Excessive anterior pelvic tilt has long been considered a possible contributor to both lower back pain and sacroiliac joint pain. An anterior pelvic tilt is when your pelvis is rotated forward and downward which forces your lower spine into an exaggerated curve. This potentially results in extra pressure experienced through your spine and added strain on your spinal extensor muscles.
What causes an excessive anterior pelvic tilt?
The usual culprit is short and tight hip flexor muscles, often a result of prolonged sitting. When you sit for long periods of time over many years, your body recognises less of a need for them to be long. As a result, the body invests less tissue into the hip flexors and they may shorten. This is opposed to activities such as running where there is a greater requirement for the hip flexors to lengthen during hip extension.
Prolonged sitting equates to a lack of movement. Without regular movement, the hip flexors become less elastic and will be experienced as tightness when you attempt to lengthen them either during a stretch or activity.
As compensation for these tight hip flexors our hamstring muscles and glutes have to relax and lengthen and subsequently become weak. Similarly, when this happens, our spinal extensors are placed under increased stress, working overtime to maintain an erect position. This causes lengthening and weakness in our abdominal muscles, particularly the lower abdominals.
These are both unwanted compensation patterns as they both lead to an imbalance in lower limb and pelvic biomechanics. The goal should be to maintain a balance of flexibility and strength in the aforementioned muscle groups.
What can you do about it?
There are countless ways to address flexibility and strength deficits in the relevant muscle groups. The methods include both exercise and treatment options. Before you get too carried away with your own research though, it may serve you to consult with an experienced therapist. Seek the professional advice of someone who understands the implications of an anterior pelvic tilt [APT] and/or whether it in fact applies to your body.
Over the years I have been in practice, many people have presented themselves to me claiming they wish to ‘fix their APT’ when they either in fact have no APT whatsoever, or it simply is not hindering them at all.
A short series of orthopaedic testing and postural analysis can quickly identify either the presence of APT or whether it in fact poses a problem for the patient. Note that these tests are not designed to test for APT specifically. Rather, they help the practitioner form a working impression of the patient in front of them. These are namely:
- Observation
- Forward bend
- Straight leg raise
- Pelvic tilt
- Reverse curl
- Thomas test
- Prone spring
- Bilateral knee flexion (prone)
- Palpation
- Sacral rocking
Last, but certainly not least, another hugely important factor in the assessment for APT is the patient’s history. The following details should be elaborated on during the history take in determining the possibility of the presence of APT in a patient.
- Occupation – prolonged sitting (work and/or travel)
- Presence of pain in the lower lumbar spine
- Activity – types of exercise performed, elite athlete versus sedentary worker
- Notable restrictions of movement – forward bending, home stretching, squatting
- Relieving factors – remedies, exercises, postures.
Something for you to try
The following set of home-based exercises are designed to bring the spine and pelvis back into a neutral position by
- Facilitating activation of the hamstrings, gluteal and abdominal muscles
- By stretching the hip flexors
If you’re a sufferer of lower back pain, be that because of the presence of APT or otherwise, these exercises may offer some relief. Since these exercises are pretty easy, there’s no real limit as to how many you can perform. As a starting point, you might aim for three sets of 15 repetitions, three times a day.
Pelvic Tilt
Lying flat on your back with your knees bent and toes facing forward, push your lower back into the ground, bringing your pubic bone towards your nose. Hold for 5-10 seconds and then relax.
Image sourced from employhealth.com.au
Hip Bridge
Lying flat on your back with your knees bent and toes facing forward, slowly raise your pelvis towards the sky until you form a bridge with your hips. Aim to have your shoulders, hips and knees in a straight line. To finish, slowly lower yourself back towards the ground.
Image sourced from employhealth.com.au
Plank
Form a plank position by lying face down with your feet shoulder width apart. Come up onto your toes and forearms. Ensure your pelvis isn’t anteriorly rotated by attempting to bring your pubic bone towards your nose. Hold that position for at least 20 seconds.
Squat
Stand with your feet shoulder width apart and slowly bend at the knees, lowering your body until your knees are as close to 90 degrees as possible and then return to standing.
Hip Flexor Stretch
Kneel on one knee and place the other leg in front of you, bending the knee at 90 degrees. Bring your bent knee forward until it is just over your toe, feeling the stretch in your other hip. Ensure your torso is kept perpendicular to the floor at all times. Hold for 10-20 seconds.
Image sourced from workoutlabs.com
Here’s one other exercise worth trying – not just for APT but for lower back pain in general.
Summary
I would suggest you steer away from thinking of APT as something that needs to be ‘fixed’ or ‘gotten rid of’. It’s likely that for years you have adopted a certain posture either because of your upbringing, the level of physical activity over the course of your life, and your occupation. Most people won’t have the time nor dedication to commit to a physical program that would aim to ‘correct APT’, if that’s even possible.
If it is found that you have a typical presentation of APT, try the above exercises. As you explore the range of motion offered by your body in these movements, you will have greater body awareness. This awareness translates to increased mind-muscle control which means you will be less likely to injure yourself during activity.
There’s an endless amount of information about this topic. Here’s a good article about APT written by Bret Contreras, otherwise known as, “The Glute Guy”. It’s an oldie, but a goodie I think.
You may have been researching APT and now think you have it, or that it’s the cause of your condition. Whilst you may be onto something, at some point, you’d be wise to get a professional opinion. Who should you see? Well, that’ll require some more research.
Herein lies the point, your time would be better spent researching the right professional to help you with your musculoskeletal needs. Outsource your body issues to someone who deals with them every day, and is truly ‘in the know’ with respect to biomechanical conditions.
