Anterior Pelvic Tilt: Pain While Squatting

Bigger Stronger Leaner Injuries and Rehab
1

Okay so i’ve been lurking on these forums and ive actually posted threads pertaining to this issue before. I’ve actually been suffering from hip pain from squats or squat like movements(tyre flipping etc) since about 2 months ago. I’ve been experiencing a deep sharp-like pain when i go heavy on squats, but the pain isnt that pronounced when im doing bodyweight squats.

The pain usually happens during the concentric motion of the squat, when im trying to squat out of the hole. But the pain doesnt rly show up in deadlifts.

Here is the link to my prev thread that i posted on, regarding the same injury
http://tnation.T-Nation.com/hub/rafsanjaniii#myForums/thread/5780492/

However, in the past i didnt really know what the problem was, whether it was a muscular imbalance or a joint issue, so i visited an osteopath today and after a good thorough 30 mins of checks, she diagnosed me as having Anterior Pelvic Tilt.

She said that my hip flexor strain was being exacerbated by the lack of mobility in the lower back region and also due to the anterior pelvic tilt.

She recommended me to stay off squats completely and focus on mobility stretches for my lower back. So my question is, what other stretches can i do for lower back mobility and to help with my anterior pelvic tilt. Cause the only stretches my ostepath recommended were the cat stretch and the lower back stretch. Are there any lower back mobility drills that i could do, which would have a carry over to my squat form? And would strengthening my glutes help out in getting rid of the APT? If so, what glute exercises would you guys recommend?

any input and feedback from you guys will be greatly appreciated!!!

2

There are a number of good lower back stretches out there (IMO Kit Laughlin’s material is the best for building adult flexibility/mobility) on youtube and in print. Remember also that there are a lot of muscles that comprise the “lower back” and that contribute to APT, so you will probably benefit from stretches that include:

-forward spinal flexion (there are a bunch of slight adjustments that you can make to hit everything from the lower, to middle, to even upper back with these types of stretches)
-lateral spinal flexion
-spinal rotation
-and hip flexor stretches (you want to stretch the Iliopsoas, and Rectus Femoris primarily, but stretching the Sartorius may also be of benefit)

I’m on my phone right now, so I can’t post links to videos, but hopefully this will get you started.

3

I’m a little wary of the idea of promoting lower back mobility. The lower back is supposed to be stable, rather than mobile. You will hurt it if it moves due to inappropriate mobility of the hips and thoracic spine…

That being said it isn’t supposed to be stabilized into a position of anterior pelvic tilt, for sure.

How is your glute activation? I mean… When you drive out the hole the main muscle doing the work should be your glutes. I am a little puzzled how it is that you are feeling that in your hip flexors… I can make myself feel it in my hip flexors if I lean forwards a little and transfer muscular tension more to the anterior chain and don’t consciously use my glutes / hammies to drive up. Perhaps that is how you are squatting?

If you are holding your pelvis locked into hard anterior pelvic tilt (I do this sometimes - till I learned otherwise) then you would likely experience this as cramped / seized lower back spinal erectors.

Side on vids would help.

4

That being said I did need to do some lower back mobilization to start with because my back was locked tight into anterior pelvic tilt.

Can you hold yourself in neutral position with conscious effort even if you need to look into the mirror to cue it? If you can’t then you need to work on your mobility so you can get into that position for sure.

Most helpful thing to me was sitting on the ground and curling myself up into a tight little ball. Variations on pilates roll - like a slow lower from sit up position lowering one vertebrae to the ground at a time.

5

[quote]rafsanjaniii wrote:
Okay so i’ve been lurking on these forums and ive actually posted threads pertaining to this issue before. I’ve actually been suffering from hip pain from squats or squat like movements(tyre flipping etc) since about 2 months ago. I’ve been experiencing a deep sharp-like pain when i go heavy on squats, but the pain isnt that pronounced when im doing bodyweight squats.

The pain usually happens during the concentric motion of the squat, when im trying to squat out of the hole. But the pain doesnt rly show up in deadlifts.

