Reducing Lower Back Pain with a Pelvic Tilt

Learn how to improve your lumbar spine with a pelvic tilt

Article at a glance

  • Sean Fyfe asks 'Can you do a Pelvic Tilt?' This article will teach you what a pelvic tilt is and how to do one.
  • Injury prevention starts with good movement control. And that starts with the pelvic tilt.
  • Investigation the movements involved with the pelvic tilt and exercises that can be used with it.

Injury prevention starts with good movement control. And that starts with the pelvic tilt. Sean Fyfe explains

In sports injury rehabilitation, there is a lot of talk about 'neutral spine' being the starting point for any rehab involving the low back (lumbar spine) and pelvis. To stand with good posture by definition means you are in neutral spine: you will be maintaining a mild lordosis (slightly extended low back), with your front hips equal and anatomically level.

Neutral spine is the foundation of good postural control, regardless of sport. But to be able to hold good neutral spine against body movement or loading, you have to know how to tilt and hold your pelvis. It is not at all fashionable these days to teach sportspeople how to do a pelvic tilt, but little else in the way of core stability and trunk strengthening can be achieved until you have mastered this specific art of body movement.

"Little else in the way of core stability and trunk strengthening can be achieved until you have mastered this specific art of body movement"

What is a pelvic tilt?

The pelvic tilt is broken down into anterior (front) and posterior (rear) tilting. Although the movement is quite simple, it can get confusing because of how the pelvis sits, crossing from front to rear of the body. Anterior tilt refers to the front of the pelvis moving down, and the back of the pelvis moving up. In posterior tilt, the opposite occurs: the back of the pelvis moves down and the front moves up (see figure 1).

Figure 1: Pelvic tilt

When you tilt your pelvis anteriorly, it is mostly the extension muscles of the low back that perform the movement, with some help from your hip flexors. In posterior tilt the lower abdominals are contracting and with a more forceful movement, the buttocks will work. Ideally you should be able to posterior tilt using abdominal control, without having to contract your bum muscles.  Anterior tilt and posterior tilt are at opposite ends of neutral spine - or, put another way, neutral spine is mid way between anterior and posterior tilt.

Do not expect to be able to perform injury rehabilitation exercises with good technique unless you are fully afigble to control your range of pelvic tilt smoothly in standing.

How to do it

Even though the movement is simple, it can prove very difficult to do in practice: your brain may have trouble getting the concept, joints may be stiff and very unused to moving in this way, and muscles may be weak and/or working in the wrong order. Don't expect to get it right first time if you've never practised this before, just be prepared to try different kinds of approaches to see what works best for you. Here are some suggestions:

General tips

  • Practice while you stand side-on to a mirror, making sure you can clearly see your low back, bum and pelvis.
  • Watch someone else do it first, who has mastered pelvic tilting.
  • Try to keep knees straight and chest upright.

Tips for posterior tilt

  • Try to tuck your pelvis underneath (tuck your bum under).
  • Flatten the bottom of your lower back.
  • Face your pubic bone to the ceiling.

Tips for anterior tilt

  • Arch just the lower part of your spine.
  • Make your bottom stick out.
  • Face your pubic bone to the ground.

You can also try out pelvic tilting lying on your stomach, lying on your back or sitting. Any of these positions might be the one that helps you to get the movement right.

Holding steady

Once you can perform anterior and posterior tilting smoothly, you can try out the exercises below. The aim in each case is to adopt a gentle tilt in the direction specified, and then use your muscles to hold that position while performing the exercise - they are designed to 'destabilise' your pelvic tilt.

Lying leg extensions (figure 2)

This exercise, to develop strength in posterior tilt, is done all the time in gyms - usually badly.

  • Lie on your back with hips and knees bent up to 90 degrees, arms out at the sides of your body.
  • Tilt the pelvis posteriorly to flatten the lower back and then straighten one leg out in front of you.
  • Stop as soon as you feel your lower back starting to arch and lift off the ground, bringing your knee back to the starting position.
  • Repeat with the other leg
  • Initially straighten your leg in a diagonal line, but as your lower abs strength improves, straighten the leg in a more horizontal line, just parallel to the ground. When that gets easy, progress by straightening both legs at the same time.
  • Perform up to 10 reps each side, alternating, but only if you can hold the pelvic tilt throughout. Stop if you feel yourself starting to lose control

When you can maintain a posterior tilt position with both legs straight and heels just above the ground, you have very good lower abdominal strength.

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Figure 2: Lying leg extensions

Front lying hip extensions

Develops strength in posterior tilt.

  • Lie on stomach with forehead resting on your hands, and begin by doing a small posterior tilt.
  • Contract glute (bum) muscle on one side and then keep the leg straight while you lift the thigh just off the ground (lift from the hip).
  • Hold briefly, then return to the ground and repeat with the other leg.
  • Make sure you do not tip over from side to side as you change legs: keep hips level throughout.
  • The leg raise will cause the pelvis to tilt anteriorly (producing an arching of the lower back) if the lower abdominals are not adequately stabilising the position of the pelvis.
  • Perform up to 10 reps each side, alternating, but only if you can hold the pelvic tilt throughout. Stop if you feel yourself starting to lose control

Romanian dead lift (figure 3)

This is the best exercise to train maintenance of good anterior tilt.

  • Stand side-on to a mirror, holding a light barbell (or broomstick) with straight arms.  Lower the barbell while flexing at the hips and only slightly bending the knees.
  • Lower the barbell only as far as the point where the hamstrings begin to stretch. If you go beyond this point, you will lose pelvic and lower back position.
  • Hold in this position briefly, then return under control to start position and repeat.
  • Throughout the movement, try to hold on to your anterior tilt to maintain the slight arch in your lower back.
  • Perform up to 10 reps but only if you can hold the pelvic tilt throughout.

This exercise challenges your ability to hold anterior tilt against the efforts of your hamstrings to pull the pelvis into posterior tilt at the bottom of the movement, and against the weight of your body flexing the spine.

Figure 3: Romanian dead lift

Adding strength

Once you can hold a pelvic tilt effectively, you can start to work on increasing the strength of the lower abdominals and back muscles in holding this position.

Probably the best known exercise for holding posterior tilt is the plank (or front bridge), in which you brace your body just off the floor, balanced on elbows and toes. Another good example is the Swiss ball pullover.

Swiss ball pullover (figure 4)

  • Lie face upwards on a Swiss ball with your upper back resting on the ball, feet flat, knees and feet in line with hips.
  • Squeeze bum muscles and do a slight posterior pelvic tilt to flatten your back.
  • Hold a dumbbell in both hands, arms straight up above your chest.
  • Lower the dumbell over your head and bring it back under control.
  • Maintain posterior tilt throughout: do not let your lower back begin to arch.

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Figure 4: Swiss ball pullover

To progress anterior tilt strength, you can start by adding weight to the barbell during the Romanian dead lift. Then add in a bent-over arm row movement at the low point of the dead lift by pulling the barbell into the chest and back. Perform the desired number of repetitions without losing pelvic or low back  position.

My favourite exercise, the single leg squat, is also another high-level drill that will train the strength of holding anterior tilt.

'Little else in the way of core stability and trunk strengthening can be achieved until you have mastered this specific art of body movement'

Sean Fyfe is the strength and conditioning coach and assistant tennis coach for the Tennis Australia National High Performance Academy based in Brisbane. He also operates his own sports physiotherapy clinic.

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