Abstract

Background: Outside red‑flag conditions, anterior pelvic tilt (APT) is proposed as the primary biomechanical driver of most low back pain (LBP). Its clinical declaration, however, is most consistently lateral. Greater trochanteric pain syndrome (GTPS) is the obligatory lateral expression of APT and the most practical station for diagnosis and phenotyping. Objective: To present a clinic‑first, cascade‑based framework that (1) extends Janda’s Lower Crossed Syndrome into a dynamic four‑stream model; (2) mandates a lateral‑first diagnostic entry via GTPS; (3) employs a targeted trochanteric injection as a biomechanical filter and transient reset; and (4) restores durable pelvic neutrality by correcting muscle imbalance. Model: APT initiates a reproducible four‑stream cascade: Lateral stream-gluteal inhibition, TFL–ITB overdrive, GTPS, and SIJ shear. Upstream stream-hyperlordosis, facet capsular strain/synovitis, posture‑provoked foraminal irritation, posterior annular tension, and low‑grade listhesis as a lordosis amplifier (not frank instability). Downstream stream-femoral/tibial internal rotation, subtalar unlocking (flexible flatfoot), posterior knee strain, and gastrocnemius shortening. Fascial stream-integrative non‑dermatomal echo zones linking regions (pseudo‑sciatica, paravertebral “renal” mimic, coccygodynia). Diagnostic fulcrum: A targeted trochanteric block (local anesthetic ± corticosteroid) functions as a biomechanical filter and transient reset. Same‑session or ≤72‑hour multizone relief (lateral/SIJ/paravertebral/coccygeal/posterior knee) confirms APT with obligatory GTPS and opens a time‑sensitive window for corrective motor retraining. Nonresponse prompts reconsideration of non‑cascade etiologies. Conclusion: APT is the origin; GTPS is the gateway. The lateral stream is not optional it is obligatory. Trochanteric injection clarifies diagnosis and resets mechanics; durable resolution is achieved by restoring muscle balance and pelvic neutrality across streams. 

Keywords

anterior pelvic tilt, greater trochanteric pain syndrome, lower crossed syndrome, facetogenic pain, iliotibial band, sacroiliac joint, subtalar unlocking, fascia, phenotyping