Decrease the risk of knee pain, lower back pain/injuries, and other musculoskeletal disorders with these five tips...
The number of people experiencing bad posture and back or knee pain is steadily increasing. Millions of dollars are spent each year on pharmaceuticals and other symptom-based treatments to alleviate the pain. However, as most coaches, trainers, and other practitioners involved in corrective exercise know, proper training (even a minimal amount) is a far better long-term option. One of the most common postural deviations you will encounter is excessive anterior pelvic tilt (APT). Some visual cues of anterior pelvic tilt are:
- A forward tipped pelvis
- Increased lower back curve (sway back)
- A “bulging” (not necessarily fat) abdomen
This pattern is characterized by overextension of the lumbar spine, lack of glute involvement, and quad and low-back dominance. These visual cues, in combination with a screening that reveals stiff hip flexors, poor glute and abdominal strength, and compensation patterns are good indicators of anterior pelvic tilt.
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A certain degree of anterior pelvic tilt is normal and usually unproblematic. Excessive APT, on the other hand, leads to poor exercise technique and increased risk of knee pain, lower back pain/injuries, and other musculoskeletal disorders, all of which in turn exacerbate anterior pelvic tilt.
Why This Postural Deviation Is So Common
Excessive anterior pelvic tilt is characterized by the following weak/lengthened muscles:
- Rectus abdominis
- External obliques
Simultaneously, the following muscles are strong/stiff:
- Rectus femoris
- Tensor fascia latae
- Erector spinae
This muscle imbalance pattern develops over time and involves reciprocal inhibition, a process where muscles on one side of a joint are relaxing to accommodate contraction on the other side of that joint.
Excessive anterior pelvic tilt is especially common among females. Its primary causes include a sedentary lifestyle (e.g., prolonged sitting), poor movement patterns and posture, and genetic predispositions.
There’s no surprise that so many people in the modern world display signs of excessive anterior pelvic tilt. Sitting and performing tasks with poor posture for extended periods of time lead to shortening of the hip flexors, increased tension on the lower back, and glute atrophy. These problems develop over time, and once present, perfoming daily activities like tying one’s shoes can cause pain.
Correcting Excessive Anterior Pelvic Tilt
Some believe that chiropractic and rehabilitative intervention are necessary for correcting this type of spinal deviation. However, after having coached many clients with APT, I’ve found that correct exercise is the most effective approach. This is also consistent with studies which show that it’s possible to change lumbopelvicposture through strength training.
I think most trainers will agree that one of the keys to being a good coach is to understand that all exercises, mobility drills, and so on should be included only if they serve a purpose. This is especially important when training clients with muscular imbalance patterns, as poor exercise technique and selection will only worsen the problem. (Another key to being a good coach: Staying up-to-date on the latest exercise science and fitness training methods with the free PTDC newsletter.)
I’ve tried various approaches for dealing with this postural deviation, but after a lot of trial and error (there’s only so much you can learn from reading science and theory on the subject), I discovered certain patterns regarding what works and what doesn’t. From my own experience, I developed a step by step protocol that is very effective for dealing with APT. Because excessive APT is one of the major challenges personal trainers encounter, this step by step plan can be a valuable tool to have in their toolbox.
Typically, hip flexor stretches are often considered an essential component when trying to eliminate APT. However, while hip flexor stretching does serve a purpose, I’ve found that strengthening the posterior pelvic tilt movement pattern (as coach Contreras is a big advocate of) and ingraining good movement patterns in the gym and daily life are the keys to dealing with anterior pelvic tilt.
I want to emphasize that there are a range of spinal alignments that are considered “normal,” and although a lot can be done through strength training, some people will naturally have a more anteriorly tilted pelvic alignment. I also want to make clear that although there are some universal characteristics of anterior pelvic tilt, not every trainee is the same. Assessing flexibility, strength, and movement patterns is therefore always a good idea.
Step 1. Master the lying pelvic tilt.
Many trainees who possess excessive APT have no idea their low back sway, bulging abdomen, back pain, inability to perform good squats, and/or poor glute strength are actually a part of a muscular imbalance pattern that, to a great extent, can be corrected. Also, folks in excessive APT often have no idea how to posteriorly tilt their pelvis. For these people, step one is to learn how to get the pelvis into a neutral position and posterior tilt. The lying pelvic tilt is a great exercise for achieving this, as “push the lower back into the ground” is an easy cue for most people to understand.
Step 2. Improve things more with the standing pelvic tilt (SPT).
