Pelvic Tilt Measurement
A common email question I receive is about measuring pelvic tilt. The best way to measure pelvic tilt is with a specialized set of calipers that were developed by neuromuscular therapist Paul Chek. These can be quite pricey, and are only usually found in the offices of skilled therapists.
The other way to measure pelvic tilt, which is quick, cost-free, and easily done is home is by looking at your belt line in the mirror. Usually, the front of your belt line rests either slightly above, or slightly below the Anterior Superior Iliac Spine, which is the small bony protuberance just above your thigh. The backside of your belt line usually rests again just above or below the Posterior Superior Iliac Spine, which are found about 2 inches to the side of the spine.
When you look in the mirror at your side view, you will look at the angle of the belt line. For men, the line should be parallel to the ground, with neither the front or the backside higher than the other, with normal measuring 0-5 degrees. For women, the angle should be slighter lower on the front side than the backside within approximately 7-10 degrees being normal.
It is important to note, that these are the “textbook” normal values for pelvic tilt. It should not be the ONLY evaluation for normal function and balance of the core muscles. You should also evaluate the range of motion and strength of all the associated muscles in order to really test total function of this area. You do NOT have to be perfect, but close enough to be out of pain!
Sam Visnic–
Welcome back!
The Case Against Crunches For Back Pain Relief
Its a common belief that weakness in the abdominal muscles can cause lower back pain. I agree with this statement, however, the general recommendations for strengthening your abs when you have back pain are most likely to make you hurt more!
There are 4 muscles in the abdominal wall that are important here:
1. The Rectus Abdominus: This muscle is the “six pack” muscle. Its primary job is to flex the spine, meaning, to flatten the lower back. The best exercise for this muscle is a crunch.
2 and 3. The Internal and External Obliques: These 2 muscles work together in both rotating the spine, as well as side bending it. They also assist in posterior pelvic tilt, which, when both sides activate, will flatten the lower back.
4. The Transverse Abdominus: This muscle is the deepest muscle in the abdominal wall. Its job is to pull inward, protect the internal organs, assist in respiration, and stabilize the spine and sacroiliac joints.
Typically, the common recommendation to strengthen your abdominals when you have back pain is to do crunches, however, this movement does not produce the desired outcome when it come to pain relief. Instead, if you have attempted to do this when your back hurts, it usually makes you feel worse.
The most effective way to train the abdominal muscles lies in not using your abs in the “crunch” movement, but instead using them to create posterior pelvic tilt. This reversed muscle action involves the obliques to a much greater degree.
A video on this is coming up soon!
–Sam Visnic
How To Measure Anterior Pelvic Tilt and Posterior Pelvic Tilt
The Top Lordosis Exercise
Lordosis refers to the inward curve of the spine, focusing on the neck and the lower back, which have natural “lordotic” curves. Most of the time, particularly in back pain sufferers, this curve becomes exaggerated, creating an excessive lordosis. Correcting this featured postural dysfunction can be challenging to even the best therapists, but if you have the right exercise, it can be a much simpler task.
One of the most important aspects of excessive lumbar lordosis is to remember where it is coming from. There are two major players here. The pelvis is frequently involved, which will be in excessive anterior pelvic tilt, or the neck, which will usually be doing the same thing as the lower back. Since anterior pelvic tilt is the primary cause, it is wise to start there.
Anterior pelvic tilt is caused by muscular imbalance between two main muscle groups. The muscles that create anterior tilt include the psoas, quads, adductors, and lumbar extensors. The muscles that create posterior pelvic tilt include the glutes, hamstrings, obliques, and rectus abdominus.
The ideal exercise will assist in lengthening the muscles that anteriorly tilt the pelvis, and strengthen the muscles that perform posterior pelvic tilt.
This exercise is found in the Supine Hip Extension.
The primary focus of this exercise is contraction of your butt muscles, along with a light contraction in the lower abdominal region, to assist in posterior pelvic tilt.
Here is a sample:
Supine Hip Extension
Lay on your back with your feet about 12 inches from your butt
Keep your feet flat on the floor and emphasize lifting through your heels
Squeeze your glutes and perform a SLIGHT posterior pelvic tilt (to lightly flatten your lower back)
As you continue to increase the tension in your glutes, lift your hips up toward the sky
ONLY go as high as you can get a full glute squeeze. Going too far up usually results in the movement “flowing into your lower back”
Hold for a count of 10 seconds, then return back to the starting position.
Repeat for 10 repetitions.
Getting good at this movement will go a LONG way towards reducing excessive lumbar lordosis!
–Sam Visnic
Why Do So Many More Back Pain Sufferers Have Anterior Pelvic Tilt Than Posterior Pelvic Tilt?
Without a doubt, there is MUCH more anterior pelvic tilt amongst back pain sufferers than posterior pelvic tilt.
Why you may ask?
Well, because your body operates in such a way where it has groups of muscles that operate together when certain factors are present. Say, for example, when you go into “fight or flight”, your chest sinks as your upper abs tighten, the back of your neck and upper shoulders tighten, all with the purpose of protecting vital organs.
In the pelvis, the muscles that shorten and increase tone when you are under stress include:
1. The Psoas
2. The Quadriceps
3. The Adductors (groin muscles)
All 3 of these muscles contribute to anterior pelvic tilt! Now, interestingly enough, a smaller percentage of the population goes the OPPOSITE direction when they get stressed! They actually go into posterior pelvic tilt.
