Courageous Conversations With Coaches: Anterior Pelvic Tilt With Elsbeth Vaino

A year and a half ago, I wrote a TNation article pertaining to anterior pelvic tilt (APT) titled Don’t Be Like Donald Duck. I still think it’s the best way to train for improvements in APT, but recently my friend Elsbeth Vaino (FYI – Elsbeth and I have written two articles on push-ups together – HERE and HERE) wrote an article for TNation on the same topic that was very well received (click HERE for the link, but the article is pasted below as well). As you’ll see, her recipe is quite different from mine, and I suspect that her plan and my plan could be integrated for a more thorough plan.

Nevertheless, I disagreed with some of Elsbeth’s statements, and so I contacted her to see if she’d have a point-counterpoint with me. Being the passionate student of strength & conditioning that she is, Elsbeth was gracious enough to accept the challenge. Here is our exchange. In red are my comments and in green are hers. We’d love to hear your thoughts in the comments section below! If you’ve succeeded in improving your pelvic posture, what strategies did you employ (or if you’re a practitioner, what strategies have worked with your clients)?

Trouble with the Tilt – Correcting APT

by Elsbeth Vaino   11/22/13

DL

Here’s what you need to know…

• Anterior pelvic tilt (APT) isn’t just unsightly. It can lead to serious back problems and a stalled deadlift.

• Most popular methods to address the problem either fail to work or make the problem worse.

• To fix APT, you need to make it a priority. That means attacking it with a comprehensive plan before your lower body workouts. You can cut back once your APT is under control.

Anterior pelvic tilt is a common postural position where a person’s low back appears to arch significantly while standing. Anyone afflicted with APT will always look like his gut is protruding and his butt is sticking out.

APT can also significantly limit your deadlift and even lead to a back injury, which will make you either stop lifting or become that annoying guy who can’t stop talking about his sore back.

How Does APT Affect Your Deadlift?

Most lifters with APT have a small hinge in the mid back, a point where they tend to bend when they move. It’s almost unnoticeable (you have to really be watching closely to see it), but when you’re pulling hundreds of pounds off the floor, even a little mid-back bend is a problem.

Interestingly, it’s a bend in the opposite direction most are concerned about. You often hear that you shouldn’t round your back when you deadlift, which is sage advice, but extending your back during a deadlift isn’t great either. Even a little bend means a loss of tension – and when you lose tension, you lose strength.

If a lifter overarches in the deadlift, this requires greater erector spinae activation, or more tension. That is the only way to achieve this hyperextended position – the spinal erectors must create an extension moment that exceeds the flexion moment induced by gravity and the load. This can indeed occur in a particular motion segment, but it should not be thought of as a “loss of tension,” but rather sub-optimal spinal positioning and motor control. I’d also posit that “mid-back hinging” can occur in lifters with APT, neutral, or PPT postures, though you’re probably right in that those with APT probably exhibit this characteristic more commonly.

I want to address this in parts as I think we agree on part of it, and I’m not sure if the rest is disagreement or difference of terminology. I’ve broken the paragraph above into parts below.

  • If a lifter overarches in the deadlift, this requires greater erector spinae activation, or more tension. That is the only way to achieve this hyperextended position –

This first part of your comment is where I think we disagree. I don’t see it a good deadlift as a hyperextended position (yes, this was misunderstood – I don’t like hyperextended deadlifts either – neutral spine is best) in the back as much as an isometric hold in the back as the hips move from flexion to extension (agree). Now that said – I do accept that a slight extension in the back as the lats engage is likely and probably even desirable. And based on what you wrote below, I wonder if that’s what you’re saying too? In which case I agree and accept that I should have been more exact. My intention was to point out that an extension-hinge in the back is problematic. I do agree that a small amount of appropriate extension in the back is fine. In fact I often watch a client deadlift and ask myself “is this appropriate extension or is this a hinge?” To me an acceptable extension is one that has a very gentle curve with a very small slope. But if I see a sharp curve and/or a steep slope, I suspect mid-back hinge and I will aim to correct it – usually starting with cueing during the DL (“keep the abs engaged” sometimes does the trick). (agree on all points)

  • the spinal erectors must create an extension moment that exceeds the flexion moment induced by gravity and the load.

I wonder if we’re talking semantics here. An extension moment yes, but does an extension moment require movement? (geeky side note – this feels like a very timely point given that I just read Dr. McGill’s recent article about training flexion moments not flexion movements) (exactly – you want the extension moment to balance the flexion moment, so that no concentric or eccentric motion occurs, but rather an isometric hold as you described)

  • This can indeed occur in a particular motion segment, but it should not be thought of as a “loss of tension,” but rather sub-optimal spinal positioning and motor control.

I think we do agree that this mid-back hinge is sub-optimal and demonstrates poor motor control. But I have a hard time wrapping my head around the notion that this sub-optimal position doesn’t yield a loss of tension. (I’m referring to muscle force or “tension in the muscle” in that spinal hyperextension and APT is often too much erector spinae muscle force, but you might be referring to “total body tension” which I’ve seen discussed but would be hard to define) I think it may still maintain the same activation level, but because that activation is now applied to muscles that are following an altered (and inferior) path, I don’t see how the resultant tension can be maintained.

  • I’d also posit that “mid-back hinging” can occur in lifters with APT, neutral, or PPT postures, though you’re probably right in that those with APT probably exhibit this characteristic more commonly.

Great point. In fact as I read one of the comments on the TNation article about whether it’s really possible to fix APT, I wondered if it may make more sense to talk about functional vs physical APT, because I have also seen people who don’t look to be in APT hinge at the mid-back. In fact I find these people are usually harder to spot because they don’t look the part – but then they show you a plank and its sag city, or a deadlift and their ribcage flares right out. (Agree)

What’s The Cause of APT?

Strengthening the lower abs as a means to fight APT makes little sense. The abs attach the ribs to the pelvis, and if the abs get stronger, won’t they just pull on the ribcage more?

This statement is in direct violation of Newton’s third law, a basic tenet of physics and biomechanics. When one body exerts a force on a second body, the second body simultaneously exerts a force equal in magnitude and opposite in direction to that of the first body. If the abdominals are strengthened, the increased sarcomeres and neural tone will create an equal pull on the ribcage and the pelvis.

