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Anterior Pelvic Tilt - Is It Causing You Injury?

An anterior pelvic tilt has long been attributed to numerous injuries, namely lower back pain but also various hip and groin injuries, knee injuries etc. Now whilst it's true that some injuries can be maintained by an excessive anterior pelvic tilt, I think it's gotten a lot of bad press and I often have people come to see me in the clinic fretting about their pelvic tilt. So I'm going to clarify a few things - what is it, to what extent it does or doesn't impact injuries, and how you can 'reduce' it.

What is it?

Anterior pelvic tilt is a slight forward tilting of the pelvis that as you can see from the below picture, creates an increase in the curve of the lower back. It is associated with shortened hip flexors and shortened tight lower back muscles and conversely weaker/lengthened hamstrings and core. The scaremongering good posture vs. bad posture picture below is exactly why I have chosen to write this blog post!

Anterior pelvic tilt is normal anatomical variation, some of us rest in a more neutral pelvis, some with more of a posterior pelvic tilt and some with anterior pelvic tilt. Right now most of you can stand up and tilt your pelvis back and forth, many of you will know this already from instructions in yoga or pilates to tuck under with your pelvis or being asked to squeeze your pubic bone up towards your belly button to create more of a posterior pelvic tilt. If you have more of an anterior pelvic tilt at rest, it does not mean you are going to be bombarded with injuries for the rest of your life, not at all. Some of us are just built this way. What IS important is that you have the strength and flexibility to maintain a posterior pelvic tilt when you need it. What does that mean? it means that when you do a back bend in yoga that you have good enough strength and flexibility to hold a posterior pelvic tilt to effectively use your core and avoid compressing your lower back. Exactly the same goes for abdominal exercises when you're lying on your back - some people experience pinching in the lower back as they do this, this is often because they are struggling to perform the exercise whilst maintaining good form i.e. holding a more neutral pelvis or posterior pelvic tilt.

So to summarise - neutral pelvis is fine, posterior pelvic tilt is fine, anterior pelvic tilt is fine, ALL FINE - so long as things are not so tight that you are unable to change the pelvic tilt for certain activities when required.

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How does anterior pelvic tilt impact injuries?

If you are one of these individuals that does live in anterior pelvic tilt with everything you do i.e. your lower back muscles are very tight, your hip flexors are very tight and your hamstrings and core are weak to the extent that you struggle to tuck under with your pelvis effectively, then it can contribute to certain aches and pains such as lower back pain, hamstring tendinopathy, femoral acetabular impingement for example, but it is highly unlikely that it is the sole reason for your pain or injury. In fact there are several situations where anterior pelvic tilt is more advantageous for example, during squats and deadlifts and during pregnancy.

What can I do about it?

So if you do tend to have more of an anterior pelvic tilt, I'm hoping you are now reassured that it is not necessarily the issue you thought it was! There's a lot of bad information out there online and we all want to believe that there's this one big thing that is responsible for all of our issues and we can fix that and that's the end of it.

If you have however, identified that you maybe struggle to maintain a pelvic position that isn't anterior when you need it, then there are a few things that you can look at doing. Firstly, get whatever it is that is shortened and tight moving again e.g. if your lower back is very tight, you will slightly fight against that tightness when you try to effectively tuck under with your pelvis, so your osteopath can help to mobilise the joints and work with the muscles to reduce compression in that area for example. You can also work on stretching out your hip flexors and quads regularly for example.

Once things are a little bit more flexible in that area, it will then become much easier for you to strengthen the other muscle groups e.g. core strengthening in pilates it will be much easier for you to engage the correct muscle groups. You can also strengthen your glutes and hamstrings with exercises like glute bridges, but you will have to start off with the basics, learning to really tuck under with the pelvis and holding that position throughout the entire exercise before you can then progress to more advanced strength work.

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