Next Article in Journal
Transapical vs. Transaxillary Access in Transcatheter Aortic Valve Implantation: Comparative Mortality and Long-Term Outcomes Using Inverse Probability of Treatment Weighting Analysis
Previous Article in Journal
Clinical, Genetic, EEG, Neuroimaging Insights and Conservative Treatment in Pediatric Focal Epilepsy: A Retrospective Observational Study
Previous Article in Special Issue
3D Digital Anatomical Models Based on Computed Tomographic Morphometric Analysis of C1 and C2 for Surgical Navigation
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 14
Issue 7
10.3390/jcm14072229
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination

by
Karol Bibrowicz
1,
Katarzyna Ogrodzka-Ciechanowicz
2,*,
Zuzana Hudakova
3,4,5,
Tomasz Szurmik
6,
Bartosz Bibrowicz
7 and
Piotr Kurzeja
8
1
Science and Research Center of Body Posture, Kazimiera Milanowska College of Education and Therapy, 61-473 Poznan, Poland
2
Institute of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Culture in Krakow, 31-571 Krakow, Poland
3
Faculty of Health, Catholic University, 034 01 Ružomberok, Slovakia
4
Department of Health Care Studies, College of Polytechnics, 586 01 Jihlava, Czech Republic
5
SNP Central Military Hospital, Faculty Hospital, 034 01 Ružomberok, Slovakia
6
Faculty of Arts and Educational Science, University of Silesia, 43-400 Cieszyn, Poland
7
Research and Development Center Legia Lab, Legia Warszawa, 00-449 Warszawa, Poland
8
Institute of Health Sciences, Academy of Applied Sciences, 34-400 Nowy Targ, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(7), 2229; https://doi.org/10.3390/jcm14072229
Submission received: 13 February 2025 / Revised: 13 March 2025 / Accepted: 21 March 2025 / Published: 25 March 2025
(This article belongs to the Special Issue Challenges in Spinal Deformity)
Browse Figures
Versions Notes

Abstract

:
Background: The pelvic girdle is an important component of the human stabilization system, both during the maintenance of an upright standing position and during motor activities. Frequent functional and structural asymmetries within it can affect the structure and function of many organs and systems of the human body. The mechanism of their occurrence is not fully explained. The objective of the present study was to verify the hypothesis regarding the relationship between the value of pelvic asymmetry and the functional state of muscles that stabilize the lumbo–pelvic–hip complex, as measured by changes in their stiffness. Methods: The study group consisted of 40 young women aged from 19 to 29 years. The observational cross-sectional study incorporated the following elements: an interview, an anthropometric test, an inclinometric assessment of the magnitude of hip girdle rotation utilizing a duometer and tensiomyography. Results: Analysis of the variables examined in subjects with symmetric or rotated pelvises did not show significant differences between the studied sides in the two groups. Evaluation of associations between the magnitude of pelvic rotation and tensiomyography findings showed that with increased pelvic rotation, the stiffness of the back extensor muscles and the rectus thigh muscles increased only slightly bilaterally, and the contraction rate of the rectus abdominis and biceps thigh muscles decreased. Conclusions: The results of the tensiomyography study did not unequivocally demonstrate that changes in pelvic symmetry in the transverse plane are associated with dysfunction of the muscles that stabilize the pelvic girdle.

1. Introduction

Symmetry is quite rare in the human body. However, asymmetries are commonly observed. They can be both morphological and functional. They are connected with ontogenetic development, lateralization, the character of work, sport activities or lasting diseases [1,2,3,4,5,6,7,8,9,10]. Mechanisms are described in which diseases can be primary causes of pelvic asymmetry or the opposite—where they can lead to illnesses and ailments [11,12,13,14,15,16]. Sometimes, body asymmetries among children and adolescents can have a direct impact on posture development and the occurrence of spinal deformations as well as on postural stability [17]. The role of physicians, anthropologists, biomechanics and physiotherapists is to evaluate these asymmetries and determine their origin, their influence on the patient’s health, and—if they can cause overloads and, consequently, degenerative changes and pain—to develop preventive strategies and therapeutic methods. Asymmetries in the pelvic girdle area seem to be worth particular attention. They are connected with, among others, the pelvic girdle, which functions as a buffer in transferring biomechanical loads, in locomotion or in back pains [11,13,15,18]. So far, the mechanisms of asymmetries have not been fully explained [19,20]. Those who search for the causes and, consequently, methods of therapy for pelvic asymmetries often assume that musculoskeletal asymmetries often coexist with myofascial disfunctions [13,16,18]. Since changes occur in the orientation of the selected skeletal landmarks and with them, changes in the location of muscle attachments and the fascial system, then some changes in muscle functions, especially tension, should occur as well [14,16]. Many popular therapeutic methods based on the correction of the myofascial system, like PIR, myofascial release or Rolfing [19,21,22], involve different types of activities to restore myofascial balance and, thus, eliminate the overload factors.
Different forms of asymmetry, regarding both morphology and functioning, are much more common. This is true also for the pelvic girdle area. Pelvic asymmetry is observed in the orientation of pelvic bones in the frontal, sagittal and transverse planes [11,20,23]. Asymmetries can be of the primary type, with a functional background, as well as the secondary type, resulting from different diseases like scoliosis or leg length discrepancy [12,13,18]. One of the symptoms of pelvic asymmetry is its rotation. Lewit [19] describes it as a contralateral asymmetry of both pelvic bones, which involves elevation of the posterior superior iliac spine with simultaneous lowering of the anterior superior iliac spine on the same side. Most often, the anterior superior iliac spines are lowered on the right side. This mechanism leads to an oblique positioning of the sacral bone, which results in posture asymmetry and asymmetrical transfer of dynamic loads from the lower limbs to the trunk. This may cause a reflex increase in the muscle tone which, in turn, leads to an apparent shortening of one leg. So far, the pelvic rotation mechanism has not been fully explained. Numerous studies revealed asymmetric tissue adaptations within the bone and muscle systems in persons engaged in sports, which are mainly unilateral [1,5]. This finding suggests the hypothesis that directional asymmetry can be interpreted as an asymmetric anatomical adaptation that occurs in response to unilateral, repetitive biomechanical loads [7,24]. According to the classic overload principle, anatomic adaptation of biological tissues occurs when these tissues are subjected to a level of stress that exceeds their typical stress threshold during routine daily activities [25]. The hypothesis posits that asymmetries of the pelvis can result in an inaccurate mechanical distribution of load on the body, thereby increasing the stress on the soft tissues in the lumbar region. These asymmetries have been linked to the onset of non-specific chronic back pain [15].
A question arises about effective prevention of pelvic asymmetries, and about the relationship between the asymmetry magnitude and stiffness of the muscles that stabilize the pelvic girdle. Assessment capabilities regarding the functional condition of tissues have improved greatly in the recent years. This is due to the development of research methods and tools which eliminate the shortcomings of palpation.
In particular, this may be the case when assessing muscle stiffness. Some studies have suggested a possible link between muscle stiffness and factors such as joint flexibility, postural balance and the risk of injury [26,27,28]. Furthermore, it has been suggested that an appropriate level of lower limb stiffness may be required to achieve optimal performance in activities such as running, jumping and hopping [29]. The measurement of muscle or tendon stiffness is believed to have several valuable applications. These applications include the detection of pathological changes, the monitoring of the effectiveness of rehabilitation programs, the direct assessment of athletic performance and the comparison of the effectiveness of different interventions for research purposes [30]. This refers to both evaluation of the surface muscles using a Myoton and tensiomyography (TMG), and examinations of more deeply located muscles by means of elastography [31,32,33,34,35,36,37,38]. TMG is a highly reliable method [32,33]. The examination is performed using a TMG device consisting of an electric stimulator, electrodes, a sensor which measures the size of the muscle belly displacement and the dedicated software [32].
The purpose of this study was an attempt to verify the hypothesis about the relationship between the value of pelvic asymmetry and the functional state of muscles stabilizing the lumbo–pelvic–hip complex, expressed as a change in their stiffness.

