This week’s blog is a bit of a tangent from the usual physiology. I’m writing it because so I’ve spoken to so many people in recent months have had problems running, which appear to be related to ‘anterior pelvic tilt’. I’m not a qualified physio, but I do have a good understanding of posture and how it can impact running and cycling. Lordosis posture, which is caused by anterior pelvic tilt is the enemy of so many runners, yet most runners have never heard of it. In fact, I’d be brave enough to say that at least 75% of people reading this blog have anterior tilt to some degree and a muscle issues as a result. Got your attention? Ok, let’s read on. From my experience, athletes with lordosis or anterior tilt are at high risk of suffering the following injuries or problems:
- Lower back pain (pretty much always a link between lower back pain and anterior tilt of the pelvis).
- Constant tightness in the hamstrings (certainly can’t touch your toes!).
- Possible pain or tightness in the front of the hip/groin area.
- Potential cramp or spasm in the quads (front of your thighs), more common running downhill.
- Running ‘stitch’ (bearing in mind that a stitch is a word used to describe and pain in the abdominal region when running!!).
- Problems breathing (can’t breathe deep and have to breathe rapid and shallow), sometimes but not always coupled with stitch.
- For triathletes, these problems are worse when running after cycling (when running immediately after cycling your hamstrings are tight, get quad cramps and breathing difficulties or stitches).
Tilting the pelvis
- To tilt your pelvis forwards, arch your lower back inwards and simultaneously push your stomach out. Stick your bum out so you look like Donald Duck.
- Now tilt it backwards (posterior tilt) by pulling in the stomach and doing a ‘pelvic thrust’ action. If there is anyone watching, you may wish to explain at this point that you are practicing a posterior pelvic tilt.
As I mentioned above, the pelvis isn’t actually rotating on a pivot. You’re making the pelvic region rotate forwards or backwards by using your muscles and doing specific movements.
Sit down now, people are watching…
Ok, so you get the basic principle of anterior and posterior tilt. Most people have some kind of anterior tilt and it’s caused by muscle imbalance. The pelvis is a bit like a central tent pole with several ‘guy ropes’ attached. If all the ropes are pulling equally hard, the pole stays vertical. If some ropes pull harder than others, the pole starts to lean. You have muscles pulling in different directions and if they all pull with the same force, the pelvis stays in a ‘neutral position’. If some get weak and other get strong or tight, the pelvis moves out of position.
The 4 key muscle areas:
- The hip flexors are on the front/top of your thigh and they attach to your pelvis. If they are tight, they pull down on the front of your pelvis, which creates an anterior tilt.
- The hamstrings are at the back of your thigh and attach to the back of your pelvis. They pull down on the back of your pelvis and create a posterior tilt. The hamstrings and the hip flexors therefore do the direct opposite of each other. If they are both healthy and pull with equal force, the pelvis stays in a neutral position.
- The core abdominal muscles (in particular the transverse abdominals) wrap around your torso. They start at your spine and wrap like a band around your stomach back to your spine. It’s a bit like a cummerbund (for my friends and training buddies in Wigan, that’s the large belt looking thing which goes round the waist of posh people when they wear dinner suits). Imagine if you stood behind someone and reached your arm around their waist, then pulled the stomach inwards. That would cause the pelvis to tilt backwards (posterios tilt). That’s the job of the ‘core abdominals’.
- Only one muscle group is left and that’s the lower back. Picture the muscles running vertically up the lower back, parallel to the lower spine. Now look at the image of lordosis and anterior tilt. If your lower back is arched inwards, the lower back muscles will be shorten and tighten as a result. Likewise, if those muscles are shortened and tightened, they cause an inwards curve of your lower back (chicken and egg). The issue with this curvature is that it compresses the lower vertebrae at the back and can cause nerve related problems (which may transfer down the legs) or muscle spasm in the lower back.
Why is it so common?
There are lots of things, which we do on a daily basis, which create an anterior tilt of the pelvis. The hip flexors are on the top/front of your thigh (where the crease in your groin is). Stand up straight and raise your knee to waist height, that’s the job of the hip flexors (so pretty important for the running stride!). When the knee is raised, the hip flexors are shortened, when you put your leg back down, then lengthen again. If you spend all day sitting down at a desk or in your car, the hip flexors are always in a shortened (but relaxed – you’re not using them) position. Eventually, they get used to this and they naturally shorten. Remember, we said earlier than when the hip flexors shorten, they pull down on the front of the pelvis and tilt it forwards. It’s actually worse than that, one of the hip flexors runs from the front/top of your thigh, backwards through the pelvis to attach to your lower spine (front of the vertebrae). When this pulls, it’s actually pulling the spine forwards and making your lower back arch inwards! Let’s think about cycling. When you are riding a bike, you’re exercising in a ‘hip flexed’ position. We ride in the foetal position when viewed from the side, this makes the hip flexors even shorter. The more aerodynamic your position, the more you shorten the hip flexors. The only point at which your hip flexors go back to normal length is when you get off and stand up straight. After several hours in the foetal position, you might actually find it hard to stand up straight again and feel the urge to stay a bit hunched over. You may even get a bit of a spasm or pain in the front of your hip due to suddenly standing up. When you try and run after cycling, this can be a real issue. When cycling, your hip has been in a flexed position (your thigh was almost touching your stomach). When running, you do the total opposite, your thigh swings backwards behind you as you push off the ground, that’s hip extension. For hip extension you need long and flexible hip flexors, not short and tight ones which have been in the aero position for several hours.
Is this you?
Good, then this blog may well be useful. If not, you’ll probably meet someone soon or know someone already who would find this advice valuable. You can then sound educated and pretend this is your knowledge, using terms such as “from my experience I’ve found…..” I think I can get at least 3 weeks out of this blog, which is great, it’s bloody hard thinking of a topic every week! Next week I’m going to explain why lordosis / anterior tilt causes the specific problems I mentioned earlier (hamstring pain, stitch, breathing etc). Then the following week, we’ll go through some exercises which can help to cure you’re tilted pelvis. If you’re convinced you have this problem and you need it sorting sooner than that, email firstname.lastname@example.org and I’ll put you into a man who can ASAP. Now, go and stand in front of the mirror and practice your tilting. I find that doing the movements to the sound of ‘Uptown Funk’ by Bruno Mars tends to work best.
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