So far in our series about reducing anterior pelvic tilt, you’ve learned:
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·         What is anterior pelvic tilt
·         How to test for it
·         How to sit properly
 
Can you stand properly to get out of anterior pelvic tilt?  Absolutely.  However, there is no one perfect way of standing for everyone.  This is why you need to individualize the way you stand.  We’re going to find the perfect standing exercise for you to get out of anterior pelvic tilt. Here’s how:      

Section 1:  Flatten the back

We are going to do a posterior pelvic tilt which is basically flattening your low back. 
We need to see how much you can do a posterior pelvic tilt. To do this, you’ll need a broom handle, dowel stick, long ruler, or whatever straight thing you can get to put on your back.

1. Make sure the stick touches the back of your head, mid back, and sacrum.
2. Place your thumb on the stick behind the biggest gap behind your low back.
3. Perform a posterior pelvic tilt by flattening your back so your thumb is touching both the dowel stick and your low back.

If you can touch, awesome!  You can proceed onto section 2 below.

If your thumb can’t quite touch or your thumb is really far away from touching your low back, you need to work on getting your thumb closer to your low back. Whenever you stand, practice flattening your low back as much as possible.

Now that we’ve assessed quantity, we need to look at quality. Quality in our assessment is measured by which muscles you use to accomplish your posterior pelvic tilt. Let’s test this below. 

Section 2:  Activation Test

While standing up, I want you to press into your obliques and glutes.  Now, flatten your back like just like we did with the stick. 

Did you feel a significant contraction, protrusion, or hardness in both of the muscles?  If you did, that’s great!  If not, you need to focus on the one(s) which didn’t activate as much.  For example, let’s assume you didn’t feel it in the obliques, but your glutes activated a lot. This means that whenever you stand, you should try to perform a posterior pelvic tilt with mostly your obliques. 

If you didn’t feel much activation in your obliques and your glutes, you should try to activate both them while standing. 

Some of my clients get discouraged because when they exclusively try to use the deactivated muscle, their range of motion is small.  Don’t worry about your range of motion when practicing with your weaker muscle.  As you practice, your range of motion will get better.  You will also notice that your weaker muscle will get stronger and more activated too.

Congratulations!  You’ve now found the perfect standing exercise to get out of anterior pelvic tilt.  Remember, focus on quality first by using your weaker muscle. Don’t worry about your range of motion.  However, once your weaker muscles get stronger, go for full range of motion. How do you know if what you are doing is working?  If your thumb gets closer and closer to your low back, you are making progress. Eventually, you will find your thumb can touch behind your low back and your glutes and obliques are activating sufficiently.   
 
 
 

Which one of these guys is more likely to get out of anterior pelvic tilt?

Guy 1:  Greg

Greg is a rock star in the gym.  He prides himself on his perfect technique for every exercise. Greg also does exercises to offset his all-day computer job including deadlifts, planks, and push ups. In other words, he’s awesome. 

However, outside the gym, Greg sits with a hunchback posture, doesn’t use a backrest, and has forward head posture when looking at his computer.  He sits like this roughly twelve hours out of the day when he’s at work and at home.  

Guy 2:  Adam

Adam is new to the gym and thinks he’s getting the hang of things. But, his form still sucks. He rounds his back while deadlifting, flares his arms during bench pressing, and is lumbar extension while doing planks.  However, Adam has decent posture while sitting. He does his best to sit upright, takes breaks about every thirty minutes off of his seat, stretches his arms while at work, and has his computer set up about chest level.

Both Greg and Adam have been working at their jobs for 10 years.  Who is more likely to get out of anterior pelvic tilt?

Adam is the winner.  In fact, Adam doesn’t even have anterior pelvic tilt, forward head posture, or rounded shoulders, because of how he has been sitting.  While Adam’s exercise technique is lacking, he is actually training with great form outside of the gym an average of 12 hours a day at sitting.

If you train at ANYTHING 12 hours a day, it’s going to show.  If you sit terribly for years on end, anterior pelvic tilt is likely already present.  If you dominate your sitting, you can get out of anterior pelvic tilt and stay out. 