By that argument, we’d never have any movement! (Not sure what you mean – even ground reaction forces are “reactionary” in that they exert the same force back into us as we exert into the ground) But let’s break that down. I’ll concede that there will be an equal and opposite force in both directions. But if we were to draw the free body diagram of the resultant forces at both the pelvis and the ribcage, what will it show as the overall net effect? If the net force holding the pelvis into APT is stronger than the net force holding the ribcage in neutral, then the result will not be a leveling of the pelvis, but rather a lowering of the ribcage. In a tug of war between pelvis and ribcage, I’m putting my money on pelvis. (I agree, and that’s what’s happened – the erector/hip flexor couple is winning the tug of war, so the ab/glute couple must be strengthened to achieve balance)

Perhaps the problem with APT isn’t that the lower abs are weak, but that the hip flexors are stronger or shorter (or both) than the abdominals. If the hip flexor is too strong and kicks in when standing, it will pull the front of the pelvis down into APT.

It should not be thought of as “hip flexors versus abdominals,” but rather, “the hip flexor/erector spinae force couple versus the abdominal/gluteal force couple.”

Good point.

Another possible culprit is the hamstrings. If they’re weak or stretched long, they can neglect to do their job in keeping the superior posterior pelvis in alignment. And since we’re talking about hip flexors and hamstrings, we also have to talk about glutes. Hip flexor troubles often occur in tandem with weak glutes, and weak hamstrings can be the result of weak or poorly patterned glutes.

While I agree that the hamstrings and glutes are inextricably linked as hip extensors, I also feel that they’re rather independent in that the hamstrings are so highly activated and conditioned as knee flexors. I do not see how weak hamstrings can be the result of poorly patterned glutes, as they’re fairly independent. In fact, poorly conditioned and weak glutes typically leads to overburdened and stronger hamstrings. 

I wonder if our difference here is based on different populations. The people in whom I see weak hamstrings in concert with weak glutes are people with desk jobs who also participate in sports involving running. In fact many of the clients I see are post-rehab clients who had hamstring injuries, all of whom also have weak and/or underactive glutes on that side. I believe these hamstring injuries occur at least in part because the hamstrings were overworked due to the poorly patterned glutes, but in all honesty, I don’t know if the glutes were weak before, or if they became weak after. (Fair enough)

Finally, what if APT is just a habit? If a person’s been hinging at L5 (or somewhere in the lumbar region) since he was seven years old, it’s now so ingrained that he just keeps hinging. Strengthening the underlying muscles may not be enough to fix this; patterning work may also be needed.

Excellent point!

With so many muscles involved with the pelvis, is it possible for one to pull too much or not enough, without a reaction elsewhere in the chain?

2

Why Don’t Reverse Crunches Help?

If you’ve ever tried to address APT, odds are the recommendation you’ve been given is either to do planks or reverse crunches, or both. Neither of those suggestions are effective solutions for APT.

What about RKC planks, where the precise posture we’re trying to shift towards is held for time? In this manner, the abs and glutes will be strengthened in a shortened position while the erectors and hip flexors are slightly lengthened.

Good point and I do like RKC planks, but I view them as a subset of planks, and in fact I generally consider them a progression of a plank. You raise a good point that they do force the body into a favourable position, and I have tried the cues that you note in your article, but I found it was just too challenging for some people, and meanwhile, I really liked the results I had with starting with the bench plank. (Fair enough)

The main reason I refrain from using reverse crunches with clients who have APT is because I agree with Dr. Stuart McGill in that we should limit our volume of spinal flexions.

Also, reverse crunches aren’t appropriately challenging. A reverse crunch is an open chain exercise with a long, heavy lever (the legs). Open chain means multiple degrees of freedom, and the legs plus pelvis is a very heavy load. Does that make sense as an exercise for someone who’s incapable of simply holding their torso in neutral while standing?

What About Planks?

Most of the people I see with APT are unable to hold a plank for very long without the back either hurting, sagging, or both. I tell my clients to stop at the point of pain, explaining that feeling planks in their back is a sign that the abs have given up and the exercise is no longer doing what it’s supposed to be doing. At that point, and when the back is sagging, planking may even be encouraging a dysfunctional pattern.

Great point!

Unlike the reverse crunch, the plank is closed chain, so the lever is supported at two ends. However, the lever is much longer in the plank, and the greatest load occurs exactly where a person with APT has the lowest capacity to stabilize – midway between elbows and feet. For this reason, the plank is too advanced an exercise for someone with APT.

I think this is overgeneralized; there are freakishly strong lifters with APT who have strong abdominals and can perform advanced planking and abdominal maneuvers. In contrast, there are weak sedentary folks and beginners who should indeed start out at the very bottom of the totem pole.

Maybe. But I’ve had some people as you describe – they can plank till the cows come home (not actually sure how long that is) yet they still struggle with APT, and when I regress them do a bench plank, they have a very hard time at it. I have seen a couple people like this for whom a basic Sahrmann breathing and bracing exercise was excruciating – at first. (Okay, good point)

To your point about strong lifters with APT who can do impressive abdominal maneuvers – I would still want to run them through all of the 9 exercises I recommend. Do they struggle with any of them? If not, then cool –they probably fall into a subset of people with APT who suffer no functional effects of it. As you noted above – it happens. But I think more often than not, there is a weakness there – it’s just not showing up in their plank. (Fair enough)

The other reason planking fails is because it assumes the problem is bilateral. What if the weakness or dysfunction is only one-sided? Will the plank address that, or will the dominant side cover for the weak side

What To Do For APT?

Address everything simultaneously. That may sound like overkill but you’re dealing with a faulty pattern that you’ve probably had for years. Maybe at one point there was one cause, but odds are everything’s involved now.

Agree!

Alternatively, I approach APT with the nine exercises below, knowing that we’re hitting everything. If we accidentally do one or two unnecessary exercises, no big deal. Treat it like a bed bug infestation – if you have them, are you only going to get one room treated, or are you going to go ape-shit on the whole apartment so they never come back?

Agree!

Nine exercises might sound like a lot, but once they get the hang of them, my clients do them in less than 10 minutes, which also warms them up nicely. We typically top that off with another five minutes of more general movement preparation, leaving 45 minutes to lift. Plenty of time for deadlifts!

