Name: Anterior Pelvic Tilt Break Down (Workshop Snippet)
Uploaded: 2023-04-26T01:01:17.000Z
Duration: 12 min 41 s

English captions

https://stream.mux.com/VTJaVdVSRgXaG4007omfCJKlR3aWlgkLup01XZRuQktQw.m3u8

Learn how to identify, understand, and address anterior pelvic tilt in this comprehensive workshop snippet from the Brookbush Institute. This evidence-based video provides expert guidance on recognizing postural characteristics, understanding common muscular and movement-related contributors, and applying effective exercise strategies to improve pelvic alignment and lumbopelvic control. Develop a clearer framework for correcting anterior pelvic tilt to enhance movement efficiency, reduce injury risk, and support optimal performance. Perfect for clinicians, fitness professionals, and athletes seeking to refine postural assessment skills, inform corrective exercise programming, and improve functional outcomes.

Understanding the Overhead Squat

Corrective Exercise Principles

Addressing Anterior Pelvic Tilt

Exercises for Muscle Lengthening

Strategies for Strengthening underactive Muscles

Navigating Muscle Confusion in Mobility and Strength

Anterior Pelvic Tilt Break Down (Workshop Snippet)

So how'd you do on your overhead squat? You did okay? Did everybody kind of get it? It's not all that complicated right? It's not like, 'oh my god I see 800 things, this turn,  that flex, that extension,  ahh!'. It's not that bad. It's not that bad, at least in this area. At this level we need to set a foundation, we need to get good at seeing a few things, and then it's just like layers of an onion. Well add layers. Let's get good at one layer at a time though, you know, before we totally confound this thing to include a bajillion different joints and all of these different muscles, and all of these different things that can happen. Let's stick to feet turn-out, what's happening at the knees, what's happening at the hips, do we have an excessive forward lean, do the arms fall forward. You got that? Good. Now, the question is what we do with that information. You have seen this. Yes, this is your solutions table. Probable overactive muscles. What do we do to overactive muscles? Before we stretch them, what do we do them? Foam roll. We foam roll them. So you foam roll and stretch these. Then these are some exercises to help increase the activity of our long muscles. So, all it is, is short muscles on this side, long muscles on this side. Release and stretch short muscles, activate and integrate long underactive muscles. Does that make sense? Ok, so these are the short muscles we're going to stretch and release them. That makes sense, right? If a muscle is short we want to do what to it to get it to optimal length? We want to lengthen it. And if a muscle is long, we want to do what with it? Shorten it. Which we're going to do by increasing it's activity, by working it. Are you with me there? Now, I know this probably seems a little, what's the word I'm looking for...? It probably doesn't make a whole lot of sense just laid out in this format. This is the K.I.S.S. version. Anyone know what K.I.S.S. is? Keep It Short and Simple. Alright, so this is the Keep It Short and Simple version, you could memorize this and you would be well on your way to understanding corrective exercise, but I am going to take you through at least one or two solutions, to show you how the math works out, I don't want you to think this is rumor. There is a logic behind this. So, I'm going to show you how to work this out, then maybe you can work out a couple others on your own. Let's start with an anterior pelvic tilt: APT, Anterior Pelvic Tilt. The first thing we need to do is figure out what joints are involved in an anterior pelvic tilt. Hips and lumbar spine. So you've got your hips, and your lumbar spine. Now, next thing we have to do is  we have to figure out what joint actions happen to get us from neutral to an anterior pelvic tilt. Are you with me? So when I went from neutral to anterior pelvic tilt what joint actions just happened? Let's start with the hip. Hip... Flexion, ok, so hip flexion. What happened at my lumbar spine? Extension. The hard part's over. Give yourself a big round of applause the hard part's over. If you can get that far the rest of it is just simple, I don't want to say math, because I know math scares people, but it's like simple fill in the blank. What are my hip flexors? Psoas. Keep going. Iliacus. You've got to two more and a group that's assisted with it. Not pirifomis, it's not on the right side. Adductors as a group can. What about the muscle in your quads? Isn't there a muscle in your quads that can hip flex. You all do do your quad stretch like this, right? No, like this right, you go into extension. The rectus femoris,  and we're missing one other nasty little bugger. You'll probably foam roll it later. It uses the