By Matt Stensrud, PT, Clinic Director
Midwest Orthopaedics Physical Therapy
- Neutral Pelvis Position 2. Anterior Pelvic Tilt
Many individuals we see in our practice get diagnosed with Femoral Acetabular Impingement (FAI). There are two main reasons for this impingement including structural changes in the joint and poor mechanical positioning/neuromuscular control of the joint. Most cases we see involve both structural and mechanical reasons for the pain, but in varying degrees. The above pictures show positions of the pelvis including:
- Neutral pelvis on the left with normal resting tone of the quads and hamstrings to allow for balanced anterior chain and posterior chain activity.
- Anterior pelvic tilt on the right 2 pictures with increased tone of the quads, hip flexors and lower back muscles with inhibited or weak hamstrings and abdominals.
If someone presents to physical therapy with a “pinch” in the front of their hip it is very common they are presenting with the pattern of an anterior pelvic tilt on one or both sides of their pelvis. The below picture shows how this anterior tllt position can lead to “pinching” in the front of the hip with sitting or squatting as the front of the pelvis quickly impacts the femur. On the right, the posterior rotated pelvis allows for more room during sitting and squatting reducing the chances for impingement complaints.
Most individuals with FAI will have some deformity of their hips on radiographs, but it is very important to correct the mechanical reasons for impingement through proper muscle integration even if the case will end up being surgical (usually involves reshaping a malformed socket or neck of the femur). If the mechanics are corrected, you can see how much more space there can be in the front of the hip when learning to squat or sit with a neutral to posterior tilt biased position of the pelvis. This allows for abolishment of the impingement and inflammatory condition or improves mechanics so that a post-operative FAI patient will already have a good movement foundation to maximize their recover after surgery.
Below are a few good exercises to learn to get this proper posterior pelvic tilt with abdominal integration and during deep squatting to reduce anterior impingement.
- Short seated balloon – works to integrate abdominals with posterior pelvic tilt position to reduce lower back tension
- Sit on a 6 inch step and rock back to feel your sit bones
- Take a breath in through your nose and slowly exhale for 6-8 seconds
- Pause 3 seconds without pinching the balloon
- Inhale again without pinching the balloon (feel upper back expand)
- Slowly exhale again for 6-8 seconds without using neck or cheeks
- Repeat for 1 more breath focusing on filling your back with air during inhalation
- Relax and repeat 4 more times.
- All Fours “Cat” breathing – Focus is on feeling outer abdominals and buttock work to maintain a rounded back and posterior pelvic tilt
- Start on your hands and knees with your nose over your fingertips. Do not tuck your chin during this exercise.
- Maximally round out your spine by arching your back upwards while you tuck your bottom under (posterior pelvic tilt).
- Hold this position for 4-5 deep breaths (in nose out mouth) focusing on filling the back of your chest wall with air during inhalation.
- Relax and repeat 4 more times
- Full deep squat with breathing – focuses on posterior pelvic tilt, strength to get up from a squat with this posterior pelvic tilt position and stretching of the back
- Squat down as far as you can without letting your heels come up from the floor while keeping your back rounded and pelvis tucked under you
- Hold this position for 4-5 deep breaths (in nose out mouth) focusing on filling the back of your chest wall with air during inhalation.
- On the final exhale, focus on pushing through your heels as you keep you back rounded and bottom tucked under you.
- Relax and repeat 4 more times.
