How Pelvic Tilt Influences Hamstring and Spine Mobility

how pelvic tilt influences hamstring and spine mobilityHow many people come to you and complain that they have tight hamstrings?  It seems like an epidemic sometimes, right?  I know it’s pretty common for me, at least.  

Many people just tug away at their hamstrings and aggressively stretch, which may not only be barking up the wrong tree, but also disadvantageous.

I have really gotten away from blindly stretching the hamstrings without a proper assessment, as I feel that pelvic position is often the reason why people think they are tight.  This is pretty easy to miss.

In the video below, I want to explain and help you visualize the how pelvic tilt influences hamstring mobility and spine position.  Often times the hamstrings feel “tight” or “short” when in reality their pelvic position is just giving us this illusion.  I talk about this a lot with clients at Champion and often find myself making these drawings on our whiteboard.

Keep this in mind next time you think someone has tight hamstrings or has too much thoracic kyphosis.  Often times the key is in the hips!

 

How Pelvic Tilt Influences Hamstring and Spine Mobility

 

Strategies for Anterior Pelvic Tilt

If you are interested in learning more, I have a couple of great webinars for my Inner Circle members that you may find helpful:

Hip Variations and Why My Squat Isn’t Your Squat

Today’s article is an AMAZING guest post from my friend Dean Somerset.  I’ve been talking a lot lately about how hip anatomy should change your mechanics and why exercises like squats should be individualized based on each person, but Dean blows this topic out of the water with this article.  If you love this stuff as much as I, check out the link at the bottom for Dean and Tony Gentilcore’s new program, The Complete Shoulder & Hip Blueprint.  This is just the tip of the iceberg of what is covered in the program.

 

Hip Variations and Why My Squat Isn’t Your Squat

In a recent workshop, I had a group of 50 fit and active fitness professionals and asked them all to do their best bodyweight squat with a position that felt good, didn’t produce pain, and was as deep as they could manage. As you can imagine, looking around the room produced 50 different squats. Some were wide, narrow, deep, high, turned out feet or some variation all of the above.

Did these differences mean there was a standard everyone should aim for, and those who weren’t there had to try to improve their mobility or strength or balance in that position? Maybe, but there’s probably a bunch of other reasons as to why 50 people have 50 different squats.

A standard requirement for powerlifting is to squat to a depth that involves having the crease of the hips below the vertical position of the knee. That’s probably the only known requirement for squat depth out there. The universal recommendation of “ass to grass” depth being the best thing since sliced bread may sound nice on paper (or in Instagram videos or Youtube segments), but it might be something that’s relatively difficult for some people to achieve, and for others it could be downright impossible, regardless of how much mobility work or soft tissue attacks they go through. The benefits of a deep squat seem to only be reserved for those who have the ability to express those benefits by accessing that range of motion without some other compensatory issue.

Let’s just consider simple stuff like anthropometric differences between individuals. Someone who is taller will have a bigger range of motion to go through to hit a parallel position than someone who is shorter, and someone with longer femurs in relation to their torso length will have a harder time maintaining balance over their base of support compared to someone who has shorter femurs. A long femur could be any femur that comprises more than 26% of an individual’s’ total height. So someone who is tall and long femured will have trouble getting down to or below parallel due to simply having the limb lengths to allow the bar to stay over the base of support during the squat motion without losing balance one way or the other.

Not as commonly known is the degree of retroversion or anteversion the femoral necks can make. The shaft of the femur doesn’t just always go straight up and insert into the pelvis with a solid 90 degree alignment. On occasion the neck can be angled forward (femoral head is anterior to the shaft) in a position known as anteversion, or angled backward (femoral head is posterior to the shaft) in a position known as retroversion. Zalawadia et al (2010) showed the variances in femoral neck angles could be as much as 24 degrees between samples, which can be a huge difference when it comes to the ability to move a joint through a range of motion.

hip variations squat

The acetabulum could itself be in a position of anteversion or retroversion, and this difference itself could be more than 30 degrees. This means the same shaped acetabulum would give someone who has the most anteverted acetabulum 30 extra degrees of flexion than someone who had the most retroverted acetabulum, but would give them 30 degrees more extension than the anteverted hips.

