THE ANATOMICAL RECORD 300:633–642 (2017)

The Human Pelvis: Variation in

Structure and Function During Gait
CARA L. LEWIS ,1* NATALIE M. LAUDICINA,2 ANNE KHUU,1
1
AND KARI L. LOVERRO
1
Department of Physical Therapy & Athletic Training, Boston University,
Boston, Massachusetts
2
Department of Anthropology, Boston University, Boston, Massachusetts

ABSTRACT
The shift to habitual bipedalism 4–6 million years ago in the hominin
lineage created a morphologically and functionally different human pelvis
compared to our closest living relatives, the chimpanzees. Evolutionary
changes to the shape of the pelvis were necessary for the transition to
habitual bipedalism in humans. These changes in the bony anatomy
resulted in an altered role of muscle function, influencing bipedal gait.
Additionally, there are normal sex-specific variations in the pelvis as well
as abnormal variations in the acetabulum. During gait, the pelvis moves
in the three planes to produce smooth and efficient motion. Subtle sex-
specific differences in these motions may facilitate economical gait despite
differences in pelvic structure. The motions of the pelvis and hip may
also be altered in the presence of abnormal acetabular structure, especial-
ly with acetabular dysplasia. Anat Rec, 300:633–642, 2017. V C 2017 Wiley

Periodicals, Inc.

Key words: pelvis; pelvic; hip; gait

Evolutionary changes in the shape of the human pel-
vis were necessary for habitual bipedalism. Fossil pelves
early in the hominin lineage illustrate these adaptations
including a wider sacrum and more laterally positioned
flared ilia than what the human-chimpanzee last com-
mon ancestor is hypothesized to exhibit (Robinson, 1972;
Lovejoy, 2005). These distinguishing characteristics early
in hominin evolution allowed for lumbar lordosis, which
is necessary to maintain the upright posture, as well as
the conversion of hip extensors to hip abductors with an
increased moment arm to balance the center of mass in
the frontal plane (Robinson, 1972; Lovejoy, 2005). While
the gait mechanics in fossil hominins has been debated
(Berge, 1994; Hunt, 1994; Stern and Susman, 1983;
Ruff, 1998; Ward, 2002), the modern human pelvis is
adapted to habitual bipedality that results in specific
pelvic motion during walking. These motions are
thought to reduce energetic costs (Saunders et al., 1953;
Leonard and Robertson, 1995; Bramble and Lieberman,
2004). Potentially counter to the energetic cost savings,
the female pelvis evolved to allow the birth of large-
brained infants (Caldwell and Moloy, 1933; Meindl et al.,
1985; Abitbol, 1996; Rosenberg, 1992; Tague, 1992;
Lovejoy, 2005; but see Warrener et al., 2015). Recent
studies have challenged assumptions about the role of
pelvic motion during gait and differences in that motion
between males and females. The purpose of this article
is to review the structure of the human pelvis and dis-
cuss the typical movements of the pelvis during human
gait. Sex-specific variations in pelvis structure and two
abnormal variations in acetabular structure and their
influence on pelvic motion during gait will also be
discussed.
Grant sponsor: National Institute of Arthritis and Musculo-
skeletal and Skin Diseases of the National Institutes of Health;
Grant number: K23 AR063235.
*Correspondence to: Cara L. Lewis, PT, PhD, Department of
Physical Therapy & Athletic Training, Boston University, 635
Commonwealth Avenue, Boston, MA 02215. Fax: (617) 353-
9463. E-mail: lewisc@bu.edu
Received 8 April 2016; Revised 19 October 2016; Accepted 19
December 2016.
DOI 10.1002/ar.23552
Published online in Wiley Online Library (wileyonlinelibrary.
com).

C 2017 WILEY PERIODICALS, INC.

V
634 LEWIS ET AL.
Normal Structure of the Human Pelvis
The human pelvis includes the sacrum, the coccyx,
and two os coxae (White et al., 2011). Each os coxae is
made up of three parts: the ischium, the ilium, and the
pubis (White et al., 2011). The articulations within the
pelvis are: inferiorly between the sacrum and the coccyx
(sacrococcygeal symphysis), posteriorly between the
sacrum and each ilium [sacroiliac (SI) joint], and anteri-
orly between the pubic bodies (pubic symphysis). The SI
joint offers some movement during childhood, but transi-
tions to a modified synarthrodial joint, which allows lit-
tle to no movement, by adulthood (Brooke, 1924; Lovejoy
et al., 1985). The pubic symphysis is a cartilaginous syn-
arthordial joint with a fibrocartilaginous interpubic disc
(Hagen, 1974). This articulation allows a small amount
of translation and rotation. As the pelvic ring creates a
closed chain, movement at the pubic symphysis requires
simultaneous movement at the SI joint, and vice versa.