2. Materials and Methods

2.1. Study Design

This observational cross-sectional study adheres to the guidelines of the Helsinki Declaration and was conducted in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies [39].
The observation was conducted as part of a long-term research program that was approved by the Bioethics Committee of the College of Physiotherapy in Wrocław (No. 1/2010, 25 June 2010).

2.2. Setting

This study was carried out between March and November 2020 at the Kazimiera Milanowska College of Education and Therapy in Poznań, Poland.

2.3. Participants

A total of 136 female students pursuing a degree in physiotherapy at the College of Education and Therapy in Poznań, Poland, were included in the study. The participants ranged in age from 19 to 29 years (X = 21.43, SD = 3.18). The survey revealed that none of the women were engaged in competitive sports.
The inclusion criteria were as follows:
  • age between 19 and 29 years;
  • right lateralization of the hand and foot;
  • no discernible abnormalities were observed in the subject’s body composition;
  • Body mass index (BMI) between 18.5 and 24.9.
The exclusion criteria were as follows:
  • pain in the lumbo–pelvic–hip complex area or use of analgesics during the tests;
  • pregnancy or menstrual phase;
  • lack of written consent to take part in the study.
From the group that met the specified criteria, 40 women were selected at random to participate in the study. These women were divided into two groups of 20 individuals each, based on their pelvic symmetry as determined by a thorough evaluation. Twenty women with a symmetrical pelvis and 20 with symptoms of pelvic asymmetry were selected. The authors’ clinical typology of the pelvic region was used to assess pelvic symmetry [10,40].

2.4. Outcome Measures

The measurement of mass and height was conducted using a verified medical column scale, specifically the UNIWAG Professional Electronic Scales (UNIWAG, Krakow, Poland), which ranges from 100 to 200 cm for height measurement. The assessment of obesity level was determined using the BMI (body mass index) calculation.
The assessment of pelvic symmetry was based on the measurement of selected anthropometric points of the pelvis and lower limbs. The position of these landmarks in the pelvic girdle was determined using a scalable anthropometric leveler with an electronic inclinometer (DUOMETR, OPIW, Chrząstowice, Poland). This device enables measurements with 0.1° accuracy, and the authors assumed an accuracy of 1° (Figure 1).
The following indicators were subjected to analysis:
  • ICA (iliac crest angle): the angle between the horizontal axis and the line formed by the apices of the iliac crests;
  • ASISA (anterior superior iliac spine angle): the angle between the horizontal axis and the line formed by the anterior superior iliac spines;
  • TMA (trochanter major angle): the angle between the horizontal axis and the line formed by the tops of the greater trochanters.

