An anterior pelvic tilt is one of the most simple to understand yet most overlooked factor in the diagnosis of back pain. This is staggering given the influence the position of the pelvis has on the lower, middle and upper back, however is a clear indicator as to why most practitioners find the back the most complex area to treat.  

What is an anterior pelvic tilt:

An anterior pelvic tilt is where the pelvis in tilting forward. The front of the pelvis (both ASIS) tilts lower than its neutral position and the back of the pelvis (both PSIS) raise upwards

What causes an anterior pelvic tilt:

Internally rotated hips and shorted anterior muscles such as the hip flexors and quadriceps. Weakened/ elongated posterior muscles such as the glute max and hamstrings provide a lack of support to prevent the opposing force from the anterior muscles groups.

How is an anterior pelvic tilt related to back pain:

Think of the pelvis as the center of gravity, as the foundation of support for the upper body. If the support is solid and in the correct position, then the structures above the support will have every chance of functioning correctly. If the support is weak, unstable and tilting forward then all structures above the support will also be unstable with their function compromised.

The spine commences at the lumbosacral junction, therefore if the pelvis is tilted forward, so to is the position where the spine commences requiring compensation to occur. The spine will compensate to maintain a level eyeline. The spine holds a natural ‘S’ shape, so in order to compensate for the pelvic tilting forward and the eyeline maintaining a level position the excessiveness of the ‘S’ shape is increased.

The lordotic curve of the lumbar spine becomes more excessive or acute. The kyphotic curve of the thoracic spine becomes more excessive as does the lordotic curve of the cervical spine at the neck region.

So as we can see, the position of the pelvis plays a massive role in the health and function of the spine and the muscles, structures and joints that support it.

The vast majority of treatment focuses on the localised symptoms of the back; the restricted joints, damaged discs, painful muscles whilst completely overlooking the real reason why the back was affected in the first place.

For the majority of chronic back pain sufferers, they will go from physio to physio, try all kinds of different treatment options such as chiro, osteo, deep tissue massage only to experience short term temporary relief from their pain. The joints and muscles of the back are successfully released through treatment only for the tension to return soon after due to the anterior pelvic tilt not being addressed. The spine continues to compensate to maintain the level eyeline with the muscles and joints of the back becoming once again tight, restricted and in pain.    

What needs to be done to rectify an anterior pelvic tilt:

Address the cause of the anterior pelvic tilt and you will unlock a lasting solution to chronic back pain.

1. Effective treatment that lengthen the anterior muscles that are generating a constant downward force on the pelvis;
2. Effective treatment that lengthens the muscles that contra-laterally rotate the hip. To remove the constant internal force upon the hip joints.
3. Strengthen the major muscles of the hips to take the pressure of the deep muscles that are overloaded from compensating for the weakness.
4. Strengthen the posterior muscles that support the pelvis in its correct neutral position; hamstring and adductor muscles.

This treatment approach to addressing long term chronic back pain is not an overnight fix. It will take time and dedication by you and your therapist, however you will notice results along the way that will provide you with much longer lasting relief than they treatment that just focused on your back. Over time the pelvis will return to a neutral position providing you a lasting solution to your chronic back pain.