If you have a neutral scapula and a neutral humerus, you need to maintain that neutrality.
For the scapula, this means doing a balanced combination of aBduction work (i.e. push ups, protractions, etc.) and aDduction work (i.e. rows, scap retraction holds, etc. ).
For the humerus, it means doing a balanced combination of internal rotation (i.e. push ups, chin ups, etc.) and external rotation (i.e. DB external rotations, face pulls, etc.).
Even while trying to maintain a balanced combination, you may find yourself in rows 2nd through 6th below.
If you play a sport, where the upper body is used at all, you'll also likely find yourself in rows 2 through 6.
Let's go into treatment options if you are in rows 2nd through 6th by starting on row 2.
In this scenario, we want to keep the scapula neutral. However, the humerus is internally rotated because the pencil points inward. The humerus might be internally rotated because of a mobility restriction (i.e. tight pecs), stability restriction (i.e. weak external rotators), or both.
We don't need to make this more complicated than it is. If you want to test the length of the pecs and lats, you are welcome too. However, I've found that even if you don't find them to be short, it can still help to deactivate dominant pecs and lats which can help in correcting the dysfunction.
In our case, we're going to go through everything.
Let's begin with the pecs. The pecs are a primary humeral internal rotator, and if you're client has done any significant amount of bench pressing or push ups, chances are their pecs may be tight or at the very least contributing towards greater stiffness than the humeral external rotators.
Let's stretch them out. We're going to focus on a static hold for this stretch because this is one of the best ways to help deactivate the pecs. If our scapula is too abducted, this is a great opportunity to try to squeeze the shoulder blade together. Noticed that I said shoulder blade, not shoulder blades. The other shoulder blade might not need squeezing, so make sure you individualize your programming.
This gives us two ways to do our pec stretch. The first is without us trying to retract (or adduct) our scapula, and the other is with trying to retract the scapula.
In the picture below, I'm trying to feel a stretch in the pec area, and not adduct my scapula since it's not abducted.
The last major internal rotator of the shoulder are the lats. We've covered stretching the lats before, but I want to point out that we want to make sure we eternally rotate the arm, then bring our arm overhead. This is a basic lat stretch:
We've addressed the mobility, so let's focus on stability. Specifically, we need greater external rotation of the humerus. We need to work on the primary external rotators which are the infraspinatus, teres minor, and the supraspinatus.
In order to do this correctly, you need to make sure you are getting pure rotation from the shoulder. If you feel or notice forward or posterior translation of the shoulder, you are compensating. You'll see what I'm 'talking about below.
We've come to the third row. We have a scapula which is abducted and a humerus which although it points forward is actually externally rotated. The reason why the humerus is externally rotated is, if the scapula is abducted, this will bring the scapula closer towards the humerus. But, there should always be a one-to-one relationship between the scapula and the humerus.
In order for the humerus to stay neutral, if the scapula becomes more abducted, the humerus must internally rotate. Therefore, if the scapula becomes abducted, but the humerus doesn't internally rotate, this makes not only the scapula non-neutral, but it makes the humerus non-neutral. It makes the humerus externally rotated.
This brings us to the trickiest row out of all the rows, the fourth row.
This row allows for three possibilities:
1. The scapula is abducted moderately, the humerus is internally rotated moderately, which makes the humerus neutral, but the scapula abducted. The only treatment option here is to correct the abducted scapula.
2. The scapula is mildly abducted, the humerus is heavily internally rotated, which makes the humerus too internally rotated. However, the scapula should still be corrected. The humerus needs external rotation which we covered in condition two above.
3. The scapula is heavily abducted, the humerus is mildly internally rotated, which makes the humerus externally rotated. Again, the scapula position still needs to be corrected.
Let's treat the abducted scapula which applies to all three conditions above. We need to adduct the scapula. To do this, we can use a variety of exercises including rows, arms overhead scapula adduction, and face pulls. Since everyone knows what rows and face pulls probably are, I'll demonstrate amrs overhead scapula retraction which is one my favorite drills.
The last rows are effectively the same, but one is more serious.
The only difference between row 5 and 6 is that row 6 is a more serious version of row 5. In both conditions, we need to correct the adducted scapula. Even if during the pencil test, the pencil points forward, the adducted scapula results in an internally rotated humerus. However, if the pencil points inward at all during the pencil test, the humerus is even more internally rotated.
We can clearly see we need greater abduction in the scapula for both conditions. For this, we can use some scapula protractions like these. The most popular protraction exercises are either the push up with a plus or the push-up protraction (without the bending of the elbow).
I prefer the push up protraction without bending the elbow when individuals have an adducted scapula. The reason why is because when the humerus is internally rotated, doing push ups isn't going to help that.
What will help the internally rotated humerus are DB external rotations. If you have the row 6 condition, you will definitely need to focus on DB external rotations.
You should see an almost immediate improvement after doing these exercises. Make sure to to monitor the scapula and the humerus over time to make sure they get neutral (or at least are closer to neutral). I've found that for some clients, it can take quite awhile (like many months or over a year) before even alignment is cleared up. Have patience, be persistent, and assess periodically.
