Anterior pelvic tilt: when it matters and how to address it

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You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey everyone, it's your host with the restoring human movement podcast. Thanks for joining the movement movement. This is your first time to show. Welcome you to the labs, a lot of episodes so far. This is episode 257. And we're covering anterior pelvic tilt. And is it bad for you? Because it's something that has been demonized over the years. And we're going to cover it today with Dawne Costantino, who's going to help us, uh, do a little bit of, uh, volleying the question back and forth.

If you're a clinician, you probably know that in the past, we had a little bit more technical episodes. We're not having technical, technical episodes anymore. We're being very late public friendly. And that's not to say that you won't get any information from this. Perhaps it'll help you in your own clinical practice as well. But everybody, this is going to be very late public friendly. So hang on tight. If you have low back pain, groin pain, hip impingement, uh, even, and even sciatica or pain into the leg, we're going to cover some of those aspects today. Look at your barn door closets. Is that a you choice or an alley choice?

Oh, I think you don't want to hear the story about the barn doors here. Okay. They, they, they were, they were made. Uh, this project took way too long. It was her idea. We both did it. I would never do that again. This is the worst project in the whole world. Making your own barn door, especially when the ceiling slanted. Oh no, it's terrible. It's terrible. It looks great. I won't ask questions. I like it. Okay. Well, we are going to cover today anterior pelvic tilt. Is it bad? It's a good one, right? Yeah. Cool. Dawne Costantino, do you feel, what do you, what are your first thoughts when you hear about someone concerned about an anterior pelvic tilt?

Um, I think that sometimes, um, it can be maybe a little bit of a problematic thing. I wouldn't say that I blame anterior pelvic tilt for people's issues most of the time, but I call it more of like a movement pattern that can be addressed. Um, but a lot of times it has to kind of pertain to what they're coming in for, what their symptoms are, all kinds of stuff like that. Well, let's just say then I'll give you a couple scenarios. Cause I've already gave some pretense that people with groin pain and sciatica and low back pain and so on. Like they might have, there's different, different relevances. Like you just mentioned, uh, regarding the anterior tilt.

So let's just say somebody has, um, has lumbar stenosis. They have older age type of back pain and they have an anterior tilt and they're 70 years old. Is an anterior tilt. What would you tell this person? Um, that we got to work on their anterior tilt. One hundred percent. I would say somebody with a background like that. Um, if they got some stenotic stuff and maybe some hamstring issues, some sciatica issues, all kinds of things like that. Um, the anterior tilt is probably the first place we're starting. Um, okay. What if someone was 20 years old and they have back pain in the morning, they've been diagnosed with a disc herniation and they have an anterior tilt?

Probably feels pretty good to have an anterior tilt or it may be a compensating thing. Um, in a sense that, you know, a lot of times younger population that has disc issues, they don't like rounding, bending forward or posterior tilts. Um, so the anterior tilt may be something your body is doing at this point to try to make you feel better. Um, that's the first place my mind goes. Yeah. Well, let's make it even harder. 50 years old. They're right in the middle, like 40, 45 years old. They have an anterior tilt. They have groin pain in the front and they also have tightness into the piriformis area.

They feels like a knot back there. Uh, their back really doesn't hurt. More likely not a good thing to have an anterior tilt with that one. We're just going back and forth here. See, there's just, there's times and places where maybe it's not so bad and maybe it can be the problematic issue. Okay. I'll give you one more. 40 years old. They have leg pain all the way down the backside of the leg or the hamstring area and numbness tingling into the shin or foot, the bottom of the foot. It increases when they walk and when they stretch their hamstring, it goes away when they sit down. Then yes, probably an issue with this person.

Okay. So yeah, you can tell, I don't know if everyone can tell, Dawne Costantino was like pausing until I gave her more because it is very circumstantial, right? Mm-hmm. Absolutely. I'm like picturing the person in my head as you're saying it too. It's like every person that you were just giving right now, I've probably seen in the office. It's really, actually my mind's going in two different places right now, but yes, it is very just like, I need more information. We've got to know about this person. What symptoms do you have? But anterior pelvic tilt is kind of an interesting thing that people identify with sometimes too.