2.5. Intervention

All examinations were conducted in the morning to ensure consistent measurement conditions. Each participant was tested on three occasions, and the mean values were recorded. All inclinometric and TMG measurements were performed by the same experienced investigator.
Pelvis asymmetry measure (position of selected LPHC landmarks):
During each examination, the rule was followed that the examined landmark was touched with the tip of the middle finger, and the measuring device arms were positioned strictly on the radial side of the middle finger. The materials collected were divided into groups according to the spatial location of the selected landmarks on the pelvic girdle, using the authors’ original clinical typology (Figure 2). The elements of the pelvic symmetry classification were chosen based on the analysis of the mutual position of lines running through the selected landmarks of the lumbo–pelvic–hip complex: 1. the line connecting the apices of the iliac crests (ICs); 2. the line connecting the anterior superior iliac spines (ASISs) and 3. the line connecting the apices of the greater trochanters of the femur (TMs) [10].
In view of the assumptions presented herein, respondents with a symmetric pelvis and asymmetric pelvis were identified in the analysis, while individuals with an oblique pelvis were not considered.
I.
Symmetric pelvis (SP)
It was established that all lines ran in parallel to the floor, or the value of the analyzed angles, the ICA, ASISA and TMA, were <1°.
II.
Asymmetric (rotated pelvis) (RP)
The iliac crest line and the anterior superior iliac spine line exhibit asymmetrical characteristics that vary with different factors; i.e., ICA and ASISA ≥ 1°. The trochanter major line runs parallel to the floor (TMA < 1°), or it runs in the same way as the anterior superior iliac spine line (TMA ≥ 1°) (Figure 2).
The rotation of the pelvis was determined based on the angle between the line of the apices of the iliac crests and the line of the anterior superior iliac spines.
The Tensiomyography (TMG) test was executed using a TMG-BMC Ltd. (Ljubljana, Slovenia) system, designated as the TMG-BMC Science for Body Evolution system. The methodology of measuring individual muscles followed the procedures outlined by the device manufacturer. Electrodes were positioned in accordance with the SENIAM guidelines [41]. The following muscles were measured: the gluteus maximus, biceps femoris, rectus femoris, rectus abdominis, obliques abdominis ext. and the erector spinae. All measurements were made in a laboratory at a temperature of 22 ± 1 °C. During the measurements of the erector spinae, gluteus max. and biceps femoris, respondents remained in the prone position with ankle joints placed on a triangle foam pad. The muscles rectus abd., obliques abd. ext. and rectus fem. were examined in the supine position with legs bent and knees under the 20o angle. The tensiomyography test involves evaluation of the muscle response (time of response and displacement) to an electric stimulus. Two standard, self-adhesive, 2 mm thick ECOSTIM electrodes (EL.P.NWCS50.50.sq. Shiaoxing, China) were placed symmetrically, distally and proximally to the top of the TMG-S1 sensor (2.5 cm in each direction). A stimulator was used (EMF-Furlan I Co. doo, Ljubljana, Slovenia). The electric stimulation was provided with a single-twitch impulse of 1 ms in duration and 20 mA intensity, which was increased by 10 mA every 10–15 s until no further change in Dm was observed or the maximum power of the stimulator (110 mA) was reached. The cathode was placed proximally and the anode distally. The baseline parameters were obtained after two subsequent measuring protocols in a 5 min interval, and the mean values were used for the analysis (Figure 3).
The values of displacement (Dm) describing muscle stiffness, as presented in the study, were obtained using the tensiomyographic method. It should be noted that these values represent the mean of measurements performed on the left and right side of the body (Figure 4).

2.6. Statistical Analysis

The statistical analysis of the material was conducted using the MedCalc package (MedCalc® Statistical Software version 23.1.3 (MedCalc Software Ltd., Ostend, Belgium; https://www.medcalc.org; accessed on 3 Januarry 2025). The distributions of the variables were determined by means of the Shapiro–Wilk test. A standard descriptive analysis was presented using the mean values (X) and their standard deviations (SDs). The differences were calculated by means of Student’s t-test for independent groups. The relationships between the amount of pelvic rotation and the studied tensiomyography variables were assessed using Pearson’s correlation.

3. Results

A total of 136 individuals were qualified for the tests, out of which only 40 met the eligibility criteria. The qualification process is presented in Figure 5. Table 1 presents the respondents’ anthropometric data.
The results of the analysis showed a normal distribution of the studied variable in the respondents with a rotated pelvis. The mean magnitude of rotation, viewed as the angle between the line of the anterior superior iliac spines and the line of the apices of the iliac crests, was X = 5.6°, SD 2.09, with the results ranging 2–10°. The distribution of the group investigated is shown in Figure 6.
The descriptive analysis of displacement (Dm) in the whole group demonstrated a normal distribution for all the variables in question, similar for the right and left side. The analysis of differences, conducted using Student’s t-test for independent groups, did not show any statistically significant differentiation on any side (Table 2). A repeated analysis of variables, conducted in the groups identified based on the pelvis type, did not reveal any significant differences between the sides as well as between the results obtained for the symmetric pelvis and the rotated pelvis (Table 3).
Evaluation of correlations between the rotation magnitude and displacement (Dm) did not show any clear linear correlations between the variables studied. However, some correlations were observed. The Dm values indicated that with a growing rotation angle, the stiffness of the erector spinae and rectus femoris increases. This is true for muscles on both the right and left side (Table 4).