Here is the link to my prev thread that i posted on, regarding the same injury
http://tnation.T-Nation.com/hub/rafsanjaniii#myForums/thread/5780492/

However, in the past i didnt really know what the problem was, whether it was a muscular imbalance or a joint issue, so i visited an osteopath today and after a good thorough 30 mins of checks, she diagnosed me as having Anterior Pelvic Tilt.

She said that my hip flexor strain was being exacerbated by the lack of mobility in the lower back region and also due to the anterior pelvic tilt.

She recommended me to stay off squats completely and focus on mobility stretches for my lower back. So my question is, what other stretches can i do for lower back mobility and to help with my anterior pelvic tilt. Cause the only stretches my ostepath recommended were the cat stretch and the lower back stretch.

Are there any lower back mobility drills that i could do, which would have a carry over to my squat form? And would strengthening my glutes help out in getting rid of the APT? If so, what glute exercises would you guys recommend?

any input and feedback from you guys will be greatly appreciated!!![/quote]

Did they say anything about Impingment?

6

[quote]Sentoguy wrote:
There are a number of good lower back stretches out there (IMO Kit Laughlin’s material is the best for building adult flexibility/mobility) on youtube and in print. Remember also that there are a lot of muscles that comprise the “lower back” and that contribute to APT, so you will probably benefit from stretches that include:

-forward spinal flexion (there are a bunch of slight adjustments that you can make to hit everything from the lower, to middle, to even upper back with these types of stretches)
-lateral spinal flexion
-spinal rotation
-and hip flexor stretches (you want to stretch the Iliopsoas, and Rectus Femoris primarily, but stretching the Sartorius may also be of benefit)

I’m on my phone right now, so I can’t post links to videos, but hopefully this will get you started.[/quote]

thanks, i looked up kit laughlin’s youtube channel, and his stretches seem pretty solid! but he has very few stretches that could be done solo, most of his stretches include doing it with a partner. is this good enough? or should i look out for a more variety of stretches?

7

[quote]alexus wrote:
I’m a little wary of the idea of promoting lower back mobility. The lower back is supposed to be stable, rather than mobile. You will hurt it if it moves due to inappropriate mobility of the hips and thoracic spine…

That being said it isn’t supposed to be stabilized into a position of anterior pelvic tilt, for sure.

How is your glute activation? I mean… When you drive out the hole the main muscle doing the work should be your glutes. I am a little puzzled how it is that you are feeling that in your hip flexors… I can make myself feel it in my hip flexors if I lean forwards a little and transfer muscular tension more to the anterior chain and don’t consciously use my glutes / hammies to drive up. Perhaps that is how you are squatting?

If you are holding your pelvis locked into hard anterior pelvic tilt (I do this sometimes - till I learned otherwise) then you would likely experience this as cramped / seized lower back spinal erectors.

Side on vids would help.[/quote]

I cant really recall on which muscles i recruit when i squat, cause its really been awhile since i last squatted lol. but i think it might be due to low glute and hamstring activation, cause if i recall correctly, i dont feel that sore in the hammies and glutes after a squat workout in the past.

are there any glute/hamstring activation drills that you can recommend me to do, while i wait for my hip flexors to recover?

8

[quote]BHOLL wrote:

[quote]rafsanjaniii wrote:
Okay so i’ve been lurking on these forums and ive actually posted threads pertaining to this issue before. I’ve actually been suffering from hip pain from squats or squat like movements(tyre flipping etc) since about 2 months ago. I’ve been experiencing a deep sharp-like pain when i go heavy on squats, but the pain isnt that pronounced when im doing bodyweight squats.

The pain usually happens during the concentric motion of the squat, when im trying to squat out of the hole. But the pain doesnt rly show up in deadlifts.

Here is the link to my prev thread that i posted on, regarding the same injury
http://tnation.T-Nation.com/hub/rafsanjaniii#myForums/thread/5780492/

However, in the past i didnt really know what the problem was, whether it was a muscular imbalance or a joint issue, so i visited an osteopath today and after a good thorough 30 mins of checks, she diagnosed me as having Anterior Pelvic Tilt.

She said that my hip flexor strain was being exacerbated by the lack of mobility in the lower back region and also due to the anterior pelvic tilt.