There’s also the differences in centre-edge angles, or the angle made from the center of the femoral head through the vertical axis and the outer edge of the lateral acetabulum. Laborie et al (2012) measured this angle in 2038 19 year old Norwegians, and found that it ranged from 20.8 degrees to 45.0 degrees with a mean of 32 in males and 31 in females.

hip anatomy squat

Now to throw even another monkey wrench into the problem, there’s the simple fact that your left and right hips can be at different angles from each other! Zalawadia (same guy as before) showed that the angle of anteversion or retroversion of the femur could be significantly different from left to right, sometimes more than 20 degrees worth of difference.

squat anatomy

All of this can have a direct effect on their available range of motion. You can’t easily mobilize bone into bone and create a new range from that interaction, so if one person has hips where the bony alignment and shape doesn’t causes earlier contact in a specific direction compared to someone else who has a different shaped and aligned hip structure, it’s going to show in their overall mobility.

Elson and Aspinal (2008) showed that there can be a massive variation in both passive and active movements of the hip across age ranges and gender differences. They showed a true hip flexion range of between 80-140 degrees (mean of 25)with no lumbar rounding, a strict active straight leg raise with no lumbar rounding range of 30-90 degrees (mean of 70), and active leg raise with lumbar rounding of 50-90 degrees (mean of 86). This means someone in their sample managed to get 60 degrees more hip flexion than someone else in the sample. There was also a range of between 5-40 degrees of hip extension too, and across an age range from 19-89 years old, that’s a notable difference, especially if you work in general populations where everyone walks into the gym and over to the squat rack.

D’Lima et al (2000) found that hip flexion ROM could be as low as 75 degrees with 0 degrees of both acetabular anteversion or femoral anteversion, but as high as 155 degrees, with 30 degrees of both acetabular anteversion or femoral anteversion. An increase in femoral neck diameter of as little as 2mm was able to reduce hip flexion range by 1.5 – 8.5 degrees, depending on the direction of motion.

So essentially, your ability to achieve a specific range of motion is as much up to your unique articular geometry as it is to your strength and mobility. In many cases, it’s entirely independent of your strength and mobility, and no amount of stretching, mashing, crushing, or stripping will improve it. In many cases, trying to achieve that range of motion that’s outside of your joints ability to achieve will cause less desirable results, like bone to bone contact and irritation (potentially leading to things like femoroacetabular impingement), or compensatory movement from other joints like the SI joint or lumbar spine.

So with as much involved with the structure as I’ve presented here, and how impactful it can be to the end result of total motion of the hips during exercises, how can you determine whether it’s a limiting factor or not? If you happen to have X-ray vision you can do a good job of this, but you’d likely be charging a heck of a lot more money than you are right now for your services.

What we have available is a detailed assessment that focuses on a combination of features.

Involving a passive assessment to assume a theoretically available range of motion and shape of movement capability, an active assessment to see how they can use that range and whether there’s a difference between the two, and then determining strength or motor pattern aptitudes for the movements can be the best tools we have at our disposal, and then coaching the movement until their face sweats blood.

By using multiple approaches to assessing available and usable range of motion, you can get multiple views into a room that can paint a broader picture of what’s available. If the person has the ability to easily let their knee drop to their chest on your treatment table and squat to the floor, there’s obviously no restriction to their range of motion. If they have trouble breaking 90 degrees, even if they move wider through abduction and external rotation, their active range is limited through multiple tests, and their ability to show you a squat shows a lumbar flexion at around 90 degrees of hip flexion as well, the odds of you mobilizing that tissue to produce a significantly bigger range may be limited.

 

Passive Assessment of Hip Structure

 

Active Hip Flexion Capability Against Gravity

 

Active Rockback for Hip Flexion without Gravity Influence

 

Supported Squat Assessment


If all of these tests show a specific limitation to the range of motion consistently across all situations, it could be assumed that there would be a structural limitation versus passive insufficiency, weakness or other considerations. If active testing is limited but passive or supported assessments are fine, there could be a strength or motor pattern limitation holding the movement back.

Now sure, there’s a lot of brakes that could be restricting that range, from things like scar tissue to guarding and some soft tissue restrictions. Doing some work to help reduce that can help improve overall range of motion, but in some cases will be limited to just minimal gains. In some situations, trainers or therapists may work on improving range of motion for weeks or months and see no improvement, and in many cases the deck would be stacked against them seeing any improvement at all.

customized squat pattern

As mentioned earlier, there could also be an asymmetric structural element at play, which may necessitate an asymmetric setup for the movement where one foot is either turned out more, held slightly forward or back, or even turned into something like a one-heel elevated squat. The difference between this and a lunge is merely how far back that elevated foot is relative to the other foot, but again it’s taking advantage of potential asymmetries in structure and allowing an asymmetric set up to be more congruent with the individual.

Another way to think of it is if we have a potentially asymmetric structure yet force a symmetric set up on it, we may be creating an imbalance or compensative element in our training versus preventing it.

