Influencing Posture
Monday, September 9, 2013 at 10:03PM
Aaron in anterior pelvic tilt, assessment, corrective exercise, flexibility, lumbar spine, mobility

Read time: 15-20 min

Last week, we examined how posture and position can affect one’s movement. As discussed in that article, Influence of Posture 101, excessive lumbar extension and anterior pelvic tilt alter the expression of hip flexion during movements like the squat (Figure 1).

Figure 1. Comparison of hip flexion with two different postures. A) Excessive lumbar extension and anterior pelvic tilt; B) Neutral spine and pelvic alignment.

Regaining a more neutral posture and position, both in our daily lives and during exercise, is vital to maintaining the integrity of the structures of the body and getting the most out of training. Many postural deviations or movement compensations are symptoms of some underlying issue(s).

It is paramount to determine what these underlying issues are in order to make lasting changes. I’ve mentioned in the past that these issues fall under four main categories: posture and position, musculoskeletal, neuromuscular (physiologic), and motor control.

There can be overlap between these categories, and the relationship between each category is dynamic. Each category can influence or respond to change in the others.

This relationship presents a chicken-or-egg scenario when determining what issues from each category are the root causes. Are short/tight hip flexors (musculoskeletal/neuromuscular factor) driving anterior pelvic tilt (posture and position factor)? Or did anterior pelvic tilt (posture and position factor) drive the hip flexors to be short/tight (musculoskeletal/neuromuscular factor)? For the record, the egg came first.

At some point, regardless of which factor(s) initially influenced the other(s), they will begin to reciprocate each other. Thus, any approach must address some combination of factors from each category in order to effect true, lasting change.

To apply these concepts, let’s use our previous example of excessive lumbar extension and anterior pelvic tilt. I will provide a brief account of the specific issues within each category, followed by strategies to address them.

Posture and Position

The Problem

Arching the low back, and the often associated anterior pelvic tilt, is a deviation from neutral. Using this posture as a setup during exercise provides “passive stability.” Passive stability relies on the structural rigidity and/or tensile strength of tissues such as bones, ligaments, and tendons. On the other end of the stability spectrum is active muscular control, which helps maintain neutral posture and joint centration, allowing for the most effective expression of movement.

The major problem with passive stability is that the mechanical stress on the body’s structures goes unchecked and can lead to permanent changes in them. Ligaments and tendons can become lax; bones can wear or calcify.

Postural deviations from neutral and loss of joint centration alter the contribution of involved muscles required for both stabilization during and production of movement. Also, these deviations alter the movement of tissues in and around the joint, which can lead to issues such as impingement, fraying, or tearing of tissues.

Employing a strategy of active muscular control reduces mechanical stress. While you can increase the threshold of bones and connective tissues to withstand stress to some degree, you can more effectively increase muscular strength and coordination in order to maintain posture/position at greater loads, while minimizing wear and tear on bones and connective tissue.

The Fix

Setup Using Breathe-and-Brace Technique

This technique is a standing version of the breathe-and-brace technique provided in the Motor Control section. This technique is an appropriate setup for almost all exercises.

Focus on maintaining a tall posture, with the hips square and level. Reset with a full exhalation, inhalation, and brace before every repetition of the exercise you are performing. Refer to the progression in the Motor Control section below for more detail on how to perform the breathe-and-brace technique.

Musculoskeletal

The Problem

With a posture of excessive lumbar extension and anterior pelvic tilt, the hip flexors may lose length over time. Short hip flexors will restrict hip extension. In movements that require hip extension, individuals with shortened hip flexors will typically compensate by extending at the low back instead. This extension pattern not only compromises the low back during setup, but it increases mechanical stress during the movement as well.

The Fix

Hip Flexor Stretch

Figure 2. Hip flexor stretch.

During this stretch, make sure to maintain an active core. Do not hyperextend the hip, as doing so may drive the head of the femur into the ligamentous structures of the anterior hip. Avoid extending the lumbar spine (shown in Figure 2B). Also avoid any rotation, tilting, or lateral movement of the hips.

Perform this stretch for up to two minutes, ideally after your workout or outside of a regular training session. Progress the stretch by increasing the elevation of the rearfoot (increase knee flexion).

Ultimately, you can progress this stretch so that the knee of the stretching side is unsupported—as if holding a Bulgarian (rearfoot-elevated) split squat. This type of stretch is known as an eccentric quasi-isometric stretch. Again, this type of stretch should be performed post-workout or during recovery sessions.

