Re: anterior pelvic tilt

[Guest guest]

Doug,

This may seem like a silly question, but do you

experience any problems stemming from your pelvic

tilt? If not, I would certainly recommend that you

don't try and fix something that's not broken. In

fact, this may be " your " neutral spine.

I have a pronounced anterior tilt as well. So far, it

has caused me no harm. I can perform nearly every

exercise easily, have had no low back pain thus far

and do not expect this to change barring an acute

event.

Neutral spine is different for everyone. If you can

trace a specific pathology to the degree of tilt in

your pelvis, then there may be a reason to try and

change this.

Bill Abbott, CSCS

NYC, NY

Doug Joachim wrote:

> I have a Anterior Pelvic Tilt (APT) and no matter

> what I do in the gym it will not go back to neutral.

> Stretching the hip flexors (psoas, illiacus) and

> lumbar spine while strenghtening the glutes,

> hamstring complex and the core (rectus abdominus,

> TVA, IO, EO etc) will not affect the position of my

> hips. There are 168 hours in a week and if I spend 5

> hrs attempting to correct my imbalance I will still

> have 163 hours to reinforce the condition. What can

> I do?

>

> On average I walk 5 to 6 miles per day and I rarely

> sit. So I attempt to maintain a slight posterior

> pelvic tilt as I walk and while I stand I internally

> rotate my my hips (pigeon toed) in order to stretch

> out my Psoas and deep interal rotators.

>

> My APT still exists....any recommenadations?

[Guest guest]

You might want to seek out a physical therapist or Feldenkrais practitioner

who can determine if your nervous system is holding you in a position of APT.

If so, then you may have them attempt to retrain your nervous system and get

to the root of your problem. There is not much research (if any) to support

the common belief of the direct relationship between strength and static

posture. You might try contacting Barrett Dorko, a physical therapist on this

list, to find out if he knows of any qualified physical therapists in your area.

Gabe Rinaldi, MA, CSCS, USA Weightlifting Club Coach

San Diego, CA

Doug Joachim [dpjoachim@...] wrote:

> I have a Anterior Pelvic Tilt (APT) and no matter what I do in the gym it

> will not go back to neutral. Stretching the hip flexors (psoas, illiacus)

> and lumbar spine while strenghtening the glutes, hamstring complex and the

> core (rectus abdominus, TVA, IO, EO etc) will not affect the position of my

> hips. There are 168 hours in a week and if I spend 5 hrs attempting to

> correct my imbalance I will still have 163 hours to reinforce the condition.

> What can I do?

>

> On average I walk 5 to 6 miles per day and I rarely sit. So I attempt to

> maintain a slight posterior pelvic tilt as I walk and while I stand I

> internally rotate my my hips (pigeon toed) in order to stretch out my Psoas

> and deep interal rotators.

>

> My APT still exists....any recommenadations?

[Guest guest]

Does the tilt cause any pain or hinder any function? If not you may be

better off leaving it alone. I am assuming that you have been that way

for a long period of time. If that is true, your body has probably

adapted, both soft tissue and neurological set (could be construed as

the same thing) and trying to change it at this point may actually cause

some significant problems.

Jeff L Fahrenbruch MPT CSCS*D

Phoenix. AZ

dpjoachim wrote:

> I have a Anterior Pelvic Tilt (APT) and no matter what I do in the gym it

> will not go back to neutral. Stretching the hip flexors (psoas, illiacus)

> and lumbar spine while strenghtening the glutes, hamstring complex and the

> core (rectus abdominus, TVA, IO, EO etc) will not affect the position of my

> hips. There are 168 hours in a week and if I spend 5 hrs attempting to

> correct my imbalance I will still have 163 hours to reinforce the condition.

> What can I do?

>

> On average I walk 5 to 6 miles per day and I rarely sit. So I attempt to

> maintain a slight posterior pelvic tilt as I walk and while I stand I

> internally rotate my my hips (pigeon toed) in order to stretch out my Psoas

> and deep interal rotators.

