Balance

Pelvic Tilt: Can It Actually be Resolved?

In today’s technology driven society, the effects on the body from sitting for long periods of time have been compared to “the smoking of our generation” and a “disease” (1, 2). For athletes, the effects of sitting all day can cause significant muscle and joint compensations, compromising and compressing your pelvis, spine and overall posture. Left unattended to, these imbalances can significantly impact one’s ability to perform functional movements with ease and leave you suspect to repetitive strain, chronic pain and the potential for acute injury.

One easily identifiable and common problem associated with prolonged sitting — and one that can be a significant contributor toward low back pain — is an anterior pelvic tilt or “forward pelvis.”

What is an Anterior Pelvic Tilt?

Most simply, an anterior pelvic tilt is identified by assessing the pelvis position in the sagittal (side view) plane and palpating the two crests of the ilium bone (ASIS and PSIS). By identifying their positions relative to one another in the side view, pelvic position is then recorded. When the ASIS is marked lower than the PSIS, the pelvis appears to tip down toward the feet in an anterior direction and creates an increased curve in your low back.

Known as lordosis, an increased low back curve creates a chicken versus egg scenario where the thoracic spine increases kyphosis and the neck and head move forward of the shoulders. This postural presentation creates compression on the spine which can lead to mild to severe low back pain, increased disc pressure, disc degeneration, joint irritation and muscle and nerve disruption.

Can Anterior Tilt be Corrected?

Correcting an anterior pelvic tilt is possible. However, simply addressing pelvic tilt as a standalone issue is a somewhat limited and constrained view of how the body has come to present itself in this position.

As a CES, I find that one of the biggest misconceptions about correcting an anterior pelvic tilt is assuming the axis of rotation allowing a pelvic tilt movement comes from the S-I joint where the sacrum meets and connects to the pelvis. Anatomically, the axis of rotation is actually at the hip joint (iliofemoral joint), so an anterior pelvic tilt is most often the result of muscle and joint imbalances above and below the hips which pull it out of position.

Think of all the muscles that act on and cross the hip joint. The lumbo-pelvic-hip-complex is made up of 15 bones and 29 muscles. From the front side, the psoas, iliacus and rectus femoris respond to the quadratus lumborum, multifidus and erector spinae on the back side. But you also have the rectus femoris and quadriceps fascia, gluteals, hamstrings, tensor fascia latae and adductor group that can have imbalances. Now you have to look at the muscles and joints below them!

So the term anterior pelvic tilt is a vague description that lumps a variety of spinal architecture sharing the common element that the pelvis is pulled into a forward position relative to the ground (3). The term does not distinguish between rotation or elevation that can also accompany it which most often result in symptomatic pain and dysfunction.

As a Corrective Exercise Specialist (CES), I spend a great deal of time doing postural evaluations, explaining the integrated relationship between load joints and soft tissues and how imbalances in their position(s) and function lead to chronic pain, structural changes in position (like an anterior pelvic tilt)  and movement problems or restrictions. By evaluating the body as a whole, from all three planes of movement it provides a far more in-depth picture of what causes the alignment of the pelvis and spine to shift out of an ideal position and what actually needs to be worked on to correct it.

Who is Right?

There is an vast industry built around correcting anterior pelvic tilt.  If you search the term on Google, literally thousands of results pop up with all kinds of experts and specialists from chiropractors to massage therapists and personal trainers all offering often conflicting opinions and methodologies on what to do to fix it. And everyone has an opinion to offer, all the way from simple stretches to manipulations and surgery. Wading through this muddy mix makes it confusing at best as to which option is “right” for you.

To begin, simply trying to correct an anterior pelvic tilt as a standalone issue is, in my opinion, a symptomatic and compartmentalized view of the integrated human body. Without a better understanding of what an anterior pelvic tilt is or how it occurs, you can get misguided or misinformed advice on what you need to do to correct it.

Take for example the common advice that you should do some crunches, pelvic tucks or strengthen your core. This usually makes me cringe. In my experience, often this causes more problems for someone already experiencing low back pain because it does not address the underlying muscle and joint dysfunction at the hip joints, let alone the joints that also affect the position and function of them both above and below.

When it comes to helping an individual correct an anterior pelvic tilt, I believe the “right” way to correct it is to first look at the bigger picture. The pelvis is designed to respond to the demands placed upon it by the four major load joints (ankles, knees, hips and shoulders). Imbalances in the joints, muscle and connective tissue (fascia) in any of these areas are what result in compensations and dysfunctions in activities of daily living and athletic movement patterns.

Professionally, I rarely correct anterior tilt specifically. I let the body do it on its own. From my perspective and experience, once you bring good alignment to the four major load joints by addressing fascia, joint position and muscle balance, the body begins to properly support itself. Well aligned vertebrae allow the spinal discs to perform their shock-absorbing function without compromise and pelvic tilt naturally corrects itself because it follows the proper alignment and demand of the body because it has no other alternative but to follow design.

Correcting Anterior Pelvic Tilt is a Whole Body Issue

So, yes! An anterior pelvic pelvic tilt can be corrected. The takeaway from this article is to address correcting it from a broader and integrated view of how the body works to be effectual. Remember that the body works as a unit and should always be addressed as a whole. Corrective exercise does not just involve strengthening muscles. It involves retraining the way the entire body coordinates movement throughout all the structures of the body. In my professional experience, modalities that work extremely well at this include Foundation Training, STOTT Pilates and posture alignment programs.

With so many modalities to choose from, here is some simple yet profound advice from my colleague Dr. Eric Goodman, creator of Foundation Training, to keep in mind (4). Forget about correcting your pelvic tilt until you:

  1. Teach your body to use the arches of the feet nearly every moment of the day.

  2. Teach the rib cage to expand appropriately with each inhalation and the torso to support this newfound axial expansion efficiently.

  3. Your head is able to remain supported easily over your shoulders instead of your toes.

  4. Feel the muscles of the body beginning to naturally support you instead of the joints most of us rest upon.

Once the body begins supporting itself properly, with the muscles and joints aligning and performing in the way they were designed to function, you will naturally fix your pelvic angle simply because it had no other alternative but to do so. Establishing and maintaining good posture is exercise when done well.

To successfully correct an anterior pelvic tilt, I suggest partnering with a certified professional who is well trained in kinesiology, postural assessment protocol and designing programs from an integrated whole-body view of how the body functions. Implementing an at-home, easy-to-do corrective exercise program to address the body’s imbalances is a very cost effective way to correct an anterior pelvic tilt caused by musculoskeletal imbalances.

Alongside your training, nutrition and recovery, implementing regular corrective exercise programming is an integral key to helping you have good pelvic and spinal alignment, keeping you out of chronic pain and free of repetitive strain/overuse injury.

References

  1. “Sitting Is The Smoking of Our Generation.” Nilofer Merchant Harvard Business Review. 2013.

  2. “What are the risks of sitting too much? Dr. James A Levine. 2015.

  3. “Forward Pelvis: the Good, the Bad and the Ugly.” Esther Gokhale. 2016.

  4. Foundation Training July 23, 2016 pElvis

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