Like they'll come in and they'll be like, my anterior pelvic tilt, as if it's just like something they're born with or it's something they carry around in their purse with them. Like it's a really interesting like diagnosis that people are either given or have found on the internet and they identify with it really in interesting ways. And, you know, sometimes we address it and sometimes it's not necessarily needing to be addressed. It really just depends on the person, but I'm glad we're talking about this topic today. Yeah. It's kind of like an accessory that goes well with your, with this, with the power suit you're wearing with the shoulder pads and everything.

Absolutely. Actually, can I share my patient that I just had this week, actually? Sure. Just don't share their name. No, of course not. But I would say that this person's anterior pelvic tilt was their issue in a sense that I don't know if I've ever really given like somebody just the problem of like anterior pelvic tilt is your issue and that's all you're going home with. Like there's always more. But with this guy, he's coming in with hamstring issues bilaterally and it only comes on when he's standing for long periods of time. He's younger. He's like 23 years old and it does get a little bit worse after dead lifting and squatting.

But in his exam, we really couldn't reproduce anything. And there was a moment where when I was describing something to him and giving him some education, he's standing up, he's listening to me. And as he's standing and listening to me, I see his stance sort of like shift into this kind of like lazy anterior pelvic tilt. His hips came forward, his like butt kind of like tucked out underneath him. And he just kind of like found his stability and standing through his low back and spine. It was just like instant pelvic tilt. And he goes, hey, actually, now that you're talking to me about this issue, I feel it right now.

And we look at his stance and we see that that's kind of what was provoking it. So really, it was more of like a movement pattern. Long term being in that position was what was creating his symptoms. But yeah, anterior pelvic tilt was definitely his issue there. And he needed to find out better ways to find stability and standing then through his spine like that. Yeah. And it's funny. So we gave up the example earlier with the 20-year-old who, and you said, no, don't worry about it. Now you have someone who's 20 years old and you kind of think about it. You said a couple of things there that we maybe can elaborate on.

What do you mean find his stability? So, oh, great question. So finding your stability is like ways for, wow, how do you describe that? So when we think of like core stability or spine stability, like ways for your body to just like find a position or go through a movement. So for him standing up, how did he find a way to keep himself standing for long periods of time? Some people will use their core, their glutes, their feet, something to just stay in position. He found his stability or his way of staying in position through his spine. That was what he was comfortable with. That was what felt strong to him.

But that ended up being what created some of his symptoms. I don't know if I've ever had to describe what finding the stability means. That was a great question. Nobody asked you? Do you think that way to people? I feel like most people just kind of understand what stability means. But that was a great question. Well, how do you describe that? How would I? Are you going to volley this one? That's no fair. Yeah. So I would probably say this. What are they dominantly using? What structures might they be dominantly using? What pattern might they be dominantly using? I know that when I'm standing, I tend to shift onto one side, like one leg.

That's just kind of what I do. You know, over the course of time, maybe that becomes my quote-unquote anterior tilt, my problem. But if you are one that you tend to do that one thing, that anterior tilt, maybe you're requiring certain sections of your body to do too much work while other parts of your body are just being lazy. And so, yeah, I bet those people, like sometimes runners will, like, I think they'll get the cue, bring your pubic bone up to, towards your face, almost like doing a lift or a posterior tilt or a backside tilt, the opposite of an anterior tilt. And that'll help them. And so I bet, I bet you gave a suggestion to this guy where he was standing there and you said, oh, try this.

And he's like, oh, probably, oh, it feels better just standing here just right now, right? Yeah, absolutely. Well, the thing is, what's interesting about it too is, like, how easy it is for somebody to find that when you try to cue them into it or not, which can really then kind of guide you into how much of an issue this is for this person or not. Like, can we cue pubic bone to face and they get it really well in standing or in a certain exercise? Sure. But this guy, it was like, it almost took us five, ten minutes to try to figure out what the opposite correct direction was for him, which better emphasized the fact that this was something we needed to work on.

