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Understanding Anterior Pelvic Tilt and its Importance to Hip Function

Written by: Nick Jack
Category: 2014
on 10 September 2019
Hits: 7727

One of the most confusing and at times controversial topics to discuss is the role of the anterior tilt of the pelvis concerning optimal hip function and movement. We have worked with a considerable number of people in recent months to help rehabilitate severe injuries to either the spine or the hips that were caused by their training methods. Many were trying to “fix” what they believed was an excessive anterior tilt of the pelvis by using various gripping methods and exercises to flatten out their back. What they failed to understand is that they need some degree of anterior tilt to maintain a neutral spine and pelvis. Too much anterior tilt is not great either, but there are much bigger problems associated with the flat back posture that features a posterior tilt or lack of anterior tilt. In this article, we explain everything you need to know about pelvic stability and hip function to avoid potential injury. This is a must-read for anyone currently dealing with a hip or lower back problem as it will help to explain where the source of your trouble might be coming from.

What is Anterior Pelvic Tilt & How Much Is Normal?

Firstly let's define the various postural types and exactly what anterior pelvic tilt is. Take a look at the pictures below that give you a great visual of the different postural types, in particular the curvature of the spine seen with the lordosis and kyphosis posture versus the flat back.

You will notice that the "ideal posture" shown in the picture to the far right still shows a small curve in the lumbar spine created from a slight tilt forward of the pelvis. This is known as a neutral pelvis and neutral spine.

  • For males, the optimal range of tilt is between 5-7 degrees.
  • For females, the optimal range of tilt is between 7-10 degrees.

This anterior pelvic tilt provides your lumbar spine with a small lordotic curve which is perfectly normal. This position is essential to the health of the spine and provides a stable and strong base required for efficient movement. Problems arise when there is either too much curve or not enough curvature of the spine and this is greatly influenced by the position of the pelvis.

It is more common to see people with lordosis than a flat back posture. Having completed over 1000 postural assessments over the past 15 years I would estimate 70% fall into the lordosis category with a very small percentage presenting with a flat or swayback posture. In my experience, I see many more serious injuries resulting the flat lumbar spine than the lordosis type posture.

The lordosis and kyphosis postures share a similar trait in that they both have excessive curvature of the spine and the abdominal area protrudes noticeably, giving the appearance of being fat. For many people, this is so undesirable that finding a way to flatten the abs and improve their aesthetic appearance sounds like a great idea. This to many is so undesirable that finding a way to flatten the abs to improve their appearance sounds like a great idea. Little do they know that this strategy of flattening the spine will lead to a host of potential problems with their body.

Why do people try to reduce their Anterior Pelvic Tilt?

Apart from the physical appearance, this posture is associated with, there is a belief held by many exercise professionals that lordosis as is “bad” for the spine. I was told very early on in my career many times that lordosis is "bad" and we need to stretch hip flexors and tighten abs and butts to reduce the curve to reduce the enormous strain on the spine it creates. I completed several advanced courses on postural correction and even became certified in Pilates to learn more about how to do this. All of these courses had a strong focus on reducing the anterior tilt and flattening the spine. Pilates calls this positioning “imprint” and this is a foundation element that is applied to almost every movement in the belief it enhances core stability.



This philosophy that we must squeeze the glutes and abs in every exercise was constantly being reinforced to me in these courses. Along with the fact that most people are very weak in the abdominal and gluteal regions, it all made perfect sense to me. For many years I adopted this strategy in the belief I was teaching them great core and hip function. When in reality it was setting people up for potential dysfunction.

While it may be true for the glutes and abs to be known as weak muscles, constantly gripping and posteriorly rotating the pelvis does not allow for their most effective use and can set you up for a host of future problems.

They say you learn the most from your failures because the people you ‘fail’ with force you to go back to the drawing board, re-evaluate what you have done, determine what did or didn’t work, and find a new approach or strategy. This is exactly what happened to me and to be honest still occurs today. I failed a lot in my early years of training, and not just with my clients but also with my own body and suffered some painful injuries as a result. These failures were a gift for they provided great lessons for me as to the need to continue to develop my knowledge appreciate how we move is of most importance.

It also taught me that there is more than one way to approach the same problem. Previously I wanted to have a one size fits all approach that made things easy to implement. I now understand that I need to have a much wider and more integrated perspective and base things on how people move instead of applying an isolated muscle approach.

