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How Pelvic Tilt Influences Hamstring and Spine Mobility

how pelvic tilt influences hamstring and spine mobilityHow many people come to you and complain that they have tight hamstrings?  It seems like an epidemic sometimes, right?  I know it’s pretty common for me, at least.  

Many people just tug away at their hamstrings and aggressively stretch, which may not only be barking up the wrong tree, but also disadvantageous.

I have really gotten away from blindly stretching the hamstrings without a proper assessment, as I feel that pelvic position is often the reason why people think they are tight.  This is pretty easy to miss.

In the video below, I want to explain and help you visualize the how pelvic tilt influences hamstring mobility and spine position.  Often times the hamstrings feel “tight” or “short” when in reality their pelvic position is just giving us this illusion.  I talk about this a lot with clients at Champion and often find myself making these drawings on our whiteboard.

Keep this in mind next time you think someone has tight hamstrings or has too much thoracic kyphosis.  Often times the key is in the hips!

 

How Pelvic Tilt Influences Hamstring and Spine Mobility

 

Strategies for Anterior Pelvic Tilt

If you are interested in learning more, I have a couple of great webinars for my Inner Circle members that you may find helpful:

A Simple and Easy Hip Mobility Drill for Low Back Pain

Low back pain continues to be one of the most common health complaints that limit people, especially as we age.  Rehabilitation of low back pain has transition from simply focusing on reducing the local pain to emphasizing a biomechanical approach of how other areas of the body, such as the hips, impact low back pain.

Essentially we have done a great job moving away from simply treating the symptoms and working towards finding the movement impairment leading to the low back pain.  Sure, using something like a TENS device may have a role to neuromodulate pain, but it is now common knowledge that the improvements seen are transient at best and not addressing the real dysfunction.

One area that has received a lot of attention, and rightfully so, is looking at limitations in hip mobility as a cause of low back pain.  Much of the research to date has focused on looking at the loss of hip external rotation and internal rotation mobility.  In fact, I have an older article on the correlation between hip mobility and low back pain.

I can say that my own ability to help people with low back pain has greatly improved as I’ve learned to focus on hip mobility over the years.

 

hip extension mobility low back painHip Mobility and Low Back Pain

A new study was recently published in the International Journal of Sports Physical Therapy that adds to our understanding of the influence of hip mobility on low back pain.  In the current study, the authors evaluated hip external rotation, internal rotation, and extension mobility in two groups of individuals, those with and without nonspecific low back pain.

While using a Thomas test to assess hip extension, the authors found the follow:

  • Hip extension in those with low back pain = -4.16 degrees
  • Hip extension in those without low back pain = 6.78 degrees

That’s a total loss of 10 degrees of hip extension in those with low back pain.

 

A Loss of Hip Extension Correlates to Low Back Pain

So now in addition to rotational loss of hip rotational mobility, it has been shown that a loss of hip extension correlates to low back pain.  To me, this has always been something I have focused on and makes perfect sense, especially as we age.

The vast majority of our society sits for the majority of the day and becomes less and less active as they age.  Among many things, this results in tight hip flexors and an anterior pelvic tilt posture.

Putting recreational activities like sports and running aside, this anterior pelvic tilt posture with tight hip flexors causes a loss of hip extension mobility and the low back tends to take the load but hyperextending.  This happens while simply walking and in a standing posture.

Think about the results above, people with low back pain have negative hip extension, meaning they can’t even extend to neutral!

As we all know, the human body is amazing and will compensate.  Hips don’t extend?  No problem, we’ll extend our spine more.

So a pretty easy step to take to reduce back pain is to work on hip extension mobility.

One drill that almost everyone that trains at Champion PT and Performance gets is what I named the “True Hip Flexor Stretch.”  I’ve talked about it at length in past articles, but I am a believer that most of our hip flexor stretches commonly performed in the fitness world are disadvantageous and not actually stretching what we want to stretch.

The True Hip Flexor Stretch is a great place to start to work on hip extension mobility:

As you can see (and feel), this gets a great stretch on your hip flexors without causing any compensatory low back extension.  And by focusing on posterior pelvic tilt, we gear this towards those with a lot of anterior pelvic tilt.

 

I really believe that the “True Hip Flexor Stretch” is one of the most important stretches you should be performing.  [Click to Tweet]

 

Next, Focus on Reducing Anterior Pelvic Tilt in People with Low Back Pain

Updated Strategies on Anterior Pelvic TiltI’m not a big believer that static posture is the most important thing we should all be focusing on when outline our treatment and fitness programs, but it’s a start.  Someone in an anterior pelvic tilt static posture isn’t always evil, and can be the result of many things such as poor core control, poor mobility, and even excessive weight.  I tend to care more about how well people move.

But based on the current evidence, it’s a great place to start.

Once you’ve started to gain some hip mobility, there is a ton more work to do.  We also have to work on glute and core control, among other things.  If you’re interested in learning more, I have a hugely popular Inner Circle webinar on my treatment strategies for anterior pelvic tilt that goes into detail on what I recommend:

 

In summary, we now have a nice study that shows people with low back pain have 10 degrees less hip extension that those without.  This makes sense, and focusing on hip extension should be one of the key components of any low back pain program.

