Welcome everyone – I’m dr sam Spinelli, physical therapist, with e3 rehab, and today we’re going to discuss a common question: how to fix anterior pelvic tilts to do that. We’Re going to need to clarify what anterior pelvic tilt is the theory around why people have it and some of the proposed issues with having it? Let’S start off with discussing what it is, a lot of people might know it when they see it, such as seeing someone who has their butt sticking out and a big back arch. But most people don’t know what the term actually means. The term anterior pelvic tilt can be broken down quite easily.
The word anterior means forward pelvic references, our pelvis bone, and tilt in regards to a change in rotation. So together, that means a forward rotation of the pelvis going in the opposite direction is called a posterior pelvic tilt. Generally speaking, most people are going to have some degree of an anterior pelvic tilt. In fact, if we measure the anterior tilt in most people done by drawing a line from their posterior superior iliac spine to their anterior superior iliac spine, it’s considered the norm to have between 4 and 10 degrees of an anterior tilt. Now a lot of people want to know what causes anterior pelvic tilt.
The common theory is known as a lower crossed syndrome. This is where people point at muscle, imbalances and say they cause the anterior pelvic tilt most commonly. This is identified as weak, abs and weak glutes with tight, hip flexors and tight lumbar erectors. This is because the abdominals and glutes are posterior tilters of the pelvis. So, theoretically, if they’re weak, they can’t rotate the pelvis posteriorly and the hip flexors and lumbar erectors are anterior tilters.
So theoretically, if they’re tight, they can’t lengthen, then you’ll be stuck in an anterior tilt. You may wonder why your glutes and abs are weak or why? Your hip, flexors, and spinal erectors are tight. Some people point to sitting as the problem stating that sitting for long periods of time causes adaptive shortening of the hip flexors, which leads to the various issues we’ve discussed, and then anterior pelvic tilt is the cause of various issues, such as back pain, si joint pain, Hip pain, knee pain and just about pain anywhere that you want to point now. Everything I’ve discussed so far is not based on research, just people’s opinions and beliefs.
I want to shift from here and discuss some flaws with these theories. Whether or not we should be worried about anterior pelvic tilt, but I also want to provide some exercises that can be helpful for people concerned with anterior pelvic tilt and pain of various kinds. So, let’s get into it first off, I mentioned the lower cross syndrome. Earlier this theory was not based on research when it began getting shared. Just a famous physician originated the idea, while well-intentioned the information he spread has done a bit of harm.
You see people have begun, focusing on and fearing anterior pelvic tilt and other normal postural positions because of the poor science that was utilized. When we look at the research around the muscle imbalance concept, our first problem is, we don’t have any operational definition of what a muscle imbalance is when we are muscles balanced. Is it measured by strength, length capacity? Personally, I don’t like the term, because it’s usually just thrown out there without having any substance to it and just put into to help individuals support claims when they don’t have any legitimate evidence to do so. When we look at the research on this, if the model was correct, someone with an anterior pelvic tilt should have tight, hip flexors, which would reduce the hip extension range of motion.
However, we have multiple studies, such as that from Hino and Shashi that showed in different populations. There was no association between pelvic angle and the amount of passive hip extension as well. We have research looking at the likelihood of adaptive, shortening showing that if someone spends a significant amount of time sitting, but they spend at least a half-hour a day, not in that position, it likely won’t occur. So, unless you’re sitting with an anterior pelvic tilt for 24 hours a day, this doesn’t even seem like a probable scenario. Plus most people don’t sit with an anterior tilt.
They sit in hip flexion with a posterior tilt which wouldn’t necessarily shorten the hip flexors. All that much building off this, we have papers from groups such as walker and Ludus, who found that there was no consistent relationship between pelvic angle and lumbar lordosis. If individuals with anterior pelvic tilt truly had shortened lumbar erectors, they should consistently have an increased lumbar lordosis or a bigger back arch flipping over to the weak side of the conversation. We can look at the abdominals. There have been multiple studies looking at this, such as the ones we already discussed, like Hino walker and yutis, plus many others, such as the Takaki and Drysdale papers, which I’ll link down in the description box below, and we have some varying results.
In some studies, we see no difference in abdominal strength, activation, or endurance with anterior pelvic tilt. In some studies, though, we do see a small difference, it would theoretically make sense if someone was stuck in an anterior pelvic tilt that the abdominals would have a much harder time expressing their ability because they’re in a lengthened position, which is not mechanically advantageous. When we look at the glutes, we see a similar scenario. First off we have research from groups like mills and van gelder, which looked at emg during tasks such as kettlebell swings and squats and looking at the range of motion of the pelvis, their research basically leaves us with questioning this concept even further. We broke these studies down more in the gluteal amnesia videos which I’ll link down in the description box below.