She recommended me to stay off squats completely and focus on mobility stretches for my lower back. So my question is, what other stretches can i do for lower back mobility and to help with my anterior pelvic tilt. Cause the only stretches my ostepath recommended were the cat stretch and the lower back stretch.

Are there any lower back mobility drills that i could do, which would have a carry over to my squat form? And would strengthening my glutes help out in getting rid of the APT? If so, what glute exercises would you guys recommend?

any input and feedback from you guys will be greatly appreciated!!![/quote]

Did they say anything about Impingment?[/quote]

she didnt really mention anything about hip impingement tho, just strained hip flexors…

but now that you mentioned it, i kinda forgot to ask her to rule out the possibility of hip impingement. i might send her an email just to verify tomorrow lol.

9

[quote]rafsanjaniii wrote:

[quote]Sentoguy wrote:
There are a number of good lower back stretches out there (IMO Kit Laughlin’s material is the best for building adult flexibility/mobility) on youtube and in print. Remember also that there are a lot of muscles that comprise the “lower back” and that contribute to APT, so you will probably benefit from stretches that include:

-forward spinal flexion (there are a bunch of slight adjustments that you can make to hit everything from the lower, to middle, to even upper back with these types of stretches)
-lateral spinal flexion
-spinal rotation
-and hip flexor stretches (you want to stretch the Iliopsoas, and Rectus Femoris primarily, but stretching the Sartorius may also be of benefit)

I’m on my phone right now, so I can’t post links to videos, but hopefully this will get you started.[/quote]

thanks, i looked up kit laughlin’s youtube channel, and his stretches seem pretty solid! but he has very few stretches that could be done solo, most of his stretches include doing it with a partner. is this good enough? or should i look out for a more variety of stretches?
[/quote]

If you can find a reliable training partner who will be willing to help you stretch (and you can help stretch them as well), then partner stretching is a more effective method of stretching as it allows you to be completely passive and put your undivided attention into feeling the stretch and relaxing the target muscle(s).

Many of Kit’s stretches can be done solo though if you have a yoga strap/belt/bar/wall for support and they are still highly effective for gaining flexibility. He also has several books where he thoroughly details his method of stretching as well as gives many variations (some solo, some partner assisted) for stretching just about every major (and some minor) muscles of the body. It’s a little pricier than some other books on stretching, but IMO it’s absolutely worth the money.

And lest this sound like an advertisement, I am in no way affiliated with Laughlin, nor do I have anything to gain by you purchasing his products; this is a completely unsolicited plug for the book from someone who has read a ton of flexibility books, tried out just about every methodology out there, trained with some of the best and most knowledgeable Martial Artists on the subject, has a degree in Exercise Science, and trains both athletes and the general population and has found Kit’s material to be the absolute best there is out there for improving adult flexibility.

10

[quote]alexus wrote:
I’m a little wary of the idea of promoting lower back mobility. The lower back is supposed to be stable, rather than mobile. You will hurt it if it moves due to inappropriate mobility of the hips and thoracic spine…

That being said it isn’t supposed to be stabilized into a position of anterior pelvic tilt, for sure.

How is your glute activation? I mean… When you drive out the hole the main muscle doing the work should be your glutes. I am a little puzzled how it is that you are feeling that in your hip flexors… I can make myself feel it in my hip flexors if I lean forwards a little and transfer muscular tension more to the anterior chain and don’t consciously use my glutes / hammies to drive up. Perhaps that is how you are squatting?

If you are holding your pelvis locked into hard anterior pelvic tilt (I do this sometimes - till I learned otherwise) then you would likely experience this as cramped / seized lower back spinal erectors.

Side on vids would help.[/quote]

There is absolutely nothing wrong with having a flexible/mobile lower back as long as you are capable of stabilizing it when necessary.

11

If one doesn’t have the mobility to voluntarily move into anterior and posterior tilt then one probably needs to mobilize, yes.

My point was that if one has this mobility there are better things that one could be doing with ones time.

some people spend years stretching out their hamstrings thinking that is the magical answer to their squats… And it isn’t. some people spend years stretching out their lower back and / or giving it all this extra work to do because they are convinced it is the weak link… And really the problem is that the lower back is doing the work that their glutes and hamstrings should be doing and they end up injuring it as they load it up good on squats (even though their squat it objectively not the strongest since they aren’t making good use of the larger muscles that are supposed to be the main movers) the lumbar region shifts under the bar (from all their mobility work) and they hurt themself.