The articulation between the pelvis and the femur is
the acetabulum, which is formed by portions of the ili-
um, ischium, and pubis (White et al., 2011). This synovi-
al ball-and-socket joint allows substantial motion within
the sagittal plane, with additional motion in the frontal
and transverse planes. The acetabulum has articular
cartilage in the shape of a horseshoe where the femoral
head articulates with the os coxae. The normal orienta-
tion of the acetabulum is described as being rotated
approximately 20–40 degrees off vertical in the frontal
plane (Werner et al., 2012), and 20–30 degrees anteriorly
(Murray, 1993; Reynolds et al., 1999; Perreira et al.,
2011; Merle et al., 2013). This orientation positions the
bone to provide the most stability medially, superiorly,
and posteriorly.
In addition to the bony stability, other structures
including the acetabular labrum, ligaments, and joint
capsule, as well as muscles, provide stability anteriorly
and laterally. The acetabular labrum, which is composed
of fibrocartilage and dense connective tissue (Petersen
et al., 2003), deepens the hip socket and helps provide a
sealing mechanism for the joint (Hlavacek, 2002; Tan
et al., 2001). The primary hip ligaments (iliofemoral,
ischiofemoral, and pubofemoral) each provide stability
throughout different hip positions. All three ligaments,
however, tighten as the hip moves into extension. The
ligaments and capsule are most taut when the hip is in
extension, slight internal rotation, and abduction (Neu-
mann, 2010b). Unlike at most other joints, this position
of maximal ligamentous stability is not the position of
maximal bony congruency. In the hip, maximal joint con-
gruency occurs in 90 degrees of hip flexion with moder-
ate hip abduction and external rotation. In addition to
the capsular hip ligaments, smaller ligaments may also
play a role in stability. For example, the ligamentum
teres has recently been suggested to provide stability at
end range hip motions, particularly hip abduction, medi-
al rotation, and lateral rotation (Martin et al., 2013),
and to prevent femoral head subluxation with combined
hip flexion and abduction (Kivlan et al., 2013). The
higher prevalence of ligamentum teres tears in individu-
als with decreased bony stability further supports this
assertion (Domb et al., 2013). This role of stabilizer is in
addition to the traditional role of the ligamentum
teres—carrying the blood supply to the femoral head.
Muscles around the hip joint can also provide substan-
tial dynamic stability. Muscles which are close to the
joint axis of rotation (local muscles) likely provide joint
stability whereas muscles farther from the axis of rota-
tion (global muscles) provide the joint torque. At the hip,
these local muscles include the deep external rotators,
iliopsoas, and gluteus medius and minimus [see Retch-
ford et al. (2013) for an excellent review].
Sex-Specific Differences in the Human Pelvis
Sex-specific differences are expressed in the overall
structure of the human pelvis (Caldwell and Moloy,
1933; Meindl et al., 1985; Tague, 1992). The female pel-
vis tends to be wider and broader, with less prominent
ischial spines (Meindl et al., 1985; Tague, 1992; Kurki,
2011). The male pelvis typically has a longer, more
curved sacrum, and a narrower subpubic arch (between
the left and right ischiopubic rami) (Caldwell and Moloy,
1933; Tague, 1992). While the female pelvis is wider
when measured between the ischial spines (bispinous
width) (Tague, 1992), the biacetabular width is not sig-
nificantly different between females and males across all
populations (Kurki, 2011). This discrepancy is partially
because of the larger male femoral head (Kurki, 2011)
which shifts the hip joint center laterally. Whether the
morphological differences between the sexes result from
obstetric constraints or from differential allometric
growth trajectories has been debated (Schultz, 1949;
Rosenberg, 1992; Abitbol, 1996; Abouheif and Fairbairn,
1997; Badyaev, 2002; Kurki, 2011).
Sex-specific differences in the pelvis allow for a wider
pelvic aperture in females which functions as the birth
canal, facilitating the passage of large-brained neonates
(Caldwell and Moloy, 1933; Abitbol, 1996; Meindl et al.,
1985; Rosenberg, 1992; Lovejoy, 2005; Kurki, 2011). In
females, the birth canal is expanded as a result of anato-
mies including a wider sacrum, a wider subpubic angle,
and less prominent ischial spines (Tague and Lovejoy,
1986; Tague, 1992; Kurki, 2011). A larger birth canal
becomes essential with the encephalized neonatal heads
in humans (Caldwell and Moloy, 1933; Meindl et al.,
1985; Rosenberg, 1992; Abitbol, 1996; Lovejoy, 2005).
When this pelvic sexual dimorphism occurred in
human evolutionary history is unclear because of the
paucity and fragmentary nature of fossil pelvic remains.