You've all see the big guys that look like this:
Well, the problem is their not neutral. By that, I mean their shoulders are not neutral. If hold a pencil in our hand, that pencil should point forward like this.
This is actually called the Pencil Test. Simply hold a pen or pencil in both hands. Stand up. Relax. Look down at your hands. Note the angle measure of each of the pens in your hands. If they point forward, you can just write "forward."
However, if it points inward at all like this, you may or may not mean you have a problem with your shoulder. You may have a problem with your scapula, shoulder, or both.
To find out which area you have a problem with, we also need to assess the scapula.
We are going to measure the distance from the middle of your spine to the scapula. For our purposes here, we'll measure the middle of the scapula, meaning this area here:
On the scapula, I want you to measure not at the top of the scapula, nor at the bottom. Measure in the middle of the scapula like the picture shown above.
Next, note the measurement. You need to keep track of this over time. Then, we will compare it to the humeral findings above.
A normal measurement of the distance from the middle of the spine to the middle of the scapula is 2.5 to 3 inches. If you are below 2.5 inches, you would be considered aDducted. If you are greater than 3 inches, you are considered aBducted. In either case, you need to try to get back into the normal range.
Here is what you need to know. The scapula and the humerus are intimately connected. The most essential group of muscles which connect directly from the scapula to the humerus are the deltoid, teres major, and the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis.)
If either the scapula or the humerus is out of neutral alignment, it will affect these muscles.
Here's the thing. There are a lot of variations for how the humerus and scapula will be and we are going to go over all possibilities here.
Here is a chart I created to help you.
Let's examine the first row.
If your scapula and humerus is neutral, you don't have to worry about anything. You just need to try to maintain that neutral posture. However, I don't often see much clients who find that are initially like this. They'll usually fall somewhere in rows two to six.
If you are in the second row, you have a neutral scapula position, but your humerus is internally rotated (because the pencil points inwardly). Because of this, you need to get your shoulder more externally rotated. We'll go over these treatments in the next video series.
If you are in the third row, you have a scapula which is aBducted, and you have a shoulder which is externally rotated. You might ask, "but the pencil faces forward, how can I have an externally rotated shoulder?" Well, you would have a neutral shoulder alignment IF your scapula is also neutral. However, if you scapula is abducted, it results in an externally rotated position for your humerus.
This is why the treatment for this condition is both to get your scapula more adducted, and to get your shoulder more internally rotated.
In the fourth row, you have a scapula which is abducted, and you have a pencil which faces inwardly. In this situation, there are three possibilities for the humerus, and we'll cover those right now.
Let's assume you have a scapula which is abducted to 3.5 inches. Let's also assume you have pencil test which results in the pencil inwardly rotated at 45 degrees. In this case, your humerus would actually be neutral, and we would only need to adduct your scapula to get it back to neutral.
Let' assume a different scenario. You're scapula is abducted 4 inches. The angle of your pencil is only rotated inwardly by about 20 degrees. In this case, because the scapula is so abducted, and the inward rotation of the arm is slight, your shoulder is still considered externally rotated. You definitely need to get the scapula adducted, but you can still focus on internal rotation for the humerus.
In our last scenario (under row 4), let's assume you have a scapula which is abducted to 3.25 inches. Now, assume you have a pencil test which is 90 degrees. Basically, the pencil is pointing at the other arm. In this scenario, we have slight abduction of the scapula, and significant internal rotation of the humerus. We can still focus on adduction for the scapula, we we would make sure to try to externally rotate the humerus as part of our treatment.
In row 5, we have an individual who has an aDducted scapula, and a pencil test with the pencil facing forward. In this scenario, we actually have a humerus which is internally rotated. We will need to focus on adducting the scapula and externally rotating the humerus.
In row 6, we have an individual who has an aDduted scapula, and a pencil test with the pencil facing inward. This is a dangerous scenario and in many cases that I've seen, accompanied by shoulder, neck, or upper back pain. It is imperative to not only get greater abduction for the scapula, but to really get the shoulders more externally rotated. In this scenario, we likely have a rotator cuff which is stretched out not only from the scapula being more adducted, but from the humerus being more internally rotated.
With just two simple variables: the scapula and the humerus, we need to be careful which exercises we choose. With anyone who plays a throwing sport, or has had a history of injury around the shoulder, it is critical to understand and track the measurements of both the scapula and humerus. Both need to be neutral (or get more neutral), and stay neutral.
If you find your pelvis does not level with legs spread wide, we need to get you fixed. This article will demonstrate the ways you can fix your pelvis with structural and strength training methods.
It's quite possible that if you had one pelvis higher than the other when spreading your legs wide, you unconsciously stand like the picture below.
It's also quite possible that despite what the picture shows (which is an elevated right pelvis in standing), you have an elevated left pelvis (when trying to stand symmetrically).
How could this be?
What happens if you pound a really long nail into the ground? The more force you pound with, the deeper the nail will go, right? So, imagine you spend hours or at least everyday for 30 minutes or more standing mostly on one leg.
