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The Tipping Point: Anterior Pelvic Tilts

Not many people know what a pelvic tilt is, or how it’s developed! In fact, it is a maleficent player in faulty body mechanics, instability and deficient posture and can stem (or be stemmed from) other musculo-skeletal dysfunctions. The origination of pelvic tilting can come from our everyday activities and postures which we hold for a sustained period of time. On the other hand, Pelvic tilting can come from other pre-existing structural or mechanical pathologies. There are two types of tilting – posterior and anterior; for this articles purpose Anterior Pelvic Tilting will be reviewed in depth – and it will focus on correction of the tilt, while exposing underlying issues contributing.

Picture a bucket of water, spout pointing to the right- you tip the pale forward, and the water flows out onto the floor. This is a great analogy for a pelvic tilt! The pale is your pelvis – the spout is the front of your body. If you arch your back and rotate your hips forward so that your lumbar spine becomes compressed at the low of your back – VIOLA! You have yourself an exaggerated anterior pelvic tilt.

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Lower Crossed Syndrome


Lower Crossed Syndrome (LCS) is a muscular imbalance causing reciprocal inhibition - this term is given for the hyperactive musculature acting in a synergistic fashion over powering the smaller, weaker and lengthened musculature resulting in the bodies’ tendency to rely on its dominant partners (2). LCS causes changes arthrokinematically - how the bones and joints move about eachother. This has an impact above and below the tilt and can effect poor posture (hyperlordosis), disc pathologies (herniated discs), sacroiliac joint problems (impingement or mal alignment of the joint itself), pelvic tortion/rotation (leg length discrepancies) and contribute to knee injuries (tendonitis, quad strains, weak VMO, and faulty patellar tracking). As you can see the ripple and snowball effect that can happen by muscular imbalances and we go about our everyday lives without noticing much as we just tend to deal with the symptoms rather than target the problem.

It should be noted that the type of footwear can have an impact on exacerbating an APT as well. High Heel or inserts raising the heel will amplify a pelvic tilt. You will see females disproportionately present with an APT because of the wearing frequency of shoes with an elevated heel.

The pelvis serves as the main saddle for which our skeleton sits upon and serves as origination/attachment points for our postural and anti-sway muscles (muscles which make us stand erect.) There are several main muscle groups which act as co-contractors to keep our pelvis level and rotated in the proper position. The Glutes/Erectors in the back, and Abdominals & Hip Flexors in the front – usually in an Anterior Pelvic Tilt the Gluteals are lengthened and the Erectors are weak and aren’t supportive. Leaving the Hip Flexors to become hyperactive, and thus contracted – it’s easy to see how this could lead to an imbalance.(3)

Our everyday postures and activities contribute to this. Think of how often you carry something in front of your body as in bending down to tie your shoe or pick up your child, inversely how much time does someone spend in a sitting position – body erect or slumped forward, hips and knees flexed! This means that our hip flexors are in a constant state of contraction and our Glutes are being lengthened and weakened in the process. It’s not like we are balancing all of this front carrying or flexed activity with the opposite. This is the perfect storm for creating lower back pathologies as well as anterior tilts of the pelvis!

Reciprocal Inhibition & Glute Amnesia


The problem with the Glutes is that throughout our daily lives our body conditions itself to be over active in a flexed position, utilizing the stronger and hyperactive muscles like the quads to take the brunt of the load during strenuous activity. Our Glutes forget to do their job! Support & balance! This isn’t even a question for athletes – this involves everyday people. The theory is that if we remind the Glutes to activate themselves, they will start contracting again and eventually pull the Pelvis posterior until its in permanently neutral position. This is key because once the pelvis and spine is in a neutral position then we can properly strengthen our lumbar stabilizers which will further support the pelvis either anterior or posterior and promote its neutrality. (2)

The main bullets for correcting an APT are…


• Stretch and mobilize anterior hips (Psoas/Quad insertions) to promote laxity and weaker anterior pulling of the pelvis.
• Activate & Strengthen Glutes to pull the anterior tilt posterior to promote a neutral position for both the pelvis and spine.
• Corrective & Muscle Energy Breathing Technique.
• Lumbar Stabilization Program (Anterior/Posterior/Lateral).


There are of course more we could throw into this bag but in my experience with athletics and treating this pathology one can adequately recover from an Anterior Pelvic Tilt by keeping it simple by making a mobility & postural correction routine while maximizing body mechanics second nature.

