Today's discussion will be about a very common postural dysfunction known as an anterior pelvic tilt. A Thomas Test is a physical examination/evaluation that exposes an anterior pelvic tilt.
With an Anterior Pelvic Tilt...
the Pelvis is position/angeled forward and downward (rotation)...typically in response to weakened muscles in the hip region. Hips are slightly flexed and lumbar spine is excessively hyperextended. Hip flexors, erector spinae are short. Abdominal, hamstrings, gluteus maximus muscles may be weak. Increased risk of lower back injury during standing or lying hip extension, flexion, or stabilization activities, and weighted overhead activities. See abdominal weakness and hip flexor inflexibility.
Examples of affected exercises:
Squat
Hack Squat
Military Press (standing)
Roman Chair Situp
Example preventative / corrective exercises:
Hip Flexor: Kneeling Hip Flexor Stretch
Erector Spinae: Lower Back Stretch
Abdominal: Crunches
Hamstrings: Leg Curl
Gluteus: Seated Leg Press
A more involved description of an anterior pelvic tilt, when the ASIS (anterior superior iliac spine) is lower than the PSIS (posterior superior iliac spine). This leads to a downward/forward slope of the pelvic region.
When the PSIS are higher than the ASIS, we see an increase in the lumbar lordosis and a decrease in the hip angle.
As already stated, clinical issues associated with anterior pelvic tilt include: tight hip flexors; tight quadriceps; tightened spinal extensors; weakened abdominal muscles; obesity; and increased lumbar lordosis.
Now that We know What an anterior pelvic tilt is...
In anatomical terms, "anterior" refers to the "front" side of the body (the side your face is on), and "pelvic tilt" means that the pelvis is tilted to one side. In this case, the tilt is towards the front...I sound like a broken record, but sometimes that is how we learn...hearing it over and over again!
Since our spines are naturally slightly curved, but with anterior pelvic tilt the curve is excessive compared to a neutral posture. According to some physiotherapists, a desirable tilt is 0-5 degrees in men and 7-10 degrees in women. You can estimate your tilt by standing with your back against the wall and measuring how much space is between your lower back and the wall. If you can fit one hand in there you're fine. If you can fit a couple of wine bottles you're in trouble.
But what exactly is the problem with the anterior pelvic tilt? Well, for one thing, it doesn't make your posture look very good – at least not if you're a guy. If you're a woman, you may be able to pull it off. An arched back is considered a feminine trait, after all. Still, there's no need to go overboard, because the second reason to avoid (excessive) anterior pelvic tilt is that it causes lower back pain, especially with old age. Besides, a protruding belly doesn't look good on anyone.
So...
Identifying the muscles that need fixing
Not using certain muscles eventually causes other muscles to overcompensate, which leads to some muscles becoming lengthened and weak and other muscles short and stiff. Here's a list of things that typically lead to anterior pelvic tilt (or characteristics of anterior pelvic tilt; it's difficult to say what causes what):Lengthened (weak) hamstrings
Lengthened (weak) abdominals
Lengthened (weak) glutes
Shortened (tight) erector spinae
Shortened (tight) hip flexors
Hamstrings are the long thick muscles on the back of your legs that flex the knee and extend the hip. Abdominals are the muscles around the torso. While the outermost muscle (rectus abdominus) is responsible for that six-pack look, it's the deeper muscles that have the biggest effect on posture. Glutes are simply the butt muscles.
The erector spinae (or spinal erectors) is a group of muscles in the back that supports the spine. Finally, hip flexors are a group of muscles near the pelvis that move the hip forward during walking and running.
Exercises for correcting anterior pelvic tilt
To fix the problem and bring the pelvic tilt back to normal levels, a set of exercises that target these issues is needed. In essence, we need to do two things:
Make the hamstrings, deeper abdominals and glutes stronger
Stretch the spinal erectors and hip flexors
There are numerous exercises that can be done to achieve these ends, and quite possibly the most effective ones are those that also involve weights and gym equipment. However, there are also exercises that you can do at home using only your body weight. It's these exercises we'll be looking at next.
