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The pelvis is like a house and the pelvic floor is its floor. The stability of the pelvis is directly related to the presence of pelvic floor dysfunction. There are two common presentations of the pelvis: anterior (forward) and posterior (backward) pelvic tilt. This blog will review how to tell which is which, how they impact the stability of the pelvis and pelvic floor dysfunction, and what type of treatment addresses the issue most effectively.

What Is Posterior Pelvic Tilt?

If you imagine the pelvis being like a bowl, we want the bowl to be neutral while it has the full capability to tilt back and forth. Posterior Pelvic Tilt is the backward tilt of the pelvis, where the top of the pelvis moves backward and downward. This means the lower back spine gets curved and your mid back extra hunched!

What Are Signs Of Posterior Pelvic Tilt?

When the pelvis tilts backward, the following becomes obvious:

  • Reversed Lower Back Curve

While there are different degrees of posterior tilt, the outcome is some degree of the opposite curve of the lower back. This comes with the instability of the lower back because you are taking it outside its natural design. The lower back spine is connected to the pelvis and when whatever is connected to the pelvis becomes unstable, the pelvis has no choice but to respond accordingly which means it now has to be outside its most ideal position.

  • Tucked Buttocks

This looks like the tailbone is tucked under which puts the hip joint at a disadvantage. The hip joint is a ball and socket joint with the socket being provided by the pelvis. In the tucked buttock position, the socket sits behind the ball, compressing certain structures and stretching others; the result ends up not only a pelvis that is not in a neutral position but a hip that is losing its mobility.

The hip joints are essentially the lower extremities connected to the pelvis and their lack of stability directly impacts the stability of the pelvis. Remember that pelvic floor dysfunction has many faces which all have one thing in common, pelvic instability.

  • Forward Head Posture

In response to the backward tilt of the pelvis, for you to stay as balanced as possible given the chances that we just discussed, your neck and head have no choice but to glide forward. This comes with another set of issues that may be different from those symptoms associated with pelvic floor dysfunction.  A trained clinician should always look at the forward neck as a potential feedback loop to pelvic floor dysfunction.

  • Hamstring Tightness

With the backward tilt of the pelvis, the hamstrings are forced to stay in their shorter version of their abilities, and that by itself continues ‘feeding’ the unstable pelvis. Labral tears can happen from this presentation!

What Is Anterior Pelvic Tilt?

Forward or Anterior Pelvic Tilt is when the pelvis (the bowl) is tilting forward and down. This tilt creates an arched  lower back which automatically causes muscular imbalances, and pelvis instability.

What Are Signs Of Anterior Pelvic Tilt?

Take a look at yourself standing up to see if you have any of the following:

  • Arched Lower Back

With the forward tilt of the pelvis, your lower back has no choice but to arch. This means the muscles of the lower back are over-contracted, causing lower back, sacroiliac joint pain, dysfunctional movement, and pushed forward chest.

  • Protruding Abdomen

A bulging tummy is not always because the person has a fat tummy! With the forward tilt of the pelvis and over-activation of the lower back muscles, the lower torso muscles are ‘being asked’ to not ‘talk. That means they become less active and the protrusion comes from their lack of activity.

  • Tight Hip Flexors

What keeps the pelvis in the forward tilt position is the over-activation of the hip flexors. That means the socket part of this ball and socket joint now sits toward the front of the ‘ball’ provided by your lower extremity. This translates into compression of the front structures and stretching of the back structures attached to this area. Labral tears can be caused from this presentation and hip mobility issues are guaranteed.

  • Weakened Gluteal Muscles

Without the pelvis being in its balanced state, with the hip flexors being overactive, the opposite muscles become less active; this means the glutes and hamstrings become weak from not getting the opportunities to ‘shine’.

What Is Pelvic Floor Dysfunction?

As discussed in my previous blog, “If there is one thing I wish for you to get out of this blog, that is to understand that pelvic floor dysfunction is not pain in the pelvis only, incontinence, and for old people and especially women. Not every woman with childbirth has it and should get it. If you are trying to prevent this from being your problem, understand how to avoid it, and get yourself checked by the right kind of clinician who is equipped with the understanding of postural neurology, movement principles of kinesiology, and ergonomics because the traditional category of people with it and the customary treatments are no longer true to the resolution of this problem.

How To Tell The Type Of Pelvic Tilt

  • Visual Assessment

Stand in front of a mirror and look at your pelvic alignment. Is your lower back arched or curved backward?

  • Foot Arch

Typically, a prolapsed arch results in a posterior pelvic tilt, and a shift of weight to the outside of the feet, causing a forward rotation of the pelvis.

  • Hip Flexibility:

If you are not able to stand up balanced on both feet, weight distributed evenly over the bottom of the feet, without moving the torso and bending the knees to rotate the pelvis back and forth, you likely have hip mobility issues. This, as explained earlier, can lead to pelvic floor dysfunction.

  • Trunk Stability:

Your core is not your abs. It is your whole trunk that you should keep in mind. Your limbs do not move the trunk, nor does the trunk move your limbs. There are exercises we do at the clinic to see if the trunk stability exists or not and when need be, they become the type of exercises that our patients have to practice to bring back the stability. Here is an example of these developmental movement exercises.

Your posture plays a huge role in your pelvis stability and pelvic floor dysfunction. If you have pelvic floor dysfunction, you suspect you have it or are unhappy with your current treatment, do not hesitate to contact me.

Dr. Shakib

Recommended Reading:

Who Treats Pelvic Floor Dysfunction?

HyperMobility, Pelvic Floor and Pelvic Pain