If you googled reasons for back pain, anterior pelvic tilt might come up. Today we want to address what is anterior pelvic tilt, how to tell if you have an anterior pelvic tilt, and if that is one of the causes for back pain.

What is the anterior pelvic tilt?

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Anterior pelvic tilt refers to the posture where your pelvis is rotated forward. It is often associated with an increased in lumbar lordosis – that is in the curve in your low back. We are not going into the history of the anterior pelvic tilt debate but you can refer to our blog post on ‘text neck’ for the history of posture.

Like how ‘text neck’ is closely associated to Janda Vladimir’s work on the upper crossed syndrome, anterior pelvic tilt is the lower back version of it. Not surprisingly, it is known as the ‘lower crossed syndrome’.

The hypothesis was that tight back extensors and tight hip flexors combined with weak abdominal muscles and weak glut or hamstring muscles give you the anterior pelvic tilt. However, no research has been able to validate this claim.

If you hear people telling you to strength your gluteus maximus or core muscles, and do regular hip flexor stretches for your back pain, they are probably thinking you have an anterior pelvic tilt.

How do I know if I have an anterior pelvic tilt?

So there are probably apps for this.

Posture Zone is a free iPhone app that you can use. All you need to do is a photo of yourself against a grid background if possible. This is one of the apps chiropractic clinics in Singapore use to evaluate posture.

If you are feeling rich, you can try Posture Screen for USD$19.90 onwards. I believe both apps will tell you instantly if you have an anterior pelvic tilt.

If you want a more serious analysis, you would have to be able to identify your ASIS and PSIS.

To find your ASIS, put your hands at the side of your pelvic bone or hip bone and palate for the highest edge (iliac crest). Once you have located it, follow the contours of the bone forwards. You’ll notice a drop off. That specific prominence/spot is your ASIS.

It’s hard to find your own PSIS so I’ll suggest you get some one to help. Your assistant will have to look for the Dimples of Venus. Place his or her thumbs on it and palpate downwards. He or she should feel a bony prominence right under it. That is your PSIS.

If you draw an imaginary striaght line across your ASIS and PSIS and they are perfectly aligned, you have a neutral pelvis. If the front is higher than the back, you have an anterior pelvic tilt.

 

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Is anterior pelvic tilt a cause for back pain?

This is when things get interesting. We have a few studies to share.

Study 1: Relationship between Hip Extension Range of Motion and Postural Alignment

No relationship between hip extension range of motion and standing pelvic tilt, standing lumbar lordosis, or abdominal muscle performance. If ‘lower crossed syndrome’ was true, tight hip flexor (psoas muscle) in the case of standing pelvic tilt or standing lumbar lordosis should result in reduced hip extension. But the study shows there’s no such relationship.

Study 2: Lumbar lordosis: study of patients with and without low back pain.

No difference in lumbar lordosis in women with or without lower back pain. For men, lower back pain patients tended to have reduced lumbar lordosis but it wasn’t statistical significant. I.e. most likely due to chance. But reduced lumbar lordosis = less anterior pelvic tilt. So if anterior pelvic tilt causes back pain, you’d expect people with low back pain to have MORE lumbar lordosis. Right?

Study 3: Variation in Pelvic Morphology May Prevent the Identification of Anterior Pelvic Tilt

This is more complicated so I wouldn’t really go into details. But the study found that anatomical variations of the pelvis significantly changes the measurement of anterior pelvic tilt. So, maybe anterior pelvic tilt tells us more about the shape of your bones rather than the actual tilt?

Study 4: The biomechanics of the lumbosacral region in acute and chronic low back pain patients

No relationship between low back pain (both acute and chronic) and lumbar lordosis angle.

Study 5: Relationship between mechanical factors and incidence of low back pain

Lumbar lordosis, pelvic tilt, and even difference in leg length (!) are not associated with lower back pain.

Why are we sharing this with you?

We don’t you want to blindly take our word for it. At Square One, informed decision making is important to us. The only way we can help you reached an informed decision is if you have all the pertinent information.

We don’t want to be one of the chiropractors or physiotherapists in Singapore who make unsubstantiated claim. As such, all of our blog posts are based off scientific studies. We also make a point to include a direct link to the study so you can fact check against our sources.

Does bad posture in the low back cause back pain?

The short (and evidence-based) answer is no.

Posture is largely a social construct and there is no research to support that it causes pain of any kind. Please read our earlier blog post on ‘text neck‘ to learn more about how posture doesn’t matter.

It’s common for chiropractors and physiotherapists to talk about alignment and posture. A doctor of chiropractic may suggest that you come for regular chiropractic adjustments to realign your spine to prevent back pain. A physiotherapist may prescribe posterior pelvic tilt exercises for low back pain relief. None of these are evidence based.

As a society, we are obsessed with symmetry and being in a neutral position, research says that doesn’t matter. Even having a shorter left leg is okay! There many things people claim to cause back pain that are not true. Even slipped disc or herniated disc is not one of the risk factors for back pain.

What causes lower back pain then? I am afraid we don’t have the answers to the question. We do understand pain and we know what are the risk factors of lower back pain. When it comes to what exactly causes it, we aren’t very sure. If you want to get into the nitty gritty details, check out our 5000+ word article on lower back pain.

I have low back pain, what do I do?

You have low back pain. Maybe it is a nerve pain or muscle spasms. It doesn’t matter. We suggest starting with a good chiropractor who offers exercise rehabilitation. The number 1 recommendation for lower back pain treatment – by virtually all clinical guidelines – is exercise.

You can read more about why we choose exercise here or check out this post for the clinical guidelines.

Choose chiropractic first

Most of you will use some sort of AB testing methodology or engage in data-driven decision making process at work. Your lower back pain should be no different. Research has also shown evidence-based treatments to deliver superior outcomes than those based on “it worked for my other patients so it should work for you”.

There are tons of research on how chiropractors are better trained at delivering treatments for lower back pain. In fact, we deliver results superior to those of physiotherapists and medical doctors. Check out our lengthy blog post on everything you need to know about lower back pain or 6 things an orthopaedic surgeon got wrong.

In any event, should you decide to seek chiropractic care with other chiropractors, do avoid those who only offer spinal adjustments or physical therapy. These modalities are unlikely to relieve pain as exercise rehabilitation.

To book an appointment with us, you can use our online booking form. Our office is in a beautiful conserved shophouse along Bukit Pasoh Road. It is a two-minute walk from Outram Park MRT (Dorsett Hotel exit). If you are coming from Tanjong Pagar or 100 AM Mall at Tras Street, take a walk through the scenic Duxton Plain Park to get to our clinic.