 

Mobility & Stretching


The first step in ironing out the force couples at work. It is paramount that these steps are taken to release the contracted and shortened structures so that we may recruit and strengthen the lengthened.


• Couch Stretch: 5 x 30 seconds stretch each leg.


• Kneeling Hip Flexor Stretch: 5 x 30 second stretch on each leg.
Make sure your spine is neutral and you are lengthening your hips rather than compensating and going into hyper extension of the spine.

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• Quad Stretch: 5 x 30 seconds stretch on each leg.

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• Piriformis Stretch: 5x 30 seconds stretch each leg.
(4, 12)

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(4.12)


Corrective & Muscle Energy Breathing Technique!


Breathing is something we do every day, every minute, every moment without even thinking about it – unless you catch yourself at a Brazilian steak house with the meat sweats or at Thanksgiving dinner. But breathing can be so much more, especially when it comes to activating dormant musculature and setting ones spine. Using corrective and muscle energy breathing techniques you can make sure your spine is stabilized, hips act in unison and/or rotate freely to the various forces and angles applied to them without creating anymore imbalances.


Posterior Pelvic Tilts ( PPT’s)

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Lie on the ground in a Hooklying Position, feet firm on the floor, arms extended and at 45 degree angle with your palms on the ground. Your body naturally creates a small vacant space at the low of the back because of your lumbar’s natural lordodic curve & anterior pelvic tilt (APT). Pushing down with your arms and feet firmly, imagine you’re initiating a crunch exercise and begin to flatten the low of the back into the ground. This is a Posterior Pelvic Tilt. This exercise will help mobilize and free up any stiffness in the soft tissue as well as prep your body for the next additional movement.

 

Sustained PPT’s + Serratus/Lat Activation


The next step is to hold a PPT for a long, sustained repetition. Try to hold each PPT/Exhaling repetition for a 5 count. Try to increase the length of the spine with each rep, make sure you are holding a sustained PPT contraction (low back flat on the ground) and Serratus/Lat contraction ( pushing the arms into the ground). The Serratus/Lat action will activate the upper anterior, posterior and medial musculature of the core firmly solidifying a set spine, Lumbar up to through the Thorax. This is a great movement brought to my attention and generally primes the whole posterior and supportive musculature.

Gluteal Activation


We will activate and recruit the Gluteals to properly support the pelvis as well as become active once again in structural loading and distribution of stress. (3)


• Supine Posterior Pelvic Tilts with Glute Isometrics: Perform a PPT but squeeze your butt cheeks together, hold isometrically (3x 10 seconds).
Quadruped Leg Lifts: These exercises will help free up the anterior hip while help recruit the moving lower extremities’ Glute and contralaterally make the opposite Glute fire isometrically (3x10 reps).

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Fire Hydrants: Assume a quadruped position, one hip at a time lift the leg up to the side like you’re a dog that’s about to relieve itself (3x10 reps).
Fire Hydrant rotations Clock Wise/CCW: Initiate rotations clockwise and counter-clock wise (3x10 reps).

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Donkey Kicks: While in quadruped, one leg at a time extend the leg back, straightening the leg out (3x10 reps).
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Trendelenburg Hip Hikes: Standing with your shoulder against a flat wall, stand unilaterally on the leg farthest to the wall, place an iso-ball or object between the wall and your hip. Let the opposite hip (closest to the wall) dip down, pull the hip up and down, having the object roll against the wall – this is a Trendelenburg hike, pull up leveling the pelvis (4x20 reps each leg).
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Lumbar Stabilizations


We want to recruit the lumbar and core musculature anterior and posterior to the spine and hips. This will stabilize the pelvis and keep it in a neutral position. These will target the Multifidis, Spinal Erectors and smaller stabilizers as well that are deep within the posterior chain which are responsible for stabilizing the spine and pelvis.

*Initiate the PPT & Isometric Glute Set to set the spine into a neutral position – from here you will perform –


Sustained Bridges and Single Legged Bridges: Perform a Bridge after the initial setting of the hips/glutes with the PPT and Glute iso-hold, 3 x 10 each leg.
• You can advance this exercise by extending one leg at the top of the bridge movement creating a single legged stance bridge. Be sure to clear the lower scapula off the ground to assure you are keeping a neutral spine throughout.