Whichever leg you stand on most, the deeper that hip will go into the socket (or acetabulum), which effectively makes the leg shorter. If one leg is shorter, this will lower the that same-sided hip toward the ground more. Consequently, the opposite pelvis will be higher. This is why if you stand a lot, you are more likely to have a socket-caused issue rather than a postural-caused issue.
What's the fix for a socket issue? Assume you have an elevated left pelvis issue because you stand on your right leg like the picture above. The answer is to begin to stand on the opposite leg. However, we don't necessarily need to continue to lower the right pelvis to get the benefit of mostly standing on the left leg.
In my experience, even standing with a depressed right pelvis like the picture above will still lead to positive results if you have an elevated left pelvis.
That's really about it. Here's the thing though. You will stand on your right leg unconsciously. It means you really need to pay attention as much as possible to standing on your left leg.
I tell all of my clients who've had this problem that that you will not be perfect. You will find that you find yourself standing on your right leg, and when you do, it's time to swtich, not give up . The more you practice or notice yourself - and correct yourself, the faster an effect you will get.
Let's assume you have a client who does the wide leg stance test and finds their right pelvis is still elevated. It's no wonder as this client stands a lot and happens to stand on their left side. Again, this makes left femur deeper into the socket of the left acetabulum. It results in a lower left side.
In this scenario, we want to put more pressure into the right acetabulum and distract or take away pressure from the left acetabulum. We can accomplish this with:
It's important to note that the left leg is not supported on anything. It's simply hanging. That's the goal because we want the left femur not so impacted into the left acetabulum.
As you can see, I can also focus on the likely weaker left obliques by trying to raise my left pelvis to the ceiling.
To challenge the obliques more and to get a greater distraction for the left side, you can use a DB in the crux of your left knee. (I find this is a good left hamstring warm up too as the left hamstrings are frequently weaker than the right hamstrings.)
I recommend putting this exercise before stretching and strengthening exercises. Think of it as a realignment exercise. After this, we can begin to address mobility and stability.
Before we get into the strength training, you need to make sure that all positions you are in have at least a level pelvis. Let's assume you have an elevated right pelvis. You could also position yourself with an elevated left pelvis to correct yourself in the short term. Let's assume you're normal pelvic position during the plank is:
You want to make sure that you can at least get a neutral pelvis or even an elevated left pelvis in this situation (since the right pelvis is elevated)
The bottom line is that no matter what exercise you do, always make sure you have a level pelvis (or an elevated pelvis in the opposite direction).
Let's get into how you can use strength training to correct your lateral pelvic tilt. This will apply whether you have a socket-caused or a postural-caused lateral pelvic tilt.
Whenever a lateral pelvic tilt is present, you will have abductors on the elevated side which are lengthened (and possibly weaker) and abductors on the shortened side which are shortened (and possibly stronger).
Whenever abductors on one side are lengthened, the antagonistic adductors are shortened. In our case, let's assume we have an elevated right pelvis (which is the opposite of what we just discussed above.)
In this scenario, the abductors on the left side are lengthened, the adductors on the left side are shortened, the abductors on the right side are shortened, and the adductors on the right side are shortened.
We also must contend with the abdominal musculature. With an elevated left pelvis, the left oblique muscles are shorter. The right oblique muscles are longer. Consequently, it is wise to insure that whenever we are strengthening or stretching our hip muscles, that we coordinate these efforts with stretching or strengthening the oblique muscles.
An appropriate go-to methodology is simply to strengthen the lengthened muscle in a shortened position and to stretch the shortened muscle in a lengthened position. Here's how we can do that. Again, we must be very careful to pay attention to how we place the hip depending on which side we are working on.
Again, if I have an elevated right pelvis, I will want to work on my right side hip abductors. I will have clients hold this position above (if it's sustainable). Some clients you will find have cramps, so you may need to gradually increase the time you hold this position.
Eventually, you should try to get your way up to holding it as high as they can. I will have my clients work their way up to 30 seconds with ankle weights for at least 3 sets per day.
However, you must make sure to not hike up your right pelvis because then, we are giving into the direction of our elevated pelvis. At least, try to keep your pelvis level like I'm trying to do below.
The next part we can focus on is the left adductors.
I'm not doing a great job of keeping my pelvis level, but I should be more level. Basically, my pelvis line in this position should be vertical.
For the adductors, you should be able to hold this position for along time. You can build your way up to putting a 10 to 30 pound dumbbell on your mid thigh. Hold for 30 seconds in the top position for multiple sets.
You may need to mobilize your adductors and abductors and to be honest, it usually never hurts to do this. Even if you are hypermobile, stretching the shortened abductors and adductors can help turn these muscles off.
In our case (as we are still working with the elevated right pelvis), I'm going to put my right leg on a wall as shown in the picture below to feel a good stretch in my adductors. If you cannot make it to at least 45 degrees, then you definitely need to try to get to 45 degrees. Hold for 30-40 seconds.
I don't do a great job keeping my pelvis level, but you should try to keep it level or even have the left pelvis elevated.
Next, it's time to stretch out the left hip abductors. To do this, we are going to make sure we have a level pelvis, then get into the stance like the picture below.