If you’re not a fan of warm-ups but your current training involves long rest periods between sets, consider breaking up the exercises below and do one in between each set. Ideally choose them such that they don’t interfere with the muscles involved in your work sets.
The Program

1. Crocodile breathing. This exercise is for the diaphragm, the ribcage, and the t-spine.

Details: Lie on your stomach and breathe deeply. The goal is to have your belly expand into the floor, which will push your body away from the floor. Then exhale completely. Repeat for 12 breaths.

2. Box hip flexor stretch. Use a 12″ plyo box for this but a stair works too. I discussed above that hip flexion is probably part of the problem, so let’s try to improve it.

Details: Place one foot on the box, lower yourself into position, and then maintain great posture while you breathe deeply. Count 10 breaths and then switch sides.

3. Side lying quad stretch. The rectus femoris is a secondary hip flexor, and so it may be a contributor to APT. There are other quad stretch options, but this one allows for a quad stretch while preventing cheating through lumbar spine extension.

Details: Lie on your side and grab the top of your upper foot with the same side hand while flexing the hip and knee of the lower leg. Breathe deeply for 10 breaths and then change sides.

4. Leg-lock bridge. This is for the glutes in case the poor hip extension is the problem. I chose this version of the single-leg glute bridge because the “locked leg” keeps us from cheating lumbar flexion for hip flexion, which is why we’re here.

Details: Do 10 reps on one side, holding the up position for two seconds, then repeat on the other side. If you get hamstring cramping, that’s confirmation that your glutes don’t work properly. As a cue, try pushing the heel into the floor and think of pushing the toes through the front of the shoes.

5. Rolling. Nope, not foam rolling – developmental rolling. People seem to be very divided when it comes to rolling. I was skeptical at first too, but they’ve grown on me. Regarding the point above about the problem not necessarily being bilateral, rolling effectively splits the core into diagonal quadrants, so if there’s weakness on one side but not another, it will come out.

Details: Start supine to prone (S2P), with 1-2 sets of 5 upper body rolling the first week, and then move to lower body (if time isn’t a factor do both upper and lower). That’s on your back, rolling to your stomach.

Week 2, assuming the movement is good and S2P is getting easy, we move to Prone 2 Supine (P2S). Note: If you have neck problems or if they cause pain in your neck, don’t do them.

6. Hip hinge. For some this is a no-brainer, but for others it’s the most important movement you’re not doing right. To make sure the movement is great, use a dowel held vertically behind the back, with the dowel touching the back of the head between the shoulder blades and the butt. Now bend over without losing any of those points of contact. As soon as one of these points is lost, stop and correct.

Details: Do 10 reps, switching hands halfway.

7. Off-weight Romanian deadlift (RDL). This is an exercise where the first time you do it will determine whether you need to do it, as it’ll show if you have a major imbalance between your left and right side.

Details: Set up a bar on a rack with a 5-pound plate on one side. Place your hands on the bar normally (don’t adapt for the slight offset). Now pick it up and do 5 RDLs to a normal depth. Rack the bar and move the plate to the other side and pick the bar up again, making sure to use the same hand placement as before. Repeat.

Notice anything? If not, then you don’t need this exercise and you can skip to number 7. If, however, the bar felt 10 times heavier on one side than the other, this one’s definitely for you.

8. Bench plank. I noted above that I think planks are too advanced for most people with APT, but building the plank is part of the solution.

Details: To make it a more appropriate challenge, move your forearms up onto a bench. This change is often very profound as people suddenly feel the plank where they’re meant to feel it. I also cue people to stop once they feel it in their back, with a goal of extending the time each session.

Once you can get to 60 seconds without sagging or without feeling it in your back, progress to the floor, but use the same discipline as you did with the bench version.

If you’re unable to hold the bench plank for more than 30 seconds without feeling it in your back, consider regressing it further by doing it with a slight bend in your knees. Doing so can help take the hip flexors out of the equation and allow a proper abdominal contraction.

9. Single-leg lowering. This one can be a shocker and is a fantastic option to help teach your body to stabilize the core in the presence of leg movement. Think of the relevance here: Every step you take when walking or running involves this movement, but if you can’t stabilize it you’re going to end up extending at your lumbar hinge instead of at the hips, which is really a unilateral expression of APT. Hopefully this helps bring home the notion that this pattern is relevant both bilaterally and unilaterally.

Details: Start this exercise with one foot supported on a box or door frame, and move the other leg. Form is crucial here – you’ll need to focus on engaging your core to stabilize your pelvis so that the only part that’s moving is your leg.

Do 10 reps on one side and then 10 on the other. Once it gets too easy, progress to the unsupported version where you do this with your hands holding something solid (leg of a plyo box or power rack). Lift both legs up in the air and hold one leg up while lowering the other, making sure that the pelvis does not move with the leg.

Putting it all Together

Here’s a summary:

Crocodile breathing: 12 deep breaths
Box hip flexor stretch: 10 deep breaths per side
Side lying quad stretch: 10 deep breaths per side
Leg-lock bridge: 10 reps per side with a 2 second hold
Rolling: 5 each direction
Hip hinge: 10 reps
Off-weight RDL: 5 on the easy side; 10 on the hard side. Or skip it if there’s no difference
Bench plank: Hold for time
Single-leg lowering: 10 each side

Get Your Tilt Off

Add these nine drills to your workout for a couple of months (yes months – reality sucks) to save your back, your deadlift, and to put an end to the faux belly.

It should be noted that some folks will be able to improve their pelvic posture (I have several clients who have noticed marked improvement…but I did not conduct pre and post-training measurements so these are just anecdotes) (me too  – and I also haven’t done measurements. I’m starting to re-evaluate what measurements I do pre- training so that in future I can have hard evidence vs anecdotes), whereas others will not. Some lifters will seem to do everything “right” and still not see any improvements in pelvic posture, which is likely due to genetics and also sport/lifting/lifestyle factors. These folks need not fret as one can do just fine going through life in APT. APT is common in sports, it’s not correlated with low back pain, and exercise modifications can allow for long pain-free lifting careers.