Ardipithecus ramidus (ARA-VP-6/500), a hominin from
4.4 million years ago, exhibits synapomorphies with
humans in its pelvic morphology including superior-
inferiorly shortened and mediolaterally broad iliac
blades (Lovejoy et al., 2009; White et al., 2009). The
small cranial capacity in Ar. ramidus indicates that
these pelvic morphologies are probably a result of loco-
motor, rather than obstetric, demands (Lovejoy et al.,
2009; White et al., 2009). Later hominins such as A.L.
288-1 (Australopithecus afarensis) and Sts 14 (Au. afri-
canus) exhibit female-specific pelvic morphologies (Berge
et al., 1984; Tague and Lovejoy, 1986; but see H€ ausler
and Schmid, 1995). However, it is not until the dramatic
increase in brain size around 1.8 million years ago that
obstetric constraints probably contributed to hominin
pelvic morphology (Simpson et al., 2008).
The pelvic differences between males and females
may be a result of hormonal influence on bone growth
(Tague, 1989; Badyaev, 2002; Huseynov et al., 2016).
 PELVIS: STRUCTURE AND FUNCTION DURING GAIT
Sex-specific hormones during growth, such as testoster-
one and estrogen, have been hypothesized to influence
pelvic morphology (Tague, 1989; Badyaev, 2002; Husey-
nov et al., 2016). There is a greater degree of sexual
dimorphism as body size increases across most mamma-
lian species (Abouheif and Fairbairn, 1997). In humans,
where males are slightly larger than females, the growth
trajectories between the sexes vary (Badyaev, 2002;
Huseynov et al., 2016). Whether this is the cause of the
sex-specific pelvic morphologies in humans has yet to be
determined, but recent research has suggested that
female hormones at puberty influence the obstetric
dimensions of the pelvis (Huseynov et al., 2016).
As reviewed, intersexual pelvic morphological differ-
ences in humans may be the result of obstetric demands,
differences in growth patterns, or a combination of the
two. The idea that the wide pelvis increases the locomo-
tor costs for females has been proposed (Zihlman and
Brunker, 1979; Tague, 1989; Rosenberg, 1992; Bramble
and Lieberman, 2004), but has not been supported by
empirical data (Dunsworth et al., 2012; Warrener et al.,
2015). In one study by Leonard and Robertson (1995), it
was found that when walking normally, women were
actually more efficient than men. Nonetheless, kinemat-
ic differences between men and women have been noted
in pelvic motions (Bruening et al., 2015) which may be a
result of a wider female pelvis. We discuss the sex-
specific differences of pelvic motion in human gait later
in this article.
Abnormal Structure of the Human Acetabulum:
Under-Coverage and Over-Coverage
In addition to the sex-specific variation in the human
pelvis, such as widening of the female pelvis, there is
also variation in the structure of the human acetabulum.
This variation, when viewed through an evolutionary
lens, may be a by-product of the changes in overall pel-
vic morphology necessary for bipedal locomotion (Hoger-
vorst et al., 2011). While a wide range of this variability
is considered normal, two structural abnormalities com-
monly noted today can generally be described as under-
coverage and over-coverage of the acetabulum on the
femur. Although these abnormal structures are thought
to contribute to hip pain, the exact point at which these
structures vary enough to be termed pathologic is not
well established (Harris-Hayes and Royer, 2011; Ander-
son et al., 2012; Nepple et al., 2013; Diesel et al., 2015).
Under-coverage and over-coverage are clinically referred
to as acetabular dysplasia and pincer femoroacetabular
impingement (FAI), respectively. Interestingly, each of
these occur more often in females than males (Bache
et al., 2002; Tannast et al., 2007). This sex-specific
prevalence may be a result of the dual evolutionary chal-
lenge of bipedalism and obstetric constraints (Hogervorst
et al., 2011).
Acetabular dysplasia is when the acetabulum fails to
provide the normal amount of bony coverage, or stability,
around the femoral head. The reported incidence of dys-
plasia ranges from 0.06 to 76.1 per 1000 live births, with
most developed countries reporting an incidence between
1.5 and 20 per 1000 live births (Rosendahl et al., 1994;
Patel and Canadian Task Force on Preventive Health
Care, 2001; Bache et al., 2002; Loder and Skopelja,
2011). Risk factors for dysplasia include breech
635
intrauterine position, female sex, high birth weight, fam-
ily history of dysplasia, firstborn status, and race (Bache
et al., 2002; Storer and Skaggs, 2006).
The degree of under-coverage exists along a continu-
um. The mildest forms can be asymptomatic and unde-
tected, while moderate and severe forms can cause hip
instability, subluxation, or dislocation (Storer and
Skaggs, 2006; McWilliams et al., 2010). The more severe
forms are usually diagnosed in infancy during physical
examination or ultrasonography screening. Milder forms
of dysplasia, however, may not be diagnosed until insidi-
ous hip or groin pain develops in skeletally mature
adults (Hickman and Peters, 2001; McCarthy and Lee,
2002; Peters and Erickson, 2006; Nunley et al., 2011).