Yeah. If any of you out there listening have that problem that Dawne Costantino was mentioning, I think Stuart McGill called it as, like, jazz legs. He just says, bend your legs and act like you're ready to, I don't know if you use those terms, but I say, bend your legs, act like you're ready to dance. You know, like you're just kind of ready. And so that kind of takes some of the stability away from the back of doing that work and it puts it in the legs a little bit. Yeah. And sometimes it just makes them feel better. Yeah, definitely. I mean, trying to find it in standing is probably the, one of the harder things to find.

Going seated is a regression of that, putting them onto the floor and using the floor as a way to try to learn how to get out of anterior into posterior or tilting the hips backwards. And then trying to find that in your movements, into your complex movements like squatting and deadlifting and all that is even the hardest things to get to. But I don't know where I was going with that. Yes, is the answer to your question. Well, funny, I have a, I had someone I was working with that they had, they had a lot of problems with, I don't want to say getting rid of their posterior tilt, but, but do, or anterior tilt, but doing the opposite, just exposing the body to the opposite.

She was someone who was a little bit older, so he was over the age of 50 or so, kind of had the symptoms of stenosis and things of that nature, or foraminal stenosis. And to coach her even on the floor to do it, to push her back into the floor was really hard. And so it's funny, I was talking to a friend about the situation this morning, not about the specific person, but she's in the fitness industry, so she coaches a lot of people. And so we're talking about the posterior tilt, or sorry, anterior tilt. And she's like, geez, how, why is it so hard for people to find? Like, maybe they just need more sex.

And I was like, I think, I think you're probably not wrong. I mean, the therapeutic value of the, of the movement, right? So, I don't know. Just learn how to move the pelvis better. Go dancing a little bit more. Who knows? Make some salsa lessons. Yeah. That's too funny. Well, where do you want to go with this? Do you have a certain direction we're headed in with this discussion? Well, so we have about a 10-episode series where we've gone through. 250 was understanding low back pain diagnosis. And then there was understanding hip diagnosis. Should I stretch or strengthen my low back? Why is my back getting crooked?

Why does my back pain only come in the morning? My low back spine MRI is normal, but I have pain. I have failed back surgery, which, and how to recover, which you did with me. Now we're on anterior post or anterior tilt. Is it bad? And then we have two more, which is perfect posture. We could be creating your pain and how, here's how. And then spinal stenosis, non-surgical treatment options that may work. So I thought we'd use conversations surrounding that today because, and we can obviously relate this to knees and ankles and sciaticas and necks and stuff, but let's just stay within the context of the groin, the hip, the piriformis, the low back, and maybe some leg pain.

Does that sound fair? Sure. So we can volley some stories or maybe some Q&As about that. Yeah. Well, I think like, I mean, the next thing my brain wants to go into with anterior pelvic tilt is like really, truly what's going on structurally with that. It's a long-term if you're finding your stability in anterior pelvic tilt. What does that mean? What is the relation you're talking about? What's happening at the structures and why are they starting to hurt can be really important there if you think that's important to cover in the podcast today. Sure. So why does a post, why does an anterior tilt at some point become painful?

Is that what you're saying? Sure. Yeah. Okay. So I tend to think that an anterior tilt, if we're talking about groin pain, there is a possibility where you're just creating less room on the front side of the hip with hip flexion movements or hip bends, bringing your knee to your chest, laying on your back, bringing your knee to your chest, pigeon position, deep squats, barbell, kettlebell, whatever squats, even body weight squats, sitting on and off the toilet, all those types of things that can create pain in the front side of the hip can be related to just having less room with basically we said there's a structure of the hip in the front, which is a, the rim of the socket of the hip, which theoretically, according to some of the x-ray studies has more of a pinch point when there's more of an anterior tilt.