With an elevated right pelvis, it means the left obliques may be weak. To correct this, you can do a left side plank, but again, make sure the pelvic line is neutral or you actually have an elevated left pelvis (which is a wise correction in the short term).
With clients in the position below, I'll even try to pull their left pelvis low so they have to keep it elevated. This challenges the obliques the way we want them to adapt which is to elevate the left pelvis.
As you can see, there are many different ways we can attack a lateral pelvic tilt. Make sure that you at least test the wide leg stance first to know which direction you should go with either a postural-caused or socket-caused lateral pelvic tilt.
Regardless which you have, you should do appropriate strength training and always make sure your pelvis is level before beginning any exercise. I'm confident that you will get out of your lateral pelvic tilt fairly quickly if you are diligent in watching your posture and using stretching and strength training together.
This woman obviously looks like she is in shape, and she may or may not have a lateral pelvic tilt.
Lateral pelvic tilt simply means that one of your pelvis is higher than the other. (This is different than a leg-length discrepancy because how far up the femur is in the socket can influence this.)
In this article, we’ll explore some postural corrections if you have a lateral pelvic tilt due to your posture. There is another possibility which we will explore in my next article. We'll also cover the strength training corrections in the next article as well.
Our corrections here will entail checking your alignment and correcting all the postural positions which could be contributing or causing it.
Our first test is going to directly assess the pelvic rim using our hands. Make sure both feet are together and that one foot is not in front of the other.
Using your palms, make sure that you don’t tickle the hell out of your client because if you go with fingers digging into the sides, it’s not comfortable. If you use your palms at first, they will be a lot less likely to be tickled.
You can either use your palms or fingers to go into the sides of the pelvis. From here, you can use your middle fingers (or palms if they can’t tolerate the middle fingers), to see how your fingers line up. If you find they are equal, great! You’re done, and can move onto another assessment.
If you find there is a half inch difference or greater, you need to correct it.
The second assessment you need to perform is simply standing with your legs wide. If you find that your pelvis becomes completely level or significantly improves, you should continue with the postural recommendations below. If however you find there is no change, check out the next article.
The corrections are simple. The first is standing. Let’s assume you have an elevated left pelvis. To correct this, we are simply going to try to stand like this as often as we can.
As you can imagine, if you had an elevated right pelvis, you are going to stand like this as often as possible.
I think you get the idea. Let's assume you had an elevated left pelvis. You can use a small folded up towel to put under your left ischial tuberosity.
You wouldn't even be able to tell that you are sitting on the pad. Here is something you need to be careful of however.
Since we sit so much, I've found myself and clients can ruin or efforts if we tend to lean to one side or the other. Sometimes, having a pad under our right side can cue us to lean to the left like this:
Avoid this position and make sure to sit straight up. You can literally ruin your efforts, because this position effectively puts us back in an elevated left pelvic position which we do not want.
The last position we are concerned with is our lying posture.
For those with wide hips and a small torso, this can be a real problem. It can be even more of a problem if you only sleep on one side or the other. One of the best ways to stay neutral is to sleep on both sides. If you can't however, one thing you can do is to use a pillow under your torso like this:
Lastly, some people simply like to lean to one side or the other when they are lying down. This can lead to a lateral pelvic tilt. It simply feels more comfortable to them. If you can get a picture of yourself, you might look like this:
To correct this, you need to try to get into the opposite posture. It will feel weird. In fact, all of your new postures should feel strange and unfamiliar at first. It's because you don't do them. By making sure that you address all of your main postures, you will get out of lateral pelvic tilt.
When I get clients in the gym and I tell them to simply stand up straight, here is often what I see:
The weird thing is that we can’t really know if we are rotated because it’s simply normal to us. In other words, your neutral is not neutral.
The problem is pelvic alignment is a big deal. The pelvis can of course effect the pelvis, but it can also affect the low back, the hip, the knee, thoracic spine, neck, all the way down to the ankles.
For individuals suffering from back pain or hip pain, I highly recommend taking the 10 seconds required to merely check for pelvic rotational asymmetry at every session.
What is pelvic rotational alignment? It’s simply this:
Put your fingers on the ASIS and make sure your thumbs are of equal distance to you. If you find that one thumb is farther away from you like this picture below, you have a pelvic rotation. (It's difficult to really tell in the picture, if you try it out, you'll quickly be able to tell.)
You can also do a self-assessment by putting your own thumbs on your ASIS and see if any of them are more forward than the other.
It might not seem like a big deal, but if you find one thumb is more forward than the other, this automatically entails:
·The lumbar spine is automatically rotated because of the close proximity to the pelvis.
·The thoracic supine and upper thorax are automatically rotated (or have a torque) because of the rotation going on in the lumbar spine. The upper thorax may compensate or not.
·One of the femur’s will internally rotate while the other will automatically externally rotate.
·The knee joint may be internally or externally rotated.
·The ankle joint may be affected either in internal/external rotation or pronation/supination.
Typically, the low back and the hip joint will experience the most discomfort or pain when there is a pelvic rotational malalignment.