So when we look at the research on muscle imbalances, it doesn’t look very promising for the concept as well. If we start to look at the research of association of anterior, pelvic tilt, and back pain, we have tons of research showing either no association or poor association. This can be expanded on to basically every area that we start to look at. It doesn’t consistently seem that anterior pelvic tilt increases the likelihood of pain. Now, this isn’t to say that people don’t or won’t ever find anterior pelvic tilt, painful or aggravating.
We do have research to suggest that for some people it can be symptomatic, they may try to avoid it because of it or they may even spend time in it and then find getting out of it to be relieving it’s just not that we can solely blame Anterior pelvic tilt for everything. So if you’re, someone who has an anterior pelvic tilt – and you don’t have pain – don’t feel like you need to change it. Arguably anterior pelvic tilt can be a beneficial thing. If we look at most high-level athletes, there’s probably a reason that they have an anti-group pelvic tilt as a general, we have some studies that suggest that for running and for weightlifting, it can be an advantage to being an anterior pelvic tilt because it might put the Hip extensors in a more mechanically advantageous position to produce force if you’re, someone who has an anterior pelvic tilt and you’re in pain, you don’t have to change your pelvic tilt to get out of pain. It’S very likely that you could do the things that we’re going to discuss and have some temporary relief, but you don’t have to try and change your pelvic position for the rest of your life.
If you find it’s temporary leaving and it lets, you do more, then go for it, but once you start feeling better and moving around, try not to worry about it and blame it for everything. Alright, let’s discuss some options for exercises that you could do. Firstly, walking is a great activity to start doing more of here at e3 rehab we champion walking a lot and, if you’re someone who doesn’t walk very much, it should be the top of your list for things to start doing. Secondly, doing general exercises like squats, deadlifts, push-ups, etc are great, and we highly encourage that the exercises that we’re about to go through are a bit more specific to this situation. The first one is a cat camel it’s a great exercise that we can start to use to teach people how to get in and out of different pelvic positions.
You can sit up in a quadruped position and focus on trying to roll your pelvis back and forth. You can also try and do a dead bug. This is a great exercise for working on abdominal strength. It’S going to be focusing on implementing a posterior pelvic tilt, we’re going to set up on our back, bringing our knees and arms pointed up towards the roof. Then roll our pelvis back into the ground, thinking to bring your belt buckle to your chin, and then from here we’re going to focus on keeping that pelvis against the ground as we reach an opposite arm and leg out, you’re going to want to try and control It out and then come back and switch sides from here.
We can go to a strengthening drill for our hippie sensors, the glute bridge, the style of glute bridge that we’re going to show you is going to be an emphasized, posterior tilt bridge. This is going to be to maximize the abdominal and glute work in it think to maintain your posterior tilt that we were discussing earlier and then bridge up. If you find it’s hard to do this, and you start to arch your back a lot, you can try doing a mini crunch as you lift up. If you’re crushing it, you can add weight, do a single leg, and many other options. One last exercise I wanted to discuss is the splitsk one.
We’Ve actually put out four videos in the past on split squats, since we’re huge fans of them, something that I particularly like about them is that they get our rear leg into hip extension, while working our lead leg, glutes, and quads. It’S kind of a nice combo exercise where you get a bit of mobility and strengthening effect. As you do them, you can keep the rear, hip extended and then lean forward if you’re looking for some specific hip, flexor drills I’ll link, one of our videos where we discuss various hip flexor options down in the description box below so, let’s summarize anterior pelvic tilt, isn’t inherently a bad thing, it actually can be a very good thing at times. If you find it symptomatic, you can experiment with shifting out of it, but don’t become fearful of it for the long term. You can try out some of the exercises and see if they help you in reducing your symptoms in the long term for most conditions implementing a program that works.
Your whole body incorporates some good strengthening resistance training exercises and helps to ensure that you’re getting in some good steps, quality, sleep, and managing your other life stressors is going to be ideal. Hopefully, you found this video helpful. I know this might disagree with what you’ve been told, either by your physio, your doctor, your personal trainer, or your friendly youtube guru. But while those people are well-intentioned, they’re operating off of quite flawed information using a lot of post-hoc fallacies where we see something and then assume it’s from the prior information and then they spread this misinformation. That causes us to fear different positions that we have no legitimate reason to fear.
So thank you for watching and we’ll catch you in the next video you