4. Discussion

The objective of the present study was to ascertain the existence of a reciprocal relationship between the magnitude of pelvic asymmetry, as indicated by the size of the angle between the straight lines passing through the anterior superior iliac spines and the tops of the iliac crest, and the stiffness of the stabilizing muscles of the LPH complex, as demonstrated by the magnitude of the radial displacement of the muscles under study following an electrical stimulus on tensiomyography (Dm). It was hypothesized that if a correlation could be identified between the functional status of the muscles studied and the magnitude of pelvic rotation, this could contribute to more effective targeting of therapeutic measures aimed at restoring symmetrical pelvic position. This could have important implications in relation to the role of spatial shaping of the pelvis in the occurrence of dysfunctions and diseases associated with its asymmetrical position [11,12,15,42,43,44]. However, the results obtained did not clearly confirm the assumption that there is such a relationship. This is because the presence of differences in bilateral muscle stiffness in subjects with symmetrical and asymmetrical pelvis was not confirmed. The only differentiation that was expected to be observed was for the gluteus maximus muscles, where slightly lower muscle stiffness was found on the right side. However, this differentiation was above the assumed threshold of statistical significance (p = 0.0698). Additionally, no significant correlations were identified between the amount of pelvic rotation and the stiffness of the muscles studied by tensiomyography. In addition, previous studies by the authors showed no direct relationship between the stiffness of the muscles stabilizing the LPH complex and the amount of pelvic tilt in the sagittal plane [45]. The lack of a relationship between the magnitude of pelvic asymmetry and bilateral functional variation in the muscles of the lateral abdominal wall using ultrasound imaging was also confirmed by Biały et al. [46]. When we analyze the results of our own study and those obtained by Bialy, it is not possible to clearly determine whether the pelvis rotates due to changes in the functional state of the muscles that stabilize the pelvis, or whether the pelvis rotates due to other causes and the functional state of the muscles is a consequence of changes in the spatial positioning of the iliac crest. Determining the causes of pelvic rotation is beyond the scope of this paper. However, for a better understanding of the issue, it may be helpful to cite here some concepts that attempt to explain the causes of pelvic rotation. This is especially relevant in the context of selecting therapeutic methods used in cases of observed asymmetries. Lewit describes the mechanism of pelvic torsion as an alternating asymmetry of the two pelvic bones, in which an elevation of the posterior superior iliac spine is accompanied by a lowering of the anterior superior iliac spine on the same side. It is often observed that there is a lowering of the superior frontal knees on the right side. The mechanism described by Lewit is thought to cause oblique positioning of the sacrum, which may lead to asymmetry of the base for the spine and asymmetric transfer of dynamic loads from the lower extremities to the trunk. It is thought that these changes are reflexive in nature and their primary cause is a disturbance at the level of the junction of the cranial and cervical spine [19]. Ackermann suggests that the asymmetry may be the result of an external force or sudden overloading of one of the lower extremities, and that there may be a twisting of the pelvic bone in a clockwise or counterclockwise direction. This, in turn, may lead to an increase in muscle tone, which can sometimes be mistaken for limb shortening [47]. The loading mechanism for the formation of functional asymmetry of the LPH complex is also pointed out by Gnat [48,49]. According to Savory and Kaute [50], there appears to be a physiological basis for the appearance of functional pelvic torsion. It is evident that due to the lateralization of the body, there is a peculiar functional specialization of the lower limbs. This specialization can be defined as follows: one leg (the dominant one) plays a supporting role, while the other leg plays a motor role. It has been observed that right-legged individuals tend to place more weight on their right leg, which they utilize in situations requiring greater force release. In contrast, the left leg is more adept at leaping. It is also used for bouncing. It has been suggested that prolonged loading of one limb may potentially lead to an asymmetrical alignment of the two hip bones relative to each other, where one side of the hip bone may rotate upward and backward, while the other side may rotate downward and forward. This can potentially result in a perceived shortening of the lower limb on the side of the posterior rotation. Other possible causes of hip rim asymmetry may be rotated body patterns, which can result in fascial tension in specific body parts, potentially leading to asymmetry in the lumbopelvic complex [51]. Torsional Upper Crossed Syndrome (TUCS) has been described by Morris et al. [52]. Kouwenhoven et al. [53] observed what appeared to be a tendency for the high thoracic vertebrae to rotate to the left, and for the middle and lower thoracic vertebrae to rotate to the right. This observation may possibly offer a potential explanation for the subsequent rotation of the pelvis to the right side, which could be a contributing factor to the observed asymmetry in pelvic floor muscles. It has been hypothesized that the asymmetrical range of motion of the hip joints and pelvis may result in alterations to muscle and tendon length and function [54]. In addition to the mechanism of pelvic rotation, the authors of the study encountered a second difficulty, namely the assessment of muscle stiffness. The definition of stiffness, and the methods of measuring it, are not entirely clear and could be clarified. The variability of opinions and the lack of a clear definition of muscle tension mean that clarification is always needed when examining muscle tension as to how the term should be understood [55,56]. In the majority of cases, the focus is on passive or dynamic stiffness [57]. The assessment of passive stiffness typically involves the implementation of methodologies that are founded upon elastographic, myotonometric and tensiomyographic measurements, in conjunction with clinical evaluations. However, it should be noted that these methods study and analyze different aspects of tissue stiffness, which makes it difficult to compare results [31,39,55,58,59]. In the context of TMG analysis, the calculation of stiffness is indirect, with its interpretation being based on the measurement of maximum radial displacement (Dm) [60]. Myotonometry, on the other hand, defines stiffness differently, as the relationship between the force produced by a mechanical impulse and the depth of tissue deformation [61]. If we may make a suggestion, it might be beneficial to consider expanding therapy for muscle imbalance to include the assessment of the function of higher-order mechanisms controlling muscle tension at the level of the central nervous system, in particular the pontomedullary reticular formation (PMRF) [62,63,64].
This study did not confirm the relationship between changes in the stiffness of the muscles stabilizing the LPH complex and changes in their geometric position. Therefore, we cannot unequivocally conclude that, in light of the results obtained, the existing methods used to restore muscle–fascia balance and achieve a symmetrical pelvic position are ineffective or inappropriate. We can only conclude that tensiomyographic studies of the stiffness of the muscles isolated in the muscle study did not show direct correlations with the amount of rotation of the hip girdle.

Study Limitations

The authors are aware that the most significant limitation in determining the relationship between the functional state of the muscles and, in particular, their stiffness, and the asymmetry of the pelvic position is the absence of a precise definition of the concepts of muscle tone and muscle stiffness. The assessment of the relationship between changes in pelvic position and muscle stiffness, as defined by tensiomyography, is limited to the presence or absence of a maximal displacement (Dm) or their contraction time parameters, Td and Tc. To ascertain a definitive relationship between stiffness and pelvic rotation, the study should be expanded to encompass additional methods for evaluating stiffness in other domains, as well as muscle strength and length. A further limitation of the study methodology was the inability to reach deeper muscles, for instance, through elastography. The exclusive inclusion of women in the study group may also have been a constraint. While it is true that one of the conditions for inclusion was the absence of periods and pregnancy, it should be noted that changes in muscle stiffness can also occur during other periods of the menstrual cycle. The study’s homogeneity, in terms of the gender of the respondents, may also be considered a strength, despite appearing to be a limitation. Another strength of the study is the use of tensiomyography, a method that is gaining acceptance as a research tool. This study also employs an anthropological inclinometer of a bespoke design, in conjunction with a clinical classification of pelvic asymmetry that is original to the study.

5. Conclusions

The tensiomyography examinations did not show any significant differences in the stiffness of muscles in respondents with a symmetric or rotated pelvis. There were also no bilateral differences in muscle functions in the participants with the diagnosed pelvic rotation. Additionally, no clear linear correlations were observed between the amount of pelvic rotation and the tensiomyography variables studied.

