The number of people experiencing bad posture and back or knee pain is steadily increasing. Millions of dollars are spent each year on pharmaceuticals and other symptom-based treatments to alleviate the pain. However, as most coaches, trainers, and other practitioners involved in corrective exercise know, proper training (even a minimal amount) is a far better long-term option. One of the most common postural deviations you will encounter is excessive anterior pelvic tilt (APT).
Anterior pelvic tilt is a condition characterized by the pelvis being tilted forward so that the front part of the pelvis is lower than the back. This causes the stomach and buttocks to protrude. APT can cause a number of symptoms and should be corrected in order to avoid chronic pain.
Causes
The most common cause of anterior pelvic tilt is muscle imbalance. Balanced muscles in the legs, buttocks, hips, stomach and back keep the pelvis in a neutral position. When these muscles become imbalanced in terms of length, strength and flexibility, the pelvis can be pulled more one way than the other.
People with anterior pelvic tilt generally have shortened, tight quadricep, erector spinae and psoas muscles. The quadriceps are in the front of each thigh. The erector spinae muscles run up the lower back along the spine. The psoas muscles are hip flexors; stretching from the thigh bone to the lumbar spine on each side, they work to lift the legs and rotate the thighs outward. The pull of these tight muscles will not countered by overstretched and weak hamstrings in the back of the thigh, gluteal muscles in the buttocks and deep abdominal muscles in the stomach. This causes the pelvis to tilt downward in front.
Muscle imbalances can be caused both by athletic and sedentary lifestyles. Those who exercise in an imbalanced way or who participate regularly in an activity that taxes the body unevenly will develop muscle imbalances. Those who spend long periods of time sitting also develop imbalances, as the sitting position shortens the psoas and weakens the gluteal muscles.
Symptoms
Since anterior pelvic tilt affects posture, your most apparent symptoms will be a protruding stomach and buttocks with an increased lumbar arch. If postural distortion is advanced, your upper body will also be affected. The spine is a unit and a change in one location causes change in another; as the lumbar arch increases, the upper body will round out more to balance the body, leaving the shoulders stooped and head jutting forward.
Back pain is a common symptom of anterior pelvic tilt. This may be spinal, muscular or both. The spinal discs between the vertebrae in the spine are subjected to greater pressure when the curvature of the spine is exaggerated. This can lead to disc degeneration, bulging or herniation. The facet joints connecting vertebrae together are also subjected to extra stresses and may wear early.
Pain may be felt in any of the muscles contributing to anterior pelvic tilt. The muscles that are tight are chronically strained and likely have knots called trigger points. The weaker, overstretched muscles are also strained by the stretching they’ve endured; muscles contract as they’re stretched to protect themselves from tearing. The constant contraction of both the weaker and stronger muscles can cause pain, cramping and spasms.
Treatment
The best way to correct anterior pelvic tilt is to balance the muscles affecting the pelvis. Tight, imbalanced muscles require more than stretching to regain their flexibility. Foam rolling, or self-myofascial release (SMR), can restore length to these muscles. You’ll want to focus on your quads, hip flexors and lower back when performing SMR.
Part of balancing your body is strengthening muscles that are weak. Hamstring, glutes and deep abdominal muscles will need to be activated once the tight, short muscles countering them are relaxed. Traditional crunches and sit-ups should be avoided, as these can overtax the psoas muscles.
Aside from directly correcting muscle imbalances, preventing them in the future will be an essential component of back pain treatment. If you are athletic, make sure to cross-train, working all of your muscle groups evenly; if sedentary, work on maintaining proper posture and introduce a balanced exercise plan into your daily routine. Anterior pelvic tilt is likely to worsen if left untreated; get to the root of the problem to end your back pain.
References:
Smith A, O’Sullivan P, Straker L. Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine (Phila Pa 1976). 2008 Sep 1;33(19):2101-7.
Kritz M and Cronin J. Static posture assessment screen of athletes: benefits and considerations. Strength & Conditioning Journal. 2008. 30(5):18-27.