Understanding Back Pain - Posterior Pelvic Tilt
Updated: Mar 26
A large majority of people who contact me, contact me because they have chronic back pain (possibly amongst a host of other symptoms as well). It is an affliction that nearly everyone has in our modern day, Western society.
People get told they have extremely scary sounding and complicated things that are wrong with them; they resign to their fate of a lifelong problem and something being inherently 'wrong' with their backs for evermore . They think there is nothing they can do to aid their back pain and will go down the rabbit hole of immobilisation, painkillers, injections and possibly even surgery.
I want to make the bold claim that the combination of:-
a) someone who is committed to getting themselves better and knows their body WANTS to be free from pain (but just needs to learn a new way of moving)
b) Postural Alignment Therapy can ease the symptoms of back pain in the vast majority of people suffering most types of chronic back pain.*
Most chronic back pain ultimately stems from the positioning of your pelvis (many other types of pain can also be caused by the position of your pelvis - it's really important).
The position of your pelvis is dictated by the muscles that hold the pelvis in place. (The position of your pelvis is also dictated by what your feet are doing, your calves are doing, your thighs are doing, your hips are doing ... but for the purpose of this article, let's stay pelvis centric!)
When the muscles that hold your pelvis in place shift (through tightening/overuse and/or loosening/underuse), the position of your pelvis shifts. This has a ricochet effect on the functioning capabilities throughout your whole body, especially the spine.
The pelvis is the base support for your spine (and many other body parts!) and therefore, when the pelvis shifts, the architectural integrity of your spine is upset and the spine has to shift to try and balance out the new position of the pelvis and to keep your heavy head upright. This creates an unnatural and uneven load through your spine and eventually, pain sets in.
We get very focused on the symptoms of pain that we get diagnosed with (eg. the bulging/herniated disc, the osteoarthritis, the spondylosis etc). Those symptoms are very real: they are very scary and paralysing to experience, but treating the symptoms will not treat the root cause of the pain in the long run. Symptoms often present in areas taking too much load, not the ones not working at all. These bits are the underlying dysfunction causing your problems.
Pumping yourself full of injections (et al) into the area of pain is simply masking the pain. The underlying movement problem that is causing the symptom isn't being treated, you'll be continuing to move dysfunctionally but you just won't feel the pain ... that is, until it hits another part of your body. As an analogy, you're mopping up a drip from the floor rather than fixing the leak.
We are movement machines. We need to move. The human body grows and heals through constant physical stimulation. Our cells and systems literally need movement to work. Without movement, we are starving them of things they need to operate. Keeping still (ever, but especially as part of a recovery programme for chronic pain) makes no sense whatsoever.
I have said a lot of stuff which might not make too much sense or may have made TOTAL sense and you want to read more. So please, get reading below!
If you're thinking -
"Don't be ridiculous! I have a bulging disc which was caused by me bending over to pick up a dog toy once. My back pain has NOTHING to do with the muscles that hold and support my pelvis and my lifetime of habits, it is much more serious than just my muscles! How can it be my muscles when I have been constantly on my feet my entire life? I have never driven in a car, I have never sat down for hours at time, I don't use computers! It is irreversible. This is my life now. My disc is bulging because it is diseased and I am getting older, nothing can be done and I need to take it easy and not move too much."
... that's your prerogative and maybe don't bother reading on!
* P.S - I am not discouraging ANYONE from going to the Drs if you suffer back pain, please go! There may be other underlying medical conditions that are causing your pain. But I also implore you to really ask questions of the medical intervention that is being offered to you as a solution. Ask them WHY the cortisone injections will help improve your movement patterns (which are the cause of the wear and tear) long term? HOW will the spinal fusion help you move more and keep you mobile, when some vertebrae will be glued together prohibiting natural movement? You're your best judge. You know your body and how you feel. Do the answers given satisfy you? Does the methodology make sense for a long term solution to your problem? If you're happy with it, then go with the experts. If you think it's not quite rock solid, please do get in touch before you go ahead with anything which may be irreversible. It's worth a chance even if you're skeptical. The one thing you can't reverse is medical intervention. Also, please read the 'Pain Free' by Pete Egoscue book.
So, to start with, you need to decide if you think you have an anterior or posterior (or neutral!) pelvic tilt. Have a look at this picture. Imagine your pelvic girdle (the triangle in the picture) as a fruit bowl. Does your fruit bowl tilt backwards (like the first skeleton), is it balanced or is it tilting forward (like the third skeleton). Got your answer? (Hint - most people are posterior. Lots of people THINK they are anterior but it's only because they have a stiff lower back, rather than actually having the downward tilt at the front of the pelvis)
Today we look at the Posterior Pelvic Tilt (PPT) and why it causes you pain, for all you PPTs out there!
Posterior Pelvic Tilt
If your pelvic girdle tilts backwards, you've a PPT. You might look a little bit like this.