And if you reduce that anterior tilt, you'll get the structure in the front side, which would be your hip impingement, your labrums, your blah, blah, blahs, you can, we can say hip flexor in this category too. Generally, they become less sensitive and then their symptoms go away because everybody knows at some point, most people, when they have symptoms of some type, they're like, I just, I just rested and it went away, you know? And then everybody's got friends that have that story. This is this phenomenon where those tend to work. You just let the body recover for a couple of days and it goes away.

But then we tend to see the people where it doesn't go away on its own. But that's my first thought with symptom generating structures and anterior tilt with groin pain. What do you feel about with low back pain? Yeah. So really when we think about the backside there, there's actually some, it's funny how I always end up with the facet, the facet, the facet. I don't even say it like that anymore because of you. It's been corrected. I don't even know if it's been corrected or it's been corrupted. Anywho, there's a joint back there called the facet joint, which ultimately is responsible for preventing too much extension in the spine, which is like if you were to go into a backbend or if you were to create a anterior pelvic tilt, that joint hits the one below it.

And over time, it can cause just some irritation at the joint itself. So it may start off feeling like a little bit more local. You can probably point to it with one finger bending backwards, probably increases it a little bit more. And over time, chronically, if you go or one of those people goes, get some imaging done and sees, you know, what the imaging is saying, it'll say that this joint is starting to hypertrophy or grow more bone because we're putting so much stress on it that your body's trying to adapt to that amount of stress by just growing more bone to help with what you're asking of it.

So that usually can create more local low back pain. And even those joints can refer pain too. It can refer into like the upper glute, maybe even deep into the glute and sometimes even as far as the hamstrings as well. It just refers pain down that area. So yeah, backside structures can create pain like that as well. And even, you know, when those structures, you know, chronically over time, there's nerves that are close to it as well. Your spinal nerves that can even be responsible for the pain in the front of the groin. So looking at the levels of like L1, L2, if we're kind of pinching on those structures on the backside because of this positioning in the pelvis, we can get referral pain into the front of the hip and groin that we may notice may look and feel like pseudo hip diagnoses when really it's coming from that backside.

I feel like a lot of times it goes hand in hand. You know, it's never really truly just one, you know, one comes on first or the other comes on first. But, you know, you just fix the tilt and a lot of those things end up going away. Yeah, it's kind of like whatever tilt bothers you, do the opposite for a little bit. And then the tilt that bothered you will probably stop most of the time. And it sounds probably really simple. We don't have to make this super complicated. Just do the opposite. But I think you're right. The mechanics of anterior tilt and then low back extension go hand in hand. So people will tend to have a lot of arthritic findings that occur with anterior tilt in the back and sometimes even in the hip too.

Like you're just asking the bones to help out a lot. The passive structures where you're finding your stability versus the active structures which would help out to deload the areas. So with sciatica then, actually, you know, let's go back into that glute pain you mentioned because you talked about that upper glute pain. It's really common for people to think that there's a trigger point there and they need to put one of those Steraguns in it or they need to put a lacrosse ball in it. But you mentioned it was referral, could be referral. What do you, can you elaborate a little bit more? Yes. So what referral pain is, is more of where we're feeling our pain isn't actually truly where it's coming from.

Is there a, like a wording for the certain, you know how like there's the cervical spine ones? Is it one of those in the low back? Do you remember what it's called? I don't think so. I wouldn't think I'd prefer to call it a somatic referral. Yeah. But anyways, like feeling it into the glute, a lot of times if we feel that like upper glute or deep glute pain, we'll go to a doctor. We want to see what's going on. We might image in that area and then we might, you know, we might just not find anything. And that becomes really frustrating for people who don't understand their bodies very well or seeing people who don't understand this diagnosis really well.

And they're wondering why they have pain in this area, but imaging isn't showing anything or rehab or therapy to that area isn't working for them. And it's probably because it's referral pain. That's not where it's coming from. And you got to look at the area that could be referring the pain. Kind of like we always use heart attack as an example. The heart is the origin, but we feel pain radiate into our arms with a heart attack or, you know, people will present with that. Not that I've experienced that or anything, but so that's just kind of an example. You know, if we looked at the arm, we probably misdiagnosed this person who's really suffering from a heart attack.

