Saturday 22 June 2019

It's all in the hips - neutral pelvic alignment

A vital component of exercise, and indeed every day life, that most people have never heard of is neutral pelvic alignment. PT's are quick enough to tell you to brace your core or abs during an exercise, but whilst that is important it is a compromised technique without first setting your pelvis.

Table of contents

The importance of your hips

The hips have the unenviable task of being the major weight-bearing centre of the human body. It is the lynchpin that connects your entire upper and lower skeleton. As the upper skeleton connects to the hips via the spine, any movement in the hips greatly affects your spinal alignment.

Poor pelvic alignment leads to poor spinal alignment creating extra and unneeded stress on the spine, especially the lower back. Think of the havoc being caused during dynamic sports. Neutral pelvic alignment however creates a stable and stronger core and helps maintain a neutral spinal alignment making tasks much easier and safer and improving performance considerably.

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The types of pelvic tilt

There are several different ways your pelvis can tilt affecting your posture:

  • Anterior pelvic tilt: characterised by the butt and belly bulging outwards as a result of the pelvis tilting forward and pulling the lumbar spine into lumbar-lordosis. It results in short and tight hip-flexors and lower back and elongated and weak hamstrings and abdominals.
  • Posterior pelvic tilt: charaterised by flat back and the shoulders and head protruding forward. The result of the pelvis tilting backwards pulling the lumbar spine flat. It results in short and tight hamstrings and abdominals and elongated and weak hip-flexors and lower back.
  • Scoliosis: characterised by abnormal spinal curvature as a result of one hip-bone being higher than the other with a shift of the waist and trunk to one side. Scoliosis is beyond my scope so unfortunately I cannot elaborate more on it.

A key aspect of how these hip alignments come into being is down to posture. Poor repetitive posture causes certain hip musculature to lengthen and weaken and others to shorten and tighten. These alter the natural muscular balance of the hip tilting it.

The following picture (from West Coast SCI) helps show the typical muscular imbalances associated with anterior pelvic tilt. Reverse the imbalances for posterior pelvic tilt.

Some muscles will be in a constantly shortened state, whereas others will be lengthened too much and weaker. This continues up the chain altering your biomechanics in other joints and muscles.

Thus poor pelvic alignment plays increased havoc with your posture when doing any weight-bearing movements. The dreaded butt-wink during the squat is a typical anterior pelvic tilt issue.

Lower back pain is another common ailment resulting from these issues as is the ability to perform certain exercises properly and safely such as the deadlift, which requires good flexibility and proper hip hinging. It even affects your running ability!

Below is a great short clip from YouTube showing the postural differences between anterior and posterior pelvic tilt.

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What is neutral alignment?

As can be guessed from the above, neutral pelvic alignment is when your pelvis is set so that it is not tilted forwards, backwards or rotated. What this means is:

  • The pubic symphisis and anterior superior iliac spine (ASIS) are in vertical alignment with each other in the frontal plane.
  • The posterior superior iliac spine (PIIS) is parallel to the ground.

The reasons why your pelvis is not already in such a state are varied, but amongst the biggest causes for both anterior and posterior pelvic tilt is sitting down too much without thought as to how you are sitting.

Anterior, neutral, and posterior tilt in the hips

The major benefit of neutral pelvic alignment is that it creates a stable base for your spine allowing it to be able to achieve a neutral alignment. This allows the spine to have largely even gaps between each of the vertebrae, giving our vertebral discs more leeway and breathing space. It also helps reduce the risk of nerve impingement.

It is also a vital aspect in properly bracing your core and also helps set attached muscles such as the hamstrings closer to their proper length.

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How to achieve a neutral pelvis?

There are two main methods for setting your pelvis into neutral if you have anterior pelvic tilt:

  • Squeeze your glutes as hard as you can. This automatically helps tilt the bottom of the pelvis forward.
  • Actively tilting your pelvis using a combination of engaging your pelvic floor muscles (the muscles that help you control the flow of urine), hip-extensors (gluteus maximus and hamstrings) and drawing your naval inwards towards your spine (like sucking your belly in).

For posterior pelvic tilt:

  • Using a combination of your back-extensors (lower-back muscles) and hip-flexors to pull the pelvis downwards, kind of like sticking your butt out.

Once the pelvis has been set into neutral you use your transverse abdominus (inner core, see picture below) to keep the whole thing locked in place. This can be done by drawing your naval towards your spine.

The transverse abdominus 'corset' abdominal muscle

The transverse abdominus is basically your body's natural weight-lifting belt wrapping around the mid-section of the body from the ribs to the hip, creating thoracic and pelvic stability. It is the deepest of the six abdominal muscles and is responsible for stopping the abdomen from protruding outwards and helps create a flat belly.

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Maintaining a neutral pelvis

To aid in maintaining a neutral pelvis you need to work on the affected musculature. This means stretching the shortened tight muscles and strengthening the loosened weaker ones.

  • For anterior pelvic tilt: stretch your hip-flexors and lower back; strengthen your hamstrings and abdominals.
  • For posterior pelvic tilt: stretch your abdominals and hamstrings; strengthen your hip-flexors and lower back.

It is also important to improve your daily posture. Once you make it habitual it will be easier to maintain a neutral pelvis. Constantly returning to your old postural habits counteracts the remedial work you are doing.

There are however other things that may cause a pelvic tilt that might need to be addressed. For example a lack of ankle dorsiflexion can result in muscular imbalances throughout the legs affecting the pelvis.

If stretching and strengthening the affected hip musculature and improving your daily posture doesn't result in sustained results after a period of several months there may be other issues affecting you. In such instances you should consult a physio or other qualified postural health professional to diagnose.

I hope this has help shed some light on the importance of working towards a neutral pelvic alignment and correcting pelvic tilt issues. In the near future I will provide some common exercises and stretches used to help. If you have any questions then feel free to ask away in the comments or send me some feedback!

Lyle Richardson,
Gym Pal - Your Friend In Fitness


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