For more on this see our article why you cannot blame a muscle for a movement problem

Where did this Logic originate?

To understand where the logic of reducing the anterior tilt originates from you need to understand some of the terms coined "Lower Cross Syndrome" and "Upper Cross Syndrome" from the legendary Dr. Vladimir Janda. He demonstrated that the lower crossed syndrome is the result of muscle strength imbalances around the pelvis and many injuries in the body will result from poor pelvic alignment.

These imbalances can occur when muscles are constantly shortened or lengthened concerning each other. He found that there is over-activity and hence "tightness" of hip flexors and lumbar extensors with simultaneous under-activity and weakness of the deep abdominal muscles and glutes on the opposing side. This imbalance results in an anterior tilt of the pelvis, increased flexion of the hips, and a compensatory hyperlordosis in the lumbar spine. 

Hence trying to reduce the anterior tilt all seems to make sense, right? 

I adopted this approach for many years and in my mind, it was successful for there were many people this worked for, but there were many where it did not, and I needed to find out why. This led me to find other methods and philosophies and the research by Shirley Sahrman conflicted with some of Janda’s research. I continue to follow much or Janda's work and his book "Assessment and Treatment of Muscle Imbalance" is one of the best books I have ever read. In particular, his ground-breaking research on phasic and tonic muscles still makes up a big part of my overall training method and is accepted by experts all over the world as first class.

See our article on posture for more detail on how I use this information today.Posture for more on how I use this still today.

However, I knew something was missing for I was coming across more and more people that this method did not work. In the postural assessment, they showed as being hyper lordosis but the methods I was using to help them were making them worse, not better. 

In an attempt to counter the impact of the lower cross syndrome we are trained to begin stretching the hip flexors and lower back and strengthen the weak glutes and abdominals. Cues to over-activate the glutes at the end range of the deadlift, lunges, squats and even simple hip extensions are encouraged and this is where gripping starts.

This looks a lot like the picture shown below.

Unfortunately, the consequences of using this strategy are that a person is now set up for potential problems at the hip where we see what is known as "anterior femoral glide syndrome" where the femoral heads have moved excessively forward and overly compressed in the acetabulum.

The hip is a ball and socket joint designed to be able to handle the forces of weight-bearing (walking, running, jumping etc.) throughout the day. Because of this, it is inherently strong and stable. The ball portion is the head of the femur and the socket portion is part of the pelvis known as the acetabulum.

The postural changes from excessive hip stretching and squeezing of glutes and abs have a direct impact on how you move and greatly inhibit your ability to center the head of the femur within the hip socket.

Take a look at the picture below where the image on the left (a) has the head of the femur right in the middle when you lift your leg. The picture on the right (b) shows how the head of the femur is unable to stay in the centre of the socket when you lift your leg and begins to move forward and eventually pinch the front of the hip. This is when you feel pain and the need to stretch. But it is not the front of the hip you want to stretch! We will explain this in more detail shortly.

If this faulty movement is not addressed soon over the course of time it will continue to worsen and create damage to the hip joint. The tightness in the front of the hip becomes a sharp pain. Squatting in the gym can go from being your favourite exercise to the most painful and even lifting your leg to put your pants can become a problem. Trust me I know all about this pain as this is exactly what happened to my left hip.

There are more serious problems created from Posterior Tilt of the Pelvis

It is at this point that hip stiffness resulting in (FAI) hip impingement and piriformis syndrome  is very likely but also the risk of a bulging disc injury will be not far away. Once the extreme hip and glute dysfunction becomes your automatic way of moving it is just a matter of time until you develop one of these nasty injuries.

All these injuries are closely associated with butt gripping and the loss of neutral pelvic positions during movement.

Always remember the best place for the lumbar spine to function and be safe from damage is when it remains in neutral. Any excessive movement and constant bending of the spine by rotating the pelvis in a tucked under position weakens the stability of the lumbar spine and moves the discs closer to the sciatic nerve. Repeatedly doing this sets you up for a lifetime of pain.

Additionally, with chronic over-gripping of the posterior hip, the individual will tend to over-compress their hip joint during simple resting positions such as sitting. Over-compression of the hip joint makes it very difficult for people to release their hip muscles when they need to bend, squat, lunge in everyday life.

