Correcting an anterior pelvic tilt

[Phitz]

My apologies ahead of time for the long post, especially since it's my first topic. This forum is so good, though, I've been able to find answers to all my other questions by just browsing through past threads! [img]smile.gif[/img] so I haven't had much to add until now...

I recently went googling for information on correcting postural flaws and came across the Neanderthal No More I-V series of articles at T-nation (link located below). The articles were incredibly informative, but now I've suddenly come from being “comfortably naive” about my posture to being greatly concerned.

Unfortunately, I fit the classic “Neanderthal” postural image including an anterior pelvic tilt (lordosis), moderate kyphosis, rounded shoulders, and internally rotated humeri (Please don't take me to be too intelligent, I'm just copy-and-pasting the big words from the website ). The excessive ladorsis of my lower back and the corresponding kyphosis is pretty obvious even to my untrained eye so I'm assuming I'm a fairly serious case. The most obvious flaw (the one that actually first led me to start looking for postural information) is the fact that my abdomen is pushed out farther forward than my chest even though I've always been lean with visible abs.

Now, obviously after reading the rather extensive description of all the problems that can develop from this, I'm extremely motivated to try and fix it. Before I start making drastic changes to my training routine though, I thought it best to seek the advice/opinion of the folks at this forum especially since my knowledge is based on just a few articles.

I'm currently in the middle of Phase 5 of the HGM series. I've made some incredible gains with HGM and really enjoyed it thus far, so you can understand if I'm hesitant to drop it half way through. Although, I do understand the importance of being proactive by fixing problems before others develop. In this case, I'm wondering if the wisest course of action would be to begin the corrective workout described in the T-nation article (link posted at the end). My questions initially are:

1) Is this condition serious enough to validate dropping the HGM series at this point and focusing entirely on corrective training (i.e. Workouts with focus on stretching antagonist muscle groups similar to that described in the article)?

2) Has anyone themselves, or known someone, able to correct excessive ladorsis or otherwise improve their posture by adjusting their training? If so, how long did it take before you could see some improvement?

3) Does anyone know of any resources were I can go for further information? Specific training and stretching programs would be very useful.

At any rate, I see myself with the following options:

1) Stick with HGM (perhaps slightly modified to target corrective areas) and add some stretches for antagonist muscles.

or

2) Drop HGM completely and start the T-nation workout and hope with blind faith that it's effective

or

3) Insert the T-nation workout as an extra 4-8 week “Phase” in HGM just to try it and get a better feel for what muscles I need to target.

At this point I'm motivated to fix the problem but definitely open to ideas. Any feedback or opinions you may have would be much appreciated!

Link to part IV of the article which includes the recommended workout: T-Nation Neanderthal No More, Part IV

[bryanc]

At the risk of violating the holy sanctity of T-nation, I am going to patently disagree with Mr. Cressey's approach to "static posture-fixing" (mostly with the dramatic alarmist description of what happens to you if you have these issues, and also with the purely visual assessment of posture).

HGM is a generally well balanced program that does not have a huge emphasis on any particular body part; or at least none that would seem to cause "unbalanced" development.

Remember that everything in the musculoskeletal system adapts to loading and stress. This includes hypertrophy and strengthening in response to larger loads, but also atrophy and weakening in response to smaller loads.

IF (and this is a BIG IF) your posture is entirely due to your workout program, then changing your workout program to something more "balanced" should fix your posture over time. For a simplistic and extreme example, let's say that you only ever bench pressed and as a result, your humeri were rotated forward while standing in a relaxed position. By adding something like seated rows into your workout and not increasing the weight on your bench press, you would, over time, "unrotate" your humeri.

So, simply by continuing to work in a relatively "balanced" program, IF your postural changes were a result of a faulty "unbalanced" workout, your posture should just correct itself. (i.e. Just stay on HGM)

HOWEVER, and unfortunately for most, posture is NOT usually an end-product of workout alone. Poor sitting posture while sitting at a desk for 8 hours a day (exaggerating the cervical lordosis and the thoracic kyphosis, and thus, internal rotation of the humerus) probably has more of an effect on the "neanderthal" appearance than 5 sets of bench press, 2 times a week. So instead of looking towards a magical pill called a "Neanderthal No More" workout, consider that you might make some excellent postural corrections simply by watching your posture in the activities you do _outside_ the gym, repetitively, every day, for hours a day.

