Posterior pelvic tilt.

[WOP2_99]

I have a client with a fairly extreme posterior pelvic tilt. Has anyone worked to return the pelvis to the normal, slightly anterior tilt? Even neutral would be a good start for her, but I'm not sure how to go about it. Obviously the hamstrings need to be lengthened, and she is working on stretches - but what else?

 

[Robby]

gastocs/soleus, ql, lumbar erectors, and quads (surprisingly). strip and stretch.

adductors will be off balance, and the biggest one: illiopsoas. get in there and tear that mother up. haha. seriously, it may be reducing the lumbar lordosis and contributing to the pos pelvic tilt.

does he/she sit all day long?

s/i and lumbar vertebral segment joint mobes. passive ROM for the hip. strengthen transversus abdominis, quads and ant leg compartment muscles.

take twice a week, and call me in the morning if anything changes.

 

[Bryndis]

How does HT iliopsoas cause posterior pelvic tilt?

Honestly RoseofSharon, there's not enough information here. Is the tilt caused by muscle imbalance, or is the muscle imbalance caused by avoiding pain in the spine due to some condition like spinal stenosis or bone spurs? What other parts of the body are affected, and did the post tilt come on suddenly, or has the client always had this condition since you've been treating? What happens if the client tilts the hips anteriorly? Can you create a passive anterior tilt, possibly by lifting the pelvis with the client supine?

Does the client have full hip ROM? Trunk flexion/extension and rotation?

Has the client seen a chiro for possible facet dysfunction? Are there bulging discs that the posterior tilt relieves pressure?

I don't know, a slight posterior tilt is not terribly uncommon, and I wouldn't hesitate to just start treating for tight glute and vastus L & M, kind of the reverse treatment of typical lower crossed syndrome. But a "fairly extreme" posterior tilt... definitely need more information before making suggestions.

Yeah, quads will be tight, but in eccentric contraction in an effort to "anchor" the pelvis. If you start treating the eccentrically contracted muscles with typical massage techniques (MFR, stretching, TPT,) before pressure on them is relieved, you will examassageplanetate the problem. First relieve strain on quads (and iliopsoas) by lengthening the tight, facilitated muscles, then you can treat any resulting issues in the tight inhibited muscles after posture starts improving.

 

[Pinkboots]

Posterior Pelvic Tilt (or Pelvic Extension)

Muscles on the anterior side creating pelvic extension:

Long fibers of Psoas
Anterior fibers of the External Obliques
Lower fibers of Rectus Abdominus

Muscles on the posterior side creating pelvic extension:

Hamstrings
Gluteus Maximus
Posterior fibers of Adductor Magnus and Gluteus Medius

.

 

[Pompal 09.]

How does HT iliopsoas cause posterior pelvic tilt?

The effect is sometimes called the "Psoas Paradox", according to Travell and Simon. Patients with weak abdominal muscles lose lumbar lordosis from the action of the psoas to extend the spine. It is not obvious from the anatomy and required some sophisticated analysis in a clinical setting.

.

 

[MommyTrujillo]

Posterior Pelvic Tilt (or Pelvic Extension)

Muscles on the anterior side creating pelvic extension:

Long fibers of Psoas

Doesn't seem mechanically possible, based on location of vertebral attachments and position through the deep abdomen and below the inguinal ligament. Due to its attachment inside the pelvic foramen, it's theoretically possible that psoas minor could cause a slight posterior pelvic tilt, but also due to it's location, working that muscle would be ill-advised in extreme pelvic tilt because of additional release of already eccentrically contracted iliacus and psoas muscles.

 

[B*tchKitty]

"psoas paradox" appears to refer to the weak action of psoas when attempting to straighten a lordotic curve when standing, but strong recruitment of psoas during the spinal flexion phase of a sit-up, that caused a strong hyperextension of the spine, instead of the psoas being inhibited by contraction of rectus abdominis as would be expected during sit-up.

I could be misunderstanding that passage...

 

[TAHA]

Ida Rolf also describes the psoas as a pelvic extender:

http://www.somatics.de/Psoas&Adds.html

 

[zerojohnnyx]

Very interesting, especially considering a seated position would also contribute to this shortened psoas contributing to posteriorly rotated pelvis. But what does that mean for treatment, considering that one has to be in a very specific position for that action? If the pelvis is tipped posteriorly in a standing position, or with legs straight, would you still consider psoas hypertonicity to be a predominant factor? Since the majority of fibers and main action still contributes to anterior tilt and flexion of the lumbar spine, how would you treat psoas to decrease posterior tilt, or would you even do so?