Author Contributions

Conceived and designed the experiments: K.B., K.O.-C., T.S. and P.K. Performed the experiments: K.B. and B.B. Analyzed the data: K.B., T.S., Z.H. and P.K. Contributed reagents/materials/analysis tools: K.B., K.O.-C., T.S. and B.B. Wrote the paper: K.B., K.O.-C. and T.S. Critical review of the manuscript: Z.H., B.B. and P.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the ethical standards of the Human Experimentation Committee of the institution in which the experiments were conducted or in accord with the Declaration of Helsinki of 1964 and its later amendments, and received approval from the Bioethics Committee of the College of Physiotherapy in Wrocław (No. 1/2010, 25 June 2010).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The minimal data set is contained within our paper.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Krahl, H.; Michaelis, U.; Pieper, H.G.; Quack, G.; Montag, M. Stimulation of bone growth through sports. A radiologic investigation of the upper extremities in professional tennis players. Am. J. Sports Med. 1994, 22, 751. [Google Scholar] [CrossRef] [PubMed]
  2. Boulay, C.; Tardieu, C.; Bénaim, C.; Hecquet, J.; Marty, C.; Prat-Pradal, D.; Legaye, J.; Duval-Beaupère, G.; Pélissier, J. Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives. J. Anat. 2006, 208, 21–33. [Google Scholar] [CrossRef] [PubMed]
  3. Kanchan, T.; Mohan Kumar, T.S.; Pradeep Kumar, G.; Yoganarasimha, K. Skeletala symmetry. J. Forensic Leg. Med. 2008, 15, 177–179. [Google Scholar] [CrossRef]
  4. Maloney, S.J. The Relationship Between Asymmetry and Athletic Performance: A Critical Review. J. Strength Cond. Res. 2019, 33, 2579–2593. [Google Scholar] [CrossRef]
  5. Bussey, M.D. Does the demand for asymmetric functional lower body postures in lateral sports relate to structural asymmetry of the pelvis? J. Sci. Med. Sport 2010, 13, 360–364. [Google Scholar] [CrossRef] [PubMed]
  6. Güntürkün, O.; Ocklenburg, S. Ontogenesis of Lateralization. Neuron 2017, 94, 249–263. [Google Scholar] [CrossRef]
  7. Kurki, H.K. Bilateral asymmetry in the human pelvis. Anat. Rec. 2017, 300, 653–665. [Google Scholar] [CrossRef]
  8. Alqadah, A.; Hsieh, Y.W.; Morrissey, Z.D.; Chuang, C.F. Asymmetric development of the nervous system. Dev. Dyn. 2018, 247, 124–137. [Google Scholar] [CrossRef]
  9. Traver-Vives, M.; Guillén-Villar, A.; Del Río, L.; Casinos, A. Asymmetry in the length of human humerus and radius during ontogeny. Anthropol. Anz. 2021, 78, 151. [Google Scholar] [CrossRef]
  10. Bibrowicz, K.; Szurmik, T.; Ogrodzka-Ciechanowicz, K.; Hudakova, Z.; Gąsienica-Walczak, B.; Kurzeja, P. Asymmetry of the pelvis in Polish young adults. Front. Psychol. 2023, 14, 1148239. [Google Scholar] [CrossRef]
  11. Al-Eisa, E.; Egan, D.; Deluzio, K.; Wassersug, R. Effects of pelvic asymmetry and low back pain on trunk kinematics during sitting: A comparison with standing. Spine 2006, 31, E135–E143. [Google Scholar] [CrossRef]
  12. Gum, J.L.; Asher, M.A.; Burton, D.C.; Lai, S.M.; Lambart, L.M. Transverse plane pelvic rotation in adolescent idiopathic scoliosis: Primary or compensatory? Eur. Spine J. 2007, 16, 1579–1586. [Google Scholar] [CrossRef] [PubMed]
  13. Khamis, S.; Carmeli, E. Relationship and significance of gait deviations associated with limb length discrepancy: A systematic review. Gait Posture 2017, 57, 115–123. [Google Scholar] [CrossRef]
  14. Kuszewski, M.T.; Gnat, R.; Gogola, A. The impact of core muscles training on the range of anterior pelvic tilt in subjects with increased stiffness of the hamstrings. Hum. Mov. Sci. 2018, 57, 32–39. [Google Scholar] [CrossRef] [PubMed]
  15. Yu, Q.; Huang, H.; Zhang, Z.; Hu, X.; Li, W.; Li, L.; Chen, M.; Liang, Z.; Lo, W.L.A.; Wang, C. The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system. BMC Musculoskelet. Disord. 2020, 21, 596. [Google Scholar] [CrossRef]
  16. Zhang, F.; Zhang, D.; Huang, Z.; Wang, Z.; Cai, X. Morphological Asymmetry of Pelvic Rings: A Study Based on Three-Dimensional Deviation Analysis. Orthop. Surg. 2022, 14, 967–976. [Google Scholar] [CrossRef]
  17. Stȩpień, A.; Maślanko, K.; Rekowski, W.; Fabian, K.; Tuz, J.; Graff, K. Analysis of the prevalence of asymmetry and muscle tone disorders in the first year of life among youth with idiopathic scoliosis: A retrospective case-control study. J. Back. Musculoskelet. Rehabil. 2022, 35, 1003–1011. [Google Scholar] [CrossRef] [PubMed]
  18. Sorensen, C.J.; Johnson, M.B.; Norton, B.J.; Callaghan, J.P.; Van Dillen, L.R. Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing. Hum. Mov. Sci. 2016, 50, 38–46. [Google Scholar] [CrossRef]
  19. Lewit, K. Manipulative Therapy: Musculoskeletal Medicine, 1st ed.; Churchill Livingstone: London, UK, 2009. [Google Scholar]
  20. Gnat, R.; Bialy, M. A new approach to the measurement of pelvic asymmetry: Proposed methods and reliability. J. Manip. Physiol. Ther. 2015, 38, 295–301. [Google Scholar] [CrossRef]
