Anterior Pelvic Tilt
Excessive anterior pelvic tilt is a common postural fault seen in many individuals in today’s society often leading to pain, discomfort, muscular imbalances, and reduced mobility. This condition is characterized by an increased forward rotation of the pelvis which impacts the natural curvature of the spine increasing lumbar lordosis, leading to commonly seen syndromes of the lumbopelvic region. This blog post will provide detailed understanding of this condition, covering etiology, symptoms, effective treatment and preventative measures.
By definition, anterior pelvic tilt is a forward rotation of the pelvis that results in an increased inward curvature/extension of the lumbar spine (lordosis) and protrusion or lengthening of the abdomen. Naturally, the pelvis has the propensity to tilt anteriorly; however, excessive tilt of the pelvis increases chances of lumbopelvic syndromes which is a group of symptoms that commonly occurs together.
A common syndrome associated with excessive anterior pelvic tilt is known as lower-crossed syndrome (LCS). LCS is a muscular imbalance around the pelvis, hips, and lower back. This imbalance contributes to a pattern where certain muscles become tight/overactive, while others become weak/underactive. The primary muscles involved with this phenomenon are the hip flexors (iliopsoas & rectus femoris), hip extensors (glute medius & glute maximus), abdominals (transverse abdominis & obliques) and lower back muscles (erector spinae & quadratus lumborum). LCS is characterized by a specific pattern of hip flexor tightness paired with hip extensor weakness, and lower back tightness paired with abdominal weakness.
The muscular imbalance identified in LCS creates joint dysfunction at the lumbar spine causing compression and pressure particularly at segments L5-S1 and L4-L5. Oftentimes increased pressure and compression within a joint leads to decreased mobility, muscle tightness and pain felt within the joint and/or surrounding muscles. Joint dysfunction is also seen at the hips as an excessive anterior pelvic tilt oftentimes leading to hip impingement causing decreased hip mobility and pain.
There are a variety of contributing factors when it comes to LCS including lack of exercise/movement, living sedentary, prolonged sitting, and maintaining poor posture in standing, all of which further exacerbates an anterior pelvic tilt. Common symptoms felt when dealing with LCS includes low back pain, hip pain/stiffness, knee pain/instability, weakness in glutes and abdominals, tightness or discomfort in hip flexors and lower back muscles.
When it comes to managing LCS or any postural faults, it’s always recommended to consult with your healthcare provider and/or a movement specialist such as a physical therapist. In general releasing/lengthening tight muscles (hip flexors/low back) in conjunction with strengthening weak/underactive muscles (glutes/abdominals). Some great preventative measures are to make sure to keep good postural alignment at all times, remain active/exercise, if you sit the majority of the day for work, set reminders throughout the day to stand and stretch your hip flexors!
~Dr. Courage Jacobs, DPT
References
Herrington, L. (2011). Assessment of the degree of pelvic tilt within a normal asymptomatic population. Manual therapy, 16(6), 646-648.
Key J. The Pelvic Crossed Syndromes: A reflection of imbalanced function in the myofascial envelope; a further exploration of Janda's work. Journal of bodywork and movement therapies. 2010 July;14:299-301
Kuszewski, M. T., Gnat, R., & Gogola, A. (2018). The impact of core muscles training on the range of anterior pelvic tilt in subjects with increased stiffness of the hamstrings. Human movement science, 57, 32-39.
Takaki, S., Ms Pt, Kaneoka, K., PhD Md, Okubo, Y., PhD Pt, Otsuka, S., Ms, Tatsumura, M., PhD Md, Shiina, I., PhD Md, & Miyakawa, S., PhD Md (2016). Analysis of muscle activity during active pelvic tilting in sagittal plane. Physical therapy research, 19(1), 50–57. https://doi.org/10.1298/ptr.e9900
Tateuchi, H., Taniguchi, M., Mori, N., & Ichihashi, N. (2012). Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension. Journal of electromyography and kinesiology, 22(3), 391-397.