Maybe you should get them to try these 9 exercises. J I’m only half-joking with that comment. Maybe adding breathing and including some unilateral abdominal work could improve outcomes on the people for who you aren’t seeing improvement? I hope that doesn’t sound too arrogant – it wasn’t the intention. (Does not sound arrogant at all Elsbeth – you’re a class-act)

I’m willing to bet that you don’t mind if I ask about the use of the hanging leg raises in your program. Wouldn’t they fall into the same category as sprinting and sit-ups in that they strengthen the psoas and rectus femoris? (Great point. In retrospect, I shouldn’t have included the hanging leg raise and should have instead written about hollow body holds – those are incredibly effective but too challenging for most beginners…although modifications can be made)

I definitely agree that genetics and other lifestyle and sporting factors play a part, and that APT may exist but not be problematic. I actually think the lifestyle sporting factors are part and parcel of the patterning point I make in the article: If you are doing something in the “other 23 hours” that sustains and encourages the APT position, that’s going to have a big negative impact on the hard work you’re doing in the gym.

It has been a pleasure discussing this with you. It’s so nice to get into the geeky details with someone, knowing that either of us is willing to concede to the other if they make a great point. Thank you Elsbeth! You’re awesome. This is how professionals should interact with one another!

52 Comments

  • Derrick Blanton says:

    Well played, EV and BC. And like catnip to me. I started replying point by point, and realized that it was going to turn into a 900-page e-book. I honestly lost track of who was saying what, so I will just toss out my first two bullet points, and retreat to the sidelines, and learn from other commenters. But much respect to you both for thoughtful dialogue. Love it. DB

    “APT is often too much erector spinae muscle force”.

    We have to look a little further than that! Just as often too much psoas, too much lat, and too little ab. The erectors are taking the fall here for trying to resist the psoas and keep the torso erect. Is it their fault they are in a tug of war 24-hours a day?

    They are being pulled over, and are constant tension from the PSOAS. If they don’t fire, you fold over and walk stooped, which you would prefer not to do. (This is also like blaming the upper traps for hiking the shoulder girdle up, when in reality the pec minor is hiking the shoulder girdle OVER.)

    “The abs attach the ribs to the pelvis, and if the abs get stronger, won’t they just pull on the ribcage more?”

    NO! This is what motor control is all about. Control one segment, and move another. Does doing a bicep curl mean the shoulder has to pull anteriorly? No! Of course you can learn to hold the upper back in place and pull the pelvis up via abdominal contraction. This is PPT in action.

    Try walking a mile with 30-lbs. around your neck via neck chain, and 30-lbs. around your waist via hip belt. Tell me you didn’t learn to use your abs, T-spine erectors, all the while reducing curves at both segments. PPT’ing and extending the T-spine.

    OK, off to the sidelines I go…Promise. 🙂 Big ups, guys!

    • Bret says:

      Derrick – you don’t belong on the sidelines! I’m referring to a deadlift. Erector spinae activation is the chief culprit for causing APT in a deadlift IMO. I don’t think it’s overactive psoas in this case.

      As for exhibiting APT in everyday life…you’re saying that the trunk is pitched forward via the pelvis, and so the erectors compensate to keep the body upright? Could the calves do the same thing via slight plantarflexion as well? I suppose I’ve never thought of it that way but it’s certainly logical. I just stood up and experimented with APT and tried to “feel” what was going on with posture, and it jived with your theory. Interesting conversation.

      • Derrick Blanton says:

        e-book APT theory, Chapter 1, “Posture”

        The body is working around the psoas, what else can it do? We are bipedal, upright creatures. The lumbar spine over-engages posturally due to load out in front, which the psoas maliciously provides, all day, every day.

        It’s like walking around carrying a child in your arms, and then blaming your biceps for being tight.

        The whole APT package: lousy, sagging, abs, aching tight erectors prone to spasm, calves down the chain. Perhaps it is one giant compensation pattern to stay upright and mobile while effectively driving with the spinal flexion brakes on.

        e-book APT theory, Chapter 2: “DL hyperextension”

        This could go either way. Definitely could be too much lumbar, and definitely could be too much psoas.

        You take your walking around posture, and your well worn neurological pathways into your lifts, yes?

        The abs are pretty much outnumbered all the time in the battle to set the pelvis, and if their force isn’t enough, then the body defaults to anterior stabilizing option #2, good old psoas, tried and true. (This is MWOD 101, and I tend to agree with it.)

        e-book APT theory, Chapter 3: “Glutes and Abs, Together Like You’ve Never Seen Them Before!”

        Strong glutes without strong abs won’t solve PPT in my view.

        Without a strong ab co-contraction, the glute force will move to extend the femur, rather than tilt the pelvis posteriorly.

        When the glute hyperextends the femur without a strong counterforce on the other side of the pelvis, then the pelvis is going to turn over the wrong (anterior) way.

        This is why improperly performed birddogs will dump the spine into APT, while properly performed birddogs are a great ab move!

        Once again, big time ab strength and activation is needed to use the glute on the pelvis rather than the leg.

        You pulled me right into that one, Godfather style, huh?!

        • Derrick Blanton says:

          er…driving with the “hip flexion brakes” on. 🙂

        • Anthony says:

          Derrick, do you have a website and if you do have an ebook called “APT theory” where can it be purchased? If you haven’t authored such a book, you need to. I would be one of your first customers. I thank you and Bret for the education.

          • Derrick Blanton says:

            That’s pretty cool of you, Anthony! If I do write the book, you absolutely get a free copy. Freely given, freely shared!

            Anthony, I really believe that many of these problems can be solved, the human body is a marvelous mechanism; but people have a hard time grasping the level of commitment, patience, and borderline obsession that it will take.

            You know, Bret wrote an Rx, Elsbeth wrote an Rx, what do you estimate the compliance rate is for the readers of their articles? I mean, to the letter absolute full compliance?

            One other thing that no one is mentioning, but I’ll toss out a little multi-disciplinary bro-science here, I believe the psoas, and adductors are “emotional, crawl into a ball” muscles that constrict under stress. So if you live with a chronic, high level of anxiety, (and frankly, who doesn’t these days?) I think this can all by itself start the APT snowball rolling.