But to each their own.

12

[quote]alexus wrote:
If one doesn’t have the mobility to voluntarily move into anterior and posterior tilt then one probably needs to mobilize, yes.

My point was that if one has this mobility there are better things that one could be doing with ones time.

some people spend years stretching out their hamstrings thinking that is the magical answer to their squats… And it isn’t. some people spend years stretching out their lower back and / or giving it all this extra work to do because they are convinced it is the weak link… And really the problem is that the lower back is doing the work that their glutes and hamstrings should be doing and they end up injuring it as they load it up good on squats (even though their squat it objectively not the strongest since they aren’t making good use of the larger muscles that are supposed to be the main movers) the lumbar region shifts under the bar (from all their mobility work) and they hurt themself.

But to each their own.[/quote]

I completely agree with what you are saying about people who have poor Glute/hamstring activation during their squats and it leading to increased risk of injury. But I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. The body just doesn’t work like that.

What causes the injury is much, much more likely to be the lack of mobility at another joint or the lack of strength in being able to stabilize the spine (which again is in no way contradictive to having good spinal mobility) than it is that the person performed spinal mobility drills or stretches.

So IME it’s a lack of strength with an excess of mobility (rare in men) or a lack of mobility that are the primary causes of injury.

13

[quote]Sentoguy wrote:

[quote]alexus wrote:
If one doesn’t have the mobility to voluntarily move into anterior and posterior tilt then one probably needs to mobilize, yes.

My point was that if one has this mobility there are better things that one could be doing with ones time.

some people spend years stretching out their hamstrings thinking that is the magical answer to their squats… And it isn’t. some people spend years stretching out their lower back and / or giving it all this extra work to do because they are convinced it is the weak link… And really the problem is that the lower back is doing the work that their glutes and hamstrings should be doing and they end up injuring it as they load it up good on squats (even though their squat it objectively not the strongest since they aren’t making good use of the larger muscles that are supposed to be the main movers) the lumbar region shifts under the bar (from all their mobility work) and they hurt themself.

But to each their own.[/quote]

I completely agree with what you are saying about people who have poor Glute/hamstring activation during their squats and it leading to increased risk of injury. But I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. The body just doesn’t work like that.

What causes the injury is much, much more likely to be the lack of mobility at another joint or the lack of strength in being able to stabilize the spine (which again is in no way contradictive to having good spinal mobility) than it is that the person performed spinal mobility drills or stretches.

So IME it’s a lack of strength with an excess of mobility (rare in men) or a lack of mobility that are the primary causes of injury. [/quote]

I wanted to chime in and say that both of you present valid points.
Alex- I agree with you that the lumbar spine is designed for stability and would in most cases benefit from stability training. I think most people miss out on the hip and thoracic, and c-spine mobility tho. Just a thought

Sento-What then do you consider full spine ROM?

I agree excess muscular mobility is rare in men, not necessarily joint hypermobility, which can be exacerbated by stretching.

14

[quote]Sentoguy wrote:
I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. [/quote]

Where did I say this?

Oh… I didn’t.

Again, if you LACK the mobility to move from anterior to posterior pelvic tilt then you probably want to gain this mobility. BUT IF YOU CAN DO THIS then doing EXTRA work for lumbar mobility is most probably not the best use of your time.

I agree completely with the idea of putting more work into thoracic and hip mobility. And with glute recruitment on squats.

15

I actually think that the worrying thing in this whole situation is how much we are in agreement…

But the osteo is focused on stopping your squatting and increasing your lower back mobility.

Personally… My priority would be ‘I want to squat pain free’ and so not squatting (unless it is a temporary measure) is not an option. I’m not going to be replacing squats with cat-camel stretches!!

You say they pain isn’t ‘that pronounced’ when doing bodyweight squats… One take on rehab is to find a version of the movement that produces discomfort (but not really pain) and use that as a rehab exercise. The idea is to (this is all scientific) figure out how to do the movement without producing pain.