See articles about these injuries below

Specific Injury Online Programs

Throughout this article, I state several times that specific injuries require detailed assessing to find the source of the problem. To keep this article short I have not included all of these assessments but provided you with links to specific online programs you can instantly download. These programs contain 60-90 minute videos and detailed PDF reports with all of our best exercises, assessments, mobility drills and strength methods with easy to follow instructions to guide you on finally getting rid of these painful injuries. Click on the image below of the program you require.

Controlling Pelvic Motion has more to do with Breathing & Alignment than the glutes

One of the big arguments for using gripping techniques is that excessive lordosis creates compression on the lumbar spine. While it is true compression will result from excessive lordosis, it is more important to derive the stability of the spine from the improved breathing and positioning of the rib cage over the pelvis, instead of using global muscles to provide what we refer to as false stability.

In the book “The Psoas Solution” by Dr Evan Osar he refers to a breathing strategy called three-dimensional breathing that provides a much more effective solution for the stability of the pelvis than gripping.

He states;

“Three-dimensional breathing regulates internal pressure thus stabilising the trunk, spine, pelvis and hip complex and reducing the need for overusing a bracing or gripping strategy for stability. Non-optimal breathing (shallow and rapid) necessitates over-activity of the hip and core stabilisers for stability. Over time, this over-activity restricts both hip and thoracic mobility. Using the entire thoracopelvic cylinder (trunk, spine, pelvis, and hip complex) in the breathing process mobilises all the joints in these regions. As the individual breathes in, the ribs should expand, the spine should gently extend, and the pelvis should generally expand as well. Additionally, as the diaphragm descends, it mobilises the internal organs which are fascially suspended within the thoracic, abdominal and pelvic cavities.”

I found his research and conclusions, along with work by Dianne Lee, to be a real “wake-up call” and go against much of the logic I had been using for a long time. But it made a lot of sense in explaining the dysfunction I was experiencing in my own body and many clients with hip instability and pain.

The art of breathing is a big topic in its own right so I suggest you read our full article on this for more information – Do you know how to breathe when you exercise?

As for positioning, this is where it gets a bit confusing and controversial. For you will see some exercises are modified to encourage more anterior tilt than normal which appears to be poor technique. To further explain this let’s get stuck into how we modify some exercises to encourage anterior tilt but with great control.

Find Neutral Pelvis & Spine

This is very important to understand and be able to experience what neutral is. Most people have trained themselves so much into a posterior tilt and flattened their back out that they have no idea where neutral is. I find the easiest way to learn this is in a kneeling position, to begin with. I love to place a stick on the spine to help people feel what neutral is like.

Watch the video below to see examples of this.

* NOTE: It is extremely important that you find your natural curve in your spine by moving your pelvis and not from over-extending the thoracic region. This is a very common mistake many make and it gives the illusion of the movement looking right when in fact the pelvis is still stuck in a posterior tilt.

This is also where core workouts and isolated abdominal exercises are causing more harm than good. Many of the exercises people use encourage trunk flexion and pulling the spine into a flexed position, for example, a sit-up. This places the person in the horrible position of flexion that we have seen several times in this article.

There are many other isolated drills I also might use and you can reference those in this article How To Improve Hip/Pelvic Stability

Avoid Over-Stretching the Hip Flexors

Yes, you did read that correctly.

Did you notice earlier when defining the lower cross syndrome I highlighted the words "tight hip flexors" as I was suggesting that this may not be the case? In many cases, the stiffness is a protection of instability and using stretches like the one shown below only serves to create huge problems to the stability of the hip. Sometimes it is useful but in many instances, people over-stretch the hip.

With people who claim to have tight hips your instincts fail you to some degree. When we feel pain and tightness at the front of the hip we immediately conclude we need to stretch it out, however, it is not tightness but the head of the femur smashing into the bone of the acetabulum. The tightness is coming from the gluteal region. You can see how this goes in the exact opposite direction to the lower cross sydnrome!

The symptoms people describe and how they move in various positions with squats, deadlifts and lunges give you the answers to this.

Using foam rollers to release trigger points and glute stretches as shown in the video below are vital in being able to get your anterior tilt back. The stretch with the band is awesome for helping this problem as the band helps to pull the head of the femur back into the socket.