In the presence of dysplasia, there is less containment
of the femoral head within the shallow acetabulum dur-
ing weight-bearing. The poor congruency leads to
increased stress which may cause a fracture of the ace-
tabular rim and separation of rim fragments as well as
labral hypertrophy and tears (Klaue et al., 1991; Lane
et al., 2000; Hickman and Peters, 2001; McCarthy and
Lee, 2002; Horii et al., 2003; Leunig et al., 2004; Mavcic
et al., 2008; Chegini et al., 2009). In adults, the primary
treatment of acetabular dysplasia is acetabular reorien-
tation surgery, usually with the Bernese periacetabular
osteotomy (PAO) (Ganz et al., 1988; Hickman and
Peters, 2001). The general goal of this surgical reorienta-
tion is to reduce contact stress by improving the congru-
ency and coverage of the femoral head, and thereby
delay or prevent the onset of hip osteoarthritis (OA).
However, nonsurgical interventions may be successful in
individuals with mild dysplasia (Lewis et al., 2015).
Common measures for acetabular dysplasia include
the center edge angle and acetabular depth. The center
edge angle is defined as the angle between a line drawn
vertically from the center of the femoral head and a line
drawn from the center of the femoral head to the lateral
edge of the weight-bearing zone of the acetabulum (Clo-
hisy et al., 2008). This angle is most typically measured
on an anteroposterior view of the pelvis, and is called
the lateral center edge angle (Fig. 1A). It is also some-
times measured anteriorly on a false-profile view, and is
called the anterior center edge angle (Fig. 1B). In the
false-profile view, the radiograph is obtained with the
pelvis rotated posteriorly 25 degrees (65 degrees relative
to image receptor) (Clohisy et al., 2008) to allow a less
obstructed view of the acetabulum and femur. While it is
agreed that a reduced center edge angle indicates dys-
plasia, the exact cutoff value is not well established.
Cutoff values of 20 degrees, 25 degrees, and 30 degrees
have all been used (Harris-Hayes and Royer, 2011).
Acetabular depth is an additional measure used to
diagnosis dysplasia. It is the perpendicular distance
from the deepest part of the acetabular roof to a line
connecting the lateral margin of the acetabular roof to
the upper corner of the pubic symphysis (Murray, 1965;
Lane et al., 2000) (Fig. 1C). An acetabular depth of less
than 9 mm is considered indicative of dysplasia (Lane
et al., 2000; Reijman et al., 2005).
Acetabular dysplasia has been linked with the devel-
opment of hip OA (Birrell et al., 2003; Lievense et al.,
2004; Reijman et al., 2005; Nunley et al., 2011). Untreat-
ed moderate and severe dysplasia can lead to early hip
OA and the need for hip arthroplasty (Murphy et al.,
1995). Even mild dysplasia more than doubles the risk
636 LEWIS ET AL.

of hip OA (Lane et al., 2000; McWilliams et al., 2010).

However, in one study, hips with a lateral center edge
angle even as low as 16 degrees, did not progress to OA
by age 65 years (Murphy et al., 1995), indicating that
the natural progression for mild dysplasia is less clear.
Acetabular over-coverage contributing to FAI has been
recently recognized as an abnormal bone shape contrib-
uting to hip pain, acetabular labral tears, and chondral
pathology (Ganz et al., 2003). This type of FAI called
“pincer FAI” is thought to lead to impingement between
the enlarged acetabular rim and the femur (Ganz et al.,
2003). Whereas acetabular dysplasia is diagnosed by a
smaller than normal center edge angle, pincer FAI is
diagnosed when the center edge angle is greater than 40
degrees (Tannast et al., 2007; Clohisy et al., 2011). This
over-coverage, which is diagnosed more often in females
than males (Tannast et al., 2007), can be local or global,
and can be anterior or lateral or both. In addition to the
center edge angle, the relative position of the acetabu-
lum within the pelvis has been used to diagnose pincer
FAI. When the floor of the acetabulum is touching or
medial to the ilioischial line (Fig. 1D), this indicates
coxa profunda, and is often classified as pincer FAI (Clo-
hisy et al., 2011).