    • Elsbeth says:

      Hey thanks Derrick. To your point on the pelvis v ribcage and the analogy to the bicep curl. I agree that what you describe can happen. But more often than not it doesn’t. Real vs ideal! I think if you have the combination of great coaching and a client/trainee with great body awareness, then I do believe that can be the case, although I would submit that it may take longer. The approach I use is no doubt influenced by the engineer in me – find a simple solution with a very low failure rate, and build from there. Assuming someone who is in APT will have the motor control to make that work doesn’t fit that bill, but I do agree it can work.

      • Derrick Blanton says:

        Hi Elsbeth, great point, and thanks so much to you and Bret for going in depth on this one. These types of discussions are like brain candy to me, and I learn a ton from exploring different ideas/modalities, as BC will wearily attest!

        Allow me to toss out a starter technique for learning to control the ab contraction to express at the pelvis, and not the ribcage: what I call a “Superman plank”.

        Hang from TRX straps at armpits like a parachutist and walk the feet back, this should ultimately be progressed to feet elevated, so you are parallel to the floor. Now extend arms up into full shoulder flexion, like you are flying ala Superman, (still supported at the armpits by straps, this isn’t Cique du Soleil, ha ha).

        Already this is a pretty decent ab contraction, now we perform PPTs, (pelvic tucks), always mindful of keeping the arms extended overhead and not allowing them to dip down. The straps under the shoulder will provide immediate feedback when you start “crunching forwards” from the top.

        This will also necessarily wake up the T-extensors, which now help provide the stabilizing force to work the pelvis.

        And from there progress into hollow body stuff.

        EV, obviously my bias is to get the abs really strong to counter the APT forces of psoas, adductors, lats, etc. This certainly doesn’t mean that I think this is the only component to the solution, and I am most definitely going to give your nine exercises a go! Multi-faceted solutions can be the best sometimes.

        Obviously I am losing my mind with all the comments, I have thought about this particular issue for years, like a puzzle! (shakes fists at the sky)

        Thanks for your time and thoughts, Elsbeth, high regards!

  • Christian says:

    Perhaps I am wrong but I was under the belief that it’s not so much lumbar spine flexion as a whole but flexion in a manner to end range that is the issue with lower back pathomechanics. In which case the reverse crunch is fine.

    I am not a fan of the reverse crunch just cause it does nothing for me, but I find alot of people misquote McGill’s work based on brief readings from blogs (in other words they’ve never picked up and read his research or his books).

    As for planks, like any exercise if it’s not something you find as effective as other approaches for your patients that’s fine and you have the right to practice what works for you. But really, there’s enough uneducated, inexperienced morons getting a run on pages like tnation that crucify the exercise without critiquing its execution. It’s usually the former not the later that is the issue.

    Thanks for the post – look forward to reading something from you other than APT (which frankly has been written to death about as if its the be all and end all of postural issues). You writing style seems great and your justifications given here to BC are equally great. I’ll read your material again

    • Bret says:

      Thanks Christian, the lumbar flexion debate is a whole nother topic so let’s stay on the topic of APT. Ironically, most strength coaches would blast me for the way I teach planks. I don’t just advocate a glute squeeze; I advocate end-range PPT with the plank as well, which works its way up the spine into thoracic flexion (but the lumbar spine doesn’t move into too much flexion somehow). It looks bizarre, but I feel this is the best way to strengthen the glutes as posterior pelvic tilters. Here’s a picture of what it looks like: http://bretcontreras.com/wp-content/uploads/Screenshot-at-Dec-12-23-25-44.png

    • Elsbeth says:

      Thanks for the comments, Christian. For the record, I have read McGill’s work – both research and books – and have had the pleasure of attending one of his 2-day seminars.

      As for planks, I’m not sure I disparaged them? Or maybe your’e not referring to me there?

      Thanks for the kind words about my writing style. I do hope to get some more articles out soon – got what I think is a very interesting one coming up about deadlift mechanics that I hope to finish soon.

      • Christian says:

        Neither comments were directed at the contents of your article. I’ve made the error of reading the tnation response along side BC’s post. Ie it was directed at the tnation community

        Well done to both of you for maintaining your patience and sanity in light of some of the comments made. There’s certainly a fair few derricks in this world

  • Any thoughts about this in gymnastics? They use PPT in planche/ levers.

  • Trev says:

    Odd question – if I attach a kettlebell to the back of my weight lifting belt and spend a while each day hanging out in this enforced PPT traction position, will I have discovered a ‘so-simple-everybody-wonders-why-they-didn’t-think-of-that’ fix, or end up doing wheelchair sports? I tried it out for a couple of minutes earlier and it felt okay, but I wonder if stretching hypertonic muscles might encourage more of that over time? Maybe post MF release it might help?

    Thanks for another thought provoking read.

    • Bob says:

      What about attaching the KB to the front? That would pull you into more APT, forcing (and thereby strengthing) the muscles that resist APT. If you put the KB in the back, you become dependent on the KB to maintain neutral, no?
      Bob

      • Trev says:

        That’s a great suggestion for strengthening Bob, but I’m more concerned with reducing hypertonicity and the grunginess (technical term) of tissue that’s been choked up by overcompensating for other muscles. I think that strengthening without soft tissue release is like adding 50hp to your car while the brakes are still sticking. They’re always going to be fighting each other.

        If I’m using rear traction to achieve neutral then I’m hoping that the tension convinces the non-compliant tissues to give up the fight. Maybe some judicious thumb pressure at the same time as traction and some pelvic rotation would help too. Once everything is moving freely then I’ll strengthen.

        (All of the above could be totally wrong of course)

  • Nic says:

    I have PPT. I currently perform hamstring stretches with ad/abduction, sissy squats, banded knee raises, deficit split squats. Is there anything else I can do??

    • Trev says:

      How about the opposite of what I suggest above, ie hanging a weight from the front of a lifting belt in order to induce anterior tilt? You could think of it as the equivalent of the bracing that’s used to treat scoliosis patients.

      • Derrick Blanton says:

        e-book APT theory, Chapter 4, “RNT Rx”

        Trev, I like the way you are thinking outside the box. You may find wearing the belt with anterior load to force APT is actually a great way to create an RNT (reactive neuromuscular training) effect, and teach your body how to solve the problem.

        The muscles that promote PPT will reflexively fire to try and get back to neutral, against the anterior load. This will be evident at the glutes, esp. superior, abs, and even up the chain to the upper back. Similar to wearing bands around the knees to drive the knees into valgus, which then grooves the varus moment correction at the hips.

