Causes And Consequences Of Poor Pelvic Alignment

The ideal pelvic position is “neutral”, Neither anterior, nor posterior tilt. Unfortunately, almost everyone has some degree of pelvic tilt, with over 80% of us having a condition known as “anterior pelvic tilt” (APT), which is a frontal, downward tilt commonly caused by tight hip flexors, particularly rectus femoris on the front of the thigh, which pulls the pelvis down.

Up to 90% of the population experience serious back pain in their lifetime. Lower back pain/injury costs over $9 billion annually in Australia. But what are the primary causes of pelvic displacement? Well, firstly, we are a society that spends far too much time SITTING at the computer, TV, work-desk, schoolroom, etc., and this shortens the hip flexors, which then stretch the gluteals, which are the largest muscle group in the body, and are normally very strong, but in the lengthened state, they lose reciprocal innervation and become dormant, losing the ability to contract properly when required, and so are quite weak. This may cause overloading of the calves, leading to plantar fasciitis or achilles tendonitis.

Now before I discuss the effect tight hip flexors and quadriceps have further up the chain, I need to go further down the chain, right down to the ankles. We know that bodyweight should be evenly distributed between both feet, with approximately 60% to the front, and 40% rear. But excessive frontal weight bearing indicates tight and shortened calves, which limits dorsi-flexion. In other words, you have POOR ANKLE MOBILITY, and this plays a key role in causing foot, anl=kle, knee, hip and back pain and/or injury. Furthermore, this limited flexibility precipitates the development of quadricep dominant patterns when the glutes should be firing. This condition causes an imbalance between front and rear thigh, as the quads become too strong for the hamstrings, which in itself, can cause hamstring tears ( usually biceps femoris ); added to this, the quads bear too much of the workload, become inflexible, and pull the hips forward. The rectus femoris is both a quadricep and a hip flexor, and is the main culprit. It’s usually the muscle that breaks in cases of quadricep tears. The dominant quad over the weaker hamstring can cause rupture of the anterior cruciate ligament (ACL) in the knee. These tight quads may also pull one hip more forward of the other, creating internal/external hip rotator imbalances, which quite probably could have originated from the loss of ankle mobility. If the external hip rotators are very tight, then this is a major indicator for low back pain with probable referred pain down the legs. If the piriformis ( strongest external hip rotator ) is too tight, then knee pain or sciatica might occur. Groin strain is a real danger. ( usually the adductor longus tears ). If vastas lateralis is too tight and dominates the medialis (VMO), then the patella is pulled laterally; and an overly tight ilio-tibial band and tensor fascia latae, both external hip rotators, may also pull the patella laterally. However, a large Q-angle is also directly involved in most cases. Finally, as 95% of the population have some degree of foot pronation, then if coupled with unbalanced hip rotators, then achilles tendinopathy becomes quite likely. Flat feet indirectly results from tight/short hip flexors and weak external hip rotators. Usually seen with thigh bone internal rotation, which exacerbates the condition, and is also caused, in part, by tight hip flexors and glutes. Kneecaps pointing inward are a tell-tale sign. Knees might be turned outward if the external hip rotators are tight, with the piriformis probably the main culprit.

Hyper-extended knees (locked knees) is a condition often caused by a very tight and short rectus femoris, which is the only quadricep muscle that is both a knee extensor and a hip flexor. This muscle is one of the most important focal points in my exercise prescriptions. Thigh bone is internally rotated, with ankle pronation, which stresses the external hip rotators, causing lateral knee pain, and eventual knee damage. This change in muscle length/tension increases anterior pelvic tilt, thus increasing pressure on the joints and nerves in the lumbar region, and lead to back pain.

Knock-knees is also caused by tight hip flexors. This condition makes you very prone to knee injuries and chronic pain, and is very pronounced in client’s with a large Q-angle (pear-shaped, wide hips)

Excessively tight external hip rotators pull the hip forward, out of alignment with the shoulders. This leads to lower back pain, which is commonly referred down the leg due to nerve compression.

Now let’s go further up the chain, above the hips, to see what effect APT has on the upper body. Firstly, the back extensors, especially the lumbar area, compensate for the glutes by doing most of the work. Eventually, low back pain/injury will occur, and it’ll probably happen while doing the most mundane activity, like getting out of bed—believe it or not.

On the front of the torso, it’s likely there will be a breakdown in reciprocal innervation to the abdominal area, particularly the deeper transversus abdominus area, and serratus anterior, making all of these muscles weaker.

The excessive extension of the lumbar spine ( lordosis ) contributes to the excessive flexion of the thoracic spine, which in turn causes excessive extension of the cervical spine. Now, a displaced spinal column causes plenty of problems on our muscular/skeletal system over time, causing many shoulder and knee injuries in particular.

Excessive lordosis partly causes electrical inhibition of the transverse abdominal’s and serratus anterior, leading to shoulder and back pain; also multifidii, which atrophy, are all implicated in lumbar pain.

Excessive kyphosis ( thoracic spinal flexion ) causes scapular elevation and protraction, and a tendency to anterior scapular tilt. Optimal shoulder function will never be attained unless optimal thoracic spine position can be maintained. It is vital that I address the lack of thoracic spine extension, and re-stabilize the scapulae, otherwise injury to the shoulder joint ( gleno-humeral ) WILL occur, leading to joint degeneration, impingement, rotator cuff tendonitis/tendinosus or tears, and labrum injuries. Furthermore, most people develop tight internal shoulder rotators, anterior deltoid and pectorals, with weaker external rotators, causing a “round shoulder” syndrome, which will eventually cause impingement of the gleno-humeral joint, and injury to supraspinatus tendon ( rotator cuff ). Excessive kyphosis also leads to intevertibral disc degeneration, winged scapular, and tight/dominant upper trapezius versus weaker lower traps, serratus and rhomboids, (although rhomboids are not always weak ), and weak deep neck flexors , being causative factors for thoracic and/or cervical pain, and headaches.

Excessive cervical extension causes an over-worked levator-scapulae, from resisting the weight of the hanging head ( poke-neck ). Implicated as a causative factor in headaches because of stress on the nerves passing through the cervical spine, as well as affecting areas below the neckline.

Posterior pelvic tilt (PPT) is a backward rotation of the pelvis due to very tight/short hamstrings, and is characterized by a flattening of the lumbar curvature, excessive thoracic kyphosis, and increased cervical extension; weak hip flexors and quads, and inhibited gluteals. The major difference from APT is a dominant posterior chain, with many of the same issues present. Appropriate muscle testing, will, as always, reveal the required exercise prescription.

shane  shiels


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