When the trainee manages to perform the lying pelvic tilt and understands how to control pelvic alignment, the standing pelvic tilt is a natural next step. “Squeeze the glutes” is an excellent cue for the SPT, as it triggers the trainee to contract the glutes and posteriorly tilt the pelvis.
Step 3. Learn and ingrain the hip hinge pattern.
I’ve found that one of the most effective exercises for teaching clients the hip hinge pattern is the pull-through.
The movement pattern in the pull-through closely resembles that of the deadlift, kettlebell swing, and other hip dominant exercises. However, there’s one key difference: When performing pull-throughs, the band or cable is attached behind the trainee, and this helps force the client into a posterior weight shift.
Concentrate on keeping the chest high (without overarching the lower back), pushing the hips back, and finishing the movement by squeezing the glutes.
Step 4. Strengthen the posterior pelvic tilt movement pattern and muscles that promote posterior pelvic tilt.
I’ve found the cable pull-through and RKC plank to be among the most effective exercises for treating APT. Posterior pelvic tilt hip thrusts, American deadlifts, and other exercises that strengthen the posterior pelvic tilt movement pattern and weak muscle groups (especially glutes and abdominals) are also great additions.
Step 5. Incorporate squats, deadlifts, presses, and other compound lifts with good technique.
Many trainees tend to round their backs when doing hip dominant exercises. “Arch” is often used as a cue when coaching deadlifts, box squats, etc. However, when coaching someone who possesses anterior pelvic tilt, the “arch” cue can often do more harm than good, as the lifter ends up with an exaggerated lumbar curve.
Many inexperienced lifters (even those with no apparent postural problems) have a tendency to overextend their backs when locking out the deadlift, but people with anterior pelvic tilt often display excessive back arch during the entire lift. This position is generally considered more damaging than the more commonly seen spinal flexion.
And it’s not just during the deadlift that individuals with excessive APT display poor form. Swayback during presses, pull-downs, and a wide range of other exercises go hand in hand with APT. That in combination with quad dominant lifting, poor glute involvement, and knee drift (in squats) all reinforce poor alignment and strengthen muscle groups that are already strong, setting your clients up for injuries.
While some experienced trainees prefer a rounded upper back position in exercises like the deadlift, the general recommendation is to keep the spine in neutral. The coaching required to achieve this spinal alignment depends on the client.
When you’re coaching a client who displays a normal (neutral/slight anterior pelvic tilt) or posteriorly tilted pelvis, “arch” is often a good cue during deadlifts and squats. However, for someone in excessive APT, “chest up” is the better cue. That’s because keeping the chest high is still essential, but instructing the client to arch the back will often lead the client to overextend.
Besides the focus on spinal alignment, my two top cues for a perfect deadlift and squat are to spread the floor apart (push against the outside of your heels like you’re literally trying to pull the floor apart beneath you) and drive through the heels. When assessing a clients’ squat and deadlift technique, start with a side view, as this allows you to see whether the bar is traveling in a vertical line over the mid-foot (as it should) and the spine is in good alignment.
Neck and head position are less important. The cue “tucking in the chin” helps maintain a neutral neck position, which is always a “safe” tip, but to be honest I’ve found that it doesn’t really matter that much. Just make sure your client doesn’t look up at the ceiling, to the side, or somewhere that clearly throws him off alignment. Many of the strongest deadlifters in the world look straight ahead during the lift, and I’ve never found this head position to be problematic. Some coaches argue that you’re strongest when lifting with a neutral neck position, but if there really is an advantage to this position it’s quite small.
Squeezing the Glutes and Posteriorly Tilting the Pelvis During Training
It’s not just during lower body exercises that pelvic position is essential. Squeezing the glutes and posteriorly tilting the pelvis during exercises, such as the press, push-up, chin-up, push-down, and bicep curl, are a good general recommendation.
While it’s not a requirement, posteriorly tilting the pelvis during these types of exercises stabilizes the spine and even gives you some static glute training. Also, when performing hip dominant exercises such as deadlifts, hip thrusts, and box squats, a good tip is to finish the contraction by squeezing the glutes.
Emphasizing PPT during training is especially beneficial for athletes in APT, but it also applies to other lifters who want to get optimal benefits from their workouts (and who doesn’t want that?)
Other strategies that can help improve anterior pelvic tilt:
- Add in some hip flexor and lower back stretches.
- Postural training is an important part of treating anterior pelvic tilt. Paying special attention to sitting posture is vital.
- More glute strengthening and activation (e.g., PPT bodyweight glute bridges and hip thrusts) and abdominal work. These can be done at home.
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