And lastly, for your consideration--no one is anatomically perfect. The question you need to ask is whether the anatomic variation is something you need to be worried about--namely is your function impaired because of it? Certainly, poor posture CAN be a risk factor for future injury (though I can't imagine seeing a winging scapula as a result of "unbalanced training"), but static postural analysis (even if done properly with palpation of bony landmarks) is a poor prognostic indicator of positioning during activity--which is the REAL risk factor in terms of injury; except, of course, for injuries that happen spontaneously while you stand in a relaxed position (like impact with a falling airplane part, or sudden and catastrophic collapse of the floor, or other miscellaneous projectiles, natural disasters or, of course, spontaneous combustion).

[Rev]

whoa...awesome post... I have a little follow up question. I have a bit of a rotated humeri problem myself though my question is can this cause pain? More specifically, pain in the rear of the shoulder? It almost feels like its my rear deltoid stinging a little bit but it's more internal. This always gets to me on the days I do heavy over head presses, dips, and bentover rowing. I notice if I perform a bentover rear delt raise, the muscle contracting feels like the same muscle stinging. Which leads me to believe it is some sort of embalance possible caused by rotated humeri?

[bryanc]

I'll try to get your bigger question when I get home as opposed to trying to type out a longer response at school on my PDA.

Consider this one biomechanical experiment. It may be that your humeri are internally rotated, but I'm pretty sure you can probably rotate them in even more. So, with your humeri kept interally rotated in as much as possible, try to do the following (the key here is not to fool yourself in thinking you've rotated your humeri when all you've done is rotated your forearm at the elbow):

1) Get into a starting position for a military press--arms out to the side, in line with your body.

2) Try to do a reverse flye (rear delt raise) with some load.

3) Try to do a seated row movement.

Remember to keep the humeri internally rotated. But remember t hat you are allowed to rotate your forearm at the elbow (supinate, pronate) as much as you want.

[Rev]

Results

1) Ouch

2) Ouch

3) and Ouch

(note - only right shoulder is affected today as soreness is dying off for now. Performed tests with shoulders externally rotated as well, pain was not present. Felt way stronger with more upper back and medial deltoid activation with greater external rotation applied versus natural internal and exagerated internal rotated humeri.)

Also have forward head posture trait to a degree which may be linked to internally rotated humeri. Lower body posture testings come up normal. Thinking this is product of too much computer time. Hope this info helps, thanks again for helping me out.

[Phitz]

Thank you for that incredibly informative reply! I'm glad I posted these questions rather than blindly following the direction of a single source...

I agree that HGM is a well balanced program and feel happy with the reassurance that I can continue it without any major adjustments. Since I've not paid it much notice until now I wouldn't be able to place the exact period of time when my posture took this turn for the worse. It was certainly a long time before I started the HGM program though. Just a bit of history:

-Skinny and out-of-shape in high school.

-Discovered rock climbing in College at which point my strength increased dramatically especially in my back and arms.

-Started lifting weights to augment the climbing as well as hit the opposing muscle groups. Unfortunately, I hadn't found this site yet so my training program was pretty shabby. Your typical newbie work-out: chest day, arm day, shoulder day and back day with a 8-6-4-2 rep scheme, increasing weights. No legs to speak of but my pull-up routines were intense. At this point my lats were really strong but my legs were twigs. (Yeah, Yeah I can hear the snickering... but we've all been there before... right? )

-Started cycling (road bike) during the last few years, mixed in with the off-and-on upper-body workout. This brought my legs into the picture but I never did direct leg work in the gym until this past year.

-Last year I began my path to enlightenment when I picked up the Home Workout Bible, found the MH forum, escaped with the rest to JPs, read, read, and read some more. Now I've “found” my legs, am addicted to squats and deadlifts, fixed my diet, and am learning more and more each day on HGM...

I got your point that the real “root” of my postural problems probably has more to do with my daily habits of slouching in the chair and sitting in front of a PC at work. I wonder if the lack of fundamentals in the beginning as well as some unbalanced training, especially the large rift between my upper body and legs, tended to amplify the effects though.

So taking your advice, I'll stick with HGM in hopes that continued leg work will start to bring things back in order. Would there be any benefit to adding some targeted stretching? Considering the structures and muscle groups involved in keeping us upright, I'm guessing any postural changes are going happen over a long period of time. Will stretching the antagonist muscle groups help move things along a bit faster?