  21. Manheim, C.J. The Myofascial Release Manual, 4th ed.; Slack Incorporated: Charleston, SC, USA, 2008. [Google Scholar]
  22. Myers, T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists; Churchill Livingstone Elsevier: Philadelphia, PA, USA, 2014. [Google Scholar]
  23. Juhl, J.H.; Ippolito Cremin, T.M.; Russell, G. Prevalence of frontal plane pelvic postural asymmetry—Part 1. J. Am. Osteopath. Assoc. 2004, 104, 411–421. [Google Scholar]
  24. Gelber, J.D.; Soloff, L.; Schickendantz, M.S. The Thrower’s Shoulder. J. Am. Acad. Orthop. Surg. 2018, 26, 204–213. [Google Scholar] [CrossRef] [PubMed]
  25. Hellebrandt, F.A.; Houtz, S.J. Mechanisms of muscle training in man: Experimental demonstration of the overload principle. Phys. Ther. Rev. 1956, 36, 371–383. [Google Scholar] [CrossRef]
  26. Nelson, A.G.; Kokkonen, J.; Arnall, D.A.; Li, L. Acute stretching increases postural stability in nonbalance trained individuals. J. Strength. Cond. Res. 2012, 26, 3095–3100. [Google Scholar] [CrossRef] [PubMed]
  27. Miyamoto, N.; Hirata, K.; Miyamoto-Mikami, E.; Yasuda, O.; Kanehisa, H. Associations of passive muscle stiffness, muscle stretch tolerance, and muscle slack angle with range of motion: Individual and sex differences. Sci. Rep. 2018, 8, 8274. [Google Scholar] [CrossRef]
  28. Kumagai, H.; Miyamoto-Mikami, E.; Hirata, K.; Kikuchi, N.; Kamiya, N.; Hoshikawa, S.; Zempo, H.; Naito, H.; Miyamoto, N.; Fuku, N. ESR1 Rs2234693 Polymorphism is associated with muscle injury and muscle stiffness. Med. Sci. Sports Exerc. 2019, 51, 19–26. [Google Scholar] [CrossRef]
  29. Kuitunen, S.; Komi, P.V.; Kyrolainen, H. Knee and ankle joint stiffness in sprint running. Med. Sci. Sports Exerc. 2002, 34, 166–173. [Google Scholar] [CrossRef]
  30. Ličen, U.; Opara, M.; Kozinc, Ž. The Agreement and Correlation Between Shear-Wave Elastography, Myotonometry, and Passive Joint Stiffness Measurements: A Brief Review. SN Compr. Clin. Med. 2024, 6, 27–35. [Google Scholar] [CrossRef]
  31. Lee, Y.; Kim, M.; Lee, H. The Measurement of Stiffness for Major Muscles with Shear Wave Elastography and Myoton: A Quantitative Analysis Study. Diagnostics 2021, 11, 524. [Google Scholar] [CrossRef]
  32. Martín-Rodríguez, S.; Loturco, I.; Hunter, A.M.; Rodríguez-Ruiz, D.; Munguia-Izquierdo, D. Reliability and Measurement Error of Tensiomyography to Assess Mechanical Muscle Function: A Systematic Review. J. Strength. Cond. Res. 2017, 31, 3524–3536. [Google Scholar] [CrossRef]
  33. Lohr, C.; Braumann, K.M.; Reer, R.; Schroeder, J.; Schmidt, T. Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers. Eur. J. Appl. Physiol. 2018, 118, 1349–1359. [Google Scholar] [CrossRef]
  34. Lohr, C.; Schmidt, T.; Braumann, K.M.; Reer, R.; Medina-Porqueres, I. Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study. Sports Health 2020, 12, 341–346. [Google Scholar] [CrossRef]
  35. García-García, O.; Cuba-Dorado, A.; Álvarez-Yates, T.; Carballo-López, J.; Iglesias-Caamaño, M. Clinical utility of tensiomyography for muscle function analysis in athletes. Open Access J. Sports Med. 2019, 10, 49–69. [Google Scholar] [CrossRef] [PubMed]
  36. Kozinc, Ž.; Šarabon, N. Shear-wave elastography for assessment of trapezius muscle stiffness: Reliability and association with low-level muscle activity. PLoS ONE 2020, 15, e0234359. [Google Scholar] [CrossRef]
  37. Park, S. Theory and usage of tensiomyography and the analysis method for the patient with low back pain. J. Exerc. Rehabil. 2020, 16, 325–331. [Google Scholar] [CrossRef] [PubMed]
  38. Alfuraih, A.M.; Alhowimel, A.; Alghanim, S.; Khayat, Y.; Aljamaan, A.; Alsobayel, H.I. The Association between Tensiomyography and Elastography Stiffness Measurements in Lower Limb Skeletal Muscles. Sensors 2022, 22, 1206. [Google Scholar] [CrossRef]
  39. von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008, 61, 344–349. [Google Scholar] [CrossRef] [PubMed]
  40. Bibrowicz, K.; Szurmik, T.; Lipowicz, A.; Walaszek, R.; Mitas, A. Tilt and mobility of the hip girdle in the sagittal and frontal planes in healthy subjects aged 19–30 years. J. Back. Musculoskelet. Rehabil. 2022, 35, 1203–1210. [Google Scholar] [CrossRef]
  41. Hermens, H.J.; Freriks, B.; Disselhorst-Klug, C.; Rau, G. Development of recommendations for SEMG sensors and sensor placement procedures. J. Electromyogr. Kinesiol. 2000, 10, 361–374. [Google Scholar] [CrossRef]
  42. Stylianides, G.A.; Beaulieu, M.; Dalleau, G.; Rivard, C.H.; Allard, P. Iliac crest orientation and geometry in able-bodied and non-treated adolescent idiopathic scoliosis girls with moderate and severe spinal deformity. Eur. Spine J. 2012, 21, 725–732. [Google Scholar] [CrossRef]
  43. Oleksy, Ł.; Mika, A.; Kielnar, R.; Grzegorczyk, J.; Marchewka, A.; Stolarczyk, A. The influence of pelvis reposition exercises on pelvic floor muscles asymmetry: A randomized prospective study. Medicine 2019, 98, e13988. [Google Scholar] [CrossRef]
