Dealing With Anterior Tilt.

Look at the forward tilt of my pelvis, how my glutes sit high.

As many of you who read this blog may have noted I have been complaining of low back pain for the last few months (here, here, here), I've tried different strategies; changing training times, general foam rolling and stretching for the lower body complex, with little relief. Some of you may be asking "why not just see a physio?" and that would be a wise and just question, the answer? Nothing profound, I'm a guy, we fear doctors.

It wasn't until I put this photo up on this blog the other day that I got a really good demonstration of what the possible problem could be, as you can see my pelvis is tilted, quite dramatically in an anterior (frontal) position, so I figured I would research a hunch I had, that it could be what is known as anterior pelvic tilt (a tilting of the pelvis that causes contraindication). I asked what were my symptoms? Tight hamstrings, sore low back, weak abs. Due to this, I worked on my posterior chain relentlessly, figuring that was where the problem was (this is the pain site vs pain source problem), well upon research these problems are consistent with an anteriorly tilted pelvis, and what are the recommendations? Stay away from stretching posterior  (hip extensor) muscles such as the glutes and hamstrings, as they only appear tight, but are actually at adequate or above adequate length.

Kendall et al in their hernia inducing book Muscles: Testing and Function with Posture and Pain define the Kyphoic-lordotic (defined roughly as: "characterized by a convex curvature of the thoracic spine and an inwardly curved lower back resulting from the pelvis being tilted forward.") posture and possible causes:

"Four groups of muscle support the pelvis in anteroposterior alignment. The low back extensors pull upward on the pelvis posteriorly, the hamstrings pull downward posteriorly, the abdominal muscles pull upward anteriorly, and the hip flexors pull downward anteriorly. With good muscle balance the pelvis is maintained in good alignment. With muscle imbalance, the pelvis tilts anteriorly, the low back arches forward into a position of lordosis. In this position there is undue compression posteriorly on the vertebrae, and the articulating facets, and undue tension on the anterior longitudinal ligamnet in the lumbar area." (Kendall et al pg 223, 2005)

The result is roughly what I have above, the problem, as mentioned above, with what I was doing, was it didn't cater to my specific pathology. I was throwing everything at the problem, hoping something would stick, you don't need to tell me how silly that was. The small amount of relief I felt would have been due to the fact that I was foam rolling and stretching my hip flexors and low back. Kendall et all 2005 suggest that to reduce the anterior tilt of the pelvis there are several steps I need to follow:

1. Strengthen the anterior abdominal muscles (Rectus Femoris, External Obliques)
2. Strengthen hip extensor muscles (Glutes and Hamstrings)
3. Stretch tight low back and hip flexor muscles (Spinal Erectors, Rectus Femoris, TFL, Psoas, Illiacus) (Kendall et al pg 223,  2005)

The authors go on to suggest that the weakness in the abdominal muscles allows the pelvis to tilt forward due to the fact that they are unable to upwardly pull on the pelvis to maintain it's correct alignment, this also causes the low back to go into lordosis (curvature), which causes pain across the low back.The tight hip flexors can cause reduced range of motion in hip extension (think the top part of a deadlift movement when you drive your hips forward), therefore contributing to weak hip extensor muscles.(Kendall et al pg 223-4-5, 2005)

How is this caused? Well there are many causes, one of which is sitting at a desk or in the sitting position for long periods of time, which I do, I spend a butt load of time at the computer (you couldn't tell with all the blogging).

So far I've been sticking to the HIIT (will attempt a light MRT session tomorrow night) and doing specific foam roll drills (with cricket balls into my TFL and glutes), and stretching of the aforementioned hip flexors.  After that, to strengthen my core and glutes I superset glute bridges (10 reps) with planks (30-45s).

Further reading
Hips Don't Lie: Fixing Your Force Couples

Reference
Kendall F.P., McCreary E.K., Provance P.G., Rodgers M.M., Romani W.A., (2005). Muscles: Testing and Function with Posture and Pain. Baltimore, MD. Lippencott Williams & Watkins. Pp- 223, 224, 225.