The Complete Hip and Shoulder Blueprint

complere shoulder and hip blueprintThese and many more elements are discussed in Complete Shoulder & Hip Blueprint, a new continuing education resource from Tony Gentilcore and Dean Somerset. This digital video product is 11 hours of lecture and hands on where they break down pertinent anatomy, considerations for program design, and delve into assessments, corrective options, and training considerations for these 2 highly involved complex structures.

The series is currently on a launch sale pricing, and the entire package is available for only $137 versus the regular pricing of $177. The sale is on from November 1 through 5, so act quickly to get your copy.  Click below to learn more or check out the below preview video!

large-learn-more

 

large-learn-more

Should Everyone Deadlift?

Many people have called the deadlift, “the king of all exercises.”  And rightfully so, as there may not be a bigger bang-for-your-buck exercise out there.

In my opinion, the deadlift is the most underutilized exercise in rehabilitation.  Perhaps the move is intimidating?  Perhaps people are afraid of barbells?  Perhaps people are worried patients may hurt their backs?  Perhaps rehab professionals don’t know enough about strength and conditioning?

I always say that I am a much better physical therapist because I am also a strength coach, and always keep learning from many great strength coaches.

As the gap between rehab and performance continues to narrow, the deadlift may be the final exercise to cross the chasm.  We shouldn’t be afraid of the deadlift, however, we also need to understand the the conventional deadlift is not for everyone.

 

Why Everyone Should Deadlift

should everyone deadliftOne of the most important trends in rehabilitation and strength and conditioning over the last decade or two has been the move away from muscle-based exercises and shift towards movement-based exercises.  Rather than work on quad strength, work on squatting, for example.  (Photo credit by the man, the myth, and the deadlift legend Tony Gentilcore)

The deadlift is essentially a hip hinge pattern, which is extremely functional and equally elusive for many people.

Put simply, people can’t hinge anymore!  It’s amazing.

As our society changes and relies more on poor posture patterns, prolonged seated periods, and things like excessive use of smartphones, I’m amazed how it seems even kids can’t touch their toes anymore.

Working on a poor hip hinge pattern is extremely helpful for so many different issues that I see every day.  From back pain, to knee pain, to even poor sport performance.

We have become so anterior chain dominant.  Luckily, the deadlift hits the entire posterior chain in one big lift.  

So the the deadlift really helps with the hip hinge pattern, but there are so many other benefits including working on better posture, glute development, lower extremity power development, a stronger core, stronger lats, and even enhanced grip strength.  

You can see why it’s such a big bang-for-your-buck exercise.

 

Why Everyone Shouldn’t Deadlift

Wait a minute…

I just spent the first half talking about how beneficial the deadlift is for so many people.  Why shouldn’t everyone perform a deadlift?

Let me clarify – I’m talking about the conventional barbell deadlift.

Take a step back and remember that we are more concerned about movements, than muscles, right?  So luckily there are many variations of hinging, and even deadlifts, that can be utilized to achieve all the above great goals.

Perhaps the deadlift is so underutilized in the rehab setting because everyone just looks at the conventional barbell deadlift.  That’s like going straight to the top, saying that there is no way you can perform that exercise, then just scrapping all forms of deadlifts and hip hinge exercises.

Most people that walk into the door at Champion have no chance at being successful at a conventional barbell deadlift.  Among other things, you need:

  • Good mobility
  • An understanding of the hinge pattern neuromuscular pattern
  • The ability to load, essentially lift a weight with intent

Most people don’t have at least 2-3 of these qualities.

We’ll try to get them there with the right blend of mobility drills, corrective exercises, and manual therapy, but that doesn’t mean we have to wait to start deadlifting.  We just need to start at a more regressed level.

So, don’t immediately scrap the deadlift, find a way to incorporate it.  Work within your mobility and limited range, try a variation using a kettlebell or sumo stance, and use submaximal loads until you can groove a proper hip hinge pattern.

deadlift variations

One of my favorite resources on deadlift technique and variations is this excellent article by Mike Robertson.

As you improve, you can incorporate more advanced forms of the deadlift, but don’t simply scrap the deadlift until then, modify!

 

3 Ways to Modify a Deadlift so Anyone Can Perform

If you want to learn more, I have an Inner Circle webinar on 3 Ways to Modify the Deadlift so Anyone Can Perform.  In this presentation, I break down the 3 most common reasons why people often don’t perform a deadlift, the inability to load, poor hinge patterns, and altered hip anatomy.  Deadlifts are great, and really underutilized in rehab, but with these 3 modifications, anyone should be able to perform them.