So same thing can happen in the back there. Those joints can refer pain elsewhere. And if we just look at where it's referring pain to, we're missing a huge key component here. Yeah. Like I almost think it should be, I don't know if it is already, but I know we do it at performance place, but when it should be standard practice where if someone has arm pain and they're sweating and their face, the left side of their face is getting a little weird too, we should investigate the heart first. You know, if someone has upper glute pain, even if they don't have back pain, we should investigate the back.

And someone has sciatica before you investigate the sciatic nerve entrapped between the hamstring muscles, you should investigate the back. Like it should just be standard practice, regardless if the person has any spine pain or not. Um, and say, and similar to with the arm stuff, if you don't think it's a heart thing, you should investigate the neck. That's just the way it should be. Um, I pulled up some, uh, stuff from a training website, uh, that this is the Dr. Google stuff about posterior, uh, anterior posterior tilt. Actually, uh, we probably should cover this analogy. It's a good one. Uh, there's the bucket of water analogy in case I know we're probably hitting this late in the podcast, but if you don't know what an anterior tilt is, if your pelvis was a bucket of water and it was full of water, if, if your water spilled out the front, you have an anterior tilt.

If water spills out the back, you have a posterior tilt. If it doesn't spill at all, you have a neutral. Either way, you should be able to access all three. You shouldn't be at a loss of one. But, um, I thought Dawne Costantino, this would be fun to cover in this website. They say pelvic tilt exercises, fixing the tilts. Uh, let's just discuss a little bit about if you like these or not and why or why or why not you don't. So fixing a anterior tilt, foam roll and stretch the hamstrings. Why not? This is number one. Actually, okay, okay, okay. So here is what I think about that actually. Um, foam roll. So I think, let me think about that because I think they'll tell you that your hamstrings are lengthened in an anterior pelvic tilt, right?

Um, so the reason for what, what kind of goal are we trying to accomplish with foam rolling the hamstrings? I don't think it's going to fix the tilt, but, um, if you think about the biomechanics of the body, when you put yourself into a position to foam roll your hamstrings, like think about getting on the floor, putting your legs out and putting the foam roll under you like that, you're probably sitting backwards like this and we're probably automatically creating a posterior pelvic tilt when we're sitting there and you don't even realize that that's happening. So I don't think it actually truly, if you get up and feel better afterwards, it's probably not because you rolled out the hamstrings.

It actually is probably because for the time that you were rolling out the hamstrings, you were in a posterior pelvic tilt. Does that kind of make sense? Cause I'm trying to picture somebody rolling out their hamstrings. And I think that their pelvis would tilt backwards when we're doing that. Yeah. It depends. So the, the little graph, little pictures they have on here, people are doing it differently. Um, I, I'd say on this, I wouldn't, it's not, this is not the first place I would start, but if, if it's something that you like doing, go ahead and try it and see if you feel better after. Sometimes people have a momentary period where they're like, huh, I feel completely normal.

Um, you know, you know, it's funny before I bring this next one up, Dawne Costantino, uh, I was actually thinking yesterday, uh, and since we're going to get into the hip flexor stuff next is, uh, I know we've done podcasts already where we talk about the three possibilities of hip pain. There's inside the hip, outside the hip, and then it's referred to the hip. Like we kind of talk about the referred from the back. Um, I feel like most people I talk to you about groin pain in the front, no matter, like I've been trying to address it many different ways in the, in the first interaction to say that we addressed, it's not your hip flexor.

It's not your labrum. It's not your, you know, without fail at the end of the session. So this other doctor thinks it's my hip flexor though. Do you think, and I don't know, I don't agree with the other doctor, but, um, me and the other intern the other day, we were talking about how challenging it is for people because they're getting fed all this different information and we're no exception to that. We're giving them different information. They're more confused than they've ever been. I was just thinking now, I just kind of want to say, you're right. It's the hip flexor, but we're going to treat it better and just not even fight it because I think it's going to make it easier for them.

