PhysioGuru

Please explain the causes of pathological anterior pelvic tilt and its possible management.

Anterior pelvic tilt is one of the most common mal alignments seen in lumbo pelvic hip complex, where the ASIS is tipped beyond 10 degrees, which is the normal range of anterior tilt. Usually, anterior pelvic tilt is indicative of the lower crossed syndrome, explained by Janda, which involves the shortening of the following muscles -

• Psoas major, which by its anatomy can cause increased lumbar extension and hip flexion, causing the pelvis to tip anteriorly.
• Quadriceps, particularly the rectus femoris, which also contributes to hip flexion.
• Lumbar erectors, which cause lumbar extension.
• Quadratus lumborum, if bilaterally tight, can cause increased lumbar extension.
• Hip adductors, anterior pelvic tilt results in internal rotation of the femur. This will shorten the adductor musculature.

The long/inhibited muscles include:
• Gluteus maximus, which causes hip extension and opposes the psoas major.
• Hamstrings, this muscle can be tricky, It may be weak but appear tight simply because it is a synergist to the gluteus maximus and may be compensating.
• Deep abdominal wall, this includes the tranverse abdominus, and internal obliques which may become inhibited due to facilitated lumbar erectors.

The main contributor to anterior pelvic tilt is usually the psoas major. Dr. Vladimir Janda states that if the psoas major is tight, it can disrupt the muscle balance relationships of the entire postural chain. When the psoas is tight, it pulls the pelvis into anterior tilt, thereby increasing hip flexion and shortening all hip flexor muscles. Since the psoas has its origin on the lumbar spine vertebrae, when it shortens, it pulls the spine into extension. This causes the lumbar erectors and quadratus lumborum to shorten. The short/tight muscles will inhibit their antagonists. The gluteals, which contribute strongly to hip extension, will be inhibited by the psoas, causing the hamstrings to pick up the extra force. The deep abdominal wall will be inhibited by the lumbar erectors, and their synergist, the psoas major. Due to the neurological connection, other muscles in the deep stabilization mechanism may become dysfunctional. This may include the pelvic floor and lumbar multifidus.
Excessive anterior pelvic tilt can be caused by seated jobs, faulty abdominal training, poor muscle balance, poor posture, and pregnancy. The problems associated with anterior pelvic tilt can include: dysfunction in the lower extremity (See part 4 of series), low back pain, incontinence, pelvic instability, upper cross syndrome (via the pelvo-occular reflex), and abdominal distention.

@ devdeepahuja

Thanks for such a good explanation... could you describe some of the management strategies as well?

Correction of excessive anterior pelvic tilt includes postural cueing, stetching the tight muscles, and strengthening the long inhibited muscles.

Postural cueing for the pelvis includes finding a “neutral pelvis”. This is done by performing a posterior pelvic tilt, then perform an anterior pelvic tilt, then find the position in the middle of the two. Or you could use the test position by tilting your pelvis until the PSIS and ASIS align properly. Use this procedure in all exercises to re-enforce the motor program.

Corrective stretches should be performed prior to initiating any exercises. Stretch the quads, psoas major, hip adductors, lumbar erectors, and quadratus lumborum. Refer to a good stretching book for demonstration.

Then focus on the strengthening of the muscles which are lengthened or inhibited as described above.