While a center edge angle greater than 40 degrees or
the presence of coxa profunda are commonly thought to
indicate abnormal acetabular geometry, the prevalence
of pincer deformity detected in asymptomatic hips is
approximately 67% (Frank et al., 2015). Additionally,
multiple studies have found high prevalence of coxa pro-
funda in asymptomatic individuals, and little or no cor-
respondence with other measures of pincer FAI
(Anderson et al., 2012; Nepple et al., 2013; Diesel et al.,
2015). Together, these studies indicate that coxa pro-
funda itself should not be used as an indicator of pincer
FAI, especially in females (Nepple et al., 2013; Diesel
et al., 2015). Furthermore, the increased prevalence of
coxa profunda in females (Nepple et al., 2013; Diesel
et al., 2015) may be an adaptation to the wider pelvis
which accommodates obstetric demands. From a biome-
chanical perspective, the deep acetabulum moves the hip
joint center more medially. This change reduces the
moment arm for the center of mass, and therefore
reduces the force required of the hip abductors (Hoger-
vorst et al., 2011), a potential energetic advantage.
Thus, the deep hip socket may be a beneficial variation
instead of a pathology.
While there is strong evidence supporting the link
between hip OA and acetabular dysplasia, the link with
pincer FAI is questionable. Initial studies reported a

Fig. 1. Measures of the acetabulum. A. Lateral center edge angle: on

an anteroposterior view of the pelvis, the angle between a line drawn ver-
tically from the center of the femoral head (blue) and a line drawn from
the center of the femoral head to the lateral edge of the weight-bearing
zone of the acetabulum (red). B. Anterior center edge angle: on a false-
profile view of the pelvis, the angle between a line drawn vertically from
the center of the femoral head (blue) and a line drawn from the center of
the femoral head to the anterior edge of the weight-bearing zone of the
acetabulum (red). C. Acetabular depth: on an anteroposterior view of the
pelvis, the perpendicular distance (blue line) from the deepest part of the
acetabular roof to a line connecting the lateral margin of the acetabular
Fig. 1. roof to the upper corner of the pubic symphysis (red). D. Coxa profunda:
on an anteroposterior view of the pelvis, when the floor of the acetabulum
is medial to or touching the ilioischial line (red).
 PELVIS: STRUCTURE AND FUNCTION DURING GAIT
Fig. 2. Motions of the pelvis. A. Pelvic motion in the sagittal plane
described as posterior and anterior tilt. B. Pelvic motion in the frontal
plane described as pelvic drop and pelvic hike. C. Pelvic motion in
the transverse plane described as forward rotation and backward
rotation. The motions in the frontal and transverse planes are typically
described by the motion of the side of the pelvis opposite the stance
leg.
potential increased risk (Chung et al., 2010); however, a
more recent large cohort study did not find an increased
risk (Agricola et al., 2013).
Motions of the Human Pelvis
Generally, motions of the pelvis are described as rota-
tions about one of the three cardinal axes, each of which
creates motion in one of the planes (Cappozzo et al.,
2005). The terminology for these rotations is not consis-
tent across different scientific and clinical fields, and
therefore, will be explained in depth here. Rotation
about a mediolateral axis produces motion within the
sagittal plane, and is often referred to as anterior or pos-
terior tilt or rotation (Fig. 2A). With anterior pelvic tilt,
the anterior superior iliac spines (ASIS) each move ante-
riorly and inferiorly while the posterior superior iliac
spines (PSIS) each move superiorly (Levangie and
637
Norkin, 2011; Murray et al., 1970; Neumann, 2010a).
Conversely, posterior pelvic tilt occurs when the ASIS
move posteriorly and superiorly while the PSIS move
inferiorly.
Rotation about an anteroposterior axis creates motion
within the frontal or coronal plane (Fig. 2B). This
motion occurs when one side of the pelvis moves lower
as the other side moves higher, and is often referred to
as pelvic drop or hike; or in some fields, pelvic obliquity
or list. Typically, this occurs while weight-bearing on a
single lower extremity and is described by the motion of
the contralateral side of the pelvis (Neumann, 2010a;
Levangie and Norkin, 2011). For example, when stand-
ing on the right lower extremity, pelvic drop is when the
left side of the pelvis is lowered. Conversely, when the
left side of the pelvis is raised, this is considered pelvic
hike. Sometimes this is referred to as contralateral pel-
vic drop or hike in order to convey the sense that the
description refers to the side away from the stance lower
extremity. It is important to understand, however, that
the motion is controlled by the stance hip abductor
muscles (Neumann, 2010b).
Rotation about a vertical axis produces motion in the
transverse or horizontal plane (Fig. 2C). In some fields,
this is referred to as forward and backward rotation
(Levangie and Norkin, 2011), or similarly as anterior
and posterior rotation. Again, the naming convention is
based on the motion of the side contralateral to the hip
controlling the motion. For example, when standing on
the right lower extremity, forward rotation is when the
contralateral side is moving forward or anteriorly. Back-
ward rotation is when the contralateral side is moving
backward or posteriorly. Others refer to these motions as
internal and external rotation (Neumann, 2010a), and is
named similarly to the motions of the lower extremity
segments. Just as right femoral internal rotation is
counter-clockwise rotation of the femur when viewed
from a superior perspective, internal rotation of the pel-
vis during right stance is counter-clockwise rotation of
the pelvis or backward rotation (Neumann, 2010a).