        I’ve done this, and it has a pretty powerful PPT effect, esp when done for time, say a 15-minute walk. Note this is pretty exhausting! If you try it, I’d love to hear your experience! Good stuff.

        e-book APT theory, Chapter 5, “Hollow Body Work”

        I’m a big fan of training the lower abs with tons of hollow body position work with regressed and progressed hip flexion to solve the problem; this really sorts out where the spine needs to be as the hip flexes, and the muscles that hold it there.

        I think the body will tend to over-recruit the hip flexors in place of the abs until the abs are strong enough to do their job. This is also why after a nice hollow body ab activation you may find a nice window to work on hip mobility, as the psoas and adductors (another APT force), release a great deal of their resting tension.

        • Christian says:

          Are you people for real?????
          You honestly think that walking arpund with a belt and weight plate hanging off if is an intelligent let alone practical option?

          • Trev says:

            Derrick – thanks!

            Christian, yes I’m for real and yes I think it’s intelligent and practical! (Not to walk around, though. I tried it with a 20kg kettlebell so I’m keeping that indoors and maybe doing it for time as Derrick suggests.)

            I can see it might seem like a kooky suggestion, but why shouldn’t it work? It strikes me that by creating torsion at the hip in this way you could apply a PNF stretch and maybe reduce tone in the restricting muscles.

            Of course, if you can outline a reason why it doesn’t make sense then I’m ready to listen.

          • Derrick Blanton says:

            Christian,

            Is the farmers walk a useful exercise? Yes. Is the hip belt SQ a useful exercise? Affirmative. Bands around the knee to effect an RNT response to correct valgus effective? Yes. Monster walks, yes.

            Is it really so radical to think that these principles can’t be applied and combined to create a synergistic effect?

            Here’s the genesis of this on my end, and it was a happy accident: When I would do weighted dips with reduced rest breaks, I would just keep the belt affixed to the hips and then maybe walk and get water, etc. When I would take the belt off after several minutes, my glutes and abs were on fire from stabilizing the pelvis, and creating a posterior pelvic tilt to battle the load. I also felt taller and “wrenched in to alignment”.

            So then I would just start dragging my belt and some plates to the park and I would walk, do dips, walk, etc. It is no joke.

            If you don’t want to roll like that, fine, but don’t be so quick to dismiss ideas that are unfamiliar. After all, BC ran into all kinds of resistance with the idea of putting a barbell in the lap to hit the glutes, and we all know that turned out.

            Have you ever researched some the crazy, innovative shit the old school guys used to do to try to load and train the body?

  • X says:

    “Alternatively, I approach APT with the NINE exercises below, knowing that we’re hitting everything.”

    You only need one general exercise to cure APT, if only you understand the quote below;

    The lungs are the reservoirs of air, and air is the lord of strength.
    – Jui Meng, Shaolin Monk, 1692.

    It covers ‘ALL’ bases. In relation to APT, contraction of the long psoas fibers can tilt the pelvis posteriorly (hip flexors lengthen). Go to the mirror, take off your shirt & do a massive exhale. What is the pelvis doing?.

    “Once again, big time ab strength and activation is needed.” – Derrick Blanton –

    Covered. You don’t need to do any conventional gym ab exercises, ha ha.

    Other than that.

    Psoas & hamstrings are key muscles with regards to APT. Tight/short hamstrings require psoas muscles to tighten up & vice-versa. When you consider the superficial back line, you would almost certainly have tightness in the plantar fascia/Achilles also.

    High amounts of weight training (imbalance/muscular stiffness) but also an inadequate diet also relates to tightness/stiffness throughout the body (hamstrings/psoas take a lot of the brunt) as do the feet, as gravity pulls the nutrients/toxins downwards & these toxins eventually lead to tightness/degradation of collagen & eventually injury. Mainstream flexibility programs are inadequate, reading up on Ida Rolf will tell you why (stability related). If your doing lots of heavy hip thrusts, I would imagine your more than likely to have short/tight hamstrings = Tight/short Psoas.

    Ida Rolf emphasized that the pelvis should be horizontal with the hip flexors/hamstrings in a lengthened state. “If the Psoas muscle is where it belongs, the body lengthens in all movement.” she states.

    But if the body is tight/stiff/imbalanced it can’t ‘lengthen’. Unfortunately for all those that deadlift/lift heavy (high stiffness), they will probably never reach this lengthened’ state. It would be nigh on impossible because of the reasons stated above & how weight training affects the tone of the body. Your essentially just creating more & more problems.

    And as with most lifters, many of the bodybuilding supplements on the market today popular with athletes/strength athletes which guarantee “MORE STRENGTH/MORE EXPLOSIVENESS” further aid tightness/muscular stiffness, eventually leading to greater muscular imbalance (due to greater loads being lifted), eventually REDUCING athleticism.

    • Trev says:

      Hi X,

      The notion that gravity drags toxins south in the human body seems a little odd. Do you have any references for this as I’ve never heard of it before.

      Also, does anyone really have to choose between strength and flexibility? All the muscular gymnasts and MMA fighters who can do splits and 250lb NFL punters with their kicking feet over their heads would say you can have both.

    • AM says:

      <>

      That is… “interesting”
      ???

  • Amanda says:

    This was awesome! Perfect as I had read the T-nation article and had been thinking a lot about it. I have a background in Pilates and there are a couple of exercises from that discipline that I find really helpful for APT with my clients:

    1) “toe taps” (supine in neutral spine or with slightly “imprinted” spine, arms at sides, legs bent with shins parallel to the floor knees above hips, slowly lowering one toe down to the ground then back to start position w/o transferring weight into floor at bottom of movement, keeping same amount of knee bend in both legs and spine stable.

    What I like about this is that you feel the pressures throughout your core (from LPHC through shoulder girdle), but it’s a more manageable, lower load exercise with the bent leg lever. If you do this slowly and mindfully, even someone with great stability will find it challenging. There’s the option to place a bosu under the feet to shorten the ROM (in which case I switch to a heel tap). Really great exercise for focused breathing combined with pelvic awareness. You can FEEL how you have to breathe correctly or you will lose the canister. It transitions well into the “dead bug” which I also find to be a great exercise for APT.

