Jane Johnson addresses the anterior tilt in the pelvis describing effective and innovative ways to correct it, from both a therapist and client perspective.

Illustrations and photos in this blog are taken from Jane Johnson’s Postural Correction and Therapeutic Stretching.

Addressing anterior tilt in the pelvis

In last week’s post, we described how the pelvis can be assessed for anterior or posterior pelvic tilt and noted that clinicians often assess for this because a change in position of the pelvis affects change in the position of the lumbar spine.

An exaggerated lumbar spine position can cause dysfunction in soft tissues of the low back and hips. This may be detrimental to spine stability and function. This article is about the anterior tilt in the pelvis and what can be done to correct this, should that be your aim. It contains ideas for both the therapist and the client to help correct the position.

The anteriorly tilted pelvic position

In a neutrally positioned pelvis the lumbar spine has a gentle lordosis (inward curve) (A) but as the pelvis tilts anteriorly, this curve becomes exaggerated (B). The Anterior Superior Iliac Spines (ASIS) of the pelvis change from being aligned vertically over the pubic bone (C) to falling anterior to the pubic bone (D).

Changing an anteriorly tilted pelvic position

Attempts to correct this posture involve changing the pelvis from resting anteriorly (illustrations B and D) to resting in a more neutral position (illustrations A and C). One way to do this is to encourage posterior tilt in the pelvis. If a patient has an anteriorly tilted pelvis, a full posterior pelvic tilt is rarely achieved. This is because it involves movement of the ASIS posteriorly with respect to the pubic bone (E), flattening the lumbar curve (F).

What a therapist can do

To temporarily correct an anteriorly tilted pelvis position the following ideas can useful starting points:

• Determine whether changing the position of the pelvis is beneficial for your client. Back in 1994 Bloomfield et al. suggested that the anterior pelvic tilt position may be advantageous rather than disadvantageous for sports that involve running.
• Encourage your client to identify those times when he/she stands with an anteriorly tilted pelvis and avoid this posture where possible. For example, when tired, some clients slouch.
• A physiotherapist, osteopath or chiropractor may position their patient supine (resting on the back), place their hands between the legs of the patient and cup the sacrum, then manually draw the pelvis into a posterior pelvic tilt position. Handling a client in the manner may not be considered appropriate when performed by a massage therapist, sports massage therapist or sports therapist, who need to utilise an alternative method of pelvic correction.
• A safe but unorthodox technique any therapist can use to facilitate posterior pelvic tilt is, to begin with the client resting supine on a towel (G). The towel should be under the pelvis and low back, perhaps reaching as high as around the 12^th thoracic vertebrae (T12). Next, the therapist slowly tugs the towel in small increments until it has been removed. This tugging motion pulls the towel out from between the client’s legs, drawing the pelvis into a posteriorly tilted position.

• Another method a therapist can use is to stand to one side of the client, slide a hand beneath the client’s waist, positioning it between the couch and the client’s lumbar spine, then ask the client to press their low back into their hand. To do this, the client must tilt their pelvis posteriorly.
• Once a client has experienced what it feels like to have their pelvis repositioned, using either the towel method or your hand, you could encourage them to perform a posterior pelvic tilt regularly. This involves contracting their stomach muscles and flattening their lumbar spine (H). When taught correctly, a patient can learn to voluntarily rotate the pelvis to such an extent as to significantly decrease the lumbar curve (Day et al. 1984). Proper pelvic alignment may be important for dancers in order to ensure efficient use of muscle and movements such as external hip rotation. One method of teaching this movement is to describe it as ‘tucking the tailbone under’ (Deckert 2009).

• Tape the pelvis into a more neutral position. Taping the pelvis into a posterior pelvic tilt position decreased sacroiliac pain in a group of women who habitually wore high-heeled shoes (Lee et al.2014). Taping could be helpful in temporarily alleviating pain.
• Reduce tension and increase pliability in lumbar extensor muscles by passively stretching and massaging these.
• Passively stretch hip flexors muscles psoas and rectus femoris as these are shortened in the anterior pelvic tilt position. There are many different ways to do this including simple prone (face down) (I), and supine (J) stretches.

• Consider applying advanced stretches to hip flexor muscles such as Muscle Energy Technique (MET) and Soft Tissue Release (STR).
• Consider use of myofascial release (MFR) techniques to the lumbar region and psoas.

What a client can do

• Learn to adopt a more neutral pelvic position when standing and strengthen the muscle so posterior pelvic tilt. Regularly performing the posterior pelvic tilt exercise will increase endurance in abdominal and gluteal muscles. This will help counter the anteriorly tilted pelvis.
• You can stretch muscles which are known to be shortened in the anterior pelvic tilt position. These are the muscles of the lumbar spine and the hip flexors. For example, resting on the back, the abdominal contracted and back flattened to tilt the pelvis posteriorly. Stretch the hip flexor muscles by letting one leg hang from the side of a bed (K). You can then progress to kneeling (L) and with the arm raised (M).

More from Jane

In September 2018 Jane presented a free Webinar for Human Kinetics. Titled Advice, exercises and treatments for low back pain. Click on the link to watch now.

This post on fixing an anterior tilt in the pelvis is the third post from Jane. Check out last week’s post Postural assessment of the pelvis which is the prequel to this post. Also, check out  How to prevent and treat knee hyperextension.

Jane has written 5 books for Human Kinetics:

• Deep Tissue Massage 
• Postural Assessment
• Postural Correction
• Therapeutic Stretching 

Jane has also done a webinar for us Postural Correction: An introductory guide you can view this for free on the Human Kinetics website.