Yeah, no, that's, I mean, that's a good way to put it. I also, I'll explain, cause I noticed the same issue. I'll explain what I think it is, but then how, what I think it is, is creating what they think it is. So in a way they understand what they already have, but then understand that there's something else that's also creating that too. So kind of like just adding to what they already know instead of trying to replace what they know. Oh, you're given like a precursor. Like your hip flexor is tight because of this. Yeah. Like your hip flexor, it's not torn. We're okay with that. But your hip flexor is the issue here.

But, you know, if we only looked at your hip flexor, we're missing a key component and this is the key component, the nerve supplying the hip flexor, you know what I mean? And just kind of adding to the understanding of it. Oh, it's even better. So it's funny before we get into this, this, this one, a next suggestion is so earlier I did speak with a friend and she's like, so my friend's been seeing you. But I remember when I saw Dawne Costantino, I really liked the way Dawne Costantino explained this. Maybe, maybe my friends should go see Dawne Costantino. And I was like, well, forget you then she's like, no, Dawne Costantino says it different.

I said, I know she's probably more clear just like right now. That's honestly happened to me before with other PTs too. Like I've had someone who's seeing a different PT and then they'll come back and they're like, Oh, it's really funny. Actually, one of them came back and said, I have lower cross syndrome, which is anterior pelvic tilt. Right. And I was like, I've been telling you that this entire time, but the way it was explained by this other PT, it was just something that his brain got a lot better. So, you know, explanations in the way you do it. You can't always get everyone. You just gotta be like, do you understand?

Repeat back. I noticed that like a lot of people, if I ask them, repeat back to me what you understand about what you learned today, I think 50% of them will be like, um, you know, they're just afraid to say they don't understand. So that question is also really important too. It's a lot of information. And even going through these podcasts, like they can listen to it multiple times, but at the same time, like, I don't even know if understanding more really helps. It's just doing like, what should I do? Tell me what to do. So, um, anyways, let's go on to foam rolling and stretching the hip flexors and latissimus dorsi, the lats.

Do you like these or not? My brain can't get out of what biomechanical position are we putting ourselves in when we're foam rolling there? Um, this person is down foam rolling elbows and hands on the floor and the foam roller on, it looks like there's just the front of their pelvis and they're just using the other leg to kind of push themselves up and down the roller. Um, I mean, if it helps great, probably will come back though. I think foam roll the hamstrings, foam roll the, um, the, uh, hip flexors, if it does give you relief, it's probably temporary relief. I don't know if I've ever heard anybody say, all I had to do was do it once and I felt better.

It's kind of like a, I've had to incorporate this into my every single day routine or else I feel like crap. Um, but if I were to choose between those two, the hamstring one probably feels better. Yeah. Because of the position. I don't think, uh, based upon what I'm seeing on this picture, I don't really like this number one, because the foam roller, if we really were going to address the hip flexors, the main one, like the iliopsoas and so on, you're not really like, that's deep. Like you're never ever going to touch it or else you're going to crush everything you ate last night. Um, so it's really not really possible.

I think if we're going to stretch the hip flexor, I'm okay with that, but not because we're stretching the hip flexor itself, but we're adding some hip extension. Uh, I do like the hip extension, uh, isolated a little bit more. And that's why we do a lot of glute stuff too. Yeah. Uh, the lat stretch they're doing is on their side with the foam roller into their armpit. And it looks like he is, uh, he's kind of like almost in like a side plank and, uh, like he's catching a baseball almost, but there's a foam roller under his arm. If anything, they're doing a downside opener. Yeah, they would be in this case.