Luckily, our corrections are fairly simple. While there are some specific muscles we could chase like the TFL, lumbar erectors, or even lats, we need to correct the posture which gave rise to our malalignment. (Releasing tight muscles can definitely help too, but let’s start with the posture.)
Addressing posture becomes fairly simple. Since our malalignment likely arose from either a sitting, sleeping, or standing position, we need to focus on correcting all of these.
Stand up, and reverse your pelvic position like this:
I will even try to rotate my clients pelvis towards the right and ask them to resist me. This will strengthen the muscles which have become weakened to the pelvis being rotated towards the right.
You need to hold this and then observe if your pelvis gets neutral.
If you are training, make sure that you always start neutral. Be careful for lifts like squats and deadlifts because it is very difficult to control your pelvis with these type of lifts, especially if you are lifting heavier weight. If you’ve had pain with these type of lifts and you have a pelvic rotation, it’s very possible the rotation has contributed to your pain.
This isn’t the end of the story. You need to make sure that your pelvis is corrected when sitting. Chances are that you got a pelvic rotation from sitting like this:
To correct, you need to have your clients sit in an eutral posture.
When lying down,
You need to make sure that you aren’t lying on a groove. Make sure your bed is flat. You can even check your ASIS while laying down to make sure they are level. If not, you should put something under the glute which is lower or sleep in a different part of your bed.
Let's assume you are correcting a pelvic rotation towards the right. This means, we need to make sure the pelvis is neutral or temporarily goes towards the left.
When sleeping on your side, you should discourage right sidelying because it promotes a rotated pelvis towards the right.
You could use a cushion under your top knee in the picture above if you really liked laying on your right side.
I would say more emphasis should be placed on sleeping on your left side because this promotes your pelvis rotating towards the left.
I'll find some individuals who only sleep on their right side, and sleeping could be the sole culprit.
Still, you should examine everything to help them get neutral.
Pelvic rotation is often a culprit in hip and low back pain. Once you correct it, you may not alleviate all of your pain, but it is definitely a step in the right direction.
I'll be the first to admit, I usually don't use planks with new clients.
If you simply put a stick on people's back and ask them to do a plank, you'll likely see a few problems. Here are 7 of them.
1. You don't know whether you should protract your shoulders (or push your shoulders forward).
As a basic test to know whether you should protract your shoulders or not, you should first check the alignment of your scapulae or shoulder blades. Measure the distance from the middle of the scapula to the middle of your spine. It should be about 2.5 inches to 3 inches.
If you are beyond 3 inches, avoid protracting your shoulders. You will only create an abducted scapula position. If you are from 2.5 to 3 inches, you can protract your shoulders, but you should balance it out with some form of scapula retraction. If you are at 2.5 inches or below, you definitely need to protract.
The problem is that many individuals don't really know what their scapula alignment is.
2. Many individuals will have pain in the elbow, shoulder, or neck area simply being in a plank position.
Some individuals who have had recent trauma, are overweight, had chronic injuries, or simply have pain in these areas should be careful with planks.
If you are not overweight, and you loaded up 50 pounds for a one minute plank, think how that would feel. You might be able to do it without pain, but that is a lot of stress on the elbow and shoulders.
3. They can't achieve a neutral lumbar spine.
Their is likely a greater than one inch space between the lower back and the stick. If this is the case, the person cannot maintain a basic neutral pelvis.
The only way you will get out of anterior pelvic tilt is by maintaining and reinforcing a neutral pelvic position.
A regular floor plank for many individuals is too intense. A proper progression is to begin with a plank with forearms on a bench. It already places the hips in hip flexion and helps to flatten out the lumbar spine.
A person can then progress down to the floor, and eventually have a weight on their back, use an ab wheel, or use a long plank with the arms more overhead. Before you use these exercises however, I usually see problem number 4 rear it's ugly head.
4. Individuals quickly lose neutral pelvic posture (or don't have sufficient core endurance).
Have you ever seen plank contests for time? Have you noticed by the end of the contest that individuals look like they finished with an invisible person sitting on their low back?
You need to use a stick and monitor the space under the low back from beginning until the end. If you think you can hold a plank for two minutes, you need to be able to maintain a neutral pelvis for that long.
5. The head is not neutral.
With a stick on the back, most individual's heads look like this:
When you try to have them correct it, it then looks like this:
The reality is that the ground is too advanced for them. What you will need to do is to start off higher like putting your forearms on a bench like this.
6. Thoracic kyphosis prevents a neutral thoracic or head position.
All this means is that the upper back may be so rounded that the head and the upper back can't be neutral.
I'm a big fan of eliminating flat thoracic spines, but they often accompany thoracic kyphosis, so it is wise to address both of them.
Although we haven't dealt yet with thoracic spine corrections, it can seriously help to perform some thoracic extensions or side lying thoracic rotations before you get into your plank. This may allow your upper back and head position to be neutral or at least be closer to neutral.
7. You can't breathe with the stick on your back.
You need to breathe into your back. Because of this, the stick should rise slightly above your head on your inhale, and fall back onto your head on the exhale. If you see someone who keeps the stick stationary on their head, it means their not expanding their back which they should.