Watch the videos below

You can read more about mobility and tight hips in the articles below

Learn how to activate the Glutes in the Anterior Pelvic Tilt position

This part is very important and can be very hard for the gripper to get their head around. We know the glutes are vital for providing a bulk of the workload with all leg movements but the way they are trained can have a dramatic effect on how they work.

One of the best ways to do this is with the deadlift exercise, in particular, the Romanian deadlift where the hips are predominately used. The deadlift is by far the most effective exercise for correcting the dysfunction and it has a lot to do with HOW you complete the movement. 

For more detail on the various version of the deadlift make sure you read this article - Which Deadlift Version Is Best For You

In some cases people were already using the deadlift when I first met them, and some were lifting incredible loads too, but their technique was the big problem. I had to encourage these people to "sit back" with their hips and lengthen their butt. This allowed the head of the femur to glide deep into the acetabulum as it is meant to for optimal stability and centration of the joint.

When they were about to lift the best instruction was to say "push the ground away" and "stand tall" as opposed to squeeze your glutes hard. Standing tall is a great way to encourage the position that lengthens the body into its optimal stabilizing position.

*NOTE: It may be necessary to use blocks to assist finding neutral pelvic and spinal position.

Make sure you get a copy of our FREE Glute Checklist below by clicking the image to download.

The next part was trying to integrate this pelvic motion into other movements.

Using Anterior Pelvic Tilt with the Lunge & Step-up

Once you are able to release the hips and perform the deadlift, it is time to functionally lengthen the glutes and hamstrings in other complex movements that demand greater stability and control. It is one thing to learn the pelvic tilt and position in a simple movement with both feet on the ground. It is another thing completely to learn how to do this when your leg is already in hip flexion as required with both the box step-up and lunge exercise.

Once again this is something that completely went against everything I had learned. I was always taught to keep your back straight during a lunge and step up and it is a good thing to posteriorly tilt the pelvis. For some people, this may, in fact, be quite fine as they can maintain good mobility and stability during other movements but for those with the hip dysfunction we have been talking about it will make matters worse.

Take a look at the pictures below of myself completing two different versions of the lunge. The one on the left, is the version most are familiar with. The one on the right is the modified lunge using more anterior tilt with the rib cage positioned right on top of the pelvis.



With the picture on the left, we will see a loss of centration of the hip socket as the femur crashes into the acetabulum creating the pinch feeling we discussed earlier. The modified version adopts the position we used in the deadlift earlier and avoids this painful pinch sensation. The modified version really adopts the position we used in the deadlift earlier.

By putting the body into anterior tilt you effectively “load up” the glutes. It is very important to keep the rib cage positioned right on top of the hips and use your breathing to maintain stability of the trunk and avoid over-extending at the thoracic region.

Below features a great video of us using this positioning technique with the box step-up. An excellent exercise to teach a person how to engage the glutes with more efficient and powerful timing.

Summary

I hope you have enjoyed reading this article and it gives you a better understanding of the need to keep a more natural posture that has a curve in your lower back. Females will have a larger curve due to their anatomical structure and this is perfectly fine. Controlling excessive curvature will have more to do with breathing strategies and positioning of the body than from over activating the posterior muscles of the glutes and hamstrings. If you still do not believe me that anterior tilt is good for you then observe the postures of elite sprinters in the Olympics and note the excessive curve in their back. This position is what allows them to generate the incredible power with their legs to run insanely fast speeds. This is conclusive proof of the hip structure working at its maximal potential. If you were to try and flatten their back out you would ruin their ability to run fast and you would more than likely see them sustain endless hamstrings and groin strains.

Always remember the anterior pelvic tilt is essential for optimal hip mobility, a healthy spine, and efficient movement patterns free of pain and limitation.

If you live in Melbourne and would like to know more about any of our personal training or rehabilitation programs click the image below to request a free consultation to see how we can help you.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 14 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • Movement - By Gray Cook
  • The Psoas Solution - By Evan Osar
  • Corrective Exercise Solutions - by Evan Osar
  • Back Pain Mechanic - by Dr Stuart McGill
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Dr Stuart McGill
  • Ultimate Back Fitness & Performance - by Dr Stuart McGill
  • Core Stability - by Peak Performance
  • The Vital Glutes - By John Gibbons
  • Athletic Body in Balance - by Gray Cook
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Scientific Back Training - By Paul Chek
  • Advanced Program Design - By Paul Chek