Hips Hips Hips! My Trials with excessive Anterior Pelvic Tilt

2013 was not a stellar racing year for me.  What was probably most frustrating was the constant starts and stops.  I would think I was healing a little, then go for a run and find myself limping for hours after the workout.  It pretty much began to affect all of my training.  Biking was uncomfortable as well as flip turning in the pool (as if that’s not enough of a pain)!  In my mind I kept looking back thinking about when my problems began, until finally I traced it to the winter of 2007.  I was running a lot of miles at that point (average 45 per week – a lot for me) gearing up for a half marathon PR.  I began to have some major IT band issues in my right leg making it difficult to comfortably walk.  On top of that, at my job I was working outside standing upright for long periods of time.  In the end I finally sought out some active release technique therapy which relieved my pain, but as I would find out later, not the underlying issue. In the summer of 2011 I was training to PR my second Ironman, IM Lake Placid.  I still remember very clearly a training run in the woods when I suddenly had to stop, not really due to much pain, but my body simply gave out.  I limped my way home and thankfully, had a great race a few weeks later at Lake Placid.  Which brings me to the summer of 2012.  I was preparing for Ironman Wisconsin, everything was going great but during a typical run, again my body gave out.  I was able to run and got home but I physically could not get myself faster than a 10 minute per mile pace.  Clearly, my body was sending me some messages, which in typical triathlete fashion, I chose to ignore.  I ended up having a decent but not great race at IM Wisconsin and thought giving myself some time that fall to heal would magically fix everything.  After several months my right leg was not improving.  For a while I thought it was nagging IT band issues similar to those I had felt in 2007, but no amount of rolling or stretching was having any effect.  Throughout this past spring and summer I endeavored to find out what the hell was going on – here is what I found. Pelvic-Tilt   I had some major Anterior Pelvic Tilt which was causing some non-activation in my glutes and generally wreaking havoc on everything.  I’ll list my symptoms here: achy lower right back, tight right glute, right hamstring soreness, and groin and abdominal pain on my right side – what I thought might have been a hernia!  After several months of searching around, a lot of good advice, and especially thanks to Carlos Perez at Back In Motion Chiropractic and everyone at Dynamic Strength and Conditioning, I’m on the mend by actually treating the underlying issue.   What is Anterior Pelvic Tilt you may ask?   A real simplified description –

  • Anterior pelvic tilt is when the front of the pelvis drops and the back of the pelvis rises. This happens when the hip flexors shorten and the hip extensors lengthen.

See the above image visually describing anterior pelvic tilt (APT), and posterior pelvic tilt (PPT).  It should come as no surprise that in general, the majority of the population suffers from excessive APT.  Most of us sit around all day at work.  Add on top of this – triathlete training – a majority of which we sit on the bike, then run, and swim, making those hip flexors even shorter and lengthening the extensors, further compounding APT.  So if you find yourself with any of these symptoms, what should you do?  Well, if you’re in the Nashua, NH area, go to Dynamic Strength and Conditioning to get a movement assessment – or find an equivalent athletic movement specialist in your area.  Also, be sure to incorporate some strength training into your weakly workouts.  As with most triathletes, I was so focused on getting my sport specific training in, that I ignored common weak areas including my abs and glutes.  Strengthening the abdominal region along with the glute region can help balance out the pelvis in many cases.  In other cases, muscle weakness is not the issue, but rather muscle inhibition, meaning muscles are strong in the right areas, they are just not working in the way they are designed to or firing correctly. Sometimes an anterior pelvic tilt is due to structural imbalance, an example of this is the hips are not moving correctly (no range of motion) causing the pelvis to compensate. So what to do next?  By far the basic exercise every triathlete should be doing is the 90/90 Hip Lift – explained here by Matt Skeffington and demonstrated by Kurtis West of Dynamic Strength and Conditioning.

Bret Contreras – The Glute Guy – has a nice summary of the basics for what can be done via strength training to eliminate excessive APT; Standard recommendations for improving APT are to strengthen the muscles that produce posterior pelvic tilt and lengthen the muscles that produce anterior pelvic tilt. In other words:

  1. Strengthen the rectus abdominis, external obliques, gluteals, and hamstrings.
  2. Stretch the psoas, iliacus, rectus femoris, tensor fascia latae, and erector spinae.

Now Bret is mostly working with bodybuilders who have APT for some different reasons then triathletes, but the solutions are the same – described in his article entitled Don’t Be Like Donald Duck. For most triathletes who are having hip issues – I strongly recommend seeking outside help to make sure your form is correct when doing any kind of pelvic correcting exercises as doing them incorrectly will not solve your problems.  I have listed some example exercises below which are pretty standard for glute activation and pelvic tilt correction.

Glute Bridge and Hip Thrust

The Posterior Pelvic Tilt Hip Thrust is a bodyweight hip thrust with the emphasis on pelvic motion, in combination with hip motion. Notice the rocking action of the pelvis as the hips flex and extend. This exercise also focuses on the glutes’ role as PPT’ers.  The glute bridge is similar to the hip thrust but done by starting flat on the ground – the video below demonstrates the difference between the glute bridge and hip thrust exercises.

 

Goblet Squat

I’m not very good at these myself – so here again is the team at Dynamic Strength and Conditioning to demonstrate – it’s generally for beginners and is great to get the right technique before moving on to heavier weights.  As explained in the video, you start of with this exercise because heavier weights could overwhelm an athlete with a weak core (me) and further compound APT.

 

Hip Flexor Stretch – including psoas

The psoas is the muscle that connects your spine to your thigh and is part of the overall hip flexor muscle group.  To stretch it, you want to ‘separate’ the thigh from the hip and move it behind you, like the picture shows below. You should hold the stretch for 30-60 seconds per side and repeat several times. OZOaJ    

 

 

        To make the stretch a little harder see the following video.

 

Reverse Crunch

This last one is a little more advanced and the video talks a bit about the connection between PPT, lumbar flexion, and  kyphotic posture (rounded back), but I really like the exercise so I included it.

 

What to do?

So if you have some of the symptoms I described and think you might have excessive APT, first see a specialist.  It’s important to feel the differences in your own body between a good neutral position, APT, and PPT.  Once you get comfortable with the mechanics try out some of the exercises described above which may help you feel the glutes activating, the pelvic tilting, and those hip flexors stretching.  If you really want to dig in the science behind all of this, see some suggested articles below.   Bret Contrera – Why do I Anterior Pelvic Tilt   Lori Thompson of the Posterior Restoration Institute – The Relationship Between Postural Asymmetry and Cycling Injuries – Part OnePart  TwoPart Three   Holistic Strength Training for Triathlon – Chapter 9: Pelvic Tilt – this one is great and specific to triathlon.