The floor plank is an intense exercise. It includes a lot of components like proper head and thoracic posture, and proper breathing. Make sure you get all these components under control before you advance.
I’ll be the first to admit, lats aren’t the first thing one usually thinks of when thinking about anterior pelvic tilt.
However, the lats can contribute to APT if they are short… or if they are stiffer than the abdominals.
If you almost look like Frankenstein when raising your arms overhead, you definitely have some tight lats.
The real test is getting to 170 degrees with arms overhead. Note that one arm might be different than the other. You can also test using one arm at a time.
Even though you may not have short lats, we still need to see if your lats are too stiff compared to your abdominals.
The first test is observing if one can simply maintain their pelvic position with the arms overhead.
The real test is to try to use your abdominals to see if you keep a neutral pelvic position while you lift both of your arms.
You are observing if the pelvis can maintain its position without moving. If your arms can get to the same spot without trying to use your abdominals, and you can maintain your lats, you do not have too stiff of lats.
From the testing, there are four possibilities:
0. You don’t have tight or stiff lats. Woohoo! (I'll count this as zero because there isn't a problem.)
1. You have short lats, but not excessively stiff lats.
2. You have stiff lats, but not excessively short lats.
3. You have short and stiff lats.
Our strategy is going to be simple. If we have tight lats, we will stretch them. If we have stiff lats, we need to train the abdominals to compete with the stiffness of the lats. If we have both short and stiff lats, we need to do a combination of both stretching and training the abdominals.
The last test we'll use is the standing shoulder internal rotation test. For this test, hold a pen or pencil in your hand while standing. See if the pen or pencil is facing forward. If it points inward at all, you have some excessively tight or stiff internal rotators.
The lats are internal rotators, so you should see if stretching them has a positive effect. While there are other implications and culprits for why you maybe internally rotated, you should see if stretching the lats improves your internal rotation at all.
Let's get to the fixes. Let's first assume you have short lats, but not stiff lats (picture #1 above).
We need to do the opposite of extending our arms and going into anterior pelvic tilt. I really like the crouched position for this because you can get a big lat stretch, but you also stretch out the whole posterior fascia chain which the lats are connected to.
Since the lats can also laterally flex your spine, you can also benefit by doing this stretch (which still includes the arms overhead position and rounded back position):
And damn, if those lats don't also contribute to thoracic rotation, we can stretch them out by rotating in the opposite direction like this. (Note, you can also combine the arms overhead, rounded back, and laterally flexed positions above).
These stretches are all great if we have tight lats, but not stiff lats. If we do have stiff lats, we are need to use a different strategy. We need to make sure we increase the stiffness of the abdominals to compete with the lats.
While there are a ton of ways to accomplish this, I’ve found two methods to work great.
The first is using the ground. This is ideal for those who cannot stand in a neutral pelvic position.
Lie on your back on the ground. Raise up your arms and keep your back flattened throughout the whole range of motion. That’s it! You can either hold this position, or go back and for with your arms. Either way, always keep your back flattened.
You can keep your arms overhead, or bring them forward, then back to beside your head. Either way, make sure your back stays flat which will require you to use your abdominals. This will help you maintain your pelvic position when your arms go overhead.
Please note that you should never raise your arms higher than if your back comes off the ground.
If you have short lats and stiff lats, you can use some DB's in your hands to help you with getting a bigger stretch. But under no circumstances should you stretch beyond the point where your low back comes off the ground.
Another option is to use a stick on your back, and then simply bring your opposite arm overhead. This is a perfect strategy if one arm was limited in lat length, but the other was not.
If you want to combine your abdominal strength training with your lat stretching, and combatting your lat stiffness, then you can use a dead bug.
Make sure your back stays flat, your arms can move or stay overhead, and your legs go up and down.
While the lats might not be the only thing keeping you in anterior pelvic tilt, they can still be a contributor. Keeping them loose while strengthening your abdominals will play a big role helping you stay out of APT.
I never could figure out why a person would want to walk in an anterior pelvic tilt.
I guess I can understand why one would want to promote a butt if there really isn't one, but that's going to hurt in due time.
I see a lot of people walk in anterior pelvic tilt who aren't trying to do it. If you have a big butt like me, it pretty much guarantees that you will look like you are walking in anterior pelvic tilt. However, you might or might not have APT.
This is why I can understand why someone like Kim Kardashian who purposely goes into an APT posture and already has a big butt gets popular. The curves are even more dynamic.
The truth is if you have anterior pelvic tilt, you likely have to retrain everything including how you walk, how you run, or how you do your cardio. For this article, we'll focus just on the walking and some running.
Since most of my clients will do some regular walking or running, I've made the mistake of doing everything right in the gym, then not training how they walk.
Just last week, I had a client look at me incredulously and ask, “How do you expect to leave this place and keep up what I’m doing?”
What my client really meant was, “I know I’m getting out of anterior pelvic tilt in the gym, but how do you expect me to stay out of anterior pelvic tilt, if I’m walking out of here in anterior pelvic tilt.”
She had a good point.