  44. Yoo, H.I.; Hwang, U.J.; Ahn, S.H.; Gwak, G.T.; Kwon, O.Y. Comparison of pelvic rotation angle in the transverse plane in the supine position and during active straight leg raise between people with and without nonspecific low back pain. Clin Biomech. 2021, 83, 105310. [Google Scholar] [CrossRef]
  45. Bibrowicz, K.; Szurmik, T.; Kurzeja, P.; Bibrowicz, B.; Ogrodzka-Ciechanowicz, K. Pelvic tilt and stiffness of the muscles stabilising the lumbo-pelvic-hip (LPH) complex in tensiomyography examination. PLoS ONE 2024, 19, e0312480. [Google Scholar] [CrossRef] [PubMed]
  46. Biały, M.; Adamczyk, W.; Stranc, T.; Gogola, A.; Gnat, R. The Association between Pelvic Asymmetry and Lateral Abdominal Muscle Activity in a Healthy Population. J. Hum. Kinet. 2025, 97, 1–22. [Google Scholar] [CrossRef]
  47. Ackermann, W.P. Goal-Oriented Chiropractic: Specific Diagnostic and Therapeutic Techniques According to Dr. Ackermann, 5th ed.; Ackermann Institute: Stockholm, Sweden, 2012. [Google Scholar]
  48. Gnat, R.; Saulicz, E. Induced static asymmetry of the pelvis is associated with functional asymmetry of the lumbo-pelvo-hip complex. J. Manip. Physiol. Ther. 2008, 31, 204–211. [Google Scholar] [CrossRef]
  49. Gnat, R.; Saulicz, E.; Biały, M.; Kłaptocz, P. Does Pelvic Asymmetry always Mean Pathology? J. Hum. Kinet. 2009, 21, 23–35. [Google Scholar]
  50. Savory, B.; Kaute, B. Pelvic shift or short leg syndrome as an avoidable cause of back complaints. Man. Med. 1999, 37, 304–308. [Google Scholar] [CrossRef]
  51. Pope, R.E. The common compensatory pattern: Its origin and relationship to the postural model. Am. Acad. Osteopath. J. 2003, 14, 19–40. [Google Scholar]
  52. Morris, C.E.; Bonnefin, D.; Darville, C. The torsional upper crossed syndrome: A multi-planar update to Janda’s model, with a case series introduction of the mid-pectoral fascial lesion as an associated etiological factor. J. Body Mov. Ther. 2015, 19, 681–689. [Google Scholar]
  53. Kouwenhoven, J.W.; Vincken, K.L.; Bartels, L.W.; Castelein, R.M. Analysis of preexistent vertebral rotation in the normal spine. Spine 2006, 31, 1467–1472. [Google Scholar] [CrossRef]
  54. Snijders, C.J.; Vleeming, A.; Stoeckart, R. Transfer of lumbosacral load to iliac bones and legs Part 2: Loading of the sacroiliac joints when lifting in a stooped posture. Clin. Biomech. 1993, 8, 295–301. [Google Scholar] [CrossRef]
  55. Kopecká, B.; Ravnik, D.; Jelen, K.; Bittner, V. Objective Methods of Muscle Tone Diagnosis and Their Application—A Critical Review. Sensors 2023, 23, 7189. [Google Scholar] [CrossRef] [PubMed]
  56. Shortland, A.P. Muscle tone is not a well-defined term. Dev. Med. Child Neurol. 2018, 60, 637. [Google Scholar] [CrossRef]
  57. Bravo-Sánchez, A.; Abián, P.; Sánchez-Infante, J.; Ramírez-delaCruz, M.; Esteban-García, P.; Jiménez, F.; Abián-Vicén, J. Five-Compressions Protocol as a Valid Myotonometric Method to Assess the Stiffness of the Lower Limbs: A Brief Report. Int. J. Environ. Res. Public Health 2022, 19, 14425. [Google Scholar] [CrossRef]
  58. Calvo-Lobo, C.; Diez-Vega, I.; Martínez-Pascual, B.; Fernández-Martínez, S.; de la Cueva-Reguera, M.; Garrosa-Martín, G.; Rodríguez-Sanz, D. Tensiomyography, sonoelastography, and mechanosensitivity differences between active, latent, and control low back myofascial trigger points: A cross-sectional study. Medicine 2017, 96, e6287. [Google Scholar] [CrossRef]
  59. Labata-Lezaun, N.; López-de-Celis, C.; Llurda-Almuzara, L.; González-Rueda, V.; Cadellans-Arróniz, A.; Pérez-Bellmunt, A. Correlation between maximal radial muscle displacement and stiffness in gastrocnemius muscle. Physiol. Meas. 2020, 41, 125013. [Google Scholar] [CrossRef]
  60. Šimunič, B.; Koren, K.; Rittweger, J.; Lazzer, S.; Reggiani, C.; Rejc, E.; Pišot, R.; Narici, M.; Degens, H. Tensiomyography detects early hallmarks of bed-rest-induced atrophy before changes in muscle architecture. J. Appl. Physiol. 2019, 126, 815–822. [Google Scholar] [CrossRef] [PubMed]
  61. Huang, J.; Qin, K.; Tang, C.; Zhu, Y.; Klein, C.S.; Zhang, Z.; Liu, C. Assessment of Passive Stiffness of Medial and Lateral Heads of Gastrocnemius Muscle, Achilles Tendon, and Plantar Fascia at Different Ankle and Knee Positions Using the MyotonPRO. Med. Sci. Monit. 2018, 24, 7570–7576. [Google Scholar] [CrossRef] [PubMed]
  62. Takakusaki, K.; Chiba, R.; Nozu, T.; Okumura, T. Brainstem control of locomotion and muscle tone with special reference to the role of the mesopontine tegmentum and medullary reticulospinal systems. J. Neural Transm. 2016, 123, 695–729. [Google Scholar] [CrossRef]
  63. Takakusaki, K. Functional Neuroanatomy for Posture and Gait Control. J. Mov. Disord. 2017, 10, 1–17. [Google Scholar] [CrossRef]
  64. Kaminishi, K.; Chiba, R.; Takakusaki, K.; Ota, J. Investigation of the effect of tonus on the change in postural control strategy using musculoskeletal simulation. Gait Posture 2020, 76, 298–304. [Google Scholar] [CrossRef]