These same terms for pelvic motion (hike/drop, tilt
and rotation) are also used to describe the position of
the pelvis in certain postures or activities. In standing
with weight equally distributed between both lower
extremities, the pelvis is normally level with the left and
the right ASIS being at the same height (Michaud et al.,
2000), indicating neither pelvic hike nor drop or no
obliquity. In the sagittal plane, “neutral” pelvis has
sometimes been defined as the ASIS being in the same
vertical plane as the symphysis pubis (Kendall et al.,
1993; Levangie and Norkin, 2011). This definition is
often extended to indicate that a line drawn between the
ASIS and PSIS is horizontal, indicating no tilt. Use of
these bony landmarks allow the clinician to easily pal-
pate and measure pelvic tilt. Typically, people stand in
11–13 degrees of anterior pelvic tilt (Crowell et al., 1994;
Levine and Whittle, 1996). One should be cautioned that
this pelvic tilt is not the same as the radiological mea-
sure of “pelvic tilt” commonly noted in literature focus-
ing on the spine. In spine literature, the pelvic tilt
measurement is the angle between a vertical line pass-
ing through the center of the bicoxofemoral axis and a
line drawn between the axis and the middle of the supe-
rior endplate of S1 (Roussouly et al., 2005; Ames et al.,
2013; Garbossa et al., 2014). Using this measure, pelvic
638 LEWIS ET AL.
tilt in standing is typically between 12 and 15 degrees
(Roussouly et al., 2005; Ames et al., 2013). Despite the
range being similar to the anterior pelvic tilt measure
using ASIS as a reference, in this radiological measure
of pelvic tilt, increasing numbers indicate increasing pos-
terior pelvic tilt.
Pelvic Motion during Human Gait
During human gait, the pelvis has motions about all
three axes. The magnitude of these motions is partially
dependent on walking speed, with larger motions occur-
ring at faster walking speeds (Murray et al., 1970;
Stokes et al., 1989; Crosbie et al., 1997; Bejek et al.,
2006). Here, we present data from our laboratory collect-
ed on 44 healthy individuals [22 females (age: 22.9 6 2.8
years (mean 6 standard deviation (SD)), height:
1.63 6 0.07 m, mass: 61.1 6 8.5 kg) and 22 males (age:
24.9 6 6.3 years, height: 1.78 6 0.09 m, mass: 75.2 6
14.2 kg)] while walking on an instrumented force tread-
mill (Bertec Corporation, Columbus, OH). Data were
collected and processed using standard motion capture
methodology which has been previously published
(Ogamba et al., 2016). Individuals were tested walking
at two walking speeds: self-selected (1.27 m/s) and pre-
scribed (1.25 m/s). Using a prescribed walking speed
where all individuals walk at the same speed allows for
comparison of parameters which may be affected by
walking speed.
In the sagittal plane, the pelvis is typically main-
tained in anterior pelvic tilt throughout gait (O’Neill
et al., 2015), and completes two full cycles of a sinusoidal
wave for each gait cycle (Fig. 3). Following initial con-
tact, the pelvis tilts posteriorly for less than 20% of the
gait cycle. It then begins to tilt anteriorly again until
the contralateral foot contacts the ground at approxi-
mately 50% of the gait cycle. The cycle then repeats
itself, tilting posteriorly, and anteriorly again. The total
excursion of this movement is relatively small, approxi-
mately 2–5 degrees (Murray et al., 1964; Kadaba et al.,
1990; Crosbie et al., 1997; Smith et al., 2002; Bruening
et al., 2015). In our data, the mean total excursion was
4.3 degrees with an SD of 1.1 degrees and range of 2.6–
7.3 degrees at preferred walking speed.
In the frontal plane, the pelvis completes one cycle of
motion throughout each gait cycle (Fig. 3). At initial con-
tact, the pelvis is approximately neutral with left and
right ASIS being level (or 0 degrees of obliquity). Follow-
ing contact, the pelvis drops for less than 20% of the
gait cycle, after which it begins to raise again. When the
other foot contacts the ground, the pelvis is approxi-
mately neutral again. If viewed relative to the initial
foot, the pelvis would be described as continuing to hike.
However, in some fields, it is customary to switch the
perspective to the now stance leg, and say that the pel-
vis is dropping again (Levangie and Norkin, 2011). The
total excursion for this motion is approximately 6–11
degrees at preferred walking speed (Stokes et al., 1989;
Kadaba et al., 1990; Crosbie et al., 1997; Smith et al.,
2002; Chumanov et al., 2008; Bruening et al., 2015). In
our data, the range was 1.9–12.5 degrees with a mean
total excursion of 7.4 degrees and SD of 2.5 degrees
walking at a preferred speed.