IT band as it's tendon. The TFL. Tensor fascia latae. Those are my flexors. What are my lumbar extensors? Your erector spinae, and one more big one that most people don't think of as a low back muscle, your lats, thank you. Those are all of your short muscles. That's it. That wasn't bad, right? I mean how many of you did I just scare to death with functional anatomy, raise your hand? Let me make one more thing clear, because I want everybody to pass their exam, if you can't do that, if those muscles don't look familiar to you, you need to go home and study. You cannot pass the exam without knowing your functional anatomy. I'm not saying that to be mean, I'm saying that because I care. I want you to pass. Now, what are we going to do with these muscles that are short? We're going to release and stretch. The only discrepancies you see in your solutions table, come from things that either we can't release, like can you release your psoas and iliacus yourself? Can you foam roll your psoas and iliacus. No. Your psoas is underneath your abdominal wall, connected to your lumbar spine going down your lesser trochanter, your iliacus is on the inside of your pelvis. You can try to hit it with a foam roll, you're probably going to squish a lot other stuff though. Don't squish other stuff. Just write that down, don't squish other stuff. So when you see something like, you don't see - I'm sorry where are we here - low back arches, you see hip flexor complex, you don't really see individual hip flexors, it's because some of them can't be gotten. Can we foam roll our TFL? Yes. Can we foam roll our rectus femoris? Yes. Can we foam roll our adductors? Sure. When we stretch our hip flexors, how do we do it? The kneeling hip flexor stretch, you've all seen this before, like the NASM, everybody's like oh, this is the NASM hip flexor stretch. So that one knocks out a bunch of them. How do we stretch your adductors? What I'm saying is, when you get to your programming, and you see examples it's the same as this, don't get scared and think why did they put that, and not that? It's probably because they listed this out, but this they couldn't release, so they release what they could.  They picked the stretch that hit all three of these, so we don't need to write them out individually. Are you with me? And then how do we stretch our erector spinae and lats? Our Child's Pose. It's just easier, it takes less equipment and you get a nice little back stretch out of it too. How many of you guys do yoga? Tell me Child's Pose just doesn't feel awesome? So, how do we get long muscles? How do we figure out what our muscles are that're long? It's the opposites. So, now what we're going to do is hip extension, lumbar flexion, then we have glutes, and we have, rectus femoris,  you could put hamstrings up here as long for hip extension, but then what does lumbar flexion? Rectus abdominis. Who else? The obliques. And then just a little secret, how many of you have heard of your TVA? Anybody heard of their TVA? Draw-in, transverse abdominus activity. Anytime you have postural dysfunction that involves the lumbo pelvic hip complex, your TVA is going to shut down. It might not get long or short, so to speak, what would lengthening of the TVA look like? Abdominal distension. This is TVA lengthening, a very sexy look. So when you see abdominal distention that's lengthening of the TVA. What are we going to do with these muscles? Strengthen them. So we go over here, low back arch, and we see prone iso abs. Would that be effective for these? That's a plank, for those of you who don't know. Why we can't call prone iso ab at NASM a plank, I have no idea. But it's a prone position, isometric abdominal exercise, that everybody else know's about.  So, prone iso ab with opposite arm leg raise, that would be good: hip extension, glute activity, takes a lot of stabilization, takes my TVA holding my lumbar spine segmentally in place. Bridges, what're bridges good for? Glutes. Hopefully more glutes than hamstrings. I will say this about hamstrings. Your hamstrings are long and overactive. That's weird, right? They should be long and under active, but they're not, they're long and overactive because they become synergistically dominant for an inhibited glute complex. You know what we do with long and overactive muscles? Nothing. They're confused. Will you stop being confused, hamstrings? I'll deal with you. You get what I'm saying? You can release them a little bit. If you want to foam roll because they're really sore, and they feel really neuromuscularly  tight, fine. Don't stretch them though. And if you strengthen them, you're only going to make them more synergistically dominant. So don't strengthen them either. Leave them alone. Does that make sense how I got here? Kind of? I know some of you need to go back and study your anatomy, but can you see the logic at least?