There are a number of reasons why you might have a posterior pelvic tilt but predominantly, the reasons are a combination of a) how you sit and b) you sit too much. If you think about how you sit down, do you slouch backwards a lot? When you slouch backwards, can you feel how your pelvis has to tip back to accommodate this position? Have you always sat like this? Maybe you started sitting like this when you went to school and were at a desk all day, or maybe when you were 13 and got a Playstation and spent hours gaming in a beanbag, or maybe when you were at university you spent all your free time hanging around with your mates watching TV (and all your working time sat on a chair in the library/lectures) and NOW you spend all day at a desk and you've had 30/40/50/60/70 years of this pattern of behaviour ...
When your pelvis tips back, it affects the position of the base of your spine and pushes it backwards too. Your back now can't retain its natural 'S' shape and it starts to curve backwards into more of 'C' shape to try and keep you upright. This means your lumbar (lower) spine is locked in a state of near constant flexion, which it isn't designed for. From a skeletal system perspective, you can see in this picture why you might start having lumbar disc problems (there's too much pressure in an area which isn't designed to have constant pressure on it) and also neck problems (there's too much pressure in an area which isn't designed to have constant pressure on it) and also hip/sciatic problems (there's too much pressure in an area which isn't designed to have constant pressure on it - sense a theme?)
If we sit for too long slouching backwards like this, our muscles get frozen in this position. They are merely doing exactly what they are supposed to do - adapting to the load and demand you have put on your body. This means it is hard to then unfreeze them when we take our bodies out of our favourite comfy chair and go elsewhere. We have turned ourselves chair-shaped and our body isn't quite sure how to make itself non-chair shaped anymore. This is a dysfunction and will cause problems as you try and live your everyday (not sat down) life as a chair-shaped human.
At some point, we will try and take our frozen, chair-shaped bodies to a sport it isn't functional enough for (and blame the sport when we get hurt!) or try and do something our body isn't functional enough for (eg. tripping slightly and putting our lumbar spine into a state of extension. This sudden change to extension shocks the dysfunctional PPT body (which is only ever used to being frozen in lumbar flexion), and can cause a spasm or a herniated disc). It will ultimately be more comfortable to spend time in the chair your body has starting imitating, rather than to ask any other demand of the frozen muscles. You'll become scared of moving too much in a way that might exacerbate the pain of the chair-shaped body. You'll become a weaker and weaker chair-shaped person who is eventually pretty immobile and, most likely, in lots of pain.
Functional bodies are supple and really strong. A fully functional body has very few 'awkward' positions that could cause a massive problem. Our body is perfectly designed to move 'awkwardly' on a temporary basis, if we are moving functionally the majority of the time. The problem is that too many of us are not functional the majority of the time and we are occasionally putting demands on our dysfunctional bodies that they are simply not capable of, which causes pain. We blame that movement/sport rather than the dysfunction itself. We have had the dysfunction for so long that we have become blind to it.
At some point along this PPT journey, you'll likely go to the Drs and it becomes all about the symptoms, rather than the reason you have the symptom in the first place, the root cause ... THE MUSCULAR DYSFUNCTION. THE LIFETIME OF PPT AND WHAT THAT HAS DONE TO YOUR SPINE.
So, if you shouldn't treat the symptoms, how do you get better? Treat the muscles which are locking your body into pelvic and lumbar flexion and get them moving enough to allow you to get them into pelvic and lumbar extension.
I don't want to confuse anyone with long, Latin names and, to be honest, it isn't that important you know. All the muscles work together and there is no point isolating or focusing on one specific muscle, as it is better to focus on how to get the whole frozen area to move in synergy, but, just in case you're interested, people with a posterior pelvic tilt will generally have a tight rectus abdominis (responsible for lumbar flexion), tight glutes (hip extensors) and tight hamstrings (also hip extensors). They'll generally have long, weak spinal extensors (which keep the back upright) and long, weak iliapsoai (the primary hip flexors).
(To reiterate - These muscles not working in synergy as they should do, this locks the lumbar flexion into place and over time, will cause chronic pain due to unnatural loading and a deviation from the correct architecture of the spine.)
It is all about waking up the muscles and not about fiddling with the skeletal system.
Specifically, in the case of PPT, it is about teaching your body to move comfortably into a state of lumbar and pelvic extension. Once you can do this, the rest will follow. I have included a few videos below with some moves to try an encourage more pelvic and lumbar extension.
You need to gently remind the frozen muscles surrounding the pelvis of what they should be doing and hopefully, once they have woken up and you're a bit more functional, change some of your habits so it doesn't happen again.
It is not about quitting your job and living in a cave, it's about giving your body enough motion to keep your joints and muscles happy, so that when you take yourself to your comfy chair, you're able to fight the body's desire to adapt into it.
Postural Alignment Therapy/The Egoscue Method will give you a very gentle, physical programme (perfectly adapted your body's limitations and dysfunctions - it will not hurt you and will never ask more of you than what you are capable of doing) which will wake up the muscles and start to restore your correct, functional postural alignment and relieve you of pain you may have been told is inevitable. You will begin to permanently fix and change your posture and pain!
Four videos to help with a posterior pelvic tilt - PLEASE LISTEN to your body. If any of them cause you pain, they aren't the move for you and please don't do them!