>

>My APT still exists....any recommenadations?

[Guest guest]

Previously, Randy Dixon wrote:

>> How do you make this diagnosis without examining or even

>> having a picture or history of the patient?

Barrett Dorko replied:

> **I didn't make a diagnosis. I simply responded to a description.

> The guy with the APT offered it, so I figured it was acurate.

Randy Dixon writes:

Thank you for your reply and in reading my question I realized it was curt and

could seem disrespectful, I apologize for that, it wasn't my intention. You are

correct, you did not make a diagnosis, this was a poor word choice on my part,

you rejected a diagnosis. You did state that his APT was not a problem, without

any examination though the obvious conclusion, not necessarily correct, is that

you think APT as a problem is an impossibility. I had read a post you had posted

about this on another site and read your references their but I did not see

anything that really addressed this. I would appreciate it if you could direct

me to the relevant research, I have searched everywhere I could think of and

have not found anything conclusive, although I have found articles supporting

both views.

Barrett Dorko wrote:

> [stretching and strengthening has] never been shown to have an effect aside

> from anecdotally in " studies " done by people with a financial stake in our

> believing they will.

> I've been around a while and I've spoken to thousands of

> therapists about affecting change in this way. They agree with me - you

> can't actually do it.

Randy Dixon writes:

I have not talked to thousands but I have talked to many therapists, my

experience is different than yours in that most of them did feel it was

important, but addressable through exercise and manipulation. I did send you one

study that showed they did change the anterior tilt with exercise and this did

change the lumbar curve and other spinal curves, whether this has an effect on

health or performance was not addressed. I also sent you one article on how

pelvic tilt did influence joint degeneration. These were articles that I had in

hand, well, hard drive, but I have seen others. (and others that contradict

them). I am interested in your reasoning and the research behind this. I am not

married to this idea.

Barrett Dorko wrote:

> **We shouldn't give up on something just because its never been

> shown to be true or actually exist? Is this religion or science you're

> talking about? What's so attractive about this idea anyway?

Randy Dixon writes:

I'm not asking you to accept it, but it is a widely held belief. In the absence

of directly applicable research we are forced to use theory, experience and

reasoning, the reasoning behind it is sound, there has been a good deal of

successful experience, for the therapists I have read and talked to. So, if a

theory is sound, reasoning is practical and experience suggests it is true, then

I think it prudent to cautiously accept it until

research proves otherwise. I understand you have different reasoning and

experience so you choose to reject it. Of course this is fine, but both parties

should be cautious about declaring it absolutely. It would have been just as

incorrect for someone to say that APT absoulutely is their problem without

examination as it is to tell them it is absolutely not. Because you are a PT,

and address yourself as one, your comments are professional ones and thefefore

subject to a higher standard than personal opinions.

Barrett Dorko wrote:

> > [Randy Dixon wrote:]...don't be too quick to dismiss, and when there is

> > doubt let that be known.

>

> ** Nothing " quick " about it - 32 years of study. I don't doubt I'm

> right, if that's what you're getting at.

Randy Dixon writes:

You are right, 32 years is not exactly quick. I have little doubt that you

believe you are right. Perhaps I was mistaken though when I thought that you had

just been a bit overzealous in advancing your view, if you indeed think that it

is impossible for APT to be a cause of structural problems then you are correct

in your statement and I apologize. I would be interested in seeing the research

and your reasoning for rejecting it though.

Randy Dixon

Harlingen, Texas, USA

[Guest guest]

Nate Mosher <ndmosher@h...> wrote:

> I'm currently in a PT program now, and this is something I've brought

> up to professors, therapists out in the clinic, etc. If someone

> spends 99% of their average day in " dysfunctional " posture, then what

> difference does the inclusion of 15-20 minutes of strengthening and

> stretching do?

*** So wouldn't a possible solution be to have the person spend 99% of

their average day in a correct posture? Or, start with something

small, perhaps 25% of their day, fully aware of their posture. Then

you could gradually increase the amount.

