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Thread: Pelvic obliquity, posture and seating system

  1. #1
    Senior Member Clipper's Avatar
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    Pelvic obliquity, posture and seating system

    I've become increasingly frustrated with my posture and my seating system. I've been using an Aspen system for a little over a year (Ride cushion and custom back) but my discomfort has only increased. When I was initially evaluated, I was told I have a pelvic obliquity (my right side dips) and that it could not be corrected, only prevented from getting worse. Now it appears that the scoliosis caused by this condition has become more pronounced, and I am experiencing significant pain in my right hip. I've been to the seating clinic four times in the last two months, but the adjustments have not helped. My questions for anyone who knows:

    Is the scoliosis caused by the pelvic obliquity, or is the pelvic obliquity caused by the scoliosis?

    Could there be something more going on, like a dislocated hip or other skeletal issue?

    I've been keeping an eye on my skin, since I know I'm not sitting correctly, but there are no signs of redness. Still, I have a sharp pain in my rear (despite a lack of sensation). Should this be a concern?

    Hopefully, SCI-OTR can chime in here. I'm 20 years post injury, C-5/6 complete. I use a Quickie P-222.

  2. #2
    Have you had a recent AP (anterior/posterior) spine xray? That would reveal a lot. I would consider seeing your spine surgeon or physiatrist with this problem....
    jon

  3. #3
    I'll only be able to "chime in" briefly tonight because I've got stuff to do for work tomorrow. Sorry to hear the Ride cushion doesn't seem to be working out.

    Although I think it is kind of a vicious circle (caused by an imbalance in trunk strength/spasticity, leg length discrepancy, or issues with lower extremity positioning), the scoliosis is more the result of the pelvic obliquity than vice-versa. The pelvis tilts, the lower lumbar spine follows, and the upper lumbar and thoracic spine bend back to compensate...



    Since it must also provide pressure relief, it is sometimes difficult to reposition the pelvis symmetrically using the properties of the cushion without causing excessive pressure. If that is the case, the objective must be to stabilize the pelvis as much as possible. To prevent further progression of the scoliosis, one must find another location to provide support. In most cases this would be higher up in the thoracic area (i.e. the rib cage).

    Since the muscles of the trunk can also shorten, it may be possible to prevent progression of the problem through stretching/strengthening exercises.

  4. #4
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    Quote Originally Posted by SCI_OTR View Post
    I'll only be able to "chime in" briefly tonight because I've got stuff to do for work tomorrow. Sorry to hear the Ride cushion doesn't seem to be working out.

    Although I think it is kind of a vicious circle (caused by an imbalance in trunk strength/spasticity, leg length discrepancy, or issues with lower extremity positioning), the scoliosis is more the result of the pelvic obliquity than vice-versa. The pelvis tilts, the lower lumbar spine follows, and the upper lumbar and thoracic spine bend back to compensate...



    Since it must also provide pressure relief, it is sometimes difficult to reposition the pelvis symmetrically using the properties of the cushion without causing excessive pressure. If that is the case, the objective must be to stabilize the pelvis as much as possible. To prevent further progression of the scoliosis, one must find another location to provide support. In most cases this would be higher up in the thoracic area (i.e. the rib cage).

    Since the muscles of the trunk can also shorten, it may be possible to prevent progression of the problem through stretching/strengthening exercises.

    that looks just like me. i sleep sometime with a rolled up towel between hip and rib to open up its so uncomfortable, what exercises are recommended?


    thanks

  5. #5
    Quote Originally Posted by Clipper View Post
    Is the scoliosis caused by the pelvic obliquity, or is the pelvic obliquity caused by the scoliosis?

    Could there be something more going on, like a dislocated hip or other skeletal issue?
    Hip subluxation or dislocation can be a cause of (increased) pelvic obliquity. Hip subluxations or dislocations are not uncommon in SCI. You need an X-Ray to confirmate this. Are your thighs of the same length? A dislocated hip "shortens" the thigh. Did your involved hip loose range of motion? A dislocated hip has restricted range of motion.
    Also a worsening of scoliosis is not uncommon in SCI.
    Both conditions are orthopedic deformities that can't be corrected with physio or positioning. I would look for an orthopedic surgeon with experience in treating SCI or neuromuscular conditions.

    Antonio

  6. #6
    Senior Member Clipper's Avatar
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    Thanks to everyone who replied. I have a doctors appointment next week, so hopefully that'll get me somewhere. I hate feeling like I'm falling apart.

  7. #7
    Quote Originally Posted by SCI_OTR View Post
    I'll only be able to "chime in" briefly tonight because I've got stuff to do for work tomorrow. Sorry to hear the Ride cushion doesn't seem to be working out.

    Although I think it is kind of a vicious circle (caused by an imbalance in trunk strength/spasticity, leg length discrepancy, or issues with lower extremity positioning), the scoliosis is more the result of the pelvic obliquity than vice-versa. The pelvis tilts, the lower lumbar spine follows, and the upper lumbar and thoracic spine bend back to compensate...




    Since it must also provide pressure relief, it is sometimes difficult to reposition the pelvis symmetrically using the properties of the cushion without causing excessive pressure. If that is the case, the objective must be to stabilize the pelvis as much as possible. To prevent further progression of the scoliosis, one must find another location to provide support. In most cases this would be higher up in the thoracic area (i.e. the rib cage).

    Since the muscles of the trunk can also shorten, it may be possible to prevent progression of the problem through stretching/strengthening exercises.
    Dead SCI-OTR, I just received a request from somebody to use the image that you displayed. Since I don't know where it comes from, can you provide a link for the source or, if you are the source for the image, can you give permission for its use? Thanks. Wise.

  8. #8
    Wise,

    I originally Google'd a combination of "pelvic obliquity" with some other word and clicked though quite a few pages before finding it. I believe I only did some minor editing. I tried to similar searches to relocate it, but ironically, this image is the first to come up and the original is no where to be found.

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