This is my point:  Why would you have perfect technique for lifts, which require no more than twenty to thirty minutes of actual lifting in the gym, but you sit horribly outside of the gym for 12+ hours?  You need to train where it counts inside and outside the gym. 
Just because you grew up sitting in school does not make you an expert at sitting. Just look at how most people sit.  I’m here to tell you that how you sit will affect your anterior pelvic tilt more than anything else. 

Why does sitting cause anterior pelvic tilt and how can you fix it?  Here are 4 tips: 

1.       By it’s very nature sitting increases hip flexor and erector spinae muscle activation which cause APT. These muscles are activated because they help us be upright while sitting. 
SOLUTION:  This means when you don’t have to sit, DON’T!  When I attend physical therapy and even some fitness seminars, we end up sitting way too much.  This is why I sit and stand in the back.
 
2.       Not using a backrest increases the activation of the hip flexors and erector spinae even more than sitting with a backrest.
Solution:  You need to use a backrest.  If you don’t have one, get one or get a different chair.  There is nothing that kills a back like sitting without a back rest for hours, days, weeks, or even years on end. 
 
3.       Many individuals exhibit thoracic kyphosis while sitting. The erector spinae muscles attach from the pelvis to the up through the thoracic and even cervical vertebrae.  When the back rounds during thoracic kyphosis, this puts the erector spinae on stretch which can cause excessive passive tension pulling up on the posterior pelvis and contributing to greater APT.
 
Solution: The solution to this is to sit upright! This puts the back muscles on slack and will prevent them from pulling up the back of the pelvis. But, don’t sit with military posture which is sitting as tall as possible.  You need to be tall, but about 1-2 inches lower than your maximum sitting height.   The best strategy I know of for correcting this is to use a McKenzie Roll (or the like) behind your low back. 
 
4.       Many people sit without their feet being able to touch the ground. The problem with this is it causes the hip flexors to work extra hard trying to keep the body upright.  This problem can happen when individuals are shorter, chairs or stools are too tall, or when sofas are too deep.
 
Solution:  If you need to, use a foot rest, cushions, or pillows to rest your feet on.  This will significantly turn off your hip flexors. If you have a deep couch, put two cushions behind your low back, so your feet can reach the floor.  If you sit on a tall barstool, make sure you feet can rest on the stool’s mid stands. If you’re stool doesn’t have that, avoid sitting on it or for too long.
 
5.       Muscles possess a property called creep in which if they are in a set position for a long period of time, they will lose their elasticity.  
 
Solution:  You need to at least stand up every 30 minutes… even if it is for 10 seconds.  Set a timer on your phone, get up after every episode you watch on Netflix, or use some external cue. 
 
There are other principals which are critical for proper sitting, but these are the most important for correcting excessive anterior pelvic tilt.   I’m confident that if you sit properly, it will not only help you stay out of anterior pelvic tilt, you will be taller, be more confident, and feel better too. 
 

If I had to choose one test for checking anterior pelvic tilt, it would be the Sidelying Extension Adduction (SEA) test.  I use it for all incoming clients because anterior pelvic tilt is a global alignment problem, and this test can detect it in under two minutes.  This test is also more reliable and precise than the Thomas Test.   It is the gold standard in my book.

(A variation of this test is offered by the Postural Restoration Institute. It’s a great test. I however position my clients at 45 degrees and I check for the first sign of passive tension.) 
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Here’s how to do the test:    

1. Get the client or patient sidelying with hips pointed 45 degrees downwardly.   
2. With one hand, press into the top of the pelvis making sure the top of the pelvis is stacked right on top of the bottom pelvis. The pelvis will likely want to move, so keep a constant pressure.  
3. With your other hand, grab under the knee and make sure the person is relaxed enough that if you dropped the knee, it would suddenly drop.
4. First, abduct the leg about 15-20 degrees. 
5. Very slowly, bring the leg back maintaining the abducted state. When you feel the slightest pull forward, this is your stopping point.  Look down and observe.
6. If your leg is in line with the rest of the body and the low back has not moved, the pelvis is neutral.  It’s also neutral if it goes past zero degrees.
7. However, there is anterior pelvic tilt (APT) present if the hip does not make it to zero degrees (meaning you feel any bit of tension before you get to zero degrees).  There is also anterior pelvic tilt present if you observe that the hip gets to zero degrees, but there is low back extension present. 
8. The leg should drop down to at least horizontal and maintain it’s position.  If however, hip moves forward, anterior pelvic tilt is present.