    2) “Rollover prep” This is basically a reverse crunch (hear me out) but with an extremely small range of movement and in my opinion next to zero additional hip flexion once legs are in position. I have clients either rest crossed heels on a physio ball so the weight is less but still not totally stable, or, if they have the strength, start with the crossed ankle position unsupported but bend arms at elbow and place palms on thighs for a tactile reinforcement and bit of resistance to the hip flexion. Once there, I cue the pelvic tilt or imprint, keeping *lower abs* totally flat so the work is very deep. The pelvis will barely move, in fact if there’s too much movement I don’t think it’s working well.

    To start I often teach it with supported head and the slightest ever thoracic flexion – nothing like an ab curl, just putting the eyes on the pelvis so they can watch it shifting and slightly increasing obliques engagement.

    This exercise, when done correctly with that super deep work and very little movement, is excellent for bringing awareness of the deep abdominal stabilizers, it’s intense. People who have never felt that part of their body feel it like whoa after a few sessions. I find a huge, anecdotal, correlation between this exercise and correcting the APT while standing and walking so that people work up to a dozen or more daily corrections through the day as awareness builds.

    3) This isn’t pilates related, but, I always cue a slight pelvic tilt now when teaching glute bridges and I think it makes a huge difference with combating APT. The pelvic tilt at the beginning of the movement translates to pelvis staying neutral at the top of the movement, and keeps the thoracic in line so folks don’t go into a should bridge (so unfortunately common). People just feel their glutes so much more, it “clicks” that their pelvis needs to be in the right position for them to feel their glutes intensely. It can rock the world of someone who has been doing glute bridges without truly *feeling* them, which I find to be very widespread.

    My two cents. Keep up the great work!

    • Elsbeth says:

      Hi Amanda,

      I like your suggestions. The first one you describe sounds a lot like one of the progressions in what I refer to as a “Sahrmann marching drill” – basically starts with breathing while bracing and once that’s mastered, progress to adding leg movement – initially with one foot on the floor while the other moves and then progressing to both feet off the floor as one moves.

      Your version of the reverse crunch sounds interesting. I’ll give it a try tomorrow. It certainly addresses one of my big complaints about the reverse crunch – that it’s a heavy open chain load, but feet on a ball takes that away. Interesting.

      Thanks again.

      • Amanda says:

        The trick with “my” reverse crunch version is to work with extremely limited to zero hip flexion, with supported feet or no. I cue people to think about their pelvis moving away, toward them, from their stationary thighs. I’ll also sometimes like I said have clients support their thighs with their hands. Let me know what you think after you give it a try.

        I googled the Sahrmann marching drill and it is in fact the same focus and movement.

        • Zak says:

          Amanda,

          I am really intrigued by your drills. I tried the first one and I liked how it felt. Is there any chance of you ever making a video on how to do the second drill? Learning through text alone can be hard haha.

  • Tracy says:

    Thanks Bret & Elizabeth! I’ll share a couple cues I use but please let me know what you think of them. I respect your opinion very much! Many times I ask my clients to keep abs pulled back to support lower back and to take the tail bone to the wall behind them, not down but to stretch out breaking at the hip sending tail bone directly straight back emphasizing not to take it to ground.

    • Elsbeth says:

      Hi Tracy,

      I’m having trouble picturing that, but I think I might be getting caught up in that sounding like “drawing in”. Am I right or did I misunderstand? I tend toward the “bracing” side in the bracing v drawing-in debate.

  • Kellie says:

    I’ve learned so much for both of you over the years and this was another great lesson. Thank you so much for not only debating this topic but sharing it with us.

    Oh, I did wince to the protruding gut comment haha! Not all of us ATP’ers have this issue. 🙂 Haha!

    Thanks again!

  • Zak says:

    First of all, thanks to both of you guys for putting this together. The fitness industry needs more of this- intelligent arguments instead of ad hominem attacks.

    Elsbeth, I did a quick look at your website and noticed some posts about the FMS. I am still very new to training and I am trying to understand how all of these things work together. So, your article kind of described me. I have some hinge points in my low back, my erectors are always turned on, weak abs, APT, tight calves, little hip IR/ER, basically I am a walking ball of stiffness. In terms of the FMS, I have a 1-3 on the shoulder mobility (1 when right hand is on mid back) and a 1 on the deep squat, with 2s otherwise. Right now me and my therapist are doing thoracic rotation stuff, as I don’t rotate very much and especially not to the right (1) side.
    So, here is my question: should I be focusing on postural issues or FMS corrections? Both? How do the two play into each other? I want to see how deep this rabbit hole goes… And I would definitely be grateful for your input as well Bret!

    Thanks for all of your time and effort guys!

    • Zak says:

      *hinge points in mid back

    • Elsbeth says:

      Thanks Zak. I hesitate to touch on the FMS as I know that’s a hot topic. I’m not actually sure where Bret stands on the FMS, but perhaps we need to have an FMS convo one of these days.

      To your question, obviously I’ll preface what I say with “I haven’t seen you so take this internet advice with a grain of salt”. That said, I am generally a fan of “And” instead of “or”. I think FMS and postural corrections can work together. In fact, I might argue that a 1-3 shoulder mobility score would result in postural corrections as the FMS corrections. I’d want to see t-spine mobility work maybe quadruped rotation, sidelying rotation, t-spine SMR, but I’d also want to see a focus on breathing as poor breathing patterns will likely gum up the spine. The following shows and explains my new favourite exercise for all things shoulder: http://elsbethvaino.com/2013/11/best-ever-scapular-stability-exercise/. Note that I refer to a part 2 that in theory I posted the week after that one, but in practice I have not posted yet. I’ll try again for “next week”.

  • Bob says:

    I can’t resist a comment on the third law. A body moves (technically ‘accelerates’) by virtue of the net force acting ON the body, not BY the body. When you jump, it’s due to the force of the floor on you. Of course, the force of the floor on you is just the third-law reaction force.

    The fact these forces are equal-but-opposite does not mean they cancel, because each acts on a different body. You add up all the forces ON a given body to see if you get acceleration.

  • James says:

    Elsbeth & Bret,
    fascinating article I have a few clients who display APT, we have been working on some of the exercises you mention so I will try some of the other things you mention, just one question mainly for Elsbeth, the rolling you mention I have tried to find some videos on this but can’t would you be able to point me in the direction of one?
    thanks

  • X says:

    “Hi X,

    The notion that gravity drags toxins south in the human body seems a little odd. Do you have any references for this as I’ve never heard of it before.”

