Anterior Pelvic Tilt (APT) is becoming more and more of an epidemic among both fit and sedentary individuals. For some this cumulative issue is causing irritation to what are already herniated discs, ruptures, facet joint issues and lower back muscle tightness all leading to one thing, back pain. I have been to 3 different spine specialists for my own damage and not one of them pointed out my obvious Anterior Pelvic Tilt. A few $1,000 later, I was still dealing with back pain. The problem with most sources you find on the interwebs is they only address one aspect of fixing this issue for good. I am going to give you a complete guide to testing and defeating the infamous Anterior Pelvic Tilt aka “Duck Butt” for good.
I don’t know what it is with some people. There is a clear connection between the front of the body and the back of the body when it comes to the cause and treatment of Anterior Pelvic Tilt. Nobody seems to care about treating the body as a linked chain rather then cemented parts. Don’t get me wrong, I made this mistake for a while until finally making the connection and putting the work in to fix it.
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Lets dive in.
What exactly is Anterior Pelvic Tilt?
Anterior pelvic tilt is basically the imbalance of muscles located in and around the hip both in the front (anterior) portion of the trunk and the back (posterior). Usually what you see in a classic APT case is a shortening of the muscles in the front and a lack of control and lengthening of the muscles in the back. Just like making babies and salsa dancing, it takes two to tango. We can’t just look at the hip flexors and quads when it comes to addressing Anterior Pelvic Tilt. We need to show just as much attention to muscles like the glutes, Hamstrings, Quadratus Lumborum (QL), Erector Spinae and Multifidus as we do the Iliopsoas and Rectus Femurs (hip flexor) on the front of the body. I Know, your probably like WHOA ease up on the laboratory talk. Bare with me this is all going to make sense.
Lets start with some pictures.
Lets first address the Psoas and Rectus Femoris.
Note the highlighted Psoas Major and Rectus Femoris. These are two of the guys responsible for your chronic back pain and Anterior Pelvic Tilt. When these guys get shortened from let’s say; too much sitting, the tension yanks down on the pelvis and causes a tilting affect. Most resources will say hammer these muscles with stretches and foam rolling and your pain will magically disappear. Unfortunately, that isn’t the full story. Yes, stretching those muscles WILL help but there is a bigger picture you have to see.
The part most miss when fixing anterior pelvic tilt
On the opposite side of the leg we have some muscles who’s job is to work in line with the muscles on the front of the leg. Because of this much-needed balance, if muscles on the front of the leg become too dominate and start taking over, there is always a group of muscles on the opposite side that usually suffer.
Insert the hamstring and glutes.
With this chronic tension and shortening in the Psoas and Rectus Femoris the hamstrings are being pulled into a stretch. On-top of that, your glutes are failing at being activated to help keep the pelvis inline and stable. Because of this constant tension on the hamstrings, it gives the illusion that they are over tight to the point of feeling like they need to be stretched. The crazy thing is, someone with this issue would actually fail a hamstring flexibility test. Which to the average coach would mean stretch the hamstrings but that’s not the solution. The tight hamstrings are due to the tension the Anterior Pelvic Tilt is creating. So, the wrong answer to fixing APT would be to simply stretch the hamstrings and stretch the hip flexors.
That’s not all…
We still have the Quadratus Lumborum, Erector Spinae and Multifidus that we have to address. Unfortunately, these muscles get thrown into the pile involuntarily. Because of the pelvic tilt the lower back muscles get shortened and tight from this constant lordotic posture. In some cases, you may have been in this tilted position so long that simply stretching the “lower back muscles” causes even more irritation. Some times (not all of the time) simply correcting proper standing posture and pelvic position along with addressing the hip flexors, glutes and hamstrings will help reduce the sensitivity in these lower back muscles which will slowly begin to release and relax. In other cases, a little attention with a Lacrosse Peanut Ball or Thera-Cane will be needed to help release these muscles as well.
How does Anterior Pelvic Tilt Cause Back Pain?
Like I always say. When dealing with back pain it’s a cumulative issue that stretches over variety of different things. For the sake of this article lets just assume your back pain is caused by Anterior Pelvic Tilt. This is typically how it would play out.
