Corrective Methods For Common Postural Deviations: The Anterior Pelvic Tilt If I go a day without spotting an anterior pelvic tilt, it’s because I didn’t leave the house. How does one recognize an anterior pelvic tilt (APT) at a glance without a kinesiology background? Think of any female fitness model you’ve ever seen on the cover of a magazine hitting the traditional side pose. Her butt is arched up so high in that animal kingdom mating pose that you could rest a dinner plate, a drink, and a side salad on it…possibly with enough room to leave your elbows on the table. While this is obviously a more exaggerated APT than the average person walks around with, a huge percentage of people have some degree of misalignment at the pelvis, and I’m going to teach you how to spot it and fix it.
The Big Problem
If you remember from Part I of this article, I pointed out how an internally rotated humerus can spread to other problems and cause a cascade of unwanted physical ailments. It should come as no surprise that an APT is not an isolated problem, and if left to run its course, will certainly cause further problems all over the body.
We need to remember that the body is a functional unit working in harmony, and can’t be thought of as a group of separate parts. This is an underemphasized principle in proper weight training and rehab, so don’t ignore it. That being said, without a one-on-one assessment its impossible to diagnose specific individual problems, so take this info for what it is…a guide, not a cure-all for everyone with a misaligned pelvis. A few examples to illustrate the synchronicity of the pelvic related soft-tissue:
- Your chest position effects your pelvic position. The Thoracic Cage is roughly the area from your shoulders to the bottom of your ribs, and movement here causes a muscular chain reaction all the way down to your pelvis. According to a 2002 study in the European Spine Journal, researchers determined, “The findings of this study show that thoracic cage anterior/posterior translations cause significant changes in thoracic kyphosis (26 degrees ), lumbar curve, and pelvic tilt.” The stability of this area is governed by many muscles, including the internal/external obliques, the lats, the transversus abdominus, and the deep muscles on the spine called the multifidus. Tightness or instability of any of these can cause shifting of the Cage, which can then translate to a shift at the pelvis.
- A pelvic tilt will most certainly cause the muscles of the lower limb to compensate. It’s not always easy to tell what caused what, but usually one will find an internally rotated femur accompanying a forward pelvic tilt. Simply put, this is when the knee starts to turn inward during standing, walking, squatting, etc.
At the calf, this causes the nervous system to preferentially recruit the gastrocnemius, plantaris, and popliteus over the soleus, which can lead to strain, adhesions, and even contribute to anterior compartment syndrome or “shin splints”.
How many people think of straightening out the pelvis to fix chronic shin splints? But who knows, maybe your doctor is right, it could just be an ibuprofen deficiency.
Now that you understand a bit more about how problems at the pelvis can spread around wreaking havoc, it’s time to figure out how to see if you have an APT, and how bad.
Keep in mind, if I had you right in front of me I would be able to give a full assessment and be able to recommend more extensive and specific solutions, but this will give you someplace to start.
Quite a few tests exist for sorting this one out, from simple to complex. From my experience, there isn’t really one test that shines above the rest; they all have their limitations. Some may find that they look good on one test; yet show poorly on another. So, do them all! Look for a trend.
- The “Duct Tape – It’s Not Just For Valentines Day” Test: Grab a roll of duct tape, and take your shirt off. Tense up your abs as hard as you can, and wrap a single layer of duct tape around your waist (snug), right across your hip bones. Now relax your abs. What did the tape do? If it expanded straight out, you’re good. Fat maybe; but good. If the angle of the tape took a dive towards the ground, congrats, you have some work to do. Think of the top border of the tape as the rim of a bucket of water…are you spilling water all over the floor in front of you? The limitation with this test is, if you’re fairly fat in the midsection this won’t work quite as well. However, if you’re fairly fat in the midsection, you probably have an anterior pelvic tilt…
- The Construction Worker Test: Simple, lean up against a wall (see name of test). Walk your feet out about a foot or so and keep your weight even from heel to toe. Your head, shoulders and butt should make contact with the wall while staying fairly relaxed. Now, have a partner see what they can fit between the wall and your lower back. If it’s a couple knuckles of their hand, you’re good. If it’s a wine bottle, or a rolled up copy of FLEX, you’re going to need some help. I’ve seen this test recommended without a partner, but the problem with that is the thoracic cage adjustment it takes to swing your own arm around behind your back, which as we learned above will affect your pelvic alignment and give you possibly faulty results to your test. So grab a partner!
- The Saturday Night Fever Test: Stand next to a mirror, profile view. Place your hands on your hips. You’re going to test your range of motion for a good clue about pelvic positioning. Start by trying to rotate your hips as far forward as your can without bending your knees. You can use your hands to help push. Then, relax back to neutral. Now, do the opposite, try to rotate your hips posteriorly as far as you can (like you’re trying to raise your belt buckle up towards your nose). Do this back and forth a few times, always pausing and relaxing at neutral. If you can travel significantly farther posteriorly, there is a good chance that it’s because your pelvis is sitting so far forward already, there’s not much more room to go. The limitation with this test is that it’s a strange movement for a lot of people, and the lack of neural recruitment limits their ability to coordinate the movement properly.
You’ve probably discovered at least some degree of Anterior Tilt, so here’s a list of things you can start doing to fix it.
Once the pelvis has taken a journey out of proper alignment, you can bet there’s some degree of neural inhibition in the tonic muscles of the torso and hip region. Generally speaking, the deep muscles of the core provide the stability during movement, and the larger superficial muscles provide the action. Without the deep muscles doing their job, not only do you look like you’re on a trampoline when trying to perform compound movements, you also greatly increase the chance of injury due to unprotected joints. One note I should make, some of these movements are stability based to increase proprioception and tonic muscle activation, however, if you’re really a mess, you need to first train these muscles from a point of stability before you jump into instability. This applies more to injury rehab, but can also apply to an un-injured trainee with severe deviations.