And most of all a focus on sitting up straight which, oddly enough, is harder than it sounds. (For all the time I spend sitting on my a** you think I would be good at it by now...) From information I've read, I understand that retracting the shoulders by squeezing the shoulder blades together along with a moderate tightening of the lower abs will bring the spine into the proper curvature when you are sitting.

It tends to feel more “posturely correct” when I do this, but is it really proper form? Feels like a dumb request, but if anyone has any “Sitting Guidelines” please let me know!

[bryanc]

Originally posted by Rev:
Results

1) Ouch

2) Ouch

3) and Ouch

(note - only right shoulder is affected today as soreness is dying off for now. Performed tests with shoulders externally rotated as well, pain was not present. Felt way stronger with more upper back and medial deltoid activation with greater external rotation applied versus natural internal and exagerated internal rotated humeri.)

Also have forward head posture trait to a degree which may be linked to internally rotated humeri. Lower body posture testings come up normal. Thinking this is product of too much computer time. Hope this info helps, thanks again for helping me out.

Okay, so I'm a bit underhanded. I'm not sure it's actually biomechanically possible to do most of those movements with interally rotated humeri with any degree of efficiency or without loss of proper form. Your body, regardless of its static posture, will naturally put itself into the most biomechanically advantaged position (for the most part) to most efficiently do work. Not all of these positions are good for you (e.g. arching your back to perform a heavy biceps curl) but internal rotation is not a biomechanically advantaged position if what you want to do it push a weight over your head as in a military press. This is also why static postural assessment is not necessarily the best way to assess risk-for-injury.

But, back to your question: can internal rotation be responsible for posterior shoulder pain? The cardinal rule in medicine is, "Never say never." (fittingly paradoxical for medicine). So, I won't say it can't be, but it seems bloody unlikely that it could be--particularly in the motions you describe, since it's also highly unlikely that you overhead press with humeri internally rotated (though it's remotely possible that you might rear flye with them interally rotated). But even if you do internally rotate your humeri through some of these motions, the main question at hand is, "Why would you get pain in the posterior part of your shoulder?"

So, anatomically, there's your deltoid muscle. Close to that area is the insertion of the trapezius. And under your deltoid is the supraspinatus muscle. And inferior to supraspinatus is infraspinatus. Now, I don't know where your pain is exactly, but if I was a betting man, I'd be putting money on one of those before considering rotated humeri as the root cause of your problem.

[bryanc]

Originally posted by Phitz:

I got your point that the real “root” of my postural problems probably has more to do with my daily habits of slouching in the chair and sitting in front of a PC at work. I wonder if the lack of fundamentals in the beginning as well as some unbalanced training, especially the large rift between my upper body and legs, tended to amplify the effects though.

So taking your advice, I'll stick with HGM in hopes that continued leg work will start to bring things back in order. Would there be any benefit to adding some targeted stretching? Considering the structures and muscle groups involved in keeping us upright, I'm guessing any postural changes are going happen over a long period of time. Will stretching the antagonist muscle groups help move things along a bit faster?

And most of all a focus on sitting up straight which, oddly enough, is harder than it sounds. (For all the time I spend sitting on my a** you think I would be good at it by now...) From information I've read, I understand that retracting the shoulders by squeezing the shoulder blades together along with a moderate tightening of the lower abs will bring the spine into the proper curvature when you are sitting.

It tends to feel more “posturely correct” when I do this, but is it really proper form? Feels like a dumb request, but if anyone has any “Sitting Guidelines” please let me know!

On the one hand, yes, a lack of "fundamentals" can cause "imbalance". But on the other, HGM is rooted in the "fundamentals" and as far as I can tell, you're not suffering functionally from your posture. So, I might ask you whether you're more bothered by the physical appearance of your posture rather than the actual functional consequences of it. Lower-to-upper body discrepancies in workouts are not a likely culprit in postural problems as these problems tend to be problems of side-to-side or front-to-back movement of posture, not up and down ones. Having weak legs might contribute to having a weaker lower back or weaker abs, which might affect lumbar posture, but I'm not convinced that it would necessitate significant thoracic or cervical curvature.