To access this webinar:

3 Ways to Modify the Deadlift so Anyone Can Perform

The latest Inner Circle webinar recording on 3 Ways to Modify the Deadlift so Anyone Can Perform is now available.

 

 3 Ways to Modify the Deadlift so Anyone Can Perform

3 ways to modify the deadlift so anyone can performThis month’s Inner Circle webinar is on 3 Ways to Modify the Deadlift so Anyone Can Perform.  In this presentation, I break down the 3 most common reasons why people often don’t perform a deadlift: the inability to load, poor hinge patterns, and altered hip anatomy.  Deadlifts are great, and especially underutilized in rehab, but with these 3 modifications, anyone should be able to perform.


This webinar will cover:

  • Why deadlifts are so important
  • The 3 most common reasons why people can’t deadlift
  • How to regress and vary the movement
  • How to include at any stage of the rehab and performance spectrum


To access this webinar:

 

How Neural Tension Influences Hamstring Flexibility

Many people think they have tight hamstrings.  This may be the case for some but there are often times that people feel “tight” but aren’t really tight.

I’ve been playing around with how neural tension influences hamstring flexibility and have been having great results.

Watch this video below, which is a clip from my product Functional Stability Training: Optimizing Movement, to learn more about what I mean.

 

How Neural Tension Influences Hamstring Flexibility

 

Learn Exactly How I Optimize Movement

Want to learn even more about how I optimize movement?  Eric Cressey and I have teamed up on Functional Stability Training: Optimizing Movement, to show you exactly how we both assess, coach, and build programs designed to optimize movement.

Click the button below for more information and to sign up now!

large-learn-more

 

The Use of Non Motorized Treadmills to Facilitate Gait and The Posterior Chain

We’ve recently started playing more with non motorized treadmills at Champion and have been very happy with the results.

Non motorized treadmills have gained popularity in the fitness realm as alternatives to self-powered conditioning machines like bikes and rowers. The Assault Air bikes and Concept 2 rowers have long been popular for their ability to produce amazing workouts.

I am a big fan of conditioning machines that increase their intensity based on the amount of effort exerted. Essentially, the harder you go, the harder they push back!

These have done wonders for high intensity interval training and sprint conditioning work.

Woodway has recently developed the Woodway Curve self-powered manual treadmill. Past non motorized treadmills seemed really cheap to me, but Woodway, who makes some of the best treadmills, has really made an exceptional machine with the Curve. I started using them for sprint work with the Red Sox, but have recently been using it more and more with my rehabilitation clients at Champion.

Because it is nonmotorized, your posterior chain is nicely engaged while walking and running on the Curve. A simple period of ambulation on the Curve does a great job engaging the hamstrings and glutes. I’ve been using these in everyone with diagnoses like patellofemoral pain, low back pain, and even postoperative. We start with a slow walk and slowly build up the speed and eventually get to running.

In the video below I explain more. I’m a big fan of nonmotorized treadmills to facilitate a proper gait form and engage the posterior chain.


Do Tight Hip Flexors Correlate to Glute Weakness?

Lower crossed syndrome, as originally described by Vladimir Janda several decades ago, is commonly sited to describe the muscle imbalances observed with anterior pelvic tilt posture.

Janda Assessment and Treatment of Muscle ImbalanceJanda described lower crossed syndrome to explain how certain muscle groups in the lumbopelvic area get tight, while the antagonists get weak or inhibited.  Or, as Phil Page describes in his book overviewing the Janda Approach, “Weakness from from muscle imbalances results from reciprocal inhibition of the tight antagonist.”  Assessment and Treatment of Muscle Imbalances: The Janda Approach is an excellent book that I recommend if you’re new to the concepts.

When you look at a drawing of this concept, you can see how it starts to make sense.  Tightness in the hip flexors and low back are associated with weakness of abdominals and glutes.

Lower Cross Syndrome

 

I realize this is a very two dimensional approach and probably not completely accurate in it’s presentation, however it not only seems to make biomechanical sense, it also correlates to what I see at Champion nearly daily.

Yet despite the common acceptance of these imbalance patterns, there really isn’t much research out there looking at these correlations.

 

Do Tight Hip Flexors Correlate to Glute Weakness?

Do Tight Hip Flexors Correlate to Glute WeaknessA recent study was publish in the International Journal of Sports Physical Therapy looking at the EMG activity between the two-hand and one-hand kettlebell swing.  While I enjoyed the article and comparision of the two KB swing variations, the authors had one other finding that peaked my interest even more.  And if you just read the title of the paper, you would have never seen it!