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Planks & Side Planks: Prone and Side lying Planks are excellent to work the anterior core for all actions, flexion, lateral bending, twisting and isometric sustained holds. You can perform these in repetitions (5 x 10 reps each) or…
• For timed sets to tolerance ( 5 sets total). (13)


Deadbugs: Lie on your back, bring your legs into the air, flexing the hip and knee to 90 degrees and extend the arms out. Perform a PPT and initiate the beginning portion of crunch to activate the abs – Extend one leg and at the same time, drop the contralateral arm down above your head. Keep the low back flat against the ground, try to tense the abdominals and reach far with both the legs and arms with this exercise. Perform this on each side so both upper/lower extremities are involved – this is one rep (3 x 10 reps).

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Prone & Quadruped Supermans: Lie on your belly or in quadruped and at the same time – contralaterally lift up your arm and opposite leg into extension); if you are prone(belly) then make sure your arms and legs remain lifted above the ground throughout the set (3x10 reps each)
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(9,10)


There is a lot of information here, and should not be done all at once – my suggestion is to take two movements per section and repeat two to three times a day, rotating the movements each day. Master each movement and build up a tolerance to exercise until you can put together a sizable APT protocol.


This can be done in conjunction to your existing training split, but would work best if you treated it as your top priority. The greater emphasis you put on anything the better the result.

 

About the writer -
Jimmy Dart, ASC 105K Pro & Physical Therapist Assistant. D2 All American & Multiple Record Holder in the Shotput & Discus. I enjoy writing rehab articles exploring different pathologies in sports medicine and common reoccurring injuries with strength sports. I’ve been competing in Strongman for over 5 years with hopes to compete in Power lifting and Highland Games in the future.
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Works Cited –
1) Trouble with the Tilt – Correcting APT, Vaino. http://www.t-nation.com/img/photos/2011/11-684-01/pushup-position.jpg. Published 11/22/13. Accessed 10/1/14.
2) Muscle Imbalance Syndromes – Lower Crossed Syndromes. http://www.muscleimbalancesyndromes.com Published June, 2012. Accessed 10/1/14.
3) Functional Relationships of the Hips and Pelvis - Structure and Function of the Hip. In Kisner, Colby Therapeutic Exercises 5th Edition: Foundations and Techniques. Philadelphia, PA: F.A. Davis Company; 2002: 644-649.
4) Do These Corrective Stretches. http://beastlifestyle.com/wp-content/uploads/2013/03/Piriformis-Stretch.png. Published March 14, 2013. Accessed 10/1/14.
5) Posterior Pelvic Tilt. http://2relievebackpain.org/wp-content/uploads/2010/10/001-23.jpg. Accessed 10/1/14.
6) Core Strength Training, Exercise 6 Quadruped Pointer. http://telemarkracers.org/wp-content/uploads/2011/08/core6.jpg. Accessed 10/1/14
7) Donkey Kicks. http://www.fast-weight-loss-secret.com/images/donkey-kick.jpg Accessed 10/1/14.
8) Assessing and Treating Dysfunction of the Gluteus Medius. http://www.mikereinold.com/wp-content/uploads/blogger/32-weak%20gluteus%20medius%5B5%5D.jpg. Published December 15, 2008. Accessed 10/1/14.
9) Build a Stronger Lower Back. http://www.menshealth.com.sg/system/files/shared/lowerback_ex1_0.jpg. Accessed 10/1/14.
10) Instrumental Techniques 5: Core Exercises – The Quadruped. http://www.tristanlegovic.eu/diellou/skeudennou/physiotherapy/physiotherapy-core-exercise-5-b.png. Published 1/29/2014. Accessed 10/1/14.
11) Fixing Anterior Pelvic Tilt. http://www.swolept.com/posts/fixing-anterior-pelvic-tilt-posture-tricks-to-make-your-butt-and-gut-smaller#.UxVO9M76Rc8 Published Feb. 2014. Accessed 10/1/2014.
12) Basic postural problems at the hip: anterior pelvic tilt. http://www.fix-knee-pain.com/basic-postural-problems-at-the-hip-anterior-pelvic-tilt/ Accessed 10/1/2014.
13) Anterior Pelvic Tilt and Lumbosacral Pain as it Relates to the Hip Thrust and Glute Bridge. http://bretcontreras.com/anterior-pelvic-tilt-and-lumbosacral-pain-as-it-relates-to-the-hip-thrust-and-glute-bridge/ Published April 17, 2013. Accessed 10/1/2014.

 

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