anterior pelvic tilt

[Guest guest]

I'm curious as to how or why you realized you have this APT. It is very

common but most people don't realize it unless they are in a situation where it

is

being treated. I don't know if you have already checked out Egoscue's site or

his books, Egoscue.com. He deals almost exclusively with posture and

postioning, APT is one of the major factors looked for in their method. I came

across

his book 8 years ago but dismissed it because the rationale, though sound, was

too basic and the exercises to simple. I came back to it later and found it to

be more complete and sophisticated than I gave it credit for. The exercises

are not always what they appear to be, a " calf stretch " really isn't a calf

stretch but a muscoskeletal realignment. In short, if you have APT, then the

likely cause is tight hip flexors, as you are aware and are addressing, but the

underlying cause may be something entirely different. Therefore the whole body

needs to be addressed simultaneously and not selectively working on what seems

to be the cause. Another book I would recommend is " The Malalignment

Syndrome " , it doesn't deal with APT specifically but focuses on pelvic

rotation, which might be an underlying cause. It also talks about different

therapies that might be of interest. Lastly, you can visit a good manual

therapist who

should be able to adjust you back to normal, the problem then is maintaining

that position, along with finding a good therapist and the costs involved. I

suggest first looking at the egoscue stuff.

Good luck, I've spent the last few months correcting a hip rotation I didn't

know I had for most of my life. I've always been told I had a leg length

discrepancy. Now I don't have one. I still have a bit of APT left also so if you

come across something else that really works let me know.

Randy Dixon

Harlingen, TX

[Guest guest]

Dear Doug,

Why do you believe that you need to " fix " you anterior pelvic tilt?

I would like to ask the group :

Is there any [scientific] research showing long term (at least 6

months post " treatment " ) postural change? If not, is there any

research to the contrary?

Are there any anecdotes (individuals who have " corrected " their APT)?

My opinion is that as long as your surrounding musculature is strong

enough to support any activity performed without injury there should

be no reason to correct it.

Best Regards,

Joe Cole

Dunedin, New Zealand

[Guest guest]

Doug Joachim wrote:

> 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.

Doug,

Like everyone else who has responded to your post, I'd like to know

your reason for getting rid of your APT. If the APT is contributing

to any pain then it should be addressed, but if after reducing it and

your problem still exists then obviously you need to look elsewhere.

Also, did you have someone measure your pelvic tilt and if so were

both sides measured? Men generally have about 4-7 degrees of pelvic

tilt. It would be also helpful to know if you had the degree of

lumbar lordosis measured. To make a long story short, you should get

checked out. If you are interested I have an office in Queens, NY.

Another thing to mention is that you said that you internally rotate

your hips to stretch the psoas. Now this may stretch some of the

rotary component of the multi-plane muscle but it will also influence

more of an APT from the pull of the TFL on the pelvis. Also, by

internally rotating the hips you are stretching the deep external

rotators of the hip. I assume you made a typo in your post.

Hope this helps.

Jocson, PT,MS,OCS

Beach, NY

www.jocsonhealth.com

[Guest guest]

I recommend you do the pelvic tilt and exercises such as the reverse sit-up and

various hanging leg raises. Do this action constantly and hold with a strong

contraction for up to 6 seconds throughout the day. Once you get some

shortening of the muscles involved, you should be able to hold the neutral

position. We have done this successfully with many people.

~~~~~~~~~~~~~~~~~~~~~~

Yessis, Ph.D

President, Sports Training, Inc.

www.dryessis.com

PO Box 460429

Escondido, CA 92046

~~~~~~~~~~~~~~~~~~~~

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?

[Guest guest]

Doug,

I work in a hospital setting, and I have talked to a great number of

Radiologists, and every single one concurs that it is extremely rare

to find someone with an APT. Are you sure that you have one, or

does the tissue surrounding your lumbar spine area (glutes, lats,

fat, skin) just give the illusion of a hyperlordotic lumbar spine?

Do you have associated pain? Do you have limited hip flexion? If

you truly have an APT, depending on the cause, stretching may

exacerbate the problem. If it truly is an APT, I would suggest

seeking a Muscle Activation Techniques Therapist in you area (there

are a handfull in the city), to see if they can treat any muscle

imbalances you may have that may be contributing to the problem. I

hope that helps.