    Hi Trev, Few quick examples. Gout, inflammatory arthritis, rheumatoid arthritis etc all affecting the small joints of the feet. Many of these conditions are
    dietary related. With regards to gout it maybe high uric acid build-up in the blood. With some forms of arthritis it could be dairy/meat/sugary/GLUten products etc affecting the joint. The ailment is continually being fed until the joint finally begins to degrade.

    What we consume can either nurture or degrade the internal body (collagen/tendons/joints).

    You couldn’t make this up but some of the worst offenders are energy drinks/sports supplements (high sugars). Sugar is the devil. Everything from the marrow to the bones, organs, blood, joints is negatively affected & the efficiency of the body compromised.

    • Trev says:

      Hi X,
      Those examples don’t illustrate gravitationally selective conditions. Gout, inflammatory arthritis and rheumatoid arthritis go everywhere and would probably still do so even in zero G!

    • Inflammatory arthritis (of which both gout and RA are subsets) affects the cervical joints too. That kind of negates your theory.

      One theory of gout that seems more plausible than yours re: gravity, is that it (the crystal build up) occurs in areas of low body temperature – distal joints.

      To argue that sugar is the devil makes no sense without context.

      Going back to your original argument – you only need one movement if you understand the quote :

      “The lungs are the reservoirs of air, and air is the lord of strength.
      – Jui Meng, Shaolin Monk, 1692.”

      Could you please elaborate on this for me. Are you saying one only needs to perform deep breathing with complete exhalation, or have I misinterpreted you?

  • stephanie says:

    can you post a video of the corrective exercises?

  • Emily says:

    Hi Bret,

    Wonderful article as usual! I do have a question that hopefully you can answer for me. I was told per a chiropractor I used to see that I have an anterior pelvic tilt on one side (from the x-rays) and I also have had scoliosis since I was younger. I have pain on one side directly above the glute and althought I would like to believe that my form is good, it may not be as perfect as I think. With the exercises I’ve done in the past, one glute definitely seems larger. Do you have any recommendations for me? I will soon be seeing a physical therapist but am hoping to have some direction to know that they aren’t leading me astray. Thanks Bret!

  • This topic is of my personal interest because I have APT and I want to kill it in my deadlifts. Luckily I still retained enough first year physics to understand the whole thing (lol).

    I’m wondering if these 2 possibilities may apply that you haven’t discussed.
    1. Some structural degeneration in the lumbar spine due to years of poor posture.
    2. Some imbalances in another place in the body that causes APT. I have atlas subluxation complex possibly due to a whiplash or throwing a (way too heavy) book bags onto my shoulder as a young child. That causes uneven leg length and all kinds of crookedness throughout my body. 6 months of scouring the internet for all kinds of corrective exercises and manual treatments just didn’t work… until I figured out that I had a problem in my neck and I’d need a NUCCA chiro to fix it. My APT gets quite a bit better with some post-rehab training as well, but it hasn’t yet gone away. So now I’m wondering if there is any possible degeneration in the lumbar region although I don’t feel any pain now.

    It’s interesting that I never got back pain at all before I decided to correct my APT, even with some pretty heavy deadlifts. The one time I got really bad low back pain is when I went on a long walk with an old pair of shoes, and my tibialis posterior also hurt like hell. These are all fascinating.

    What’s your take on this?

  • Kevin says:

    jon north has the worst apt I think I’ve ever seen.

  • X says:

    “Hi X,
    Those examples don’t illustrate gravitationally selective conditions. Gout, inflammatory arthritis and rheumatoid arthritis go everywhere and would probably still do so even in zero G!”.

    Hi Trev, It’s all to do with the body’s natural protective mechanism. When toxins build-up in the body it’s the skin (acne/psoriasis/dermatitis etc) & joints (arthritis/gout/swollen ankles etc) that take the hit. Organs, brain, blood take priority.

    “To argue that sugar is the devil makes no sense without context.”

    Sugar and Arthritis.

    https://www.google.com/search?q=sugar+arthritis&client=aff-maxthon-maxthon4&hs=BXD&channel=t18&source=lnms&sa=X&ei=fueuUuynJOeg7AaRq4DwDw&ved=0CAYQ_AUoAA&biw=978&bih=637&dpr=1

    Sugar and Cancer Cells.

    https://www.google.com/search?q=sugar+arthritis&client=aff-maxthon-maxthon4&hs=BXD&channel=t18&source=lnms&sa=X&ei=fueuUuynJOeg7AaRq4DwDw&ved=0CAYQ_AUoAA&biw=978&bih=637&dpr=1#channel=t18&q=sugar+cancer

    “Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.” — Dr. Otto H. Warburg in Lecture.

    http://en.wikipedia.org/wiki/Otto_Heinrich_Warburg

  • Law says:

    I read the article and some of the comments. I like to chime in. I have some form of lordosis and been going to a NUCAA practitioner. He has corrected some of my imbalances but I still have some apt but not as bad as b4. My experience of apt is the hip is the main component of not being aligned properly. When I started doing planks I was able to stay in the position for a long time even though my lower back/hip was hurting. I found out that I had to align my hips straight(90dgs) for planks to work properly.

    You guys mention the superficial abs(rectus abdominus) and have valid points. But I believe one needs to strengthen the transverse abdominus which stabalizes the spine. Example would be yoga and horse stance like many Asian martial arts. One can reduce apt with all the exercises mentioned but the hip needs to be straight and the transverse abdominus needs to be strengthen.

  • Hi there,
    Thanks for this interesting discussion. Where could I find a detailed description of these 9 exercises.
    Kind regards,
    J.

  • Cory says:

    No one ever mentions lateral pelvic tilt 🙁

    I was always the “cool” guy in the back of the classroom leaning to one side in my chair. Now I can’t get rid of this Lateral pelvic tilt. I don’t even know how to cure it.

  • mick says:

    You guys are both badasses! But when will Bret/Elsbeth come out with articles addressing rounded shoulders, another bane of the modern worker’s existence? Keep being courageous, folks, you’re helping newbies and experts alike!

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