Updated: Sep 23, 2020
Hello everybody, as you may well have noticed, we often blog about back pain and that’s because its such a common issue and in most cases, actually very easy to improve. So, here we go once again, but looking at things in a slightly different way to some of our previous blogs. 😀
In the past we have talked about poor strength and poor activation of the spinal and pelvis stablisers, we have identified exercises and approaches that can help with these so you can always compliment this post with a quick trawl back through previous blogs.
What we have not really looked at before is understanding why the postures resulting from any weakness in these muscles give rise to certain problems.
What problems can arise from weak back muscles?
Well the answer to that is…many! but, let's start with the anterior pelvic tilt. This is so common these days that almost everybody is displaying one. Here is a rough and ready way you can check for yourself if you have an anterior pelvic tilt: roll up your shirt so you can see your midriff and then stand side on to a mirror, now look at he way the waist band of your trousers, shorts, underwear or leggings sits. In most people the waist band will sit on and therefore follow a horizontal line across the Iliac Crest of the pelvis, if you have an anterior tilt then the waist band will slope downwards, i.e. higher at the back and lower at the front. There are very few garments designed to sit like this on purpose so it is relatively indicative that you may indeed have an anterior pelvic tilt.
An anterior tilt is indicative of poor pelvic stabilsation and of overly tight hip flexors, often from significant amounts of sitting, but what back problems does it bring with it and why?
So, what back problems can an anterior pelvic tilt cause?
Well our spinal column is designed to load in compression, or put another way one vertebra directly stacks on top of another. The first problem that an anterior pelvic tilt creates is create an exaggerated curve in the lumbar spine which results in the vertebra sitting at a sloping angle. This sloping angle increase sheer forces in the spine whilst reducing the natural compression force.
This results in pain as the muscles of the back desperately try to control these unnatural forces in a way they were never designed to do. Not only can you experience pain from incorrect and overuse of the back muscles but also the pain and sensation that the brain experiences is also unfamiliar, so what might normally be a mild pain can be completely misinterpreted by the brain as complete agony.
What other back problems can an anteriorly tilted pelvis create?
The second thing this increased curvature of the spine does is bring the transverse processes closer together. This in turn has three undesirable effects:
1) The holes that the nerves exit from the spine (Neural Foremen) to serve the body become closer together so effectively become smaller. This can compress the nerves as they leave the spine, giving referred ‘sciatic’ pain into the backside or the leg.
2) It brings the facet joint closer together which can lead to osteoarthritis. The facet joint are the point of the spine that has bone on bone (cartilage on cartilage) contact and allows for actual bending and twisting movements to occur. Additional pressure through theses joint can give rise to pain and in the longer term osteoarthritis.
3) The muscles that span from the pelvis to the spine and to the ribs shorten. These muscle lower you forward and then pull you back upright, such as when bending over to open a low drawer. This shortened position leaves them very tight and therefore, vulnerable to muscle strains. Additionally it also means that when you do bend forward, say to wash up that the muscles come under almost immediate strain and can make everyday actions almost impossible due to the resulting pain
Now, that’s an awful lot of things, just because your pelvis has tilted. Therapists can, however, straighten the pelvis out and give exercises can help to stop it happening in the future. 😀
But, I have been told I have Posterior pelvic tilt!
Indeed this can occur too and as a whole the global effect on the spine is similar to that of an anterior pelvic tilt in that the spinal column moves away from loading in its natural compressive state.
Locally, however, the resulting issues can be quite different. In this position the holes for the nerves and the facet joints are actually opening up…sounds great given what we just said about the anterior tilt closing them down. But, a posterior pelvis tilt results in is a flattening of the natural lumbar curve and with that comes a rather unpleasant secondary issue:
The intervertebral discs begin to bulge backwards, this can weaken them and result in anything from a bulging disc that presses on the nerve in certain positions to a fully prolapsed disc, traditionally but incorrectly, referred to as a ‘Slipped Disc”
Can my pelvis tilt sideways?
It certainly can and it can also horizontally rotate out of position too. Funnily enough the end result of this and of any pelvic misalignment is an uneven loading of the spine away from it natural position which will affect either, disks, nerve or joints…are you noticing a theme here?
I know you are getting bored now so I probably don’t really need to expand any further.
Could I have slipped a disk?
That is, of course, what everybody worries about when back pain hits, especially if there is referred pain into the leg. Well, we only need to look at all of the issues we have highlighted above and how a simple misalignment can easily give rise to pain that easy to mistake for, or assume is this kind of injury or many other back injuries. So, in many cases no you probably have not slipped a disk but this is where getting the issue looked at becomes important.
There are a number of tests that can identify and differentiate between the causes of similar feeling types of back pain. But, if your pelvis does not sit level (remember the looking in the mirror trick we mentioned earlier?) Then have this checked before you start to worry too much about something that just may not be there.
So, I shall sign off from this blog by just highlighting that all these issues are readily fixable and in particular, here at the Reinge Clinic, with an emphasis on making sure that it never returns. Because the long term permanent fix is our specialism.
The Reinge Clinic is a Physiotherapy, Sports Therapy, Sports Science clinic based in Kenilworth, Warwickshire and Portishead, Bristol. Take a look at our facebook page for our pain, injury and exercise advice posts and learn more about us on our website.