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Thoughts on care and prevention

If I could Turn Back Time

Those who know me knew this was inevitable…using a Cher title to introduce a blog post.

Last week I talked (wrote) about how you can check in the mirror for anterior pelvic tilt (APT) and/or “sideways V” posture, as I call it. The purpose of all that is to assess core strength and abdominal control and minimize stress on the low back joints.  Core stability is important for low back health over a lifetime, and impacts all body movements and postural positions. For anybody who read that post and did the little investigational exercise in front of the mirror and found a forward tilt or a sideways V, today’s post is for you. As a culture, we’ve lost our abdominal control for the most part, but it’s not too late – we can turn back time and get it back!

Revisiting last week’s post, here is a picture of a neutral pelvis on the right. If you look at the waist or beltline, it’s pretty level. I would say this is pretty much “text book” alignment. This is the goal, but it’s not necessary to be perfect.  We all have our structural differences and perfection isn’t expected.  I say that because I don’t want anyone reading this and trying to fix things to get discouraged if it’s not perfect. Any positive change is a positive change!

Now look at the picture on the left, this one of an anterior pelvic tilt. You can definitely see how the pelvic “bowl” is tilted forward, even with a flat stomach/abdomen. You can almost see the compression (well, I can, at least) on the low back vertebrae. This can also be called “Lower Cross Syndrome,” because of tight low back structures and hip flexors (at opposite ends of that diagonal arrow) and functionally weak, or inhibited, abdominals and glutes (the up and down arrows). This creates a crossed pattern.

So how, you ask, does one fix an anterior pelvic tilt?  Before I answer specifically, keep in mind that changes don’t often happen quickly, especially changes we want to make to postural muscles.  It takes time and lots of repetition to wake up that Oompa Loompa part of our brain (see last week’s post) that is on auto-pilot when it comes to postural muscle contraction, so it’s important to not get discouraged when we find we keep forgetting to pay attention to it.  I’ve been working on my posture for (shh…don’t tell anybody) 20 years – It’s been 20 years exactly since my first trimester at chiropractic college, where we all critiqued each other in Palpation 1 class.  Before this I thought I was golden – I worked out regularly, I was on the skinny side, and when it was my turn to go up to the front of our group I found out I had a very significant APT and I won the prize for the most foreward head (thanks to 10 years of leaning over hospital patients).  I was a bit disillusioned.  So I’ve been working on it for 20 years.  I’m not perfect.  The funny thing about time, though – those 20 years went by in a flash and I’m no longer skinny (sigh), but by working on it consistently over that time, I’m better than I would have been had I not been working on it. I have some significantly degenerated discs in my low back yet I rarely have symptoms.  It scares me to think of what shape I’d be in had I just stayed anteriorly tilted all this time.

OK, down from the soap box, so how do we fix it?  Two main things:  stretching and strengthening. Remember it’s a “cross” syndrome. We have to stretch the low back muscles and ligaments, which pull up the back of the pelvis, and the hip flexors, which attach to the lumbar spine and pull it forward, taking the front of the pelvis with it. Then we have to strengthen the abdominals and the glutes. **These might actually be strong, just neurologically inhibited, so for some they need to be strengthened and woken up; for others they just need to be woken up. Stretching the tight things will make it easier to wake up the weak things, neurologically.

 Step 1:  Low back stretch

First, lie on your back and bring the knees towards the chest.  Hold for 20 seconds.  FYI, hold all stretches for 20 seconds as it takes that long to reset the muscle spindles (little transistor thingies in the muscle cells that tell the brain how much juice to send). Depending on how tight things are in the low back, you can do this a number of ways: Both knees up; One knee to chest, the other leg bent; One knee up, the other leg flat (this stretches the opposite hip flexor and engages the opposite glute).

If you do it with both knees up, you can rotate the lower body to bring the knees towards each side, holding on each side for 20 seconds. In terms of how far to go, basically you want to feel a stretch, not a pull.  Hopefully that makes sense.

