Updated: Nov 16, 2021
In the last blog, we looked at upper cross syndrome, how and why it happens, what problems occur from it, and how to fix it. In this blog, I want to go in-depth about another very common condition called a lower cross syndrome, or anterior pelvic tilt.
This common condition is often the cause of low back pain, sciatica pain, hip pain. It is an imbalance between muscles and as we know, if we keep training the same way and loading the imbalance it is going to worsen. Therefore, it is important to be aware of any imbalances and to address them first, rather than strengthening them.
The lower cross syndrome refers to weak abdominal and glutes and tight erector spinae and hip flexors. located in a cross pattern around the hip and waist area. This imbalance between muscles that must work in unison, transition to an anterior or forward rotated pelvic. That puts a lot of unnecessary stress on the lower back when you walk, sit, standing up, and especially when you lift stuff.
To explain better why it occurs, I feel like it is important to address each muscle individually. Understand its origin and insertion (the connection points) and function.
(Tight) Erector spinae
This is a group of 3 muscles (Spinalis, Longissimus, Iliocostalis) which more or less run the length of the spine. They connect the vertebras and the lower ribs. Their main function is to extend the spine and assist in its rotation. If those muscles get tight or overactive, they are going to increase the natural curve of the lower back. Decrease the load of the abdominals and glutes and transfer more load to the hip flexors.
(Tight) Hip Flexors.
Hip flexors are another group of muscles involved in flexing or bending the leg at the hip. Those are going to be Rectos femoris, Sartorius, Psoas major, and Iliacus. The one that is usually tight and is causing problems, lays deep inside the abdominal cavity, and is the one that we are going to see in-depth today.
The Psoas major is a hip flexor that originates from the last thoracic vertebra T12 and all the lumbar once L1, L2, L3, L4. And inserts into the femur. This muscle`s function is to pull the femur up towards the lower spine.
If that muscle is tight is going to prevent the full extension of the hip. Therefore pelvic is forced to rotate forward, to allow us to stand tall.
Abdominals are a group of muscles responsible for flexion of the lower spine. They connect the pelvic and the ribs. By contract, they flex the lower spine, decrease the natural curvature and pull the pelvic backward. If those muscles are weak, the pelvic is going to be rotated forward and that is going to create imbalance. This means that other muscles are going to take over the load from the abdominals.
The last muscles we are going to review are the glutes muscles, which consist of 3 muscles on the back of your hips, responsible for hip extension or opening the hips. Those muscles connect the pelvic and the femur and act as opposed to the hip flexors. Glutes are supposed to pull the pelvic down from the backside of your leg, resulting in backward rotation of the pelvic. Those muscles become tight due to overworking of the opposite once – hip flexors and more specifically Psoas major.
All those muscles work in unison to provide a sufficient and balanced position of your pelvic, as well as equal and safe load transfer. Tightness of one, resulting in the inability of another to perform as it should, and therefore problems and imbalances occur.
As we already know, tightness occurs when a muscle remains to shorten for a longer period. The longest we spend in the same position usually is sitting. We work, we drive, we study. Imbalances happen very easily and the more we ignore them, the more we are going to suffer from them. We can’t change the position we are living in, but we can create practices that allow us to be a bit more active throughout the day.
1. Try to vary between sitting and standing.
Standing desks are super useful. A couple of boxes works too. Standing, at least for me, helps with energy too. And as I listen to music I would often dance (or do some silly moves if I am alone) which provides me with movement. The more movement, the more energy.
2. Creating activity routines.
It can be 10 minutes every hour or 30 minutes every two hours. It is up to you. But a small break from the task sometimes is very beneficial and recharging. Simply walking around, doing some moves or stretching is a great option for your active break, which brings me to one of the best options you can do and that is:
3. Frequently stretching tight muscles.
Well in our case with the lower cross syndrome, the one muscle that really needs stretching is the Psoas. So why not spending the 5 to 10 minutes every other hour stretching it. That is going to relax them and allow the weak ones to fire up again.