Exercise 1: Glute bridge
This exercise, also known as supine hip extension or pelvic lift, strengthens both the glutes and the hamstrings.
One variation of the exercise is to straighten one leg so that only one foot is on the ground, hold for a while and then do the same with the other leg.
Exercise 2: Front and side plank
Plank exercises are good for making the abdominal muscles stronger. In contrast to sit-ups, which mainly affect the superficial muscles, planks target the deeper muscles. In addition to the usual front plank where both feet and elbows are on the ground, you can do side planks:
This exercise can also be made more difficult by lifting one of the legs up and holding for at least 30 seconds.
Exercise 3: Lunge stretch
The lunge stretch exercise stretches the hip flexors. It's also called by various other names like hip flexor lunge, lunging hip flexor stretch, psoas stretch, etc. Depending on who you ask, you may get a different answer as to how to perform the exercise...God I LOVE, LOVE, LOVE <3 LUNGES
This exercise can also be done as a forward lunge, in which you begin from a standing position and then lunge forward and drop your hips towards the floor. Performed this way, you'll target glutes and hamstrings more than the hip flexors, unless you also do the stretch.
Exercise 4: Lower back stretch
The lower back stretch is an exercise that stretches the erector spinae. It's also known as all fours back stretch, back arch stretch, cat pose stretch, and various other names.
You can alternate between the two arches, but keep in mind that it's the upward arch that stretches the erector spinae.
As an aside*
I find that the Cobra, is a wonderful Low Back Strengthening Exercise. From a Prone position with your palms position flat underneath your shoulder and your legs (adductors engaged! Very important for the effeciency of the exercise) together...Using JUST your low back strength, lift up.
Exercise 5: Supine pelvic tilt
Finally, here's an exercise imitating what you want to happen through all your hard work. Like planks, the supine pelvic tilt mainly targets the deeper abdominal muscles.
The exercise itself is very subtle, but it gives a good idea of what you're trying to achieve. You can alternate between short reps and holding the tilt for a longer period.
Summary
The muscles that are required to maintain a natural posture don't get enough exercise during daily routines, especially if you work at a desk job. This causes some muscles to weaken and others to compensate. As a result, the pelvis tilts forward, which in turn results in a postural problem known as anterior pelvic tilt. Many people have some degree of (excessive) anterior pelvic tilt, whether or not they realize it.There are several exercises that can be performed to train the muscles that are weakened (hamstrings, deeper abdominals and glutes) and stretch the ones that are overcompensating (hip flexors and the erector spinae). You may get better and faster results by combining many different exercises, but the ones shown here will get you started.
Personally, I recognize my posture from the first picture showing excessive anterior pelvic tilt. I also have occasional problems with pain in the lower back. Until now, I haven't really known what the precise issue with my posture was, but thankfully, I was pointed in the right direction by some members of the imminst.org forums.
For anyone interested in this condition when applied to someone wheelchair bound...here you go. There are also technical issues which may cause a client to present with an anterior pelvic tilt when sitting in his/her wheelchair. These include: excessive lumbar contour in the back rest; back support too vertical for the client, causing the client to lean forward; and having an anterior slope on the seat of the wheelchair.
It is only by taking the client out of the wheelchair and completing a thorough hands-on evaluation that we can understand the client’s range of motion and flexibility available in the pelvis-spine and in the pelvis-hip joints. Using this information, we have a better understanding of the client’s presenting posture and whether the client has a fixed or flexible anterior pelvic tilt.