Stretching, independent from strength training, can be useful, but the benefit to posture depends entirely on whether you are actually inflexible (a length problem) or whether the muscles holding your posture in its place just have higher resting tone (a contractility problem) or whether the opposing muscles to the muscles holding your posture in place are weak (a strength problem). Stretching can address length problems and somewhat, contractility problems, but not really strength problems. Chances are, any postural variations you have are a combination of the three, so stretching in general (not just the antagonists) may have some benefit, or at least very little, if any, harm.

[Rev]

Thank you!

[Phitz]

Thanks for sticking with this post, Bryan, you've provided some really valuable information. (and my apologies again for the length! I'll try and keep it shorter and to the point from now on...)

On the one hand, yes, a lack of "fundamentals" can cause "imbalance". But on the other, HGM is rooted in the "fundamentals" and as far as I can tell, you're not suffering functionally from your posture. So, I might ask you whether you're more bothered by the physical appearance of your posture rather than the actual functional consequences of it.

For this I would have to say “yes” that physical appearance is definitely part of it. If correcting the lordosis and kyphosis pulled my abs, shoulders, chest and neck back into normal alignment I believe that would dramatically improve my physique. As was the main point of my original post though, I was also concerned with the increased potential for injury or other problems as the T-nation article so clearly detailed. Your first reply cleared that up for me, though.

On the topic of stretching, I'll have to admit that I'm probably the least flexible person that I know. But as far as I can tell the “stiffness” is equally distributed. If I understand correctly (in layman's terms) being equally inflexible would produce the same results as being equally flexible? It seems that, in order to narrow it down to a flexibility issue, it would take a much more in-depth study to find out where the subtle imbalances are. This is were I'm at a bit of a loss now... or am I just thinking about it too much at this point?

At any rate, now I understand your point that postural problems cannot be diagnosed by just a photograph!

[Bill Hartman]

Rev,

A quick test in regard to your posterior shoulder pain.

Hold your arms like a goal post...that is, upper arm straight out to the sides, elbows bent 90 degrees. Now move the upper arm forward about 30 degrees forward (the elbows get closer together).

Maintaining the same elbow angle, rotate your arm backward as if cocking to throw a ball.

Pain would indicate a possible internal shoulder impingement (the inside of the cuff is rubbing on the labrum) which is associated with excessive external rotation (and maybe anterior instability). It's very common in pitchers and overhead athletes and may also be indicative of poor scapular mobility/stability. If you scapula is tilted forward (not retracted and depressed) as you bring the arm back for exercises like an overhead press or bent over lateral raises, it will be painful.

Once it's aggrevated, just about any movement can be painful.

Bill

[Rev]

Hmmm, this doesn't cause any pain suprisingly.

Due to excessive slouching which I have done TONS of I notice my shoulders have rotation internally thus causing my shoulder blades to round and seperate. Yesturday I did heavy db shoulder presses and made it a mental note to keep my scapula retracted and my shoulders down, it seemed to help. Maybe your advice on bentover row isometric holds emphasizing retraction of the scapula will help with this? Do you see this issue as a muscle embalance problem, as my pressing muscles dominate my pulling muscles as of now?

[Bill Hartman]

Originally posted by Rev:
Maybe your advice on bentover row isometric holds emphasizing retraction of the scapula will help with this? Do you see this issue as a muscle embalance problem, as my pressing muscles dominate my pulling muscles as of now?

The isometric holds will help, but it still requires attention to technique. I wouldn't call it a muscle imbalance related to strength necessarily (but it could contribute), but rather a coordination/technique issue.

It's very common in shoulder patients to note very poor coordination of the scapular muscles. Even when you provide tactile cues to put them in a retracted position they frequently have trouble duplicating the correct scapular position or posture. It's a learning thing.

Bill

[Rev]

I really have no clue I'm blabbing away here aimlessly throwing out ideas but I really don't know anything about shoulder injuries. I just got back from the gym, db bench presses started things off. Feeling the shoulders again and I took note this time and paid attention. The main is like...in the front now.

DB Chest Press = Front shoulder sensitivity

Dips, Over Head Pressing = Rear shoulder sensitivity

I also realized this, I don't warm up that much. I do windmills first off before I lift upper body but I usually never do a lite warm up set and I'm doing 5x5 so I start off pretty heavy. Maybe I should do a couple warm up sets and work up to the weight. I will try to find articles on impingement and try to generally educate myself. Thanks for the help so far.