Jcm 14 02229 g001
Figure 1. Measurement of the iliac crest angle using Duometr [own source].
Figure 1. Measurement of the iliac crest angle using Duometr [own source].
Jcm 14 02229 g001
Jcm 14 02229 g002
Figure 2. Graphic representation of pelvic asymmetry types [own source].
Figure 2. Graphic representation of pelvic asymmetry types [own source].
Jcm 14 02229 g002
Jcm 14 02229 g003
Figure 3. TMG of the rectus femoris [own source].
Figure 3. TMG of the rectus femoris [own source].
Jcm 14 02229 g003
Jcm 14 02229 g004
Figure 4. Example diagram of the muscle response to the electric stimulus [own source].
Figure 4. Example diagram of the muscle response to the electric stimulus [own source].
Jcm 14 02229 g004
Jcm 14 02229 g005
Figure 5. Flow diagram.
Figure 5. Flow diagram.
Jcm 14 02229 g005
Jcm 14 02229 g006
Figure 6. Distribution of the group according to the size of the pelvic rotation angle.
Figure 6. Distribution of the group according to the size of the pelvic rotation angle.
Jcm 14 02229 g006
Table 1. Research group.
Table 1. Research group.
VariableSP
n = 20		RP
n = 20
Mean ± Std.Mean ± Std.
Weight (kg)57.0 ± 4.0159.7 ± 5.01
Height (cm)164.4 ± 5.35167.9 ± 5.74
BMI (kg m−2)21.2 ± 1.5921.2 ± 1.71
SP—symmetric pelvis; RP—asymmetric (rotated) pelvis; n—number of participants; Std—standard deviation.
Table 2. Descriptive analysis and analysis of differences in contraction time, Tc (ms), and displacement, Dm (mm), of the LPHC stabilizing muscles (whole group).
Table 2. Descriptive analysis and analysis of differences in contraction time, Tc (ms), and displacement, Dm (mm), of the LPHC stabilizing muscles (whole group).
MusclesDM (mm)
Left Side
n = 40		Right Side
n = 40		p
Mean ± Std.Mean ± Std.
Gluteus maximus5.0 ± 2.576.4 ± 3.120.061
Biceps femoris4.4 ± 2.384.3 ± 2.120.856
Rectus femoris5.6 ± 2.465.5 ± 2.700.848
Rectus abdominis4.2 ± 2.064.4 ± 2.100.724
Obliques abdominis ext.2.8 ± 1.702.6 ± 1.830.657
Erector spinae3.3 ± 1.423.4 ± 1.470.810
n—number of participants; Std.—standard deviation; p—p-value (t-test).
Table 3. Descriptive analysis and analysis of differences in displacement, Dm (mm), of the LPHC stabilizing muscles in women with a symmetric or rotated pelvis (symmetric pelvis group n = 20, rotated pelvis group n = 20).
Table 3. Descriptive analysis and analysis of differences in displacement, Dm (mm), of the LPHC stabilizing muscles in women with a symmetric or rotated pelvis (symmetric pelvis group n = 20, rotated pelvis group n = 20).
MusclesVariableType of PelvisLeft Side Mean ± Std.Right Side Mean ± Std.p
Gluteus maximusDmSP5.5 ± 3.676.5 ± 4.070.532
RP4.9 ± 2.016.3 ± 2.650.0698
p0.5550.869
Biceps femorisDmSP4.4 ± 2.414.6 ± 2.370.845
RP4.3 ± 2.164.2 ± 1.850.874
p0.88550.584
Rectus femorisDmSP5.6 ± 3.165.6 ± 3.440.965
RP5.9 ± 2.255.6 ± 2.560.723
p0.7130.986
Rectus abdominisDmSP4.7 ± 2.344.8 ± 2.580.886
RP4.2 ± 2.104.4 ± 1.900.799
p0.5160.532
Obliques abdominis ext.DmSP2.8 ± 1.932.9 ± 1.660.922
RP2.8 ± 1.712.6 ± 2.100.851
p0.9390.745
Erector spinaeDmSP3.3 ± 0.993.3 ± 1.380.920
RP3.3 ± 1.653.7 ± 1.430.449
p0.9810.438
p—p-value (t-test); SP—symmetric pelvis; RP—rotated pelvis.
Table 4. Pearson’s correlation between the pelvic rotation magnitude and displacement (Dm).
Table 4. Pearson’s correlation between the pelvic rotation magnitude and displacement (Dm).
MuscleVariable
Dm [mm]
Left SideRight Side
Gluteus maximusr = −0.076
p = 0.763		r = −0.123
p = 0.627
Biceps femorisr = 0.198
p = 0.416		r = 0.065
p = 0.793
Rectus femorisr = −0.358
p = 0.132		r = −0.334
p = 0.162
Rectus abdominisr = 0.060
p = 0.807		r = 0.108
p = 0.659
Obliques abdominis ext.r = 0.029
p = 0.905		r = 0.002
p = 0.993
Erector spinaer = −0.416
p = 0.076		r = −0.354
p = 0.137
Dm—displacement; r—Pearson’s correlation; p—p-value.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Bibrowicz, K.; Ogrodzka-Ciechanowicz, K.; Hudakova, Z.; Szurmik, T.; Bibrowicz, B.; Kurzeja, P. Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination. J. Clin. Med. 2025, 14, 2229. https://doi.org/10.3390/jcm14072229

AMA Style

Bibrowicz K, Ogrodzka-Ciechanowicz K, Hudakova Z, Szurmik T, Bibrowicz B, Kurzeja P. Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination. Journal of Clinical Medicine. 2025; 14(7):2229. https://doi.org/10.3390/jcm14072229

Chicago/Turabian Style

Bibrowicz, Karol, Katarzyna Ogrodzka-Ciechanowicz, Zuzana Hudakova, Tomasz Szurmik, Bartosz Bibrowicz, and Piotr Kurzeja. 2025. "Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination" Journal of Clinical Medicine 14, no. 7: 2229. https://doi.org/10.3390/jcm14072229

APA Style

Bibrowicz, K., Ogrodzka-Ciechanowicz, K., Hudakova, Z., Szurmik, T., Bibrowicz, B., & Kurzeja, P. (2025). Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo–Pelvic–Hip Complex (LPHC) in Tensiomyography Examination. Journal of Clinical Medicine, 14(7), 2229. https://doi.org/10.3390/jcm14072229

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop