218782.

43. Mannion AF, Weber BR, Dvorak J, Grob D, Müntener M (1997b). Fibre type characteristics of the lumbar paraspinal muscles in normal healthy subjects and in patients with low back pain. Journal of Orthopaedic Research. 15/6: 881–887. ISSN 07360266.

44. Martin JG, De Troyer A (1982). The behaviour of the abdominal muscles during inspiratory mechanical loading. Respiration Physiology. 50/1: 63–73. ISSN 0034–5687.

45. Moseley GL, Hodges PW, Gandevia SC (2002). Deep and superficial fibres of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine. 27/2: E29–36. ISSN 15281159.

46. Negrão Filho Rde F, Silva A, Monteiro TL, Alves N, de Carvalho AC, de Azevedo FM (2009). Lumbopelvic stability and electromyography of abdominal muscles in ballet dancers. Electromyography and Clinical Neurophysiology. 49/8: 377–384. ISSN 0301–150X.

47. Ng JK, Richardson CA, Kippers V, Parnianpour M (1998). Relationship between muscle fibre composition and functional capacity of back muscles in healthy subjects and patients with back pain. Journal of Orthopaedic and Sports Physical Therapy. 27/6: 389–402. ISSN 01906011.

48. Nikolić M, Malnar-Dragojević D, Bobinac D, Bajek S, Jerković R, Soić-Vranić T (2001). Age-related skeletal muscle atrophy in humans: an immunohistochemical and morphometric study. Collegium Antropologicum. 25/2: 545–553. ISSN 03506134.

49. O’Sullivan PB, Gramamslaw KM, Kendell M, Lapenskie SC, Möller NE, Richards KV (2002). The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. Spine. 27/11: 1238–1244. ISSN 03622436.

50. Plathow C, Fink C, Sandner A, Ley S, Puderbach M, Eichinger M, Schmähl A, Kauczor HU (2005). Comparison of relative forced expiratory volume of one second with dynamic magnetic resonance imaging parameters in healthy subjects and patients with lung cancer. Journal of Magnetic Resonance Imaging. 21/3: 212–218. ISSN 1522–2586.

51. Rychlíková E (2002). Funkční poruchy kloubů končetin: diagnostika a léčba [Functional disorders of the joints of the extremities: diagnosis and treatment]. Praha: Grada, 256 s. ISBN 80–247–0237–1 (Czech).

52. Silverstolpe L (1989). A pathological erector spinae reflex – a new sign of mechanical pelvis dysfunction. Journal of Manual Medicine. 4/1: 28. ISSN 09356339.

53. Shields RK, Heiss DG (1997). An electromyographic comparrison of abdominal muscle synergies during curl and double straight leg lowering exercises with control of the pelvic position. Spine. 22/16: 1873–1879. ISSN 03622436.

54. Suga K, Tsukuda T, Awaya H, Takano K, Koike S, Matsunaga N, Sugi K, Esato K (1999). Impaired respiratory mechanics in pulmonary emphysema: Evaluation with dynamic breathing MRI. Journal of Magnetic Resonance Imaging. 10/4: 510–520. ISSN 10531807.

55. Takahashi M, Nitta N, Sawai S, Tezuka N, Fujino S, Murata K (2007). Assessment of diaphragmatic motion after lung resection using magnetic resonance paging. Radiation Medicine. 25: 155–163. ISSN 1527–1315.

56. Tichý M (2009). Dysfunkce kloubu VII. Řetězení a viscerovertebrální vztahy [Joint dysfunction VII. Chaining and viscerovertebral relations]. Praha: Karolinum, 92 s. ISBN 978–80–254–3963–0 (Czech).

57. Thorstensson A, Carlson H (1987). Fibre types in human lumbar back muscles. Acta Physiologica Scandinavica. 131/2: 195–202. ISSN 1365–201X.

58. Urquhart DM, Hodges PW (2005). Differential activity of regions of transversus abdominis during trunk rotation. European Spine Journal. 14/4: 393–400. ISSN 09406719.

59. Urquhart DM, Hodges PW, Allen TJ, Story IH (2005a). Abdominal muscles recruitment during a range of voluntary exercises. Manual Therapy. 10/2: 144–53. ISSN 1356689X.

60. Urquhart DM, Hodges PW, Story IH (2005b). Postural activity of the abdominal muscles varies between regions of these muscles and between body positions. Gait and Posture. 22/4: 295–301. ISSN 09666362.

61. Workman JC, Docherty D, Parfrey KC, Behm DG (2008). Influence of pelvic position on the activation of abdominal and hip flexor muscles. Journal of Strength and Conditioning Research. 22/5: 1563– 1569. ISSN 10648011.