Another way to stretch the low back muscles, especially the little ones that run diagonally, is to sit with one ankle up on the other knee and twist around the knee that is suspended.  For this, I’m going to defer to my favorite stretch poser, my neighbor Travis, who graciously posed for a bunch of stretch pictures on my roof a while back:

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The one adjustment to this post I will make is that you want to pull up on the knee while you twist around it (pull the knee towards the opposite shoulder).

 Step 2:  Lunge stretch

Once again, here’s Travis:

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Tips:  1.  put a pillow under the knee that you’re resting on.  2.  Don’t let the “up” knee go in front of its ankle.  You should feel a stretch in the groin region of the “down” leg.  3.  for the overachievers among us, you can rotate the “down” leg so the ankle points out to side, and then in to the other side for added vectors.

For both the Step 1 and Step 2 stretching, they don’t all have to be done in succession.  The goal is to do at least one or two of them at least once or twice a day.  Some can be done in bed before going to sleep at night, some can be done as a nice break in the office, either at your desk or on the floor (stay tuned for a future post about sitting at a desk all day).

Step 3:  Pelvic Tilt Exercises

Lie on any flat surface (your bed, the floor, the roof of the car, etc).  With knees bent and arms down at your sides, pull your belly button towards your back, feeling your low back press against whatever surface you’re lying on.  Hold this contraction for 10 seconds, while still allowing yourself to breathe.  During that 10 second hold, concentrate on feeling those muscles contract.  We’re reinforcing the neural circuits between the brain and your abdominals.  Then take a break for a few seconds and repeat.  Ideally 10 times.

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I’ve had all kinds of successes and struggles with patients in the office showing them this exercise, so don’t stress if it doesn’t come naturally.  It can be hard to learn movements from a web page.  Some people have harder times with it than others.  Soon I’ll learn how to imbed YouTube videos.  Some tips:

  • the rib cage should “flatten out” during the contraction, not “puff out.”

  • if you lay your hands on your lower abdomen and press in gently, you should feel the wall of muscle around your abdomen engage.  Coughing and/or laughing will help you find the right muscles as well.  Another thing that may work is imagining someone punching you in the gut and bracing for it.  Or you can remember your mother torturing you as a little child and waving her index finger towards your belly because she knows you’re ticklish and you start bracing against it….ah, memories

  • putting one hand under the arch of your low back and pressing into it can help you find the right muscles.

  • resist the urge to rotate the pelvis by contracting the butt and/or hamstrings and leg muscles.  Concentrate on flattening your back by contracting the abdominals.

  • don’t forget to take some normal relaxed breaths in between contractions.

This exercise activates the oblique and transverse abdominals (see image below).  It’s not the same thing as a crunch or situp.  Those work the rectus abdominus, or “6-pack” muscle.  That’s a flexing muscle, to bend your abdomen forward.  The obliques and transverse are the stabilizing muscles.

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Again, I know it can be difficult to learn new exercises by a web post, but give it a try.  It is important to do these exercises consistently, like once a day.  It shouldn’t take more than a few minutes.  My general rule of thumb is that if I get into bed and realize I haven’t done any stretching or pelvic tilting during the day (luckily I get to show people all day long), I try to do a few minutes of something before going to sleep.

One more rule of thumb, or dare I say, rule of abdomen:  these stretches and exercises should not be painful or cause pain.  If something doesn’t feel right or you feel pain or soreness that is new or that you’re not sure about contact your local chiropractor or bodyworker or whatever health care professional you trust and ask about it.  And you’re more than welcome to shoot me an email or call if you have any questions.

Once you get reacquainted with your abdominal muscles, you can then go back to the mirror and use those muscles to try to level out the pelvis or bring it back to midline (for those with the sideways V).  Remember, the important thing is not that we are perfect, but that we strive for improvement.

Like Cher says, “If I could reach the stars I’d give them all to you.”  When reaching for the stars, it’s important to be reaching with a stable core. Much less chance of injury.

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Joe Henderson