Fix Posture & Reduce Back Pain With This Warm Up

America is an injured nation. The total costs of low-back pain in the United States exceed $100 billion per year (1). I have seen this firsthand as a trainer. The majority of my clients have experienced back pain or currently have back pain. People move poorly and are weaker than ever. I am sorry to be brash, but it is the truth. And if you don't believe me, just take a look at this high school from the 1960s.

Exercise and play used to be a focal point at schools, but that is no longer the case. The average working adult sits about six hours per day (2). When you sit for too long, the hip flexors and lower back tighten causing the pelvis to tilt forward i.e. anterior pelvic tilt. Now, I am not saying you should ditch the chair and stand all day. Remember, sitting is a squat movement and when you squat, the pelvis must tilt forward for proper movement. The problem arises when you stay in the same position for hours on end.

Which posture do you have?

When you stay in the same position for too long, the body adapts to the new position to save energy. And since most people sit eight to twelve hours a day, the body adapts to an anterior pelvic tilt. Thus, when you stand up, the body is still stuck with an anterior pelvic tilt. And if you don't fix the posture, the body will stay stuck in the same position. So when you walk, run, or exercise the body will be in an anterior pelvic tilt which will compromise the muscular functions of the hips and trunk. The glutes, hamstrings and abdominals become weak forcing the lower back and hip flexors to do all the work. 

I had to learn this lesson the hard way. While in high school and college I would sit six to eight hours a day. Overtime, I developed an anterior pelvic tilt from my class schedule. And then one day while lifting weights, I hurt my back and caused a bulging disc in my L4-L5 region. It is imperative to understand that the injury wasn't due to the weight lifting, rather it was due to poor posture and muscular imbalances.In order for the body to function properly, it must be in the correct alignment. I am not alone in this thinking, a study done in the Journal of Physical Therapy Science found the same results (3).

Lordosis: Anterior Pelvic Tilt

As you can see from the chart on the left, the lumbar erector spinae and lumbar multifidus had much higher muscle activity in a lordosis posture versus a neutral posture. Also, the gluteus maximus upper and lower muscle fiber's activity were much lower too. Inactive glutes and a weak core will lead to an anterior pelvic tilt and drastically increase one's risk for injury.

The idea that an anterior pelvic tilt can increase the risk for back pain is supported by CJ Sorensen and colleagues. Their goal was to examine the effects lumbar lordosis has on back-healthy participants who do and do not develop low back pain during two hours of standing. Twenty four of the 57 participants reported back pain during the duration. The people who had reported back pain had an increased anterior pelvic tilt.  The authors found an increased lumbar lordosis (anterior pelvic tilt) to be a risk factor for low back pain. (4) Put simply, the participants who had an increased lumbar lordosis experienced more pain during standing versus the group with less lumbar lordosis. Therefore, to alleviate back pain we must bring the body back to proper alignment.

To reverse an anterior pelvic tilt, you must strengthen the abdominals, obliques, glutes, and hamstrings. When these muscles contract they pull on the pelvis and tilt it posteriorly. Also, stretching the lats, quadratus labrum (QL) and hip flexors will help too. It is important to stretch these muscles because when they contract they cause the pelvis to tilt anteriorly. Thus, we must get them to relax and stretch so that the pelvis can go back to a neutral position. Use the warm up below to reduce your anterior pelvic tilt.When performing the warm-up I want you to pay attention to your breathing and focus on the quality of movement. Perform the warm-up before each one of your workouts for the next two months. 


1. ½ Kneeling Hip Flexor Stretch 2 minutes per side

2. 90/90 Hip Lift W/ 2 Arm Reach 5 exhales

3. All 4s Belly Lift W/ IR Hip 5 exhales

4. Dead Bug 6 reps per side

5. Leg Lowering W/ Band 8 per side

6. Swiss ball Hamstring Curl 15 reps

7. Side Bridge W/ Clam Shell Iso Hold 20-second hold

8. Hip Flexor Mobilization 8 reps per side

9. Glute Bridge W/ Ball Between Legs 15 reps

10. Active Hip Lift to Lateral Lunge 5 reps per side

11. Quad Pull Back To Lunge W/ Overhead Reach 5 reps per side

12. Hips High Forward & Reverse Bear Crawls 10 reps each


Citations

1. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:21-4. Review. PubMed PMID: 16595438.

2. Chau, J. Y., Daley, M., Srinivasan, A., Dunn, S., Bauman, A. E., & van der Ploeg, H. P. (2014). Desk-based workers’ perspectives on using sit-stand workstations: a qualitative analysis of the Stand@Work study. BMC Public Health14, 752. http://doi.org/10.1186/1471-2458-14-752

3. Fujitani, R., Jiromaru, T., Kida, N., & Nomura, T. (2017). Effect of standing postural deviations on trunk and hip muscle activity. Journal of Physical Therapy Science29(7), 1212–1215. http://doi.org/10.1589/jpts.29.1212

4. Sorensen CJ, Norton BJ, Callaghan JP, Hwang CT, Van Dillen LR. Is lumbar lordosis related to low back pain development during prolonged standing? Man Ther. 2015 Aug;20(4):553-7. doi: 10.1016/j.math.2015.01.001. Epub 2015 Jan 14. PubMed PMID: 25637464; PubMed Central PMCID: PMC4469524. 

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