[Phitz]

Just an update and few added questions. In the time since my original post I've been focusing on sitting up straight and maintaining better posture as I go about my daily activities while continuing on with the HGM Phase 6 workouts. I really haven't noticed any change or improvement, although it has only been about 5 weeks. About two weeks ago I decided to add some stretching 1-2 times per day. The stretches are a mixture of those mentioned in the Neanderthal article as well as the BOM:

-Warrior Lunge Stretch
-Kneeling Hip Flexor Stretch
-Lying Quad Stretch
-Lying Hamstring Stretch (both grabbing the ankle as well as using a towel)
-Good morning Stretch
-Gluteal Stretch
-Lower Back Stretch (to be honest I haven't found a good one for this yet)
-Simple Chest and Lat stretches

All of these are executed in the traditional way: i.e. Extend until you feel a good stretch, stopping before it gets painful, and hold for 20-30 seconds. Again, it's only been two weeks so I'm not expecting any significant changes anytime soon.

Since I have begun this routine, though, I have developed an ache in the upper part of my back right in the spinal region between the scapulae, as well as some tightness in my neck

The ache in my back is most noticeable in the morning when I wake up. It will be painful as I lay in bed and then gradually go away when I stand up and stretch my shoulders and back out a bit.

My neck on the other-hand feels stiff pretty much all day. When I tip my head at an angle to the side I can really feel tightness in the muscles that run down the side (from the back of the skull, right behind the ear to the point where the upper trapezius meets the base of the neck). Also it's painful when I twist my head to the right (as if I want to look at something directly behind me). When I do this there is some pain and tension on the left side of my neck and a tender spot at the base of the skull. Oddly enough, I don't feel any pain when I look to the left.

Again, it's not a sharp pain like an injury, and I don't recall one event in particular that would have caused it. It just came on in the last 4-5 days.

I guess my biggest concern is that all of those years of bad posture and horrible neck position (and cracking) has created some damage that is now rearing it's ugly head as I try to correct it...

I'm not sure at this point if it's something I need to check out or just wait and see if it gets better. If my spine is going through some postural changes is it normal to get some aches and pains as all the bone structure, connective tissues and surrounding muscles adjust?

[Flee]

Phitz,

I will reluctantly make a suggestion with all the great minds contributing on this thread. I have long suffered from many of the structural imbalances and resulting symptoms that you are describing. However, mine issues were exaggerated due to high body fat content and poor muscular developement. These combinations created CHRONIC back problems and pain.

I mention all this so I can bring up a possible resource, a possible answer to your delima. It comes in the form of a book and I ask Bryanc and Bill H. to validate this resource. It's called Core Performance, by Mark Verstiggen.

What I learned is that my postural issues and resulting back pain, was due to many factors. The first being a poor postural existance, standing and seated at the computer for hours on end. Coupled with POOR core strength and POOR core flexibility.

My assessment is that you have core muscular issues and flexibility issues that are going to require specific training to correct. His movements are unique and will challenge you in a way that you have never been challenged before.

Consider the possibilities that this journey might afford:

Core Strength - I am a cyclist as well. I can tell you that core strength dramatically improved my riding endurance WITHOUT any additional riding. Why? Because my legs pump against a more structurally sound, stable platform, which equals more power.

Better Balance - Helps in LIFE. Also aides any athletic activity that you choose, cycling included.

Higher ceiling for muscular developement - Your poor posture, poor core strength, poor core flexibilility are creating a false ceiling in your true potential. IE: You build an incredibly stable, strong, flexible, elastic core, then you can lift heavier weights more safely. So you can get bigger and stronger and most importantly, it will be functional strength.

Helps prevent injury. Extremely important when you want to start lifting heavier weights as well as sports applications.

Improve muscle recruitment patters. The truely knowledgeable people will tell you that this is highly important.

Developement of postural muscles. Makes perfect posture more and more unconscious. Thats your goal right? To fix these postural abnormalities that you are seeing?

I can't tell you what this book has done for me. The list is so long it would triple the length of this post. I would be suprised that anyone could argue developing your perfect posture, before a serious strength training routine. It will maximize your benefits and reduce possibility for injury.

I know this is long....but I could go on and on about it's benefits. I can answer most any question you have about the program.......the book is sitting right here! :-D


Ryan