Pelvic tilt plays a major role in whether an athlete experiences back pain. When the pelvis is aligned in a neutral position weight is distributed and balanced evenly upon the vertebrates and discs of the spine. As a result, injury is less likely. If the pelvis is tilted forward or backwards, the spine is placed in a mechanically disadvantaged position. Individuals whose pelvis tilts either forwards or backwards are therefore more likely to experience back pain due to excessive pressure and muscle imbalances that occur with pelvic tilt abnormalities. Therapeutic exercise and treatments can decrease the back pain resulting from pelvic tilt.
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Pelvic tilt occurs in the sagital plane, meaning the pelvis may either tilt forwards or backwards. Forward tilt of the pelvis involves the hip, or iliac, bones rotating forwards. Also known as anterior tilt, this condition is usually accompanied by excessive lordosis of the spine. Lordosis is a condition in which the spine arcs backwards creating a hollow cavern in the low back area. Some lordosis occurs naturally in the lower back or lumbar region of a neutral spine.
Posterior, or backwards tilt, is the opposite of anterior tilt. The hip, or iliac bones, are rotated backwards in this condition. Posterior tilt is usually accompanied by excessive kyphosis of the spine. Kyphosis, the opposite of lordosis, involves a rounding or slouching of the lower back resulting in more of a hump in the lumbar region of the spine.
Excessive kyphosis or lordosis in the lumbar region of the spine results in a widening or narrowing of the intervertebral foramen. The intervertebral foramen is the opening through which nerves exit from the spinal cord to innervate muscles and return sensory signals from the appendages. If the nerves exiting the intervertebral foramen are impinged, or pinched, nerve pain or loss of muscle control can result. According to Chris Gellert, MPT, anterior pelvic tilt may compress the dura and blood vessels of nerve roots, potentially creating lower extremity nerve problems. While pelvic tilt does not always create these conditions, improper spinal patterns are more likely to present pain due to the mechanical disadvantage tilt places the spine in. For this reason spinal loading exercise is contraindicated by pelvic tilt. Additionally, excessive tilt is usually accompanied by improperly balanced muscles that are either excessively lengthened or shortened. Discomfort is a result of muscle imbalance in many with pelvic tilt.
Several forms of therapy may be used to treat forms of excessive pelvic tilt. Stretching of overly strong and shortened muscles is often used as a form of treatment, as is strengthening weak and excessively lengthened musculature. The hip flexors, glutes, hamstrings, lower back and abdominals are the main muscles treated to affect pelvic tilt. Massage and physical therapy also are often employed to treat excess tilt.
Scoliosis also can occur when the pelvis tilts laterally towards one side due to a shortened leg or tightened torso musculature. Scoliosis involves both lateral flexion and rotation of the spine that places unnatural force on the discs and nerves emerging from the spine. Quite often those with scoliosis experience a lack of nerve feedback in areas of their body due to scoliosis. According to the NSCA, those with scoliosis should avoid loading their spine with excess weight to prevent injury.