Stacey-not-a-rolfer-but-very-perplexed

 

[David S]

Big muscles do it. Treat the hamstrings and glutes.

 

[Tony Touch]

Okay - more info. Ct. is 20 yo, works full time as a cashier, standing on cement/tile flooring. Ht/wt ratio is good.

Posterior tilt has been noted since childhood. Contributing factors IMO are multiple abdominal surgeries d/t birth defects, surgical disasters/repairs. Very weak abdominals, but very tender in abdominal region, precluding much deep work in one session.

Glutes have very low muscle tone. Ct. complains mainly of foot pain, and I think it is because everything else is misaligned. No back pain, mainly feet and occasional pain in calves and/or knees. Gastrocs & soleus are very HT.

 

[italianscotschick]

MFR deals with pelvic rotations very well. We were taught to get comfortable, grab some bony handles, take up the slack and then move into the restrictions. The bony handles will be the ischium ("sit bone") and PSIS. Of course you need to release all the restrictions in the legs and back, strengthen the abdoms and glutes, install some insoles into the shoes, Did you check for long second toe?

:idea: Or perhaps it will be better to work supine, and use the ASIS as your handle along with the ischium. This is not naked work, friends. t035

 

[Marilyn]

check out this link...under posterior tilt there are some stretching exercises.....if she is motivated to improve she would benefit a great deal from doing these exercises at home as an adjunct to your massage.

http://www.exrx.net/ExInfo/Posture.html

 

[s h a h i d]

Thank you all for your input. A treatment plan is forming!

Palms down, that website is fabulous! Thank you!

 

[tomboy]

Query: is this tilt a "new" position for this person? If NOT, then consider lordotic and kyphotic spinal curvatures as a possibility for causing tilting of the sacrum....

Having a particular tilt that I was born with makes life interesting to say the very least. So many people try to "FIX IT" with major effort, etc.

All I want them to do is a simple craniosacral pelvic diaphragm release and spinal colum stretch - works wonders for me everytime.

Just to add that to the mix.
J

 

[shashou]

Query: is this tilt a "new" position for this person? If NOT, then consider lordotic and kyphotic spinal curvatures as a possibility for causing tilting of the sacrum....

Having a particular tilt that I was born with makes life interesting to say the very least. So many people try to "FIX IT" with major effort, etc.

All I want them to do is a simple craniosacral pelvic diaphragm release and spinal colum stretch - works wonders for me everytime.

Just to add that to the mix.
J

Thanks for the reply. The tilt is not new, but I believe it is a result of multiple abdominal surgeries in childhood. Her back is almost completely flat - very little natural curvature.

 

[Pandalism]

Have you considered that there may be complications from scar tissue and myofascial "clumping" [for lack of a better descriptive phrase at the moment] in and around the areas where her surgeries were done.

Have had several orthopedic surgical patients come to me with complaints of back pain following surgeries [sometimes weeks or months - in one case 10 years] and relief has been obtained in most instances by addressing the amount of fascial tension in the areas and/or working with scar tissue in the area much like one would if one were working with a race horse trying to "order" the alignment of the scar tissue to maximum advaneforum.xxxe for the horse's movement.

If you need a better explanation than the one I just typed, PM me.... am brain weary and not typing too clearly tonight.

J

 

[krishnamoorthynagarajan]

Okay, saw the ct today. She has MAJOR TP's in both adductor magnus' (magni??) very near the origin tendons. These are huge huge huge TP's - it will take awhile to work these out. Lower fibers of the rectus abdominus are extremely HT, and the illiacus are both HT. Psoas, not so tight or tender, and glutes are actually hypotonic - almost no muscle tone. I did some myofacial work - thanks for the warning that it's not naked work, Mick!

This will take awhile, but I do feel progress will happen. She's willing to do the stretches, and willing to let me work where she quite obviously needs work! I'll keep you posted.

Have to get out my goneometer and document this!

 

[Just Call Me G]

http://ww2.azfamily.com/Global/story.asp?S=2800283

Take a look at this. Lumbar curvature as well as cervical curvature is developed at an early age. As a result, pelvic rotations are also established. If, as a child you bypassed crawling and went to walking, gravity's effect on your curvature would not have established the curve of your spine.

It doens't state it as a LAW or 100% of the time, but it is interesting.

 

[LifeIsPeachy]

That is another cool website. Thank you, Jay!

My ct was a butt-scooter rather than a crawler. She learned to crawl after learning to walk, so obviously didn't use that skill much!