Is pelvic floor pain more common in individuals with an anterior pelvic tilt?
Pain is an unpleasant sensory and emotional experience which can have dramatic social implications on someone’s life when not managed well or resolved.
This can be especially true for pelvic pain…
It’s a common school of thought to view an anteriorly positioned pelvis as unhealthy or “non optimal”. The question is, why do we have the ability to anteriorly rotate the pelvis in the first place if it’s so unhealthy?
There are two ways you can position the pelvis anteriorly.
Anterior translation - pushing the pelvis forward which creates hip extension. What’s interesting about anterior translation of the pelvis is although it’s a forward motion, from the femoral head point of view, the pelvis has posterity tilted. This means that anterior translation is a forward moving pelvis in a posterior tilt.
Anterior pelvic tilt - the pelvic bones rotating forward over the femoral heads covering the anterior portion of the femoral heads, meaning the femurs need to relatively posteriorly rotate (moving into hip flexion).
The many combinations in which you can organise your femoral heads and pelvic bones is what’s needed for our upright walking to be so successful.
Because we only have two legs to walk with (and you’re on one leg for most of the gait cycle), you need to have an adaptable pelvis to manage such a challenge balancing act.
How this typically works out for the pelvis in daily life scenarios is that one end of the pelvis is more anteriorly positioned whereas the other is posteriorly positioned, creating a “functional twist” which needs to have the capacity to “untwist” and “twist” again.
So what does this all mean for pelvic floor health?
A study in 2021 (reference at the bottom of this article) included two groups of individuals:
121 women with urinary incontinence and pelvic floor pain.
113 women with urinary incontinence without pelvic floor pain.
The study wanted to find out if the pelvic floor pain group adopted a different posture in comparison to the non pelvic floor pain group.
The study found that women with urinary incontinence and pelvic floor pain displayed greater levels of anterior pelvic tilt.
This might lead some to conclude that an anteriorly rotated pelvis is causing or contributing to the individual’s pain symptoms. However, the adopted pelvic posture might be more of a compensatory pattern to help manage pain symptoms than a stressor causing or contributing to pain...
When the pelvis is anteriorly rotated, the pelvic outlet (the “space” between the sit bones, pubic bones and coccyx) widens, “lengthening” the pelvic floor muscles. The “lengthening” of the pelvic floor muscles may be a strategy to help alleviate pain / discomfort at the pelvis.
Although this may be more of a compensatory response and not the cause of pelvic floor pain, if an individual is stuck in an anterior pelvic tilt or is afraid of moving away from an anterior position, this can lead to movement restriction and further discomfort later.
A pelvis that is potentially stuck in an anterior pelvic tilt will struggle to fully posteriorly tilt which we’ve discussed earlier is important for walking and daily movements.
My personal approach when working with individuals who experience pelvic floor pain is to make sure they can move the pelvis in all three dimensions, not just in a standing position but also in the difference phases of gait.
As the femurs are rarely in the same orientation as the pelvis is rotating, it’s helpful to recreate these scenarios when moving the pelvis in class.
If you or your clients struggle with pelvic floor pain (or pelvic restriction in general), give the following exercise a try:
Take one leg forward and one back into a lunge position (no bigger than a walking stride).
Bend the forward knee slightly (20 degrees) and keep the back straight.
The forward hip will be in flexion while the back will be in extension, meaning forward pelvic bone is anteriorly positioned while the other is posteriorly positioned, the “functional twist”.
The pelvis as a whole will be rotated towards the back leg.
From this position, tilt the pelvis forward and back over the femurs and make sure your client is able to move both ends in the same direction (they won’t move equally which is normal).
Repeat for 10 reps before changing sides.
The aim of this simple exercise is to experience the pelvis rotating forward and back from an asymmetrical starting point, letting the joints fully express their capacity to move at alternating angles.
This can hugely benefit the tone of the pelvic floor as the floor will be moving with the pelvic bones, changing their tone to accommodating the change in position of the bones.
So although this particular study showed a higher level of anterior pelvic tilt in those with pelvic floor pain, this doesn’t mean an anterior pelvic tilt is to blame for their symptoms.
Instead of focusing on “standing neutral” ask yourself, how else can I move the pelvis that would benefit the tone of the pelvic floor (especially if the pelvis is stuck forward) and do the joints have the capacity to fully move?
Let the resting posture be what it is, we all aren’t designed to stand in the same place and for most of the population, standing in anterior tilt is normal and healthy.
If you’re wanting to improve pelvic floor health for yourself and your clients, I teach an extensive online 6 week programme on everything to do with creating a strong, flexible and supportive pelvic floor, improving continence and confidence!
Click here to find out more about the Fit Floor Support For Life programme which is starting THIS MONTH!
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Movement is medicine
Tom
Study reference:
Reis, A.M., Brito, L.G.O., Teixeira, C.P.F., de Araújo, C.C., Facio, F.A., Herrmann, V. and Juliato, C.R.T. (2021). Is There a Difference in Whole Body Standing Posture in Women With Urinary Incontinence Based on the Presence of Myofascial Dysfunction in the Pelvic Floor Muscles? Physical Therapy, 101(10). doi:https://doi.org/10.1093/ptj/pzab171.