Does Anterior Tilt Matter?

A common complaint physical therapists will hear from patients is pain with prolonged standing. While this can be caused by a variety of factors, one of the first things we will look at is standing posture.

 In this posture, sometimes referred to as “Lower Crossed Syndrome” Posture, the person is standing with their back hyper-extended and hips protruding forward. For many people, this is a comfortable standing position that requires less effort to maintain, but for some people over time this can lead to pain across the lower back. This standing posture can lead to increased tightness across the low back and may eventually lead to an increased curvature in the lumbar spine. 

There are several factors that contribute to the development of this posture. The protruding forward of the hips, or Anterior Pelvic Tilt, can occur due to tightness in the hip flexor muscles pulling the front of the hips forward. Hip flexor tightness is common in many people but can worsen from living a sedentary lifestyle. The prolonged sitting can cause these muscles to shorten over time and pull the hips forward creating the anterior tilt. Any excess weight in the abdominal region will further add to the anterior tilt. 

In order to combat the pulling forward of the hips, multiple muscle groups must fire to posteriorly tilt the pelvis back into a more neutral position. The main muscle groups responsible for performing the posterior pelvic tilt are the abdominal muscles and the glutes. Many people struggle to engage these muscles properly or lack the strength or endurance to maintain engagement when standing or exercising leading to poor posture.

The problems of an anteriorly tilted pelvis standing posture is multi-faceted with issues related to tightness in the hips and excess abdominal fat pulling the hips forward combined with the lack of muscle engagement and strength to counter this motion. Therefore, to best help correct this posture, all issues must be addressed. 

Building the Posterior Pelvic Tilt:

Improving abdominal and glute activation and strength:

This exercise shows how to properly engage the abdominal muscles in order to perform the posterior pelvic tilt. This exercise is an excellent building block in working on strengthening your abdominals and should be performed while performing any other ab exercises. As this exercise becomes more natural lying down, it can then be performed in standing to help correct the anteriorly tilted posture. 

This exercise is one way to learn how to properly engage and strengthen the glute muscles. As glute activation becomes easier to perform, it can then be performed in standing in addition to the abdominal bracing to help create a posterior pelvic tilt.

Reducing the Anterior Pelvic Tilt:

Perform this stretch to gradually improve the flexibility of the hip flexor muscles to reduce the pulling forward of the hips that creates the anterior pelvic tilt. 

Weight Loss most specifically at the abdominal region will also help to reduce the anterior pelvic tilt. 

If you are struggling with low back pain from prolonged standing, consider your posture. These exercises may help to improve your posture and reduce your pain. If symptoms are still present, consider an evaluation with a physical therapist to further evaluate.

5 Ways Breathing Influences Low Back Pain

Breathing seems like such a simple thing, and it is in a sense. However, when you think about how many breaths we take a day, altering your breathing can have a huge impact. When I have a patient with low back pain, I’ll always look at their breathing pattern. 9 times out of 10, I find that they are chest breathing. This is not necessarily a ‘wrong pattern’, but it gives me some insight into how their full system is operating. To explore this, I’ll explain 5 ways breathing can have a role in reducing low back pain. 

The first way it can help is through movement. When someone is in pain, it’s almost instinctual to stop moving. The nervous system goes into a sort of panic mode and movement becomes sensitized. When you are laying on your back and just breathing, you are getting a gentle flexion and extension with each breath you take. Taking some time to do some intentional breathing will help the nervous system calm down as the spine is moving in a non-threatening way. 

Secondly, there is usually swelling associated with low back pain. Generally it is in the joint spaces between the vertebrae. Being still allows it to fester. The lymphatic system is responsible for mitigating swelling. It just so happens that there is a major collection tubule of the lymphatic system, called the cisterna chyli, that sits right under your diaphragm. So belly breathing (diaphragmatic breathing) works like a pump, every breath squeezes that tubule and moves swelling out of the system. 

I mentioned belly breathing. That is usually what I’ll recommend. That doesn’t mean the chest does move, it just means that the breath is initiated by the diaphragm rather than the chest. This has an effect on the nervous system. Chest first breathing is associated with the sympathetic system, whereas belly first breathing is associated with the parasympathetic system. When we are in a sympathetic state, muscle tone increases in preparation for a fight or flight response. Conversely, when we are in a parasympathetic state, the muscles are able to relax. Yet another win for breathing and low back pain. 

Speaking of muscles, there is a muscle that almost always gets irritated in low back pain; the QL (Quadratus Lumborum). This is a muscle that aligns the sides of your lumbar spine, and attaches to the pelvis, and the 12th rib. Because of this attachment to the rib, it has a role in creating a stable support for the diaphragm to move. If the diaphragm is not moving because of chest first breathing, the QL can stiffen and get irritated. 

One final way that breathing can help is through tissue pH. It’s been known for a while that tissue acidosis, (low pH) can cause trigger points and deep muscle pain. You can quickly alter your blood pH through breathing. As 02 rises you become more alkaline, as CO2 rises, you become more acidic. To leverage this, all you have to do is exhale longer than you inhale. I recommend aiming for 6 breaths per minute so each cycle is 10 seconds. So if you inhale for 4 and exhale for 6, you’re covered. In just a few minutes, you become slightly more alkalinic. You may get lightheaded, that’s from being in a mild phase of respiratory alkalosis. 

Low Back Pain? Maybe it’s Your Lats?

I’ve seen this countless times; a client walks into my office, terrified of their recent MRI. They’ve got several disc bulges and couldn’t move for a few days after lifting something heavy. Surgery has been suggested. However, the whole time, it’s just muscle.

Unless a muscle is torn, nothing abnormal really appears on imaging. You can’t see a stiff muscle. “But Doc, I couldn’t walk, it must be the disc”. An irritated muscle can most certainly can immobilize you. 

The lats are big powerful muscles that range from the shoulder to the low back. They extend and internally rotate the shoulders. They limit the opposite, shoulder flexion and external rotation. 

Here are a couple quick assessments and exercises to use:

Now, these are some general ways to get range of motion back, however if you want to get more specific to the lat, I like to use this:

And if you want to get more aggressive you can use this:

Remember, it’s important to get a proper assessment when having any kind of pain. Even if an image shows that something is “wrong”, it has to be correlated to how you move.