Uh, it's funny. I've never actually seen anybody. I've never treated anybody who said that they stretched their lats to fix their anterior tilt. I'm going to be honest with you. Uh-uh. Have you? Uh-uh. No, that's a kind of a new one I've heard, to be honest. Maybe it's a missing part. How about planks? I like planks. This person's doing a hard style planks and they are flat as a piece of wood. They're not sagging at the low back. Do you like that? I do. I think flat or rounded will, in a plank position, will be a good starting point with fixing this for sure. Okay. I like that too. By the way, I think everybody should probably know, this is going to seem like really basic information, but after you do planks, you should feel your abs, not your back.

Uh-huh. Okay. If you feel your back or you're feeling your hip flexors do all the work, then you need to just improve the way you're doing it or regress the exercise a little bit. Uh-huh. What about bridges with a band? Yes. They look flat as a board. It doesn't look like the low back is sagging. They look like a straight line from their shoulders to their hips to their knees in the banded bridge. I like it. I think if we are talking about reversing anterior pelvic tilt, what muscles are activating to create it? It's low back muscles, the erectors, and hip flexors, right? To be very basic. That's your anterior tilt.

Anterior tilt. And then if we want to reverse that into posterior, we activate core and we activate glutes. So I think that's why you're noticing we're huge fans of plank and bridges because those are active muscles that will actively create the tilt in the opposite direction when done right. Well, I think if anyone's ever looked up the cross syndromes, the upper and lower cross syndromes, I wouldn't disagree with them necessarily, but at the same time, you're going to remember and you're looking at the person's sideline profile view in a sheet of paper. There's two of the dimensions you got to be able to move your body in.

I think something like a side plank should be incorporated into this and maybe a little bit of hip rotation work or maybe shoulder rotation work might be good additions too. I like that. How do you feel about hamstring curls with a ball? These are hard. So she has her feet on a Swiss ball and her back on the floor. Feet on a Swiss ball back on the floor. Oh, and pulling it into the butt. Yep. I'm neutral on that one. I don't know. We have hamstring issues with our lower, our anterior pelvic tilt is creating hamstring issues. Probably shouldn't be activating hamstrings. I found that like, so people, let's just say you have them face down on the table or if you're listening to this podcast and land on the floor, then maybe you can do this on your own.

You put your forehead into your hands and just relax your head on the floor and just try to keep your upper body not up into a book reading position. Put your face down the floor and then just try to bring your heel as close to your butt as you can, basically like a hamstring curl. But stop when you notice that your hip pockets in the front or your zipper of your pants is starting to come up off the floor. A lot of people start to, they start to use their back in a hamstring curl movement, probably around below 45% knee flexion or knee bend. It's, it's really, uh, it doesn't couple well all the time for people, especially if they're trying to recover from something.

This is a good advanced exercise. I like it, but I wouldn't incorporate for someone, um, base, um, bare bones anyways. Yeah, starting off for sure. Yeah. So what is your favorite exercise then for an anterior tilt? Um, well, I'd surprisingly don't start with teaching pelvic tilts right away because it's, I want to see if people can get it in a more challenging exercise first. So, um, hard style plank would be one of the first go-tos. Um, if that one is a little hard to get, then we can, we can teach it in a form of a glute bridge. So can we get glutes and core working both, um, teaching how to get that tilt as we come up into a bridge position?

Those are really great. If it's really hard to cue or we give some like external cues and it's just not working well, then we'll take it back to just learning how to create an anterior posterior tilt and a laying on their back position and just get used to that first. Um, and that might just be start with that in the session today and can that transfer into the more challenging exercises or they may go home with it just depending on how hard it is, but very baseline starting with bridges, starting with a hard plank and seeing if we can get them to find the right position with those first. Yeah.

The, for the people I had a lot of trouble with, with coaching it, if I didn't refer them straight to Dawne Costantino, because I said things poorly, uh, I would go to a posterior tilt mainly with the person on their back and having just simply with not a lot of effort, push their low back into my hand, like the squish in my hand, uh, that'd be number one. The second one would be, uh, if we really can't even get that going, uh, then we have a Swiss ball in the office, one of those big fat ones, and we don't really use it for anything else, but I use them for this. I just tell them lay on top of the ball and try to pop the ball with their, with their zipper, with the bottom of the zipper of their pants.