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Integrated functional anatomy of the tensor fascia latae (TFL) and IT band. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common foam rolling, injury prevention, and stretches for the TFL.

Tensor Fascia Latae (TFL)

 to indicate the objective of the assessment or the signs you are attempting to identify. We do not want the client/patient attempting to "fix" their alignment.

Ask your patient/client to stand with feet hip-width apart.

Because a patient/client may assume a range of comfortable foot positions, it may be necessary to cue and manually adjust foot position so that the OHSA is started with the ideal foot position (or as close to the ideal foot position as can be achieved).

Ask your patient/client to reach "straight up over their head" with "elbows locked".

Ask your patient to "sit down" and "stand up" as many times as necessary to assess for the "signs of dysfunction".

 For those who do not know how to squat or may be at risk of falls, this can be done with a chair, and thought of as a "sit-to-stand transfer assessment".

 For advanced exercises and athletes who may "know what a squat should look like", it may be helpful to have them close their eyes, reducing visual input and their ability to self-correct

 It is tempting to start noting every "deviation" based on a personal frame-of-reference of squat form. The only signs that have been correlated with dysfunction and successful intervention are the signs discussed below. Adding additional signs to the assessment, however well-intentioned, may serve to invalidate the assessment, reduce assessment reliability, or reduce the relative efficacy of the implied interventions.

As mentioned above, this assessment is designed to highlight deviations from ideal motion with the intent of informing intervention selection. It may be helpful to review the definition (discussed above) of 

Evidence-based Ideal Posture/Alignment Definition:

 A mean range of segment alignment (bone, joint, muscle, nerve) that is absent of signs correlated with dysfunction, pain, or an increased risk of injury.

The ideal alignment described here is similar to what may be anticipated during a static postural assessment or gait assessment. However, additional details have been added to aid in differentiating between ideal motion and the deviations discussed below.

 Ideal alignment includes feet parallel (2nd metatarsal and toe pointing forward), hip width, and the medial longitudinal arch maintained. That is, the 2nd metatarsals (center of the foot) are parallel, in alignment with the hip joints which are inferior to the anterior superior iliac spine (ASIS), and significant inferior motion of the navicular tubercle is not observed.

Although the neck of the femur extends the greater trochanter laterally and gives the appearance that the hip joints extend to the lateral thigh, the hip joints are only about 7" apart (6). This is about the same width as the ASIS, and the hip joints are in fact, just inferior and in near alignment with the ASIS. Because the hip joints cannot be palpated, the ASIS are used as the reference for hip width.

 The knees should maintain alignment with the hip joint and ankle joint. If optimal foot position is maintained, the anterior and posterior motion of the patella during the squat should align with the 2nd and 3rd metatarsals.

 Ideal alignment includes an optimal lumbar curve, ASIS just inferior to the level of the posterior superior iliac spine (PSIS) (within 2 cm), and the right and left iliac crest level.

During the lateral view of the OHSA, the intersection of the mid-axillary line, and a line between the ASIS and PSIS should be near 90º.

 The tibia and the mid-axillary line should maintain near-parallel alignment during a squat.

 Ideal alignment includes depression and retraction of the scapula. Shoulder flexion should be achieved via upward rotation and posterior tipping of the scapula.

 Ideal alignment is maintaining the arms in alignment with the torso with elbows at terminal extension. That is, 180º of shoulder flexion should be maintained.

Anterior Pelvic Tilt Break Down (Workshop Snippet)

Overhead Squat Assessment 16 - Sign Clusters: Posterior Pelvic Tilt ("Butt Wink") and Inadequate Forward Lean Breakdown

Overhead Squat Assessment 11 - Shoulders Elevate

Overhead Squat Assessment 10 - Arms Fall

Overhead Squat Assessment 9 - Anterior Pelvic Tilt (Excessive Lordosis)

Overhead Squat Assessment 8 - Excessive Forward Lean

Overhead Squat Assessment 7 - Knees Bow Out

Overhead Squat Assessment 6 - Knees Bow In Breakdown

Overhead Squat Assessment 5 - Feet Turn Out Breakdown

"Feet Turn Out" Breakdown

Overhead Squat Assessment 4 - Feet Flat Breakdown

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