That brings me to one of the best hip flexor stretch you can do.
Get in a split squat position. Make sure you have 90 degrees at your both knees. Use a pad under the knee as you don’t want to put a lot of stress on the knee cap. Place your hands on both sides of your pelvic and imagine that you are rotating it backward. Try drawing your belly button in and squeeze the butt. This is going to turn off the hip flexors and put them into a greater stretch.
Lean forward keeping your chest up and pelvic in a backward position. Stop until you feel an uncomfortable stretch, but no pain. Hold for 10 – 15 sec and relax. Do it for 3 to 4 sets per leg. Can be done anywhere, multiple times per day.
This is a stretch that can be done anywhere to release the tension of the tight hips. Active rest every other hour that gets you moving for few minutes. it will definitely release some pain and feel good, but it is not going to permanently fix the problem.
I am going to list 3 exercises and their progressions. The aim is to increase neurological connection with the sleeping muscles and bring back the balance of the muscle around the pelvic area.
1. Pelvic tilt (close the gap)
Lay down with legs bent at 90 degrees, if you have severe anterior pelvic tilt, you will notice that there is a gap right at the lumbar spine. the goal here is to close it.
Draw the belly button in. squeeze the abdominals and glutes. Imagine you are rotating the pelvic backward. Fully close the gap trying to touch the ground with your lower back. This exercise is great for gaining awareness of the movement and activating the right muscles. Do it for reps, as you hold the gap closed for 2 seconds every rep.
Progression - Pelvic tilt (close the gap) with straight legs.
This one is going to require a bit more hip flexor stretch and is slightly harder than the previous one. Do it for reps as you are holding the gap closed for 2 seconds each rep. do it after you have spent at least a week mastering the previous one.
Progression - Backward pelvic tilt.
This is going to test your awareness and ability to activate the right muscles, while in a more challenging position.
Start on your hands and knees in a “tabletop position”. it would be best if you use a mirror or something to give you feedback on your position.
Perform the same rotation as the previous regressions. Squeeze the butt and belly button in. The gravity is working against us as opposed to the last two exercises and that is why this exercise is a progression.
The best cue would be to think as if there is a string attached to your belly button, going through your lower back, up to the ceiling. Now imagine that someone is pulling that string. Your belly button must go in and pelvic rotate backward.
The more you do it the more you are going to improve, so there is no guideline of how many reps or sets you do for each of those. Start slow, increase the reps over time. Frequency is key when it comes to correcting posture.
2. Hip bridge.
Lay down on your back, with legs, bent at 90 degrees. Close the gap, squeezing the butt and activating your abs. Holding this position thrust your hips up towards the ceiling. This exercise aims to strengthen the glutes and hamstrings, while keeping the awareness of the pelvic, staying in the right position.
The progression of it would be adding weight or challenging yourself by using only one leg.
Perform 15 – 20 reps, slow, and control for 3 to 4 sets.
This is the hardest of all. It aims to strengthen the abs and this right position of the pelvic. Start slow, first of your knees and elbows.
The cue with the string is going to be the best for this exercise. Rotate the pelvic backward and imagine that you are trying to bring it towards the rib cage, flexing from your lower spine.
This overtime is going to build incredible strength also because is an isometric exercise, requires static hold, for a longer period.
Progression would be to extend the legs into a full plank.
This is going to increase the leverage and require the abs to work harder to resist the gravity pull.
So here it is, the lower cross syndrome or anterior pelvic tilt or forwards pelvic tilt, Donald duck posture, etc… this blog aims to bring more awareness to this imbalance and to the way we get it. The problem I see is that people would not realize that something is progressively getting weak or imbalanced in their body until it is super hard to reverse. Then they would end up seeking pain medicines or even different types of surgeries. The best doctor for back pain is always going to be movement. Be active and be happy.
Check out Episode 11 of Fit Life Radio, where I break down this subject in detail.