So, what is the difference between the two? What makes someone go into anterior versus posterior pelvic tilt, particularly when stressed? In my experience, postural imbalances are HIGHLY correlated with psychology, and particular characteristics within that realm.
But…thats another blog post!
–Sam Visnic
The 3 Major Body Centers That React To Pelvic Tilt
Excessive pelvic tilt, whether that be anterior or posterior, is by far the most destructive imbalances that can happen in the body. It can create imbalances as far down as the feet, and as far up as the neck and even eyes.
The cool part is, MOST of the time, correcting just the imbalances in the pelvis will improve other far reaching problems in your body, however, sometimes, you need to look elsewhere.
The 3 major body centers that exist include:
- The head-neck-jaw complex: These three structures are essential for human survival. Think about it, if you lived 10,000 years ago and could not keep your eyes or ears level with the horizon, you would not be very efficient at escaping predators. Just as important, if your jaw was out of alignment significantly, you would not be able to chew, and that would certainly lead to death.
- The pelvic complex: The pelvis and the hip joints work together to create stability and balance to the center of the body, as well as generating movement. Based on what the head-neck-jaw complex is doing, this area will reflexively coordinate with it. The pelvis is far lower on the survival needs list. With a dysfunctional pelvis, one could live to perform daily functions.
- The foot-ankle complex: This area provides essential information to the brain about ground forces, how to react, and other key reflex features. When the foot and ankle is imbalanced, ground forces cannot be distributed correctly throughout the body. It is well known in therapeutic circles that imbalances in the feet may contribute strongly to unresolved neck and pain.
Sam Visnic–
How Your Abs Affect Lower Back Stability
You hear it time and time again….
“You have to strengthen your abs to get rid of pain in your back.”
I think thats pretty good advice…BUT…NO ONE tells you exactly how to do that! I’m going to let you in on a little secret:
DOING CRUNCHES WILL NOT HELP YOU OVERCOME BACK PAIN!
Yep. Thats right. Why? Simple.
How do most people, including those with back pain, stand? You guessing it, with pretty crappy posture. The chest is sunken, complete with forward head posture, and a pelvis that has a massive anterior pelvic tilt.
When the chest drops, and the shoulders round, commonly called a “upper cross syndrome”, then the upper portion of the abs are shortened, and usually tight. The lower portion of the abs, are usually weakened. (Yes, you do have lower abs, but not how you think, the muscle is separated NEUROLOGICALLY). The external and internal oblique muscles are usually the ones taking a nap. These muscles are responsible for the posterior tilt of the pelvis, which goes hand and hand with flattening the curve of the lower back.
If you look at the position you are in during a crunch, and and stand up from there, what do you get? Exactly…shitty posture. Sunken chest, etc. What I am saying is that performing crunches for the majority of the back pain suffering population will make MANY people much worse off.
What you NEED to focus on is strengthening the abdominal muscles which are primarily responsible for posteriorly tilting the pelvis, which are the obliques.
So…you may be wondering, “how the heck do I do that?”
Learning pelvic tilting, of course!
I’m going to shoot a few short clips with my cool little Flip video recorder this weekend, and I’ll post them up in a few days.
–Sam Visnic
A Little Experiment…Assess Your Pelvic Tilt…
Let’s try a little exercise here. If you are in a place where you can stand up, then do so, if not, then try this exercise later.
First of all, take a few steps in place, then stop. This will set you in a natural standing posture for you. Keep your arms down to your sides. I want you to begin to notice where your weight is on your feet.
Is it on the front of your feet, or more toward your heels, or is it balanced?
Do you have more weight on the inside of your feet, or the outside, or is it balanced?
Do you have more weight on your left foot, or your right foot, or is it balanced?
Interesting, isn’t it? At any given time, you can notice what your unconscious postural tendencies are.
Now, make sure your feet are straight ahead, and without doing anything else, I want you to begin slowly contracting your butt muscles by squeezing them together. As you do this, notice what happens to your feet.
Did you notice what happens? We’re going to do it again, but this time, I want you to put your hands on the center of your thighs. Now, squeeze your butt muscles again, and watch and feel what happens to your hands.
Now, if you did this as instructed, you will have noticed that your hands move away from your mid-line as your thigh bone rotates outward. That is called external rotation of the thigh bone.
So, you are probably wondering what the heck that has to do with anything. What you just did was move your pelvis by activating your butt muscles! If you put enough tension in them to cause your thigh bones to externally rotate, then your pelvis went into posterior tilt. When this happens, it causes your lower spine to flatten.
What is the significance of this? Stand up again. If you are currently feeling discomfort in your lower back, then this will be an interesting test. Rank your level of discomfort on a 1 to 10 scale, with a 10 being the highest level of discomfort. Now, perform the posterior pelvic tilt again by gently squeezing your butt muscles until you have about a 75% of full contraction in them. Now while holding that position, rank your lower back discomfort.
What did you notice? Has it increased, stayed the same, or decreased? In my experience this motion creates at least some degree of reduced discomfort, and in many cases, almost complete reduction.
This resulting reduction in discomfort through movement of the pelvis communicates to us that perhaps your pelvic position is not ideal. Now, the opposite motion, tipping the pelvis forward into anterior tilt, may create relief if you have the opposite pelvic position.
These types of assessments can deliver an incredible amount of valuable information on what is currently happening in your body that may be contributing to your back pain, and also, HOW to reduce or eliminate it!
Sam Visnic–
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