Faulty Alignment of the Pelvis

When helping clients dealing with lower back pain, I always consider how the position of the pelvis is affecting the lower back.

After reading this article you will understand why road cyclist can develop lower back pain.

This article is going to be focused on what is referred to as the lumbo-pelvic-hip complex.  

The major joints involved are the sacroiliac joints, pubic symphasis and the hip joints.

There are about 29 major muscles that influence this part of the body, but, we will only focus our attention on the muscles that are most likely to distort posture and cause pain. 

The muscles of importance are the psoas major, quadriceps, hip adductors, erector spinae, lumbar multifidus, quadratus lumborum, gluteals, hamstrings, rectus abdominus, external obliques, internal obliques, and transverse abdominus. 

The pelvis can assume many types of malalignments in different planes, but we will only focus on pelvic alignment in the sagittal plane. The most common deviation seen is accessive anterior pelvic tilt. This faulty alignment can be seen in the picture below. 

 

Now lets look at the common tight muscles in this misalignment
The short/tight muscles include:

 

• Psoas major, which by its anatomy can cause increased lumbar extension and hip flexion, causing the pelvis to tip anteriorly. 
• Quadriceps, particularly the rectus femoris, which also contributes to hip flexion.
• Lumbar erectors, which cause lumbar extension.
• Quadratus lumborum, if bilaterally tight, can cause increased lumbar extension.
• Hip adductors, anterior pelvic tilt results in internal rotation of the femur. This will shorten the adductor musculature.

The long/inhibited muscles include:

 

• Gluteus maximus, which causes hip extension and opposes the psoas major.
• Hamstrings, this muscle can be tricky, It may be weak but appear tight simply because it is a synergist to the gluteus maximus and may be compensating.
• Deep abdominal wall, this includes the transverse abdominus, and internal obliques which may become inhibited due to facilitated lumbar erectors.

The main contributor to anterior pelvic tilt is usually the psoas major. If the psoas major is tight, it can disrupt the muscle balance relationships of the entire postural chain. When the psoas is tight, it pulls the pelvis into anterior tilt, thereby increasing hip flexion and shortening all hip flexor muscles. Since the psoas has its origin on the lumbar spine vertebrae, when it shortens, it pulls the spine into extension. This causes the lumbar erectors and quadratus lumborum to shorten. The short/tight muscles can inhibit their antagonists. 

The gluteals, which contribute strongly to hip extension, will be inhibited by the psoas, causing the hamstrings to pick up the extra force. The deep abdominal wall will be inhibited by the lumbar erectors, and their synergist, the psoas major. 

Due to the neurological connection, other muscles in the deep stabilization mechanism may become dysfunctional. This may include the pelvic floor and lumbar multifidus.