When a muscle is slightly over-stretched, this often places it at a more optimal position to exert force on a joint compared to other more relaxed muscles designed to carry out same function. In this case, the vastus medialis (the big teardrop looking muscle just above and inside the knee) starts to contribute less to knee flexion movements and the vastus lateralis picks up the slack. When your knee turns inward, your lower leg compensates by turning the foot outward to maintain balance and keep you from walking like you’re on a boat. This outward foot rotation then causes another host of problems, including a pattern change in the hamstring recruitment.
Specifically, because of the mechanical advantage, this results in an over-reliance of the medial hamstring muscles (semitendinosus and semimembranosus), and an under-recruitment of the biceps femoris group of the hamstrings; which can lead to eventual atrophy and further knee problems.
Standing Illiopsoas Stretch. Actively push pelvis forward to try to increase stretch on inner hip of back leg.
Kneeling Illiopsoas/Rectus Femoris Stretch
|Sprint Start Illiopsoas Stretch. My personal favorite; although hard to master. Actively try to push weight forward on front foot while simultaneously pushing back heel down towards the ground, and out ward away from body. Notice the angle of her back foot.||
Rectus Femoris/Illiopsoas Stretch with Incline Bench. This is a 3-step setup, here is the start.
|Midpoint. Try to drive back knee as far as possible towards (or under) the bench.||Finish. Hold back knee in position, and lean torso back towards bench/heel. Hold this position for duration of the stretch.|
Those stretches should be done before all compound movements until the pelvis straightens out significantly.
Hold each stretch for about 20-30 seconds, perform before workouts, between sets, before bed, upon waking…all the time for the first 3-4 weeks, then taper back.
Next, most will have shortened, tight adductors. Here’s a good stretch for that:
Keep foot level on bench, actively try to turn the toe downward towards the floor. Squat down and hold position, applying pressure to the outer thigh with free hand.
After stretching, performing some control drills will really help get you back on track.
Forward Rollout, start position. This can also be done with a barbell loaded with a 25lb plate on each end. I cannot stress enough the importance of actively tensing or bracing your abdominals during this entire movement. We’re trying to wake up the deep tonic muscles of the abdomen here, so it’s going to take some focus initially. Tense the midsection like you’re about to get kicked in the belly, and breathe in and out without relaxing those muscles. Once you feel stable, begin the movment.
Finish position. Note the proper slight curve (lordosis) in the lower back, but no excessive arch. Pause here, continue to tense the midsection, and return to start using your deep abdominal muscles. You should not feel like you’re pulling the ball back to you with your arms.
This is an improper finish position, demonstrating a hyper-lordotic arch. This is a great way to turn your spine into fine powder.
|This little gem I like to call an Incline Unilateral Deadlift. It’s a control drill (for our purposes), and should be done with a slow tempo and no external loading.Keep your weight on your heel, and picture doing a deadlift without the bar in your hands. Drive your hips back forcefully as you descend. The inclined angle of the bench pre-stretches the hamstring and gluteals forcing them to contribute more to the movement compared to the quadriceps. This will help teach your glutes to fire and strengthen, which are almost always the main “weakness” culprit in an anterior pelvic tilt.|
|This is a Unilateral Good Morning. Same idea as the last exercise as far as gluteal activation. This should be performed with the foot turned slightly inward, to compensate for the likely overpowering semimembranosus/semitendinosis group. This will feel awkward at first, but it will increase the recruitment of your biceps femoris hamstring group to help correct any imbalances. Keep the non-working foot slightly off the ground the entire set before switching legs. Try to maintain a good lordotic arch throughout, and take a 1 second pause at the bottom position. Go as low as possible, stop only when you start to lose the arch.|
These are some of my favorite drills that can be incorporated into your current program.
If your pelvis is severely rotated, always perform these exercises first before a workout with light weight. The goal is activation, not fatigue.
Work towards performing the movements at the end of workouts, and using heavier weights for lower reps over the course of a month.
As for frequency, when performing them light for activation, you can do these movements 4-5 times per week initially. Once you start increasing loads and taking the exercises to fatigue, drop back down to 2-3 times a week.
The proposed stretches should always be performed before workouts and in between sets.
Another consideration for those with severe rotation; is to eliminate squatting movements for the first month, to be replaced entirely with deadlifts. Once the hip musculature catches up and the illiopsoas/rectus femoris region returns to a healthier resting length through the prescribed stretching, incorporate squatting back in.
When squatting (and even Deadlifting), try to think about “spreading the floor apart” with your feet during the entire movement. This forces the body to activate the gluteals, eventually you won’t have to think about it anymore.
Give serious consideration to visiting a qualified neuromuscular massage therapist or someone who practices Active Release Techniques. You’ll want to have special attention paid to releasing the adhesions between the posterior aspect of your adductors and the anterior most borders of your medial hamstrings. You can also expect serious adhesions and scar tissue along your illiopsoas muscles from the constant shortening (this area is extremely unpleasant to have worked on, but well worth it).
Fixing an anterior pelvic tilt will save you serious back pain in the future, and increase your performance inside and outside the weight room. You can also expect your midsection/abs to look profoundly better, as this will help to eliminate quite a bit of pooch…but if you’re fat, you’re still going to be fat…and that’s a whole ‘nother story.