Neuromuscular/Physiologic

The Problem

As mentioned before, deviations from neutral affect the function of relevant muscles that maintain posture and produce movement. The posture in our given example inhibits the glutes, hamstrings, and obliques in their roles, while the low back and hip flexors become overactive.

Overactive, or hypertonic, hip flexors can restrict hip extension, resulting in the same compensation pattern of lumbar extension that we see with short hip flexors. Inhibited or underactive glutes and hamstrings result in quadriceps, or knee, dominance—versus a more ideal bias toward glute/hamstrings, or hip, dominance. The obliques become ineffective at providing trunk and pelvic stability.

Activation exercises can help prime previously inhibited muscles. Additional targeted strengthening may be needed for previously inhibited muscles as well.

It is often the case that restoration of a neutral posture will help to facilitate normal function of these muscles. Sometimes soft tissue treatment is needed to help restore normal function by reducing the tonicity of targeted tissues.

All of the approaches above are aimed at optimizing neuromuscular conditions in order to maximize force production.

The Fix

Deep Breathing

To help restore a neutral position, spending time in a supported, desired posture while practicing deep breathing can help drive some of the desired neuromuscular changes. Refer to the progression provided in the Motor Control section below for more detail on how to perform the deep breathing exercise.

Deep breathing can be used prior to your warm-up, as recovery between sets, and/or during your cooldown. Deep breathing can also be practiced outside of a regular training session, such as at home in the morning or before bed for 3 sets of 10 repetitions.

Foam Roll/Massage

To target hypertonicity, foam rolling is effective for addressing the hip flexors. Due to the locations of the psoas, spinal erectors and paraspinal muscles, manual therapy is a more effective option for these muscles.

Foam rolling can be appropriate as part of a warm-up, post-workout, or during recovery sessions. Manual therapy is typically most appropriate post-workout or as part of recovery.

Additional Targeted Strengthening

Exercises targeting the glutes, hamstrings, and obliques may be needed to overcome any strength deficits in these muscles due to their previous inhibition and underactivity. This additional targeted strengthening will help to restore and maintain appropriate balance of the muscles of the hips and lower extremities.

Specific exercises, volume, and intensity will depend on your specific goals and must be considered within the context of your overall training plan.

Motor Control

The Problem

Consider that posture during daily tasks like sitting and standing is not a conscious effort. It is simply a path of least resistance. This path is formed in the brain by processing environmental and internal cues. Default posture or movement is the least costly/risky option as perceived by the brain.

Our ultimate goal with any movement is to make proper setup, technique, and execution the default for our brains—to decrease the cost and perceived risk of one particular iteration over any others. Learning a new movement often requires lots of conscious effort. As we master the skill, we can eventually reach a state of automaticity.

Whatever stage of learning we are at with a skill, the brain will always seek the path of least resistance to perform that skill. We can promote the construction of the desired path by constantly reinforcing the desired outcome.

Correcting one’s posture throughout the day and practicing proper setup and technique during each exercise are absolutely necessary. Again, as you are first learning a new movement, or correcting an old pattern, it may require a lot of conscious effort. However, it will become more automatic and subconscious over time.

The Fix

For our example, we are interested in correcting the way a person stands and sets up for various exercises. All of our work in the other three categories will help set the stage for the changes we want to see with regard to motor control.

In short, we want to optimize our posture along with the state and relationship of our muscles and other tissues. With motor control, we now want to teach our body how to function, how to move, in this optimized state. We must build the desired path within the brain.

The following progression builds the necessary skills to set up with and maintain proper back and pelvic position during any movement:

Deep BreathingBreathe-and-BraceBand/Wall-Resisted AbsBand/Wall-Resisted Dorsi-Knee-Hip Flexion

Each earlier skill is a prerequisite for any skills following it. However, once you are proficient in a lower-level skill, you may still benefit from doing that skill—perhaps as part of your warm-up or as an exercise in your strength training regime. Something that is true of all progressions/regressions is that a specific variation may merit inclusion at specific times in a well-organized training plan, depending on targeted outcomes.

In order to build the foundation for active control and stabilization, we first have to make sure a person's breathing technique is in order. For such a mundane task, there are many ways that breathing can affect how we move and function. For instance, improper breathing patterns can drive lumbar extension, increase tonicity of the muscles of the upper chest and neck, and increase our body's stress levels.

Deep Breathing

Video 1. Diaphragmatic breathing.

The first step of the progression involves learning how to achieve full, diaphragmatic breaths. Set up as shown in Video 1, with the feet supported against the wall and the hips and knees flexed ≥90°. Place your forefingers and thumbs below your lowest ribs, as shown, to provide tactile feedback during this exercise.

