Yoga and Anterior Pelvic Tilt
The anterior pelvic tilt is a hot topic in yoga and in manual medicine. Some people are overly concerned about the fact that their pelvis is tilting anteriorly without even understanding what it means. Let’s simplify the issues behind this increasingly common postural variation and learn how it can affect other parts of our body.
A normal pelvic angle is 30°; this means that our posterior superior iliac spines (the dimples above our bottoms) are slightly higher than our anterior superior iliac spines (the bones that stick out at the front of our pelvis). This angle can vary a few degrees either anteriorly or posteriorly due to our genetic makeup and even temporarily due to tight and/or weak muscles. An anterior pelvic angle of 40° is considered excessive and will produce a lower back (lumbar spine) curve that is also extreme. Our lumbar spine should have an anterior curve which is known as a lordosis; however, when this curve is excessive it is known as a hyperlordosis, which is not ideal. Cases of increased pelvic angles and lumbar hyperlordoses are very prevalent in today’s society.
Causes of increased lumbar lordosis include:
- Postural deformity
- Lax muscles, especially the abdominal muscles in combination with tight muscles, especially hip flexors or lumbar extensors
- A heavy abdomen, resulting from excess weight or pregnancy
- Compensatory mechanisms that result from another deformity, such as an increased curve in the thoracic spine (mid-back)
- Hip flexion contracture
- Spondylolisthesis (displacement of the vertebra above with relation to the vertebra below)
- Congenital problems, such as bilateral congenital dislocation of the hip
- Fashion (e.g., wearing high-heeled shoes)
Magee, J. David. Orthopedic Physical Assessment: Fourth Edition. Saunders. Toronto. 2002.
Cause number two from the list above is the reason that affects most. The majority of the population sits for at least eight hours a day while hunched over a desk at work; this can lead to a generic condition known as lower cross syndrome. This disorder consists of the following muscular issues: Weak or inhibited gluteal muscles and abdominals & Tight and shortened hip flexors and lumbar extensors
To better visualize this, observe the illustration that demonstrates lower cross syndrome. Take note of how the two weak/inhibited muscles create one line of the cross and the two tight/shortened muscles create the other line to complete the shape of a cross, hence lower cross syndrome.
When our hip flexors are tight, specifically our psoas, our pelvis rotates forward by the psoas pulling down on the lumbar spine from its attachment sites; this increases our lumbar lordosis and subsequently shortens our lumbar extensor muscles. This is most often seen in combination with weak abdominal and gluteal muscles.
Now that the reasons for this postural condition have been noted, the way to correct it is clear: reverse the causes. However, the distinction between inhibited muscles and weak muscles must be made first before rehabilitation can effectively begin. Inhibited muscles require the re-establishment of correct muscle firing patterns, while weak muscles need to be strengthened. Some individuals have weak muscles that are not inhibited; some have the reverse, and some have both issues to correct. Tight/shortened muscles require lengthening; sometimes stretching is sufficient and sometimes alternative soft tissue treatments such as Active Release Technique® and Graston Technique® are required to decrease scar tissue and increase the range of motion of the particular muscle.
If you are concerned that you may have lower cross syndrome, or simply a pelvic tilt, paying a visit to your manual health care practitioner (sports focused chiropractor, sports physician) will be well worth the time and money. They will be able to diagnose any underlying issues related to this condition and create an appropriate rehabilitation programs specific to the weaknesses and inhibitions they find upon physical examination. They will also be able to reduce scar tissue that may be contributing to your pelvic tilt (anterior or posterior).
Education is the ticket to eliminating these sorts of conditions from society. If we understand how to mitigate the risks for such generic conditions, we will all be much healthier individuals. Here is to learning more about our bodies!
Learn More about Dr. Carla Cupido.
About the Author
3 Exercises to Strengthen Your Hips and Balance Your Body
In yoga we often speak of tight hips, needing to open the hips, balancing the opening of our hips from side to side (etc), but there is more to a balanced body than open hips. We also need stability and support from our hips. This is important not only in yoga but also in day-to-day activities like simply walking. It is especially important if you are an athlete and need to perform on one leg.
A Look Inside the Hip Our hip musculature is made up of many muscles, large and small. For stability, we need the muscles of the side of the hip to be active and engaged. If you place your hands on the sides of your bony pelvis below your waist, you can imagine a tear-drop-shaped area below the ridge of your pelvis. The front part of the tear is the Tensor Fasciae Latae or TFL which connects with your IT band to join at the knee. At the back part of the teardrop are the Gluteus Medius and Minimus, which lie underneath your big Gluteus Maximus.
These muscles are what support and keep you steady in balance poses or when you transfer weight from one leg to the next as you walk or run. For many of us, these muscles are fast asleep, so we recruit our hip flexors at the front or our glutes and our hamstrings at the back to do a job they were not designed to do. Over time this can lead to low back pain and sacroiliac joint pain. Forcing our body to compensate will lead to problems over time. A look outside the hip Tree pose can be a simple test to see if we are accessing our side/lateral hip stabilizers.
Stand in front of the mirror and take a medium-size tree pose with your foot resting on the shin (even if you can go higher). Place your hands on your bony pelvis again and see if they are level from side to side. If not, press the shin into the foot and the foot back into the leg so that the standing hip drops to make the hips level. If this is too difficult to achieve, keep your foot off the ground but come out of tree pose so that your knee is facing forward, raised to hip level with the knee bent.
Try to level the hips again here by firmly rooting into the ground with the standing leg. My Three Favorite Lateral Hip Exercises Most of us can benefit from a little extra love and attention to the side of our hips. Try these exercises to wake up your hips and begin to stand taller on one leg
1. Kick the Ball Standing: Lift one foot off the ground. Keep your leg straight and send your heel forward, toes pointing out as if you were passing a soccer ball in slow motion. Reverse this motion by turning your toes in and sending your leg behind you. Flow forward and back, heel in and out, in a short arc. Don’t forget about your standing leg: root into the earth and don’t let the hip hitch out to the side. Repeat this motion ten times and then switch sides.
2. Clam Shell: Lie on your side with either your arm or a foam block supporting your head. Bend both hips to 90 degrees with knees bent, feet touching, stacked on top of each other. Slowly lift your top knee up towards the sky while keeping your feet together (as if you were a clamshell opening). Keep your hips stacked and avoid rotating with the pelvis. Lower, repeat times, and switch sides.
3. Bicycle: Lie on your side with both legs straight. Flex your feet, as if standing, and stack them on top of each other. Lift your top leg so that feet are hip-width apart. Keep this distance as you flow through this sequence: a) knee bent move forward to the hip at 90 degrees, b) straighten at the knee, c) float straight leg back to start. This should look like you are slowly pedaling a bike. Keep the hips stacked and stable. Strengthening our lateral hips will not only improve our yoga practice, but will also balance our body and prevent injury so that we continue to walk, vinyasa, and run for years to come.