We were doing everything to get her out of anterior pelvic tilt, but I realized if we didn’t coach her walking and her cardio, she would simply be reinforcing her anterior pelvic tilt.
A lot of people think they can fix their anterior pelvic tilt by simply doing some exercises and stretches. For some, this will work. For others, they need everything.
You’ve probably seen people running like this:
We’ve already covered standing in APT. And if you don’t know what to do in standing, you need to work on this first.
However, even if you optimized your standing, you still need to work on your walking and potentially any other cardiovascular work you do.
If you have anterior pelvic tilt or didn't pass the prone hip extension in the last video, or if you regularly walk or run, I highly recommend performing a single leg balance test.
Lift up your leg, and observe the knee area of the leg which is on the ground. If the knee goes inward, this is a problem. If the leg rotates inwardly, this is also a problem. Both problems may indicate weak or deactivated glutes.
To see if the glutes are a culprit, try squeezing the glutes. If the leg becomes like the picture below, you have some deactivated glutes. (Also, just because you passed the prone hip extension test, doesn't mean you will pass this test.)
If you have deactivated glutes in standing, simply squeezing them and making sure your knee is stable is a great warm up exercise.
Eventually, you should be able to stand without trying to squeeze your glutes. Your knee should be stable.
If you have been or are prone to knee problems while running, and you didn't pass the single leg balance test, you will also likely need to work on using your glutes to propel your leg back.
You need to walk very slowly while doing this exercise. Walking literally at a 1 to 2mph pace is perfect. If this isn't easy for you, you need to slow it down.
Overtime, feeling the glute should be possible at your normal walking speed. If you run, you should be able to feel the glutes propelling your leg back. It will take some time to build up to this, but if you practice this, you will get it.
Besides focusing on our glutes while walking, we should make sure our alignment is as neutral as possible.
I've recently began having clients use the stick while walking on the treadmill, and it's worked really well. Clients can really feel what neutral feels like.
I've even had clients raise up the front of the pelvis turning on the obliques, squeeze the glutes for the leg that's going back, and use the stick on their back. While it's a lot to concentrate on, you should be able to accomplish this with practice.
You can do all the right stuff in the gym. However, if you walk and run in anterior pelvic tilt, it's going to take you a lot longer to get out of it. For some of you, being in APT is normal for your sport. That's fine, but you should still be able to do all of these exercises well.
The anterior pelvic tilt look is still in.
Unfortunately, anterior pelvic tilt (APT) is a glute killer. The biggest problem is that the glutes are responsible for posteriorly tilting the pelvis. If you go into anterior pelvic tilt, you deactivate your glutes.
By definition, APT puts your glutes in a lengthened position. Because the glutes are on stretch, they are more likely to be deactivated.
Want to see if your glutes are really deactivated?
Simply lie face down on the ground, press your hand into your glute, and lift up your leg. If you feel a protrusion of your glute throughout the whole range of motion, you're glutes are not deactivated. (Don't cheat it by squeezing your glutes, they will fire automatically if they are not deactivated.)
If you don't feel any protrusion, your glutes are deactivated. Also, if you only feel a protrusion at the top of the range of motion, your glutes are deactivated.
Remember, in APT, position is everything. If we are going to work the glutes properly, we need to make sure we are in the best position to do that.
Begin first by flattening your low back to the ground. Take notice of your pelvic line.
Before lifting up, flatten your back using your obliques. Now, squeeze your glutes before you lift up. As you lift up, keep your glutes squeezed. At the top, squeeze your glutes and pause for one to two seconds. As you lower, you can relax your glutes, but try to keep a near-vertical pelvic line.
The most important thing is respecting the vertical pelvic line. As you lift up, this vertical line should remain vertical relative to the body.
As you can see, the pelvic line stays vertical with the body.
It should not look like this:
Since getting out of anterior pelvic tilt is all about maintaining a neutral (or posterior) tilted pelvis, we need to follow a few guidelines when doing our vertical line hip lifts. These are:
1. Don’t go into a range of motion which compromises your vertical pelvic line.
In other words, you should not lift up past the point where your vertical pelvic line is no longer vertical. If you do, you are going into an anterior pelvic tilt. I realize I’ve said this in half of the articles I’ve written already, but you are not going to get out of APT while going into APT.
2. Don’t lift any weight which compromises your vertical pelvic line.
If you lift a heavy-enough weight, your pelvis will go into APT. Don’t let it. Instead, you should use as heavy a weight as possible while insuring you don’t lose your vertical pelvic line.
If you follow these guidelines, your glutes are not only going to become activated, they are going to help get you out of anterior pelvic tilt.
The next exercise which I see almost always butchered is the birddog.
The birddog is a tough exercise.
The reason it’s hard is because it’s damn-near impossible for someone with anterior pelvic tilt to go through a full range of motion with a neutral pelvis. How can you tell if you have a neutral pelvis in the birddog?
You should be able to get the apex of your thumb (or about one inch) to touch the stick while you lift up your leg.
Once again, do not lift your leg past the point where you can’t touch your thumb to the stick. If you have anterior pelvic tilt, most of you will likely benefit by starting out by using a very small range of motion.