And it basically looks like they're humping the ball. And normally this one actually works pretty good just for a little bit of baseline figuring out how to use that area of your body. Once they get about 10 good reps in, I move them back to the floor again and have them do those ones. If those ones go well, I'll take them to a bridge. If that goes well, I'll take them to a hard plank. If that goes well, I'll probably deadlift this person, um, as soon as possible. If we can do it on the same day, great. But it doesn't always work that way. Yeah, definitely. Those are, I mean, those are pretty much what I go to too.

There's, I don't think there's anything, you know, complex about teaching posterior pelvic tilt. It's as far as like, you know, complexity of exercises or something you've never tried before. It's really just about teaching the person how to do those basic movements properly. Um, that's, that's the harder thing. Cause some people may be listening to this and they're like, well, I've tried those things and it's not working for me. Well, I've had people say that to me in the office and then I say, show me and they're not doing it right. They're still finding that, that bad tilt in a bridge or can't find the right tilt in the hard plank.

So, um, although you've tried it and it's not working for you, you may still not be doing it properly or coached properly. Yeah. And there's a possibility that the people are unknowingly doing an anterior tilt in other parts of their life, which is just making it challenging to, to incorporate it in the exercise too, like, uh, the next podcast, which I think we're going to end up covering, um, is going to be, is perfect posture good for you. And, uh, no, for, for anterior tilt people who have a problem and it drives their symptom, it's the symptom generator. Uh, no, uh, a perfect posture is going to make it really hard, especially if you're just gung ho and you have to, like, I need perfect posture.

I know if I don't, then my back's going to hurt and blah, blah, blah. You know, like it's like, if you have the mentality about it, it's going to be very hard to help you because that might be what's creating your pain. I agree. Listen to that podcast when it's ready. Yeah. I have, I have it, uh, written down here that Dawne Costantino's going to help me with that one. We'll see if she actually does or not. Uh, anything you want to cover last little bits before we leave anterior tilt? Um, I don't think so. I think it's a pretty basic, uh, thing to understand. It's easier to visualize if just kind of listening to us is hard.

Just Google it and you'll see. Um, and, you know, trying to take yourself through, it can be a little bit difficult if you tried some of these things that we're talking about and it's not, you know, working out well. We can, we can help you if you want us to help you. We're happy to do that, uh, virtually or in person. Those are both options for you. Um, and you know, just because it's creating symptoms now, it doesn't mean it's a bad thing and you have to stay away from it forever. It's a movement your body should be able to do. Um, just right now it might be the provoking thing and we got to learn how to find ways to kind of even out those movements.

So, um, that's all I got. Yeah. Do you have nightmares yet about saying virtual and in person yet? No. Never thought I would, I would ever say that over and over. Maybe it's in person or virtual. Oh my God, that, my head might explode. So funny, um, we actually had a, a listener reach out and, and they were, they were a clinician. They were asking how, how we conduct our virtual sessions. Uh, and so I, I, I don't really know how to answer that unless they are familiar with movement screens, like, cause you can see a lot watching someone move. Like you, you could probably seen the posterior or the anterior tilt in association with the onset of symptoms with that person that you were working with.

Um, but if you, if you don't have the same come from in the same, uh, philosophy of, of working with people, it's a little bit hard. Um, chiropractors working people virtually is probably more challenging than it is to, to actually coach exercise. So, uh, anyways on that. Yeah. Uh, by the way, if you guys, uh, want more information on low back pain or groin pain, we do have books available to their online books. Uh, I wrote these two. There's a book coming out soon where Dawne Costantino wrote a guest section, the first guest section she ever wrote. And that one's going to be how to incorporate weight training again after dealing with groin, hip or low back pain.

So that's going to be available at some point when it, when it is, there'll be in the link description below as well. All right. Is that it, Dawne Costantino? That's it. Cool. Thanks for joining the movement movement, everybody. And we'll see you next time.