Is Your Anterior Pelvic Tilt Causing Your Back Pain? Could Posture Be Causing Your Pain?
If you are here then I can assume you have been told by your trusted health professional, that the reason for your lower back pain is because your pelvis is tilted forward. A forward tilting pelvis where the top of the pelvis (iliac crest), sits forward from your midline is known as an anterior pelvic tilt. This position and posture of the pelvis will result in the lower back arch increasing into extension. These individuals will often be described as having a sway back posture.
Now if you are new here to The Reform Lab Osteopathy, you may not be aware of the many myths we passionately bust. I myself as an osteopath with what has been described as having a sway back posture and rounded upper back, has repeatedly been told that the reason I strained my hamstring and have neck pain/ tension headaches is because of my posture. This is absolutely false! Keep reading if you want to hear me bust a few myths. The sad part is, I too was once naïve from a lack of education. I believed these physiotherapists, and tried to do everything I possibly could to straighten my upper back and fix my anterior pelvic tilt. Pointless foam rolling, plenty of silly stretches, and way too much low-level glute and core strengthening was completed in order to “correct” these postures. Of course nothing changed! I believed these “health professionals” as it made sense. How easy is it for someone to blame posture? It is an easy sell to patients, which just creates unnecessary stress and fear that they have something wrong with the way they are built.
That last 5 words of the previous paragraph are key there! “The way they are built”. You cannot pick your parents, so you cannot pick the way you are built anatomically. Everyone has different shapes of their anatomy, their skeleton and their joints are different. The closest thing you will find to you is your family. If you go to a dog park, you see the same species, however many different breeds of dogs. We are clever enough here to know that those lovely big, friendly Saint Bernards are not ever going to look like a dachshund. It would be fantastic if the message and common sense catches up with us. That because we are built completely different, we will never have the same posture that culturally society thinks we should have. You cannot change your structure, so don’t even bother wasting your time trying.
The research has shown consistently that there is no ideal posture. Despite the compelling evidence, people are still being told they need to fix their posture. If you ever get told this, you MUST find a proper qualified health practitioner that has your best interests at heart. If they blame your posture, you can be sure they see you for your bank account and are not in healthcare to help people. Because you cannot permanently fix your posture (which they know), and there is no ideal posture anyway. They will provide a band-aid massage or manual therapy which will likely provide relief. You will then come back, as you will have discomfort again and then both they and potentially you will blame it on your posture. You will get some temporary relief from the manual therapy again and be on the merry-go-round of manual therapy focused clinics. You will waste a lot of precious money and never get a solution. All you will get is a false reason for why you have pain, and unfortunately its an easy thing to believe from a “trusted” health professional.
I have already written a blog on “Text Neck”. I would encourage you to read this too, as it quells the postural myth again, especially for those who sit at a computer or desk all day.
What is the best posture?
The BEST POSTURE IS A MOVING POSTURE. THE BEST POSTURE IS YOUR NEXT POSTURE. In other words, move frequently. Change up your position to whatever it is that is comfortable. Perform some small movements throughout the day to promote movement of the body and reduce tension build up. I give all my desk based working patients desk mobility drills, quell the myth of posture and guess what? Their chronic headaches are either gone completely or rare occurrences. They do not complain of suffering with much neck and upper back tension like they did previously. I give solutions and strategies to pain and injury. I actually want to get you better, so that you need to see me for manual therapy less.
So what is the pain and tension that you feel when you are in one position for too long? It can be described as postural tension because of a lack of frequent movement. The muscles likely get an increased tension from a lack of both nerve supply and blood flow. It may even be as a result of higher mental stress, with whatever work you are doing in that position. Your fears and anxiety of having an upright posture, and trying to “fix you posture” will likely be leading to that discomfort. I will say it again, please stop worrying about posture. Your solution is to move more frequently, it often is as simple as that.
Rant over on posture.
Now, back to anterior pelvic tilt. Similar to posture, this silly reason for your pain is easy to sell by “health professionals”. It makes them feel smart. Because you trust them, and think the pelvic tilt sounds like a plausible explanation for your lower back pain, or hip flexor tightness. So, you believe it and try address the anterior pelvic tilt with multiple sessions of therapy. Health professionals, often cite medical doctor Vladimir Janda, 1979. Janda described anterior pelvic tilt as lower crossed syndrome. Where there is a muscle imbalance between the core, lumbar spine and pelvis. He believed that weak abdominals and weak glute muscles, created an anterior tilt of the pelvis. From this he believed that individuals therefore had a tight lower back, creating more lumbar lordosis (curved lower back), and tight hip flexor muscles. This imbalance he believed to cause lower back pain, among many other musculoskeletal pain conditions.
This was in 1979! More than 40 years ago, meaning we have 40 years of research that refutes anterior pelvic tilt/ lower crossed syndrome. Despite over 40 years of research debunking this fear mongering diagnosis, we STILL have allied health practitioners that tell their patients their anterior pelvic tilt is the reason for their pain! This is a great example on why you NEED to see EVIDENCE-BASED health professionals.
Evidence that debunks anterior pelvic tilt as a cause for lower back pain
The most important statistic from the research is that anterior pelvic tilt has been proven to be a very normal occurrence. One study by Herrington in 2011, showed that anterior pelvic tilt was present in 85% of males and 75% of females. These individuals were completely symptom free. Meaning they did not experience lower back pain or any other concerns.
We have higher quality studies, that conclusively state that anterior pelvic tilt is not related to experiencing lower back pain. In 2014 Laird et al, found that those with lower back pain had no difference in their lower back lordosis (arched lower back curve), or the standing pelvic tilt, as people without lower back pain. Furthermore, another study showed those with lower back pain, had less anterior pelvic tilt than those without pain Chun et al in 2017.
Both Mills et al in 2015 and Herrera et al in 2021, showed that anterior pelvic tilt was not because of having weak glutes. How about having a weak core? Again, we have evidence from Walker et al in 1987 & Youdas et al in 2000 that shows an anterior pelvic tilt is not due to having a weak core. Lastly, what about tight hip flexors? You can see where this is going. Studies by Heino et al in 1990 and Schache et al in 2000 showed that anterior pelvic tilt is not due to having tight hip flexors.
In Summary, your posture is not to be concerned about, neither is having an anterior pelvic tilt. Anterior pelvic tilt is normal and is not associated with pain or injury causation. A qualified evidence-based health practitioner like we have at The Reform Lab Osteopathy can help you get out of pain for not only the short term, but the long term. By providing active strategies for you to manage pain or discomfort on your own, we can achieve this.