 

 

Updated Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  This is actually an update on one of my most popular webinars in the past.  I am doing a couple new things and wanted to assure everyone has my newest thoughts.  In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

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.

 

 

Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Strategis for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

 

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

Can Tight Hip Flexors Cause Tight Hamstrings?

I like the title of this article – Can Tight Hip Flexors Cause Tight Hamstrings?  It is sort of like a riddle, isn’t it?

I was working with a client recently that is knowledgable and understands anatomy fairly well.  He came to see me for several reasons, but high on the list was “my hamstrings are tight” followed by a poor attempt at touching their toes.  His hands were about 3 inches from the floor with his knees bent!  He added, “I don’t know why I can’t touch my toes, I have been stretching and working on my hamstrings for months!”

After spending time assessing him from head-to-toe, I shared with him that I thought his hamstrings were “tight” because his hip flexors were tight.  He thought about it for a second and then tried to call BS, stating “If my hamstrings are tight, shouldn’t my hip flexors be loose?”

My answer was “I don’t think your hamstrings are tight.”  At this point, he was about ready to leave the session, thinking I was the craziest person in the world, stating “but I can’t touch my toes?!?”

 

How Tight Hip Flexors Can Cause Tight Hamstrings

I bet you’ve had clients like this in the past.  They know just enough to be dangerous.  The answer to my riddle is more semantics than anything else.  Yes, hamstring tightness can limit your ability to touch your toes, but that isn’t the only cause.

We have actually done a great job understanding this concept over the last several years.  People like Gray Cook, Lee Burton, Brett Jones, and others have done wonders teaching many people that sometimes there are other reasons why you can have a limited toe-touch, specifically because of poor motor control and core stabilization.

However, hip flexor tightness can be a contributor as well, as backwards as that seems.  Again, it comes down to semantics.  I am actually talking about anterior pelvic tilt limiting your ability to touch your toes.

Here is an interesting an example.  Which hamstring is shorter in the below image?

hip flexor hamstring tightness

If you answered the left leg, you are guessing!  Without a comprehensive exam, you are just guessing.  What if his left pelvis was anterior tilted?  This would cause the proximal attachment of the hamstring to move superiorly and look just like a tight hamstring, such as in this example:

tight hamstring anterior pelvic tilt

Whenever someone appears to have tight hamstrings or can not touch their toes, I look first at pelvic alignment to see if they are in excessive anterior tilt.  Everything revolves around assessing your starting point.

As you can see in the example below, if you are starting in a large anterior pelvic tilt, then you are theoretically starting with the hamstrings long.  I used the simple math numbers of 45 degrees and 90 degrees, which is pretty excessive, but you see what I mean.  In a large anterior pelvic tilt, your normal starting position in this example would already be close to 45 degrees!

Anterior Pelvic Tilt

So, can having tight hip flexors cause tight hamstrings?  I’m not sure about that.  But I know that being in anterior pelvic tilt can limit your ability to touch your toes.  Again, it always comes down to:

Functional-Stability-Training-Lower-Body

Assess, Don’t Assume

This is one of my major concepts from the Functional Stability Training for the Lower Body program.  Assess alignment before you just start treating.  Resist the urge to just foam rolling, massaging, and stretching your hamstrings without truly assessing if this is the reason why you can’t touch your toes.  Sometime having tight hip flexors and an anterior pelvic tilt can limit your ability to touch your toes just as much.

A Quick and Easy Way to Assess Pelvic Alignment

One of the aspects of the Functional Stability Training programs that I discuss is alignment.

We have really progressed our understanding of functional movement in recent years, however, you may be missing the boat if you assume that we are symmetrical and neutral.  I am a believer that we need to assess and address our alignment before we can properly look at our movement patterns and restrictions.

Some of the more basic tests for alignment, like posture assessment and pelvic palpation, have many flaws and ultimately low reliability and validity.  However, I feel that this is the case when assess in isolation.  I prefer to take clients through a detailed assessment that looks at many different aspects of alignment and mobility.  What you start to see is that patterns emerge.  When several alignment tests are all pointing in the same direction, I start to feel more comfortable about the reliability and validity of my assessment.

I talk about this a lot in FST for the Lower Body and even go through an assessment process where we put the pieces of a puzzle together for one individual.  Below is a quick clip showing a really quick and easy way to assess pelvic alignment.  Next time you assess hamstring length, look down and see what position the leg is in.  Is it rotated?  abducted or adducted?

Because we force the motion and raise the leg in the sagittal plane, if there is any pelvic obliquity, there is going to be a subsequent re-alignment of the lower extremity.

 

How to Assess Alignment by Looking at the Hamstrings

 

This is just a quick clip of one little aspect of the process, and really not very useful in isolation, but a nice little clip to get you thinking when you are stretching or assessing hamstring length on your next client!  Take this into consideration with a full assessment and it’s results may be more useful to you.

 

Functional Stability Training Lower BodyLearn More About Functional Stability Training

If you want to really learn more about these concepts, you should check out Eric Cressey and I’s Functional Stability Training for the Lower Body.  The video above is from this program.  If you’re serious about starting to integrate functional rehab and training, Eric and I’s system will show you what we do.