Yoga and Anterior Pelvic Tilt
The anterior pelvic tilt is a hot topic in yoga and in manual medicine. Some people are overly concerned about the fact that their pelvis is tilting anteriorly without even understanding what it means. Let’s simplify the issues behind this increasingly common postural variation and learn how it can affect other parts of our body.
A normal pelvic angle is 30°; this means that our posterior superior iliac spines (the dimples above our bottoms) are slightly higher than our anterior superior iliac spines (the bones that stick out at the front of our pelvis). This angle can vary a few degrees either anteriorly or posteriorly due to our genetic makeup and even temporarily due to tight and/or weak muscles. An anterior pelvic angle of 40° is considered excessive and will produce a lower back (lumbar spine) curve that is also extreme. Our lumbar spine should have an anterior curve which is known as a lordosis; however, when this curve is excessive it is known as a hyperlordosis, which is not ideal. Cases of increased pelvic angles and lumbar hyperlordoses are very prevalent in today’s society.
Causes of increased lumbar lordosis include:
- Postural deformity
- Lax muscles, especially the abdominal muscles in combination with tight muscles, especially hip flexors or lumbar extensors
- A heavy abdomen, resulting from excess weight or pregnancy
- Compensatory mechanisms that result from another deformity, such as an increased curve in the thoracic spine (mid-back)
- Hip flexion contracture
- Spondylolisthesis (displacement of the vertebra above with relation to the vertebra below)
- Congenital problems, such as bilateral congenital dislocation of the hip
- Fashion (e.g., wearing high-heeled shoes)
Magee, J. David. Orthopedic Physical Assessment: Fourth Edition. Saunders. Toronto. 2002.
Cause number two from the list above is the reason that affects most. The majority of the population sits for at least eight hours a day while hunched over a desk at work; this can lead to a generic condition known as lower cross syndrome. This disorder consists of the following muscular issues: Weak or inhibited gluteal muscles and abdominals & Tight and shortened hip flexors and lumbar extensors
To better visualize this, observe the illustration that demonstrates lower cross syndrome. Take note of how the two weak/inhibited muscles create one line of the cross and the two tight/shortened muscles create the other line to complete the shape of a cross, hence lower cross syndrome.
When our hip flexors are tight, specifically our psoas, our pelvis rotates forward by the psoas pulling down on the lumbar spine from its attachment sites; this increases our lumbar lordosis and subsequently shortens our lumbar extensor muscles. This is most often seen in combination with weak abdominal and gluteal muscles.
Now that the reasons for this postural condition have been noted, the way to correct it is clear: reverse the causes. However, the distinction between inhibited muscles and weak muscles must be made first before rehabilitation can effectively begin. Inhibited muscles require the re-establishment of correct muscle firing patterns, while weak muscles need to be strengthened. Some individuals have weak muscles that are not inhibited; some have the reverse, and some have both issues to correct. Tight/shortened muscles require lengthening; sometimes stretching is sufficient and sometimes alternative soft tissue treatments such as Active Release Technique® and Graston Technique® are required to decrease scar tissue and increase the range of motion of the particular muscle.
If you are concerned that you may have lower cross syndrome, or simply a pelvic tilt, paying a visit to your manual health care practitioner (sports focused chiropractor, sports physician) will be well worth the time and money. They will be able to diagnose any underlying issues related to this condition and create an appropriate rehabilitation programs specific to the weaknesses and inhibitions they find upon physical examination. They will also be able to reduce scar tissue that may be contributing to your pelvic tilt (anterior or posterior).
Education is the ticket to eliminating these sorts of conditions from society. If we understand how to mitigate the risks for such generic conditions, we will all be much healthier individuals. Here is to learning more about our bodies!
Learn More about Dr. Carla Cupido.
Poor Posture and Pressure on your Spine
Freddie Mercury was right: we’re under pressure. Nothing can be truer when it comes to your spine. It’s because of simple physics: the pressure or load on your back increases as you move away from a neutral posture. Here are the numbers: Standing straight puts 100mm of pressure on the intervertebral discs of your spine; add a forward bend while flexing or rounding your back and you’ve more than double the pressure, or 220mm. Can you see now why reaching your toes in Uttanasana or any standing forward bend before you’re ready isn’t worth the potential harm to your back?
What poor posture means to the ongoing health of your back?
Over time, poor posture causes the discs between the vertebrae to wear down and lose their ability to cushion and act as shock absorbers. The discs are pushed out towards the back from their normal position which causes bulging or herniated discs. These bulging and worn out discs can cause a more serious problem by increasing the pressure on the spinal nerves and the spinal cord itself. The result is pain in the legs, including sciatica, arms, shoulders, and neck, and problems with muscle innervations, movement patterns and the sensation of temperature, pressure and pain.
These same problems can be worsened when sitting, believe it or not. Sitting, in contrast to standing, actually increases the intradiscal load compared to standing; spinal pressure “sits’ around 140mm pressure. If you slouch (I’m talking to you desk slouchers!), spinal pressure increases to 190mm; add some weight and you’ve put a whopping 275 pounds of pressure on your spine. This is why in certain methods of yoga like Iyengar students learn standing poses before sitting ones as a general rule as they’re considered more advanced.
Sitting for long periods of time can definitely cause back pain or worsen an existing back problem. Sitting is a static posture that increases stress on the entire back, shoulders, arms, and legs, and especially the muscles of the spine. Slouching overstretches spinal ligaments and surrounding structures of the spine and nerves, blood supply is interrupted and the back muscles are overstretched.
If you’re not a yogi yet but find yourself slouching or sitting for long periods of time during the day, your yoga can be as simple as doing the following:
Getting up periodically to stand up and take the pressure off your spine
Sit back into your chair so your back is supported. In yoga postures, ground evenly into your support and allow your spine to straighten up
Use a lumbar roll between your lumbar or lower back and your chair. To judge the proper size of the roll, sit back in your chair, place your forearm behind your lower back between it and your chair and lean back. Your forearm is approximately the size of a lumbar roll. This works when driving too.
Move! Joints don’t have much blood flow. Joints get nutrition in and waste out by physical movement. Move freely in your chair instead of sitting still for hours at a time.
For you yogis, body awareness is key to minimizing the pressure on your back. I’m not saying never practice a forward bend or a seated pose but rather know how to practice them safely. Even a seemingly friendly pose like Savasana can do harm. Sure, while lying down you’re at the lowest end of the spinal load spectrum at 25mm. As a teacher, I ask my students to roll to the side before sitting up not simply to avoid feeling dizzy and lightheaded but also to reduce the pressures on the spine. For the record, resting on your side applies 75mm pressure on your back, which is quite a bit less than pulling yourself straight up from lying flat on your back.
So, the take home message is: do the work in other poses which don’t load the spine first to lengthen your leg muscles and hamstrings, and strengthen your back before you throw yourself into a forward bend. Realize which types of poses are right for you. Gentle flexion of the spine isn’t for everybody and that’s ok. Once your body is ready, you’ll be reaping the benefits of practicing Uttanasana instead of causing harm to our back.