Back pain (more specifically lower back pain, or LBP) is a very debilitating and common condition that many Americans suffer from. It is estimated that over 80% of all Americans will experience a bout of LBP at some point in their lives, and doctors from a variety of disciplines see over 6 million patients a year with chronic back pain. Anyone who has ever thrown out their back knows how life-altering it can be – I remember many years ago when I hurt my lower back it was so bad that just turning my head to one side caused it to spasm! There are many different potential causes to LBP but I would like to touch upon something that I and other movement professionals have noticed with people more prone to having back issues – having a pelvis with a non-neutral tilt.
In the last article we looked at having an elevated hip as viewed from the front. The kind of tilt I am describing here is the type which is viewed from the side, which tells us what the anterior/posterior or front/back orientation is. A neutral pelvic tilt is one where the front of the pelvis is about 10-15 degrees lower than the back – we measure this by finding the ASIS (anterior superior iliac spine) and drawing an imaginary line to the PSIS (posterior superior iliac spine). A neutral tilt is one where the ASIS is slightly lower than the PSIS. (Because this can be hard to look for on oneself you should see a fitness or orthopedic professional with the appropriate experience to check on yours). Any tilt where the ASIS is lower than this means that you have an anterior tilt; if the ASIS is level with or higher than the PSIS means you have a posterior tilt. Both sides should be checked because each one can be different than the other. So how does this relate to your back?
Bones don’t move themselves – they move because soft tissue (in this case muscles & tendons) pull on them. If a pelvis is oriented a certain way it is probably because certain muscles which are tight are pulling it in one direction. A neutrally-oriented pelvis is one where each set of opposing muscle groups that are pulling on it (what is known as “force coupling”) are in dynamic tension and at the proper length, which keeps it in the right place.
If an anterior tilt is noted this likely means that the hip flexors and erector spinae (low back muscles) are shortened and the abdominals and hamstrings are lengthened. This individual typically experiences intermittent bouts of low back pain that persist and usually can’t attribute a specific event which brings it on – this is because the excessive tightness in the low back coupled with weakness in the abdominal region places a huge amount of stress on the low back at all times. This “jamming” effect back there can over time lead to inflammation and even a nerve impingement in that region. Anterior pelvic tilts respond best to exercise protocols which emphasize stretching the hip flexors & low back while strengthening the abdominals, hamstrings, and glutes.
A posterior tilt is associated with the opposite issues – lengthened hip flexors & erector spinae coupled with shortened abdominals & hamstrings. This person tends to be more prone to suffering an acute injury which lays them up for days or even weeks. This is because the muscles which support the lower spine are weakened and less able to handle lifting things. Those with a posterior tilt tend to respond favorably to hamstring stretches and strengthening of the low back & quads.
Is it possible to change one’s pelvic orientation over time? Usually it is – I have done it and I’ve also helped others do so as well. The amount of time it takes to do so depends on a variety of factors such as age, consistency in sticking with an intelligently-designed routine, past orthopedic & injury history, and lifestyle. Regardless, it is important to remember that our goal is not necessarily to “fix the pelvic tilt” (there can be many variables that go into why it is there in the first place, including genetic), but to take appropriate steps to address it should you have one. It is entirely possible to help condition your muscles in a more balanced way without showing a marked change in degree of tilt – but the kind of tilt observed can serve as a clear marker as to where the emphasis should be when designing a training program.