Joe DeAntonis

Pittsburgh, PA

Doug Joachim <dpjoachim@h...> 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]

Find a therapist who is qualified in Rolfing, they should be able to

help with proper postural alignment.

Tribby

Tempe, AZ

Doug Joachim <dpjoachim@h...> 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]

There is at the minimum one technique available for correcting the various types

of abnormal spinal curves (including pelvic tilts, as one cannot be present

without the other). As I have seen both anterior and posterior pelvic tilts

corrected via the Chiropractic BioPhysics technique (aka Clinical Biomechanics

of Posture, CBP for short) both by x-ray and by the gross visualization of

patients' rear ends " changing shape " (due to reorientation of the pelvis), I

cannot agree with Barrett's statement that it cannot be fixed without surgery.

For the research to back this up, please visit their website at

www.chiropracticbiophysics.com and click on the 'Research' link. Due to the

number of articles that the creators of this technique have published, it seemed

unwieldy and unnecessary to reprint them all here when they are so accessible.

CBP is a well-researched technique, with 59 published/2 in press/9 in review/8

in preparation articles in the Index Medicus.

As nearly all of us are aware of the negative impact of " poor posture " on our

general health in our lifetime, how can it hurt to keep an open mind to a

technique such as this? There isn't any voodoo going on, just x-ray analysis,

specific exercises, specific traction, and specific adjusting, all according to

the patient's needs. One thing to remember, poor posture with a lack of pain in

a younger patient says absolutely nothing about their development of pain as

they age and are both less active and vital.

I have personally experienced the technique as a patient and I have interned in

a CBP instructor's office (a local DC). I can answer general questions,

however, if you have specific questions I suggest you address them to the CBP

website owners/operators. Thank you for your time and attention.

Garrett RKC NM-S CSCS BS

Tempe, AZ

[Guest guest]

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.

**** I would believe an optimal pelvic position should contain some

slight anterior pelvic tilt.

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

**** An excellent article to read by Ian King is titled, How to

identify and correct imbalances. http://www.t-nation.com/readTopic.do?

id=460268. Check not only your pelvis positioning but also your

pelvis position relative to your shoulders as well as tension in the

lower abdomen.

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.

**** This is not natural and I do not believe this is doing anything

to correct your situation. If anything you are now telling your body

it has to walk with a PPT and internally rotated feet. Bad idea.

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

Check out the article by King, assess your entire body and then give

us some feedback. Hope this helped.

Melnyk

College Park, MD -- soon to be off to Blacksburg, VA (Go Hokies!)

[Guest guest]

Dear Doug,

Mel Siff actually published an article in 1981 on the subject of Pelvic

Tilt. He challenged the PT community to remember that pelvic position is

not a fixed thing, that it moves in all three planes and it is

impossible to hold any position. During a squat the position or tilt of

the pelvis changes continually to adopt the most optimal angle relative

to the legs and lumbar spine (presumably for efficiency, max performance

and minimum strain- basic tenet of the optimization theory of human and

vertebrate movement).

The position and mobility or action of the pelvis has a long contorted

history in our culture and also in medicine especially Physical Therapy.

At the time Mel published his article the favourite popular belief was

that an anterior pelvic tilt was bad. Persistent constant and fixed

" posterior pelvic tilts " were the absolute recommended order of the day

and in fact continues to this day depending on your therapist, their

training, reading and on-going learning. (Where I work, a Boston

hospital, it is still a primary recommened position/exercise/posture for

all activities for some of my PT colleagues- NB: I work hard to

challenge this notion- it is unfortunate that all professions have die

hard automatic unsubstantiated traditions).

The classic book by Calliet and then Janda all continued this myth of

the bad anterior pelvic tilt.

Most recently, what has evolved is a shift from the extreme full

posterior pelvic tilt as the position of choice to the " neutral "

position, i.e. half way between anterior and posterior tilt. The problem

is, is that it is still taught as a fixed position for all activities.

This is the starting point for all " lumbar stabilization exercises " and

" core strengthening " - the current evolution of the original pelvic tilt

idiom.

I agree with Mel on this. He pointed to two important distinctions about

the pelvis that we should not forget or contrive with-

1. there is no one ideal position- well in fact there is but it changes

at every angle of bending, squatting or any movement involving trunk

motion.