Inhale slowly through the nose, and exhale forcefully through the mouth. Use a three-second count for both the inhale and exhale, with a one-second pause between. Proper inhalation will result in full, circumferential expansion of the trunk followed by expansion in the chest. It is not simply pushing your belly out. Your trunk must expand in all directions.

A common issue that accompanies excessive lumbar extension is that the lower ribs flare. Instead of remaining inline with the trunk, the lower ribs are elevated and protrude when one is at rest. When practicing deep breathing, a proper exhalation will cause the lower ribs to descend and constrict, coming back inline with the body.

You should be able to maintain this tucked position of the lower ribs through an entire breathing cycle. The tucked position of the lower ribs should be part of a normal, resting posture.

Deep breathing can be used prior to your warm-up, as recovery between sets, and/or during your cooldown. Deep breathing can also be practiced outside of a regular training session, such as at home in the morning or before bed for 3 sets of 10 repetitions.

Breathe-and-Brace

The second progression simply adds an abdominal brace at the completion of a full inhalation. Think about clamping your abs down on top of the full breath you have just taken. This progression begins to introduce the active muscular control component of stability discussed earlier.

The inability to maintain a sufficient abdominal brace can result in the previously discussed rib flare when performing overhead movements. Cuing to "keep the ribs down" during overhead movements can help address this issue.

These first two progressions isolate breathing and bracing with no external resistance or additional movement. Once we master the breathe-and-brace, we can begin to introduce additional components, increasing the complexity of the skill.

The breathe-and-brace can be used as part of the warm-up as an activation exercise or practiced outside of regular training sessions. Aim for 3 sets of 5-10 repetitions.

Band/Wall-Resisted Abs

With progression three, we can further amplify the stability and tension generated through the breathe-and-brace. The band/wall-resisted abs exercise provides resistance in a way that causes the body to reflexively engage the obliques and abdominals. We can take advantage of this enhanced activation to help lay the foundation for the high-threshold bracing required during heavy resistance training.

Figure 3. Start positions for A) Band-resisted and B) Wall-resisted abs exercise.

To perform, set up as shown in Figure 3. If using the wall as resistance, make sure to actively push into the wall with the hands at all times. If using a band, hold the band with your hands at your sides, 1-2 inches off the ground. Flex your knees and hips ≥90°. Next, breathe-and-brace, then lower your leg(s) to the end position (Figure 4).

Figure 4. Finish positions for band/wall-resisted abs exercise.

Four different variations are pictured, starting with the least difficult to perform. Regardless of the variation, lower your leg(s) to a three-count without your heel(s) touching the ground, hold with your heel(s) 1-2 inches above the ground, then exhale and inhale before returning to the start position. You can also add ankle weights to progress the difficulty.

This exercise can be performed at the end of a workout as an ab/core exercise. It specifically targets the qualities of anti-extension, along with anti-rotation depending on the variation used. Perform 3-5 sets of 5-10 repetitions per leg.

Band/Wall-Resisted Dorsi-Knee-Hip Flexion

Building off of the previous skills, this final progression continues to introduce elements that will help our body learn what hip flexion with a neutral posture feels, along with how to integrate that movement with active stability of the trunk and pelvis. This progression also represents the ideal posture and accompanying action for squatting movements.

Figure 5. Start and finish positions for band/wall-resisted dorsi-knee-hip flexion exercise.

To set up, lie on your back with your legs straight and use either a wall or band to provide resistance (Figure 5), as with the band/wall-resisted abs exercise. To perform the movement, breathe-and-brace, then simultaneously flex the hip, knee, and dorsiflex the ankle. Flex the hip as far as you can without shifting or rotating the pelvis. Exhale as you return the leg to the start position.

The band/wall-resisted dorsi-knee-hip flexion exercise can be used as an activation exercise during the warm-up or to help restore function during your cooldown. It is also an appropriate selection during recovery sessions. Perform up to 3 sets of 5-10 repetitions per leg.

Conclusion

Excessive lumbar extension and anterior pelvic tilt are very common postures. We've explored some of the ways these two deviations from neutral posture can affect movement, tissue quality, and tissue health.

Use the strategies provided to develop a comprehensive approach to improve your daily posture, get more out of your training, and minimize the risk of injury.

Article originally appeared on Five Rings Athletics - Excellence through Sport (http://www.fiveringsathletics.com/).
See website for complete article licensing information.