In addressing the seating needs of a client who presents with an anterior pelvic tilt, we have to be cognizant of addressing the cause(s) of the posture, rather than providing a bandage solution. What do I mean by this? Well, often when a client presents with an anterior pelvic tilt, as the day progresses and the client fatigues, the client may lean more forward in his/her wheelchair, trying to gain more support through surfaces in front of the client, such as a lap tray. A bandage solution to this is to reach for a chest harness to try to pull the client back into an upright posture, but what we may find is that the chest harness does not work adequately to hold up fatigued muscles, and the client leans into the harness when fatigued. To truly address the cause of the forward leaning often associated with anterior pelvic tilt, we have to determine the cause of the presenting anterior pelvic tilt and address this with seating and wheelchair configuration choices.
Ensure maximizing the client’s footprint means that the surface area contact is optimized on the areas on which the client can take load. This will include the cushion, footplates, backrest, headrest (if applicable), and arm rests/lap tray (if the client does not use his/her upper extremities for functional mobility). We may consider the use of a positioning belt to help maintain the pelvis in a neutral position (if the anterior pelvic tilt is flexible and if the client can tolerate correction). We may need to consider tilt in space to aid with positioning. It is only after we have looked at the cause(s) of the anterior pelvic tilt and have maximized the client’s seated footprint through other choices that we would consider a chest harness.
To illustrate the importance of footplates to which you might be able to relate. Have you ever sat on a bar stool that was missing the bottom rung? (If you have not, try to imagine what it would be like.) If you were to reach forward without having a stable base of support for your feet, you would find that you could not reach very far … or you might find that you try to wrap your legs around the bar stool to give yourself support so that you can try to reach for that nice, cold drink! Proximal stability is needed for distal
The content of this blog is not meant to be prescriptive; rather it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating solutions for individual clients.
P.s. Stretches that may help by Lani Muelrath
Effective stretches that anyone can do to help relieve muscle tightness that contributes to an excessive anterior pelvic tilt...Stretching Specifics To Alleviate Excessive Anterior Pelvic Tilt
When muscles are too tight, they shorten, pull and tug on bone and can easily bring them out of proper anatomical alignment.
Since we already know that there are specifically three muscle groups that contribute, through tightness, to the excessive anterior pelvic tilt. Fortunately, these respond well to precise stretches:
Psoas
Rectus Femoris (a part of your quadriceps)
Lumbar Erectors (spinal erectors)
Psoas: The psoas muscle is a hip flexing muscle. The psoas muscle attaches to all five lumbar vertebrae, and thus takes part in forward movement of the lumbar spine.
As a consequence, when the psoas muscle is too tight – or too strong relative to other muscles of the pelvic area – it contributes to excessive extension of the upper lumbar area, and deeper flexion in the lower lumbar area.
This simply means that there is an increased “sway” in the lower back. This is stressful to the lumbar region contributes to excessive anterior pelvic tilt.
This is why it is important to keep the psoas muscle from being over strengthened, and why it is also important to keep it from being too tight by implementing stretches specific to the psoas muscle.
Rectus Femoris: The rectus femoris, commonly known as part of the quadriceps muscles group, aids in flexing the hip as well as extending the knee.
Unlike the psoas, the rectus femoris doesn’t attach to the lumbar region, but rather to the front of the pelvis.
This muscle can easily become tight due to repeated lifting of the leg forward and/or specific sports activities. It also responds well to stretching – and stretching it feels good, too!
Lumbar Erectors: The lumbar erectors run up the sides of your spine in the low curve of your back behind the waist, and are often shortened due to tightness in its anterior pelvic tilt bedfellows, the psoas and the rectus femoris.
These muscles respond best to a safe, gentle stretch initiated in the abdominal wall.
To help correct the excessive anterior pelvic tilt, perform each of these exercises for 3 times on each side for a 30 second hold. You can start with one set a day and work your way up to 2 to 3 times a day, and maintenance at 3 days a week.
Note: Be sure the muscles are warm before you start to stretch. See Stretching: Don’t Do It Cold!
I hope everyone today learned a little something about the importance of developing symmetrical strength in your body. Everything in Moderation folks. So keep your body balanced and you will feel better about your self...you'll feel happier in General. Enjoy this great weather we are having, and grab yourself some good wine!
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