Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

One of the most common postural adaptations that I see on a day to day basis is anterior pelvic tilt.  In fact, it’s getting more rare to find someone that isn’t in a large amount of anterior pelvic tilt.

I blame it on our seated culture.  The human body is excellent at adapting, and the seated posture produces an anterior pelvic tilt.

 

Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

Anterior Pelvic Tilt Hip Range of Motion ImpingementA recent research study published in the American Journal of Sports Medicine looked at the effect of changes in pelvic tilt on range of motion and impingement of the hip.

The authors looked at CT scans of the hips of  50 subjects with femoroacetabular impingement and simulated range of motion using 3D-generated models.

A 10 degree increase in anterior pelvic tilt, which I would say is something we see clinically, resulted in a significant loss of 6-9 degrees of hip internal rotation and increase in FAI.  This increase in anterior pelvic also resulted in a loss of 10 degrees of hip flexion.  Subsequently, an increase in posterior pelvic tilt resulted in greater hip internal rotation, less impingement, and more hip flexion.

 

Clinical Implications

The results of the study have several implications

  • Assessment of hip ROM should take pelvic position into consideration.
  • FAI symptoms may be reduced by decreasing anterior pelvic tilt.
  • People with limited hip internal rotation or hip flexion may have too much anterior pelvic tilt.  Focus on alignment before starting to torque the joint.  This is a fundamental principle I talk about in Functional Stability Training of the Lower Body.
  • People with poor squat mechanics, especially in the deeper positions, may have an underlying pelvic position issue.  People with excessibve anterior pelvic tilt that are squatting deep maybe impinging and beating up their hips.

 

I talk a lot about reverse posturing, my terminology for focusing on reversing the posture that you assume for the majority of your day.  But there is a big difference between reducing static anterior pelvic tilt posture and dynamic anterior pelvic tilt control.  You have to emphasize both with dynamic control being arguably more important.

Keep these findings in mind next time you see someone with a large amount of anterior pelvic tilt.

If you are interested in learning more about how I work with anterior pelvic tilt, I recently outlining my integrated system of manual therapy and corrective exercise in my Inner Circle webinar on Strategies to Reduce Anterior Pelvic Tilt.

 

 

13 replies
  1. Lee Ferguson
    Lee Ferguson says:

    Also worth noting that APT rotates the femur inwards thus maybe the casue of patella maltracking (not the patella itself moving incorrectly but the femur rotating in) thus causing patella chondromalacia and osteoarthritis. perhaps APT is the reason behind the “mysterious” rise of knee osteoarthritis over the last few decades

  2. rodrigo Azevedo
    rodrigo Azevedo says:

    great article Mike Reinold !!!
    i would like make a simple question, how you assess the tilt pelvic ? you think this method is effective ? i´m a physical therapist of the sport in brazil and i really like your posts. thanks

  3. Robert
    Robert says:

    Mike, thanks for sharing this study. I was talking to some PT’s at the clinic at which I volunteer about FAI and its potential causes. I suspected that, like you wrote, alignment has a big influence. It’s also cool to see the numbers for how much IR is lost for a given amount of anterior tilt.

  4. Khaled Posture
    Khaled Posture says:

    my english is bad..i dont understund too many thinngs from the article..
    but i whant to ask u :
    if i fix my anterior pelvic tilt ..is my FAI gone to be better or no thing can be change but pelvic posture.!!!

  5. Brad Simpson
    Brad Simpson says:

    Thanks for the article; I much enjoy the reading! As for sitting causing a posterior pelvic tilt, I would agree, BUT not always. Awhile back, I began looking at patients with L/S DDD and facet pain who fit the pattern of extension patterns worsening symptoms and flexion patterns improving symptoms, but whom still had symptoms sitting (and yes, even when ‘slouched’ sitting). If you scoot fwd in a chair and then lean back against the chair with your thoracic spine, THEN really relax your body, you will find your low back easily cocks fwd into an anterior pelvic tilt. Also, if someone has unilateral symptoms, the tendency is for them to shift their weight onto their unaffected side’s buttock which hikes the affected side’s hip and further compresses that sides’ facets. As I address this with them, and teach them how to pelvic tilt (most have a poor understanding of even knowing how to pelvic tilt consciously), sitting becomes more comfortable immediately. I am wondering if other’s have found this at all with sitting postures with their patients? I look forward to other’s comments on this conversation! Thanks,
    Brad

  6. Michael Kristensen
    Michael Kristensen says:

    Great article as always!

    I would agree with the theory of the pelvic position being influenced by our sitting pattern, but as Cheryl points out – the pelvis will tilt posteriorly when in a slouched postion e.g. school, office work and so on…

    Some older osteopaths would also argue from a visceral point of view, that the anterior pelvic tilt on the right ileum (90% of the time) could originate from a pull from the ligament going from the liver towards the ileum.

    Thanks for all your efforts Mike!

    /Michael, Denmark

  7. Cheryl Stacey
    Cheryl Stacey says:

    Thanks, great information and totally agree with hip movement dysfunctions and pelvic tilts. Surely however, most of our patients tend to sit slouched in a posterior pelvic tilt at their desks all day?

    • ian
      ian says:

      I agree that we slouch while seated very often but the pelvis isn’t so posteriorly rotated that the hip is in a neutral (not flexed) position. Even with a dramatic posterior tilt the hips are still in flexion for prolonged periods of time. Subsequently the shortened ilio-psoas group pulls the pelvis into anterior tilt on a standing position.

    • Matt Giordano Yoga
      Matt Giordano Yoga says:

      I think it would be beneficial for everyone here to consider what happens in both the front and back of the body. I actually see more over posterior tilt then anterior tilt, and see that it is hard for people to find anterior tilt and easy to find posterior. however, I teach yoga and I think depending on the movement discipline its easier to see different imbalances. While the slouching idea is still hip flexion, potentially causing tightened hip flexors as stated in this article, if you look at the posterior tilted pelvis in the slouch position in relation to the lumbar spine, you will notice that back muscles are being over stretched and abdomen is being shortened. this is important to look at when making blanket statements because someone with an over stretched back, shortened abdomen would have lots of trouble with anterior tilt even if their hip flexors were tight. now lets look at it a little more openly. tight hip flexors can cause anterior tilt, tight abdomen can cause posterior tilt. REGARDLESS of what has been shortened and lengthened from someones posture we can all probably agree that muscle shortening does not mean these muscles have actually integrity/strength. In other words just because someone falls into anterior tilt because of tight hip flexors doesn’t mean they are strong in the muscles of anterior tilt, and visa versa with posterior tilt. What I think would be beneficial is to look at what muscles lack strength, what muscles lack length, and focus on strengthening and lengthening to bring balance into the body.

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