One quick example would be to place tape across the shoulder/traps

with the arms pulled back and the chest open. When they slump their

shoulders forward, the tape gets tight and they have a way to

acknowledge that they are going back to their old habit. I would still

incorporate stretching and strengthening as well.

Melnyk

College Park, MD

[Guest guest]

Below are the references I was able to obtain when researching this topic

last year.

Gabe Rinaldi, MA, CSCS

San Diego, CA

DiVeta, J., , M. L., & Skibinski, B. (1990). Relationship between

performance of selected scapular muscles and scapular abduction in standing

subjects. Physical Therapy, 70, 470-476.

Hrysomallis, C., & Goodman, C. (2001). A review of resistance exercise

and posture realignment. Journal of Strength and Conditioning Research, 15,

385-390.

Kendall, F. P., & McCreary, E. K. (1983). Muscle function in relation to

posture. In, Muscles testing and function (pp. 269–316). Baltimore, MD:

& Wilkins.

Levine, D., , J. R., & Tillman L. J. (1997). The effect of

abdominal muscle strengthening on pelvic tilt and lumbar lordosis.

Physiotherapy

Theory and Practice, 13, 217-226.

Rothstein, J. M. (Ed.). (1990). Upon these rocks [Editor’s note].

Physical Therapy, 70(8).

Scannell, J. P., & McGill, S. M. (2003). Lumbar posture – should it, and

can it, be modified? A study of passive tissue stiffness and lumbar position

during activities of daily living. Physical Therapy, 83, 907-917.

, M. L., Rothstein, J. M., Finucane, S. D., & Lamb, R. L. (1987).

Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle

performance. Physical Therapy, 67, 512-516.

Wang, C. H., McClure, P., Pratt, N. E., & Nobilini, R. (1999). Stretching

and strengthening exercises: Their effect on three-dimensional scapular

kinematics. Archives of Physical Medicine and Rehabilitation, 80, 923-929.

Youdas, J. W., Garrett, T. R., Egan, K. S., & Therneau, T. M. (2000).

Lumbar lordosis and pelvic inclination in adults with chronic low back pain.

Physical Therapy, 80, 261-275.

Youdas, J. W., Garrett, T. R., Harmsen, S., Suman, S. J., & Carey, J. R.

(1996). Lumbar lordosis and pelvic inclination of asymptomatic adults.

Physical Therapy, 76, 1066-1081.

[Guest guest]

Melnyk wrote:

> One quick example would be to place tape across the shoulder/traps

> with the arms pulled back and the chest open. When they slump their

> shoulders forward, the tape gets tight and they have a way to

> acknowledge that they are going back to their old habit.

,

Why stop with tape? Couldn't we devise some sort of electroshock device?

Nothing lethal or actually injurious of course.

Barrett L. Dorko, P.T.

Cuyahoga Falls, Ohio

<http://barrettdorko.com>

And <http://rehabedge.com>

[Guest guest]

To Mr B Dorko and others.

As an osteopath I have seen many types of patients with many types of

postures. In the training I have receieved (in which to the best of

my abilty I adhere to), one must look at the whole person to find the

root of the problem for which the patient came through the door in

the first place. In my experience I have not yet seen a " perfect "

posture. When one addresses a patient holisticaly one must consider

the emotional, chemical and physical enviroments that particular

patient is subjected to. Also, what does a patient want from the

treatent? Does the patient want to be completly free of all pain or

just want to be able to get on with work? Again, this is assuming

that this is a musculosketal problem with or without minor

neurological involvent for which the problem is based upon I presume

from the previous messages. What are the tissues causing injury? What

is the mechanism of injury etc...?

Does physical therapy (in the various forms) work? Yes, depending on

what the Diagnosis is, what the precipiatating factors, maintaining

factors and tissue involvement is/are etc. At the end of the day, all

the patient wants is to get better or improve or be maintained in

their current or previous state. If the form of treatment works,

without serious intervention than great! Treating patients isn't about

making them completely pain free, its about what is doing best for

the patients as far as the patient wants to go. They are people after

all!