2. the pelvis moves- it is not a static fixed structure.

We forget that the pelvis. It may be useful not note the pelvis not only

is a prime mover in control of trunk motion and human action but it is

also a structure supporting sexuality and sex. Certain pelvic motions

fully express sex and sexuality- right! We all recall the Elvis

Presley's visit to the Ed Sullivan show where they only showed the top

half of his trunk to hide the outrageous pelvic girations and sexual

expressions of his lower half. " Elvis the Pelvis " ...............

Remember the pelvis moves in all three planes with every step we take.

These motion are considered the primary determinants of gait by the

original research of human walking (Inman 1981 and then Stokes et al

1989)- inhibition of these motions affect stride length, energy

efficiency/consumption, trunk motion and joint sress and strain.

So, I also agree with the general responses on this list that an

anterior tilt actually is normal. We stand with the lumbar spine in some

extension. The fifth lumbar vertebrae and/or disc are wedge shaped to

contribute to this shape.

However, there is some validity to the posterior tilt notion. Consider

this: at full lumbar flexion (i.e. touching the toes) the lumbar

vertebrae align in a straight flattened line i.e. a true neutral

position- they are not in flexion and not in extension (Pearcy 1985).

The same might be said for squat, that as one squats the lumbar spine

rotates from extension towards flexion i.e. again it approximates

towards this straight line or neutral position between flexion-extension.

Why? Well it is immediately valid to conjure the notion that the lumbar

vertbrae align like a column of bricks might be safer and stronger than

any variation from the straight line. Though we stand in some extension

and anterior tilt when we bend to lift either a forward trunk flexion or

with a squat the lumbar spine (and indeed the thoracic spine)

approximate towards a straight line. This might be construed as the

safed and strongest position for taking load. Beyond this position into

flexion or extension would represent increased stress, strain and

possible damage.

But there is no need to stand in this position- this is the error is

made in extrapolation of the approximation to a straight for maximum

strength and safety in squat and bend to be adopted in stance.

So, sorry to be so long, it is a pet hate of mine that a fixed posterior

pelvic tilt as a recommended place for action exists at all.

The argument is between a CNS that is ever seeking an optimal pelvic

position in trunk control as determined by millions of years of

evolution versus a contrived fixed ideal position perhaps evolved and

contrived from or related to a sexually inhibited era but not without

some misplaced vailidity.

Two offerings from Feldenkrais principles-

1. know and experience and practice the full range of " pelvic " mobility

and action and then trust it (the CNS that is) to adopt the appropriate

position and behaviour in any action or stance.

2. Pelvic mobility/action/position is a function of the whole trunk and

personal stance and action. That is, you might make for a better pelvic

position (if indeed you need one) by increasing thoracic mobility-

remember as we squat the lumbar and thoracic spines flatten- eg the

lumabr spine flexes from extention towards flat and the thorax extends

from its rounded slightly (or more) kyphotic position. If the thoracic

is stiff and unchanging to squat it can be a factor in LBP, knee pain

and pelvic posture in stance.

Burgess

BEd, PT, PhD

Feldenkrais Practitioner

ps for a recent introduction to the Feldenkrais Method in medicine:

http://www.efeld.com/news/

[Guest guest]

Micheal-

I am curious why you think I typed an error when I stated

" while I stand, I internally rotate my hips " .

The Psoas and Illiacus are strong hip flexors and external rotators. If I

believe that these

muscles and the surrounding soft tissue including the deep six and the gluteals

have

adaptively shortened why not attempt to stretch them by postioning my legs in an

internaly rotated stance? It seems as if my external hip rotators are much

stonger then the

internal rotators(TFL's do not tend to be very poweful). Thus by increasing the

neural

drive to the interal rotators and stretching the external ones won't I be on my

way in

correcting the LPH imbalance?

Thanks,

Doug Joachim

www.Joachimstraining.com

Jocson <Mjocs@a...> wrote:

> Doug,

> ...

> Another thing to mention is that you said that you internally rotate

> your hips to stretch the psoas. Now this may stretch some of the

> rotary component of the multi-plane muscle but it will also influence

> more of an APT from the pull of the TFL on the pelvis. Also, by

> internally rotating the hips you are stretching the deep external

> rotators of the hip. I assume you made a typo in your post.