The Relevance of Pelvic Mobility on Low Back Pain
- Pain & Injury • Sept 17, 2020
By Maria Gehue, PT
3 Minute Read
ow back pain is one of the most common complaints that I see in my clinical practice. I am always shocked at how long people deal with this pain, often chalking it up to not stretching enough or improper posture. What I have found is one of the most helpful tools I can use is teaching my patients to disassociate their lumbar spine from their pelvis. After all, we cannot forget about the influence that the hips and pelvis have on our lower back mechanics.
The spine has three natural curvatures. A gentle curve outward at the neck, or cervical spine, a curve inwards at your mid-back, or thoracic spine, and another outward curve at the bottom of your spine, also know as the lumbar spine. What people often forget about is the pelvis and sacrum – the true base of your spine. The pelvis is a heart shape construct of three different bones (the ishium, ilium, and pubis) that support the entire body. The sacrum makes up for the back-middle part of the pelvis. A relatively triangular shape that ends at our tailbone. There is a joint made between the legs and the pelvis, called the hips, that sit into a socket on the ischium called the acetabulum. So if we really think about it.. the pelvis is the true bony structure linking the spine to the legs. Now, let’s consider the influence on movement. The pelvis must tilt when we go to walk, bend, lift, and reach. The movement may not be very big, which is why a lot of people overlook the importance of the motion. But, it is incredibly relevant.
What I have noticed in my clinical practice is a lot people with persistent low back pain have trained their pelvis to move at the exact same time as their spine. Overall this becomes incredibly inefficient in energy expenditure, and causes the muscles that arise from the back and attach to the pelvis to be incredibly taught and angry. These are the main muscles that extend our back and allow us to stand straight. So… how do we fix this? The first step is teaching your body to move the pelvis and the spine separately. Sounds crazy right, but it’s actually quite simple. I will admit that the first few days of these exercises are always more “brain work” than anything. Together, we are trying to overcome movement patternings that your body has developed primarily due to pain. When your back is sore, every movement you try to make becomes guarded. For instance when you try to bend, you may notice that you stiffen from your pelvis all the way up to your neck. You develop this concrete spine motion where you are too afraid to move anything connected to the back, so all of a sudden bending now is purely coming from your knees, and reaching is incredibly awkward. It’s like you completely forget that you have hips and a pelvis!
I am going to briefly walk you through a beginning exercise for lumbopelvic disassociation. You begin with laying on your back with your knees bent, feet on the ground. This is called crook lying, and is a neutral position for your spine. It also is a decompressive position for your back, aka theoretically eliminating the direct force of gravity. It likely is something you have discovered as a position of comfort if you suffer from persistent lower back pain, and if not then it is a good trick for you to know! When you are in this position, you will gently squeeze your glutes together and curl your tailbone up towards the sky. This is a posterior pelvic tilt, or backward tilt. Your back should stay relatively close to the ground, but may lift gently. Next we are going to tilt the pelvis anteriorly, or forward. You begin this motion by slowly lowering back to the starting position, and then gently arching your lower back as if you are driving your sit bones into the ground. You will notice your lumbar spine will begin to arch as your pelvis tilts forward. Always begin going through your pain-free range of motion, even if it seems almost pointless with the limitation in mobility that you have. Each day that you practice you will see improvements. You may notice that you really have to concentrate on this movement in the first few days, but eventually it will become more natural.
If you are someone who suffers from persistent lower back pain with no relief, let’s be sure to look into the pelvis. After all it is the true base of the spine, and the connection to your legs, which are quite important for many aspects of living such as standing and walking! If you would like guidance on how to progress this exercise and overcome your movement system impairments, schedule a physiotherapy assessment to guide you on your way to a pain-free active lifestyle.