This test is ideal for checking for anterior pelvic tilt because it succeeds where other tests fail. The SEA test is a stiffness test, not a length test.  One of the problems with the traditional Thomas Test is that the Thomas Test measures only the length of the hip flexors.  What the Thomas Test doesn’t do is measure the stiffness between the muscles which produce anterior pelvic tilt (hip flexors and erector spinae) and the muscles which produce posterior pelvic tilt (abdominals, hamstrings, and glutes). 

Why is this important?  Anterior pelvic tilt is not caused by short hip flexors or erector spinae muscles.  It is caused by greater stiffness of the hip flexors and erector spinae muscles over the hamstrings, abdominals, and glutes.  What’s the difference between stiffness and shortness?
Think of a slingshot. For those with excessive anterior pelvic tilt, the hip flexors and erector spinae muscles are like a thick rubber band which actually can stretch very far. If you launch a rock with this band, it’s going to go a long way.    

This is why it doesn’t matter if the hip flexors or erector spinae are very flexible, the SEA test will detect the stiffness by checking for tension, not length.  I encourage you to test this out for yourself with your most hypermobile client. What you’ll find often is that you can bring their leg back very far.  However, if you pay attention to where you actually begin to feel any hint of tension, you’ll often find these individuals have excessive anterior pelvic tilt because their leg does not make it back to neutral alignment.

If you perform a Thomas Test and find the hip flexors are short, they are guaranteed to have a positive SEA test (meaning they do have anterior pelvic tilt).  Why is this?  Whenever the hip flexors are short, their stiffness is so great that even with the weight of the leg and gravity assisting, it is not enough to bring the hip into a neutral position of zero degrees of hip extension. This is easily seen if you do the SEA test with someone who has short hip flexors from the Thomas Test.  

Why can’t you simply do a Thomas Test to determine if a person has anterior pelvic tilt?  The problem is that you can get a false negative result (meaning the person could appear to have normal length of their hip flexors, but in reality, they still have greater stiffness of the hip flexors over the muscles which produce posterior pelvic tilt (PPT).

The reason why you can get a false negative is because gravity and leg weight can cause the leg to appear to be of adequate length, but in reality, it’s not. The power of the SEA test is that it takes gravity and leg weight out of the equation and strictly measures the tension between the hip flexors and erector spinae and the abdominals, hamstrings, and glutes.   

Another reason why the SEA test rocks is that it checks for compensatory movement with the low back.  Even if you can get the hip to neutral during the SEA test, if you see extension in the low back, anterior pelvic tilt is present.  The passive tension of the hip flexors is greater than the abdominals, glutes, and hamstrings.

What happens if you find a positive result for the SEA test?  You need to do a length test for the hip flexors and erector spinae. You should measure the hip flexors with the Thomas Test.  You can measure the erector spinae using the prone rock test (as found in the SFMA).

If either the hip flexors or erector spinae are short, you should lengthen them.  How you lengthen them is of importance which we’ll cover later. However, even if you don’t find the hip flexors or erector spinae are short, there is still greater stiffness in the hip flexors and erector spinae.  This definitely calls for strength training the abdominals, glutes, and hamstrings.

If for whatever reason you’re in solitary confinement reading this article and no prison guard is going to perform the SEA test on you, you can do it by yourself.  The key is simply allowing your leg to go back in the same way as the regular SEA test. You must however, relax your whole body and even your leg when it is lifting up (as much as possible).  Bring your leg back very slowly and at the slightest hint of tension, that is your stopping point.  Once you find this point, you should look down and if you can see your leg. If you can see it, you probably have anterior pelvic tilt. 

If you can’t see your leg, you probably don’t have anterior pelvic tilt.  However, if you felt your back extend at all, then anterior pelvic tilt is present.  Again, DO NOT tense up your abdominals or your hips, just let your leg go back very lightly, and see how far it goes.

While the sidelying extension adduction test does a great job measuring stiffness between the muscles which produce APT and PPT, there are some things which the SEA test doesn’t measure. This includes potential anterior pelvic tilt that could present in your alignment, movement, and motor control. We’ll go through these tests and treatments later.