What happens if you hold a 5kg plate out front like a zombie looking through the hole. Then squat down slowly (say, take 3 or 3 and a half seconds for your descent. Then pause for a one-two count. Then try and use your glutes to push your hips forwards / up as explosively as you can. Does that produce pain? I’d love to see a vid… Side on so we can see whether you are holding your arch too hard or whether you have tail tuck at the bottom (so you lose the tension in your posterior chain which makes it hard for you to recruit it properly for your ascent)

16

[quote]alexus wrote:
I actually think that the worrying thing in this whole situation is how much we are in agreement…

But the osteo is focused on stopping your squatting and increasing your lower back mobility.

Personally… My priority would be ‘I want to squat pain free’ and so not squatting (unless it is a temporary measure) is not an option. I’m not going to be replacing squats with cat-camel stretches!!

You say they pain isn’t ‘that pronounced’ when doing bodyweight squats… One take on rehab is to find a version of the movement that produces discomfort (but not really pain) and use that as a rehab exercise. The idea is to (this is all scientific) figure out how to do the movement without producing pain.

What happens if you hold a 5kg plate out front like a zombie looking through the hole. Then squat down slowly (say, take 3 or 3 and a half seconds for your descent. Then pause for a one-two count. Then try and use your glutes to push your hips forwards / up as explosively as you can. Does that produce pain? I’d love to see a vid… Side on so we can see whether you are holding your arch too hard or whether you have tail tuck at the bottom (so you lose the tension in your posterior chain which makes it hard for you to recruit it properly for your ascent)[/quote]

or try front squats since they reduce pressure on the spine and knees

17

[quote]alexus wrote:

[quote]Sentoguy wrote:
I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. [/quote]

Where did I say this?

Oh… I didn’t.

Again, if you LACK the mobility to move from anterior to posterior pelvic tilt then you probably want to gain this mobility. BUT IF YOU CAN DO THIS then doing EXTRA work for lumbar mobility is most probably not the best use of your time.

I agree completely with the idea of putting more work into thoracic and hip mobility. And with glute recruitment on squats.

[/quote]

Sorry, wasn’t trying to imply that you had said that. It was more of a retort to the popular notion these days that moving the spine through it’s normal range of motion is going to ipso facto cause injury; which seems to be the theory that the OP was questioning when he started this thread.

We are in total agreement it seems.

18

I also second the request for a video, that would answer a lot of questions

19

[quote]Sentoguy wrote:

[quote]alexus wrote:

[quote]Sentoguy wrote:
I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. [/quote]

Where did I say this?

Oh… I didn’t.

Again, if you LACK the mobility to move from anterior to posterior pelvic tilt then you probably want to gain this mobility. BUT IF YOU CAN DO THIS then doing EXTRA work for lumbar mobility is most probably not the best use of your time.

I agree completely with the idea of putting more work into thoracic and hip mobility. And with glute recruitment on squats.

[/quote]

Sorry, wasn’t trying to imply that you had said that. It was more of a retort to the popular notion these days that moving the spine through it’s normal range of motion is going to ipso facto cause injury; which seems to be the theory that the OP was questioning when he started this thread.

We are in total agreement it seems.[/quote]

What are you considering the spines normal ROM?

20

[quote]BHOLL wrote:

[quote]Sentoguy wrote:

[quote]alexus wrote:

[quote]Sentoguy wrote:
I disagree with the notion that the reason people injure their backs has anything to do with them having the ability to move their spine through a full ROM. [/quote]

Where did I say this?

Oh… I didn’t.

Again, if you LACK the mobility to move from anterior to posterior pelvic tilt then you probably want to gain this mobility. BUT IF YOU CAN DO THIS then doing EXTRA work for lumbar mobility is most probably not the best use of your time.

I agree completely with the idea of putting more work into thoracic and hip mobility. And with glute recruitment on squats.

[/quote]

Sorry, wasn’t trying to imply that you had said that. It was more of a retort to the popular notion these days that moving the spine through it’s normal range of motion is going to ipso facto cause injury; which seems to be the theory that the OP was questioning when he started this thread.

We are in total agreement it seems.[/quote]

What are you considering the spines normal ROM? And specifically the lumbar spine?