In the transverse plane, the pelvis completes one cycle
of motion as well (Fig. 3). At initial contact of the right
foot, the pelvis is in backward rotation with the left
ASIS posterior to the right ASIS. This backward rotation
continues briefly during the double support phase, and
then changes to forward rotation of the pelvis. The for-
ward rotation continues until just after contralateral
heel strike (around 50%). From the view point of the
swing leg, the pelvis is then rotating backward again
until just after ipsilateral heel strike. Again, it is cus-
tomary in some fields to switch the perspective and say
that the pelvis is rotating forward on the left leg (Levan-
gie and Norkin, 2011). The reported magnitude of the
excursion of the pelvis in the transverse plane is as low
as 3 degrees (Crosbie et al., 1997), and as high as 14
degrees (Bruening et al., 2015) with most somewhere in
between (Stokes et al., 1989; Kadaba et al., 1990; Kerri-
gan et al., 2001; Smith et al., 2002). Similarly, the range
in our data was from 4.0 to 16.8 with a mean and SD of
9.5 6 2.9 at preferred walking speed.
Theoretically, these motions of the pelvis during
human gait help to decrease the movement of the center
of mass in the vertical and horizontal direction (Neu-
mann, 2010a). In the vertical direction, the center of
mass moves in a sinusoidal curve which reaches a maxi-
mum during each single leg stance and a minimum dur-
ing each double support period when both feet are on
the ground, resulting in two complete cycles per gait
cycle (Neumann, 2010a). In contrast, the sinusoidal
movement in the horizontal direction completes one
cycle, shifting to the right during right stance and to the
left during left stance (Neumann, 2010a). Saunders
et al., (1953) described six “determinants of gait”—
motions of the pelvis and lower extremities which were
thought to minimize the motion of the center of mass
and thus be energetically economical. Two of these deter-
minants were specifically about pelvic rotations during
gait. The first determinant was the rotation of the pelvis
in the transverse plane. For a given step length, this
rotation of the pelvis would reduce the magnitude of the
drop in the center of mass which occurs during double
support. The second determinant was the pelvic motion
in the frontal plane. The pelvic drop during single leg
stance lowers the maximum height of the pelvis and
trunk, and thus lowers the center of mass (Stokes et al.,
1989).
The notion that pelvic and lower extremity move-
ments “minimize” the excursion of the center of mass
has come under increasing scrutiny (Della Croce et al.,
2001; Kerrigan et al., 2001; Lin et al., 2014). Pelvic rota-
tion in the transverse plane provides a small, but nota-
ble, reduction in center of mass excursion (Della Croce
et al., 2001; Kerrigan et al., 2001; Lin et al., 2014). Pel-
vis obliquity has been found to contribute to the medio-
lateral excursion of the center of mass, but very little to
the reduction of the vertical excursion (Lin et al., 2014).
When taken to the extreme of eliminating vertical
motion of the center of mass, Gordon et al., (2009) clear-
ly demonstrate that metabolic cost and mechanical work
in the lower extremity increase as a result. However, it
is still appreciated, especially when analyzing pathologi-
cal gait, that normal pelvic motion plays a role in reduc-
ing exaggerated movements of the center of mass.
Furthermore, the importance of the normal movement of
the pelvis during gait has been highlighted in recent
work. Restrictions of pelvic motion, as can occur in
robotic assistive devices, lead to compensation in upper
 PELVIS: STRUCTURE AND FUNCTION DURING GAIT
Fig. 3. Sex-specific differences in pelvic motion during gait. These
data were the mean from 22 healthy females and 22 healthy males
walking at a controlled speed (1.25 m/s) on an instrumented treadmill.
Data are presented as ipsilateral initial foot contact (heel strike) to ipsi-
lateral initial foot contact. The vertical gray line indicates contralateral
initial foot contact. Differences in pelvic position and motion in all
three planes can be observed. Females walk in more anterior pelvic
tilt, and have greater excursion in pelvic obliquity, and slightly greater
pelvic rotation while males maintain the pelvis closer to neutral tilt,
and have less pelvic obliquity and rotation excursion.
and lower extremity kinematics (Veneman et al., 2008;
Mun et al., 2016).
Sex-Specific Differences in Pelvic Motion in
Human Gait
Just as there are sex-specific differences in the shape
of the pelvis, there are sex-specific differences in pelvic
position and motion during gait (Smith et al., 2002; Cho
et al., 2004; Chumanov et al., 2008; Bruening et al.,
2015). On average, females maintain the pelvis in a posi-
tion of slight anterior pelvic tilt (approximately 4
degrees in our data) while males maintain the pelvis in
a position closer to neutral (Cho et al., 2004) but differ-
ences in the motion of the pelvis in the sagittal plane
639
during walking are not typically noted (Smith et al.,
2002; Bruening et al., 2015).