Years and years of being in this default Anterior Pelvic Tilt position paired with faulty movement patterns such as posture while sitting, posture while standing and if you exercise the compounding effects of loading your spine with this pelvic position have all played a major role in the way your lower back feels today. For me, this Anterior Pelvic Tilt has caused more irritation to what is already a ruptured L5-S1 disc. Since I went so long without addressing this APT along with the years and years of doing lifts such as Squats and Deadlifts have not only made the area more inflamed and damaged but it started to affect my facet joints which is a whole other issue.
You may not be where I was so if you have no damage and you seem to be experiencing lower back tightness a long with this feeling of being in over extension after standing for a while, your APT is not only constantly pulling on your hamstrings which causes irritation but your pelvis isn’t aligned so your body weight can’t be distributed the way it should over your hips, glutes and lower body. Because of this, your lower back becomes the catch all for all faulty movement and loads. Pair that with some over tight lower back muscles and you’re a perfect candidate for chronic back pain.
Seems simple right?
Well, a lot of back pain is simple to fix it’s just finding your root cause and having the patience and determination to fix it once you find it is where it gets sticky.
How to Identify Anterior Pelvic Tilt
There really isn’t a sure fire way of diagnosing Anterior Pelvic Tilt. In a clinical setting, there are standardized numbers, formulas, and calipers they can use. If you want to spend buckets of money seeing a specialist just to do what you can do at home, be my guest. If you’re looking to get this done at home it can be easily done using images and lines showing a tilt in the pelvis. If you’re looking to diagnosis your self, the easiest tool that I use is a simple camera and line drawing tool you can easily find in a basic photo viewing program on your computer.
The point of contacts for measuring Anterior Pelvic Tilt (APT).
The reference points are we looking at in the picture above are the Anterior Superior Iliac Spine (also known as the ASIS or front bony thing in some settings) the spot on the back is known as the Posterior Superior Iliac Spine (also known as the PSIS or bony thing on the back). What’s important here is that you get a good clear picture of your hips from a side angle. Take a snap-shot and get as close as you can to estimating where these points are. You can use this picture as a reference.
Something to consider:
If you exercise regularly, keep in mind that if you worked your lower back or quadriceps recently, your tilt may be a bit more exaggerated while you recover. Base your measurements off an average if you take multiple pictures.
Notice the difference in the guys pelvis on the left. A is neutral and B would be an Anterior Pelvic Tilt.
How Does a Weak Core Affect Anterior Pelvic Tilt?
There are a lot of different opinions on the cause of Anterior Pelvic Tilt. Some people make it way too complicated and over indulge using big words and unnecessary explanations. One of those common arguments is whether or not a weak core has anything to do with Anterior Pelvic Tilt. I am here to say YES, yes it does.
BUT and that’s a big but.
It’s not just that your core is weak and needs “strengthening”.
I believe there are 3 aspects to the weak core dilemma that need to be addressed
1) Due to the APT, your core is more than likely turned off and you default to locking or bracing your stomach in extension rather than using your trunk to brace.
2) Your core doesn’t have the endurance it needs to maintain a neutral pelvis especially while you are in the stages of retraining your body to maintain a neutral pelvis. So, lets not think “strength” but instead think “endurance”.
3) Because of the above 2 things you really don’t know how to use your core to brace the way you should (with a neutral spine and pelvis) while doing daily activities or exercises in the gym.
How do you fix Anterior Pelvic Tilt?
Alright, so on to my favorite part, the action phase!
The key areas I am going to focus on in this section are the stretches, exercises and tissue release techniques needed to reverse APT along developing the habits necessary to never deal with this again.
This section is video heavy so take it one at a time and be sure to reference this section if you need to for the APT Fix program you will be able to print off at the end of this article.
Let’s start with the stretching and tissue release.
Core exercises that help fix Anterior Pelvic Tilt
Glute Activation Exercises
Stability Ball Hamstring Curl
Single Leg Hip Thrusts
Double Leg Hip Thrusts
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If you find yourself sitting often and experience a lot of lower back pain and tightness I would highly suggest you go through these simple steps to diagnosing yourself. The big takeaway with today’s post is to work both the front of the body and back when your trying to fix this APT issue. It will take time so commit to this program for at least 6 weeks and see how you are improving. Keep in mind that as you work to correct this issue, you have to also work to correct your sitting and standing posture. Actively engage the glutes and brace the trunk while you stand and sit. Stretching and strengthening is pointless if you don’t address the positions you are in that are causing the APT!.
Thanks for reading guys!
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