Posterior pelvic tilting… The good, the bad and the ugly.

November 21, 2018

Recently, I published a post keeping in-line with some really simple cues to improve your ‘efficiency’ in lifting some of our main lifts or exercises (like a squat or deadlift). The most recent was to complete ‘the chain’ of the lower limb; the hips and pelvis. Watch the video here and we will be posting up some more intricate videos about this soon.

The point of this blog is to explain, in a little bit more detail, as to why this is a movement that might be of use. But I also want to explain that there isn’t really much evidence of any link between pelvic position and pain, so no matter how many times you have been told that pelvic tilting might be the worst (or best) thing you can do, it is most likely Baloney.

Let’s start with the ugly

If you take the common approach and Google ‘pelvic tilt’, you get the following stream of excrement abusing your eyeballs.

If it isn’t apparent enough from my language that there is no definitive link between pelvic ‘tilt’ and pain, let me explain further.

This probably stems from a fairly understandable, and long accepted, but incredibly flawed piece of theory put forward by a man called Vladimir Janda (see a school for his disciples here). He proposed that muscles can get tight in one direction and overly ‘loose or long’ in another direction, predisposing them to be weak, and it is all dependant upon your posture.

It all sounds very complex and fancy, and like anything that you are told by your health professional – the fancier it is – the more it must be true right!!? WRONG, WRONG, WRONG. Generally, the fancier it sounds, the more ‘leaps of judgement’ those people have had to go through to provide a reason for pain or dysfunction. Now I don’t want to dance on the man’s grave, because he was obviously a thought leader in his day, but one of the main reasons why we develop and grow as a profession and as humans is the scientific method. The scientific method means testing these kinds of theories. As the scientific method has gotten around to testing Mr Janda’s theories, there has been a real scarcity of any kind of evidence to prove his theory is correct. So his theories remain just that – unsubstantiated thoughts. There may be some evidence of the ‘upper body’ version having some kind of relevance in school kids (Ref), but none whatsoever when it comes to the lower body version – the one we are interested in for this blog. In fact, there has been no significant link made between posture and low back pain ever.. Like ever (Ref). The real tragedy is that when something fancy sounds good, practitioners are able to sell it to you easier, because you believe complex things coming from people who are meant to know more about these things than you. The whole time you are left thinking there is something wrong with you because of the way your pelvis tilts. For goodness sakes, it must be bad if there are so many videos about ‘fixing’ my pelvic tilt right!? Well trust me, there is nothing to fix, there is nothing wrong with your pelvic tilt. Dr Google, in this instance, is just plain spreading ugly lies.

Rant over, back to the main event.

Most people who walk around on planet earth have a pelvis that tilts down at the front – we call this an ‘anterior pelvic tilt’. Most people on planet earth have been getting around just fine with this ‘posture’ for millenia, so safe to say, it isn’t something to be overly concerned about. What this blog is about is learning the capacity to move your pelvis

If my pelvis tilting isn’t bad, then why do I want to move it? The Good!

Like any other part of the body, it responds so amazingly well to being moved. To learn the capacity to move at the pelvis is a very useful skill, one that very few people learn. And when you are in pain, like any other painful part of the body – if you start moving it, starting low and progressing slowly, you may be surprised at the result! Motion is lotion!

So, as a rehabilitation tool, it is fantastic to learn. Watch the video for an introduction on learning to ‘tilt your pelvis back’ or ‘posterior tilting’. It is going in the opposite direction of your regular pelvic tilt for most people, and to keep it simple, it is just a new skill to learn. New skills are good for you.

Does it change the position of my spine?

Most definitely it will when you tilt your pelvis well. But again this is a great thing.

Will it solve all of my ailments?

If you took nothing away from the rant about posture and pain above, this should be obvious. In short, no this won’t be the ultimate ‘cure’ for your back pain or other pain. We can never be completely sure what the exact cause is for most low back pain, so once again if you have been told that your pelvic tilt is causing your pain, then that is not correct. In fact, we don’t know if it causes any kind of the muscular imbalances that are described above – and generally by Dr Google. Your physio needs to properly test each muscle they she or he suspects is weak, and if they aren’t doing that and flying by Dr Janda’s wisdom – I would find someone else. It certainly won’t hurt, and once again, is a great thing to learn on the journey of moving better and thinking differently about your pain.

What about performance?

This is the main reason I have posted this video, because it tends to be something that should be readily accessible by the athlete – a movement that is a building block of performance. There is some very poor evidence that a ‘posterior pelvic tilt’ results in an increased muscle activity around the pelvis – like your muscles at the back (which are great to strengthen!) and muscles at the front of your pelvis around your tummy (Ref). Strengthening these muscles is great, but the kind of activity that you get from a ‘pelvic tilt’ won’t do much in the way of strengthening. Once again, it may provide more of an awareness of your back and tummy muscles. Unfortunately there is no good evidence for what this movement does to the muscles around the hips – our important GLUTES ! – but anecdotally, it probably does give you a good awareness of these muscles and allow you to squeeze them harder (this can actually be a very low level strengthening exercise – give it a whirl!).

This movement is a key movement to learn if you follow the McGill ‘school’ of low back pain rehabilitation. This kind of dynamic stabilisation model does have some basis for merit, but once again it is purely theoretical until proven by the scientific method. I have a hunch that this kind of approach may be more useful, or at least, more appropriate to find small percentages of dynamic ‘core’ stability in people that lift very high loads, or are under very high loads for their sport – for example powerlifters or front rowers. But, it shouldn’t be a foundation of practice by any means. What most of the population need to learn is first, the ability to move, not the ability to avoid movement by overtly stabilising. There is plenty more to discuss around this topic, so I will leave it at that.

So a ‘posterior pelvic tilt’ may not cure the world, but an anterior tilt certainly isn’t going to make you destined for back pain for the rest of your life. Learning this movement is a great start towards building a movement language and anecdotally it does help you ‘feel’ some really important muscles around your tummy, back and butt. Great for performance but also for your pain. Learn it, try it, it can’t hurt.