Family Practice, February 21, 1994.

Any book on back care that has been written in the past dozen or so years almost certainly includes the pelvic tilt in its list of ways to alleviate back pain. Though it’s scarcely a panacea, for the thousands of back pain sufferers, it’s been a blessing indeed. We would do well, however, to ask why this condition is so prevalent and to find more preventative, as well as more permanent measures of relief.

More often than not, back pain is caused by poor posture, swayback being the most common cause of lower back pain, with muscle fatigue and pinched nerves the natural consequence of weight overload. The pelvic tilt, by stretching out and lengthening the lower back, relieves compression of the vertebrae and reduces the weight load on the lower back muscles, thus removing much of the discomfort.

The suggestions for how to do the pelvic tilt and ways to use it are many. Putting your feet up on a low stool while sitting in a chair will do it. The same goes for resting one foot higher than the other on a low railing when standing at a bar, for example. And bringing your knees over your chest when lying supine on the floor has the same effect. Another method is to stand against a wall and flatten your back against it with your knees slightly bent.

This is all very well and good. However, we spend a good deal of our time either standing where we can’t put one foot up – in queues, waiting for a bus, etc. – or walking. How do we then keep our pelvis tilted? In a word, we don’t. It goes back to the position it’s accustomed to and which is “natural” for it – in most cases, swayed, and with too much weight pressing down on our lower back. What we need to realize is that the remedies stated above are, at best, temporary and alleviating ones. They don’t eliminate the problem of a swayback and its subsequent stress on any permanent basis. And here’s where the pelvic tilt, commendable as it is as a means of relief and as an exercise, falls short. Let’s see why.

In all of the suggestions given above, the knees – whether it’s one, or both – are bent to one degree or another. You can’t, for example, flatten your back against a wall unless your knees are bent. Because of this, some authorities recommend that the knees should always be slightly bent when standing or walking.

This brings up three points. First, we are the most developed of upright creatures and bent knees don’t make us fully upright. Second, keeping the knees slack at all times only serves to shorten the hamstrings and calf muscles, which, in most people, are too tight as it is. Third, there’s something psychologically demeaning, not to mention physically demeaning, when we don’t stand and walk at our full height, whatever it might be.

What we need to know, then, is how to tilt the pelvis without bending the knees, that is, how to “straighten” our pelvis – which is a more comprehensive task than “tilting” it.

The drawings in Figures 1, 2 and 3 show the pelvis in 3 different positions: with a swayback and, as normally happens with this posture, a protruding abdomen and backward pressure through the knees; the pelvic tilt with bent knees; and the straightened pelvis with straight legs. As can be seen, the lower back is elongated in each of the last two, so the tilted and the straightened pelvis are, in fact, equally effective in relieving strain, but the big advantage of the straightened pelvis is that the legs are straight as well.

Unfortunately, straightening the pelvis is not as simple as might appear. The reason is that, when the pelvis has been tipped forward from a young age onward, the muscles in the lower back, as well as those in the thighs and groin, become shortened and tight, effectively preventing the pelvis from moving in isolation. For this to happen, the muscles mentioned not only have to be stretched out, but they must stay stretched out so they don’t pull the pelvis back into a swayback.

But this is only half of it.

The reason the pelvis tips forward in the first place is because the abdominal muscles are not doing their job – which is why girdles were invented – consequently, the viscera “fall out” and tilt the pelvis forward off its centre. The abdominal muscles, therefore, have to be strengthened in order to hold the pelvis in its straightened position, and they have to be strengthened in a particular way. It involves isolating the abdominals from the diaphragm muscles, because only then can the pelvis straighten without affecting the legs or “dragging” on the upper back, as happens with the pelvic tilt. More than this – and which requires conscious “remembering” – they must be used in a particular way, actively pulling upward and in toward the spine. This “rocks” the pelvis in the hip joints and brings the bottom of the pelvis forward, leaving the legs straight, flattening the stomach and elongating the lower back.

This brings the final evolution to uprightness into place: With the base of the torso in true vertical alignment, providing a stable foundation, adjustments can be made to the upper body to bring the ribcage, neck and head into corresponding alignment with the pelvis. And the whole body now stands straight.

What’s the point of all this? Just that when your body is aligned like this, all of your physiological functions work better and you become healthier; your blood flows more freely, so it nourishes all of your cells more liberally; your nerve fibres don‘t get pinched in tight muscles or joints, so you have fewer aches and pains; and because you’ve had to become more flexible to get your body into this correct alignment, moving your body is easier in everything you do.

To live a (possibly) long, comfortable and healthy life, it’s worth getting your pelvis straight!