In the paper, the authors not only measured glute EMG activity during the kettlebell swing, but they also measure hip flexor mobility using a modified Thomas Test.  The authors found moderate correlations between hip flexor tightness and glute EMG activity.

The tighter your hip flexors, the less EMG was observed in the glutes during the kettlebell swing. [Click to Tweet]

While this has been theorized since Janda first described in the 1980’s, to my knowledge this is the first study that has shown this correlation during an exercise.

 

Implications

It’s often the little findings of study that help add to our body of knowledge.  This simple study showed us that there does appear to be a correlated between your hip flexor mobility and EMG activity of the glutes.  There are a few implications that you can take from this study:

  • Both two-hand and one-hand kettlebell swings are great exercises to strengthen the glutes
  • However, perhaps we need to assure people have adequate hip flexor mobility prior to starting.  I know at Champion we feel this way and spend time assuring people have the right mobility and ability to hip hinge before starting to train the kettlebell swing
  • If trying to strengthen the glutes, it appears that you may also want focus on hip flexor mobility, as is often recommended.  While a common recommendation, I bet many people skip this step.
  • This all makes your strategy to work with people with anterior pelvic tilt even more important.  Here is how I work with anterior pelvic tilt.

So yes, it does appear that hip flexor mobility correlates to glute activity and should be considering when designing programs.

 

A Simple Tweak to Enhance Glute and Reduce TFL Activity

Hip weakness is a common area of focus in both the rehabilitation and fitness fields.  Combine our excessive sitting postures and the majority of activities during the day that occur in the sagittal plane of motion, and hip weakness in the frontal and transverse planes is common.

There are many exercises designed to address glute medius and glute maximus strength in the transverse plane.  But a simple tweak to your posture during one of the most common exercises can have a big impact on glute activity and the balance between your glutes and TFL.

 

The Effect of Body Position on Lateral Band Walking

A recent study in JOSPT analyzed EMG activity of the glute max, glute medius, and TFL muscles during two variations of the lateral band walking exercises.

The subjects performed the lateral band walk in a standing straight up posture and a more flexed squat position.

A Simple Tweak to Enhance Glute and Reduce TFL Activity

I’ve personally used both variations in the past but tend to perform the exercise more often in the slightly flexed position, which we consider a more “athletic posture,” as we don’t really walk laterally with our hips and knees straight very often.

Results showed that EMG of both the glute max and glute medius was enhanced by performing lateral band walks in the partial squat position, and that TFL activity was actually reduced.  Glute activity almost doubled.

 

A Simple Tweak to Enhance Glute and Reduce TFL Activity

The finding of reduced TFL activity is just as important as enhanced glute EMG activity, as the ratio of glute medius to TFL is greatly enhanced by performing the lateral band walk in this athletic position.

Sometimes it’s the simplest studies that make the most impact.

The TFL also acts as a secondary hip flexor and internal rotator of the hip.  In those with glute medius weakness, which is fairly common, the TFL tends to be overactive to produce abduction of the hip.

Considering how our chronic seated posture can cause shortening of the hip flexors and we know many knee issues can arise from too much dynamic hip internal rotation and glute medius weakness, we often try to focus on developing the glute medius ability to become more of the primary muscle involved with abduction, instead of the TFL.

Another interesting finding of the study was that the stance limb, not the moving limb, had higher EMG activity for every muscle in both positions.  This shows the importance of the stance abductors in providing both a closed kinetic chain driving force as well as a lumbopelvic stabilizing force when the moving limb transitions to nonweightbearing.

We focus a lot on abduction based exercises to strengthen the glute medius, but closed kinetic chain exercises in single leg stance may be just as important to train the hip to stabilize the lower extremity.

One thing I would add is that I rarely perform this exercise with the band at the ankles as the authors did.  I much prefer to put the band around the knee and feel it helps develop better hip control.

Based on this study, I’m not sure I see why I would perform a lateral band walk in a tall upright posture.  I’m going to maximize glute activity and reduce TFL activity by doing the exercise in a more flexed athletic position.

 

Pin It on Pinterest

5 Things You Need to Understand to Master Functional Rehab and Performance

Join Mike's Newsletter and gain FREE access to his webinar overviewing his system of integrated functional rehab and performance training, PLUS these bonuses:

1. My 1+ Hour Functional Rehab and Performance Webinar

2. My 36-Page Solving the Patellofemoral Mystery eBook

3. My Accelerated ACL Rehabilitation Protocol

Thanks! Check your email for more information and your FREE bonuses!