In the frontal plane, females have more excursion of
the pelvis while males have less (Smith et al., 2002 ;
Chumanov et al., 2008; Bruening et al., 2015) (Fig. 3).
The mean difference between males and females in our
study was 1.9 degrees [95% Confidence Interval (CI) of
0.9–2.9 degrees] which was significant (P < 0.001) as
determined by an Independent-Samples T-Test in SPSS
(IBM Corporation, Armonk, NY). The increased frontal
plane motion may contribute to the smaller vertical dis-
placement of the COM during gait as noted in females
(Smith et al., 2002), further facilitating economical gait;
however, another study did not find differences in center
of mass motion (Bruening et al., 2015).
Movement of the pelvis in the transverse plane is usu-
ally greater in females and lesser in males. (Crosbie
et al., 1997; Chumanov et al., 2008; Bruening et al.,
2015). Similarly, we found a mean difference of 2 degrees
with a 95% CI of 0.6–3.4 degrees (P 5 0.029) when walk-
ing at the same speed. Conversely, Murray et al. (1970)
reported slightly less transverse plane rotation in
females and more in males; however, this finding may
be because of the faster walking speed and longer stride
length noted in the males in the comparative study
(Murray et al., 1964).
These differences in pelvic motion may contribute to
or result from other differences between how males and
females walk. For example, walking speed can affect the
magnitude of pelvic motion (Murray et al., 1970; Stokes
et al., 1989; Crosbie et al., 1997; Bejek et al., 2006). In
our participants, there was not a difference in preferred
walking speed between our males and females. The
mean and SD of the preferred walking speed was
1.26 6 0.17 m/s in males and 1.28 6 0.16 m/s in females
(P 5 0.735). However, some studies have reported slower
walking speeds in females and faster speeds in males
(Murray et al., 1970; Cho et al., 2004; Frimenko et al.,
2015), but no difference in others (Smith et al., 2002;
Bruening et al., 2015). When detected, differences in
walking speed may be because of differences in height
as the effect is often lost after normalizing for height
(Cho et al., 2004; Frimenko et al., 2015) or including
height as a co-variate (Cho et al., 2004).
Additionally, females tend to walk with a faster
cadence while males walk with a slower cadence at their
self-selected speed ( Murray et al., 1970; Kerrigan et al.,
1998; Smith et al., 2002; Boyer et al., 2008; Frimenko
et al., 2015). Stride length has also been found to be dif-
ferent between the sexes with females taking shorter
steps while males take longer ones (Murray et al., 1970;
Smith et al., 2002; Cho et al., 2004; Frimenko et al.,
2015). Again, this difference may be because of height
differences and not pelvic structure as stride length was
actually longer in females than males after normaliza-
tion (Kerrigan et al., 1998).
Altered Gait in the Presence of Abnormal
Acetabular Structure
In individuals with altered acetabular anatomy, slight
differences in pelvic and hip kinematics during walking
have been noted. Patients with acetabular dysplasia
have altered pelvic and hip kinematics during walking.
In individuals with dysplasia, Romano et al. (1996)
640 LEWIS ET AL.
reported significantly increased pelvic drop and forward
displacement during stance on their affected side. This
was accompanied by decreased transverse plane pelvic
excursion compared to individuals without dysplasia. At
the hip, decreased peak hip extension (Romano et al.,
1996; Jacobsen et al., 2013; Skalshøi et al., 2015) have
also been reported. While no studies to date have looked
exclusively at pincer FAI separate from its femoral coun-
terpart (cam FAI), minimal changes in gait have been
reported in individuals with FAI. For example, Hunt
et al. (2013) found that individuals with FAI walked
slower than healthy controls and had lower peak hip
extension, adduction and internal rotation. When walk-
ing at similar speeds, Diamond et al. (2016) found only a
small reduction in the sagittal plane hip excursion in
individuals with FAI compared to healthy controls. It is
thought, however, that gait does not challenge the hip
sufficiently to detect changes with FAI (Diamond et al.,
2016).
CONCLUSIONS
In summary, the structure of the human pelvis
reflects the transition to habitual bipedality. The pelvic
motions during gait serve to optimize the movement of
the center of mass, producing smooth and energetically
efficient locomotion. Normal variation in the structure of
the pelvis and its motion during gait exist between
sexes. It remains unclear if these sex-specific differences
during gait are related to specific pelvic structure or to
differences in body size and height. Specific variations in
the structure of the acetabulum may contribute to hip
pain and pathology. These variations are noted more
often in females than males. In the presence of abnormal
acetabular structure, especially with acetabular dyspla-
sia, the pelvic motions also may be altered. While it is
suggested that coxa profunda may be energetically bene-
ficial, it is not well established why these variations
occur or how the variation affects gait.
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