When it comes to treating patients, my own belief is " if it aint

broke dont fix it " ! If a patient comes in with a shoulder problem

(MSK in nature) but its a rotated pelvis that may be causing it,

fine. Correct the dysfunction, but if not, by correcting something

that " Looks " out of position in our educated view may not be the best

approach. As one could open up the preverbial can of worms.

The more I know about the body the more I realise there is to know.

I don't have all the answers, but I will ty my hardest to study and

improve my knowledge to answer as many as I can.

Mark Sloam

London UK

[Guest guest]

Randy Dixon wrote:

> You are correct, you did not make a diagnosis, this was

> a poor word choice on my part, you rejected a diagnosis.

**Perhaps your definition of diagnosis is different than anyone else's. APT

is a description of bony alignment in standing and nothing more. It's

something virtually anyone can and should occasionally achieve as

circumstances warrant. Its variance in a static standing inspection is well

known and, again, I've never seen any study demonstrating that this finding

means or is predictive of anything. The ability to move from it is a

different matter altogether. Like any restricted range of motion,

" diagnosis " would include testing for the tissue at fault, treatment of

that tissue and instruction in self care. If APT in standing has been shown

to create problems other than theoretically I'm unaware of the research. In

short, " treating " it because you see it in standing is like dry cleaning

the emperor's new clothes, if you know what I mean. I presume you will say,

" We want to prevent trouble. " and I would say, " Well then, why don't you

pay attention to something we know will cause trouble and leave this other

thing alone? "

I'm aware that many therapists " believe " that exercise and stretching is

the appropriate approach for this " problem " and that some protocol of care

for it exists in many clinics. When I point out that the literature

indicates that pelvic position is unrelated to muscle strength and that

strength training has no effect on posture (see " A Big Mistake " on my site)

they usually grow quiet. The implication is that they've been trying to

change something that can't be changed in the way they propose and that

what they " diagnosed " wasn't relevant to the patient's problem anyway. I'd

grow quiet too. Given the financial pressures of practice these days, they

know their boss doesn't want to hear about dumping an easily billed for

protocol of care. I've learned not to underestimate the power of this

pressure though the practice itself is senseless. This is something you may

not be aware of and would not therefore factor into your conversation with

the therapists.

Then Randy Dixon says:

> ...it is a widely held belief. In the absence of

> directly applicable research we are forced to use theory, experience and

> reasoning, the reasoning behind it is sound, there has been a good deal of

> successful experience, for the therapists I have read and talked to. So,

> if a theory is sound, reasoning is practical and experience suggests it is

> true, then I think it prudent to cautiously accept it until research proves

> otherwise.

** In response I have to say that the reasoning here is *not* sound and

" successful experiences " with this (those that include actually changing

the standing APT) are all but nonexistent.

The skeptical mind (mine, for instance) is open to anything until evidence

indicates it isn't so, of course. The problem with the idea of APT causing

problems is the evidence in hand, the incredible difficulty exercise seems

to have changing its presentation and the number of people out there with

this " problem " who suffer no consequences others than those the " experts "

predict they will one day have. It is their job to convince me, it isn't my

job to believe them.

Then Randy Dixon opines:

> ...your comments are professional ones and

> therefore subject to a higher standard than personal opinions.

**Why would you bother telling me this?

Barrett L. Dorko, P.T.

Cuyahoga Falls, Ohio

<http://barrettdorko.com>

And <http://rehabedge.com>

[Guest guest]

At 08:55 PM 7/11/2004, you wrote:

>I spend 5 hrs attempting to correct my imbalance I will still have 163

>hours to reinforce the condition. What can I do?

Doug,

There's nothing you can or should do. This postural alignment is totally

unrelated to your muscular strength or length. Short of some heroic

surgical procedure worthy of " The Swan " (on Fox TV) this will never change.

Why are you trying to get rid of it anyway?

Barrett L. Dorko, P.T.

Cuyahoga Falls, Ohio, USA.

<http://barrettdorko.com>

And <http://rehabedge.com>