Once again, before you lift up your leg, squeeze your glutes on the leg you will lift up. Keep it squeezed all the way up and hold at the top while squeezing your glutes. When lowering, you can relax, but don’t lose your neutral pelvic position.
If you didn't pass the prone hip extension test, you should only do bent knee dead bugs. The bent-knee position will diminish your dominant hamstrings. It's also possible that you have tight quadriceps, so using a bent-knee position will also help stretch them out.
For those who have very tight hip flexors, quadriceps, or low back, if you go above 45 degrees, you’ll quickly lose spinal stability.
What this means is you need to do your stretching of the hip flexors, low back, and quadriceps before you do these exercises.
Many individuals will also benefit by doing exercises like the dead bugs before birddogs or hip lifts.
Feel free to load up the hip lift with weight as long as you can maintain a neutral pelvis. You can also add ankle weights to the birddog, but make sure you can first hit a full range of motion birddog first.
If you did pass the prone hip extension test, and can do a bent-knee birddog with a full range of motion, then you can do the straight leg version.
The glutes are the biggest muscles in the body. When the glutes are activated and strong, they help you lift more, look awesome, run faster, and perform better with fun-like activities in the bedroom.
Unfortunately, the hip lift and birddog are some of the most poorly performed exercises I see. Just about everyone I see who performs them is not keeping a neutral pelvis. I encourage you to be extra-strict with your form, squeeze those glutes, and add some load as long as you have perfect form.
At some point, we’ll all likely have some low back pain. While there are many different causes as to why this happens, it’s often due to a overworked stiff low back.
If you have anterior pelvic tilt, the low back is by definition shortened. It doesn't mean however that your low back muscles can't fully stretch.
But, if you have anterior pelvic tilt, and you find the low back muscles can't fully stretch, you need to do something about it. First, let's see if your low back muscles are able to stretch the way they should.
To do this, we'll use the prone rock test.
With the prone rock test, you need to see if your spine is rounded like a turtle shell. If you see any flat spots in the low back, you have a tight low back.
If you don't have a tight low back, it doesn't mean the prone rock test is useless. You can the prone rock position to deactivate the low back muscle.
Did you notice that Ariel has a hinge point in his thoracic spine? While this deserves attention, if we saw a hinge spot in his low back, we would make sure that if we stretch this, we make sure that there are no hinge spots during our stretch.
Anytime you stretch, there should be a smooth curve in your low back, just like a turtle shell. This might mean that you need to limit your stretch at first. If you are doing this by yourself, you will need to make sure that when you stretch, you don't observe any hinge points.
Gradually, you will be able to go through a larger range of motion while insuring there are no hinge points.
What if I'm hypermobile in the low back?
If you are very hypermobile, you still need to make sure your low back forms a turtle shell-like curve. Check this using the prone rock test.
It is possible that you may simply be hypermobile in the hips and thoracic spine while you are limited in the lumbar spine or low back.
Assuming you may be hypermobile like the picture above, you may still want to do less of a stretch to inhibit the low back muscles.
The reason why is that in anterior pelvic tilt, the low back muscles are overactivated. To deactivate it, we can do a static stretch of the low back. You don't need to do a stretch as much as the woman demonstrates above, but going to about 70% of a stretch will allow you to deactivate the low back.
While you can use the prone rock test as way to stretch your low back, you will inevitably encounter clients who have knee problems while in the prone rock test.
In that case, you can use a hip flexed chair stretch
This is a great way to stretch the low back (or deactivate it) without irritating the knees.
Since Ariel demonstrates the same hinge point in his thoracic spine in the picture above, I've had Ariel extend or straighten his upper back slightly to smooth out his thoracic spine.
Some individuals will not be able to feel a stretch using the chair stretch above. If that's the case, I recommend using an assisted low back stretch.
You should first make sure there is padding under the mid back and the glutes. This will help flex and target the lumbar spine. Push down (or pull) on the legs making sure you can feel the stretch in the low back.
This stretch is a great way to practice turning on the obliques too. Squeezing the obliques will help to posteriorly tilt the pelvis which is a great way to get out of anterior pelvic tilt.
One of the most convenient ways to stretch the low back is getting into a crouched rounded back position.
Again, make sure you feel the stretch in the low back area. To deepen the stretch, take some deep inhales and exhales.
Upon inhaling, you should try to make sure your low back (and really whole back) is expanding. When you exhale, use your obliques to make help induce a posterior pelvic tilt.
If you find this position is uncomfortable, keep practicing. It's likely that your low back, and possibly whole back is stiff. Breathing and simply being in a flexed position can help to release the tension.
Low back stretching is controversial and for good reason. If you don't have anterior pelvic tilt and are hypermobile, stretching your low back is not warranted and can be dangerous.
Make sure you never stretch into pain and do not have any hinge points when stretching. Do not stretch within thirty minutes upon waking up, as this can compromise your spinal stability.
You will find however that if you do have anterior pelvic tilt, and you have a positive prone rock test, stretching your low back will help you get out of anterior pelvic tilt faster.