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Thread: How Do You Address Excessive Anterior Pelvic Tilt In Your Intermediate Lifters?

  1. #1
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    Default How Do You Address Excessive Anterior Pelvic Tilt In Your Intermediate Lifters?

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    Rip,

    I did an LP a few years ago but slipped back into novice status and have recently been re-doing an lp, which should be finished soon. 28 y/o, currently squatting 275 for sets across and still making 10lb jumps. Deadlift is 365 x 5, Press is 125 x 5, Bench is 205 x 5.

    However, I'm having issues with anterior pelvic tilt and it's causing quad tendon pain. I've had APT for a long time, probably developed when I was in the military, but I didn't know it was a problem until my knee started hurting. I'm not sure I understand the mechanism for how apt is causing my quad tendon to hurt, I just know it does. If I allow myself to be too anteriorly tilted under the bar my knee feels unstable and I get quite a sharp pain. If I squeeze my abs as hard as possible and try my best to posteriorly tilt my pelvis, I can usually squat without pain, however, as the weight goes up I am having a very difficult time maintaining that position in the hole and my ability to hold pelvic position doesn't seem to be adapting as quickly as my ability to get the weight up. The muscles involved in holding the position fatigue quickly.

    Just walking around my pelvis is almost always tilted excessively. If I actively think about it, I can bring it back into neutral or near-neutral position, but only until I stop focusing on it and it goes back to the tilted position. As a result, my knee has a low-grade ache all the time. Nothing major, but an annoyance for sure.


    What would be your recommendations for this situation? All I can find is a lot of silly physical therapy bullshit that involves 8-12 bodyweight exercises/stretches done for 3-5 sets each. My goal is to continue to train while getting my pelvis back into normal anatomical position for normal day to day function and still be able to hold a strong lumbar extension when lifting weights. Is supplemental work for the hamstrings and the *shudder* abs...the answer?


    Squat form last year (huge apt): Shared album - Mitchell Smith - Google Photos
    Squat form from a few sessions ago (big focus on posteriorly tilting) Shared album - Mitchell Smith - Google Photos


    Thanks in advance,
    Mitchell Smith

  2. #2
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    Even in these badly-framed videos I see no excessive anterior pelvic tilt. Who told you that "excessive" lumbar extension causes quad tendon pain? How was this mechanism explained? How do you know that you in fact stand normally in lumbar overextension? There are about 9000 other ways to explain quad tendon pain without resorting to something as exotic and arcane as "Anterior Pelvic Tilt." But if you keep trying to squat with lumbar flexion, you are going to actually hurt yourself.

  3. #3
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    My apologies for the poor framing. I'm not really one to film things often, so in the first case I just handed the phone to a guy at the gym, and the 2nd is my home gym which is small and the only place to sit a camera and get anything except front view is in that spot. I know it makes things hard to diagnose.

    When viewed from the side in the mirror it's very clear that I do in fact have quite a pronounced tilt most of the time. I like ya Rip, but not enough to take bathroom photos for you, so you'll just have to take my word for it. Best I can find is an old gym photo from back before I knew what an anterior pelvic tilt was (excuse the wearing of wrist wraps both below the wrist and while not pressing haha, we are all idiots at times) Shared album - Mitchell Smith - Google Photos again, hard to see with a shirt on, but you can kinda tell based on how my pants ride on my waist, big drop from back to front, and the gut is protruding. In fact, I've always had a little "shelf" so to speak that the back of my shirt rides on.

    At rest, there's a distinct "pinched in" looking segment in my lumbar spine that's quite sharp. Almost resembles the first cut you'd make in a tree if you were cutting it down with an axe. I always catch myself standing with completely locked knees, and erectors engaged. While laying on my back, one could quite easily slide their entire forearm under my lumber spine.

    No-one told me that excessive lumber extension causes quad tendon pain, it's just been my observation through trial and error. In fact, I can't even fathom a mechanism for it. It's a mystery to me. I'm certainly open to other explanations, but to me it's quite clear that the APT is the underlying problem. Last year I wasted some money on a sports medicine doctor and a physical therapist who both said I needed graston therapy on the tendon, after months of that (and stupid things like a raised heel eccentric pistol squat, or a 1 leg side lunge on a half-bosu ball) having no effect, their response was "well, I don't know what to do, maybe we could try needling", at which time I stopped giving them money. Those pistol squats hurt real fucking bad though...

    Here's why I think the APT is the cause and the quad tendon pain is the effect.

    1. Observation that the tilt in fact is present. (Confirmed by a different DPT, not that that means much)
    2. Alleviation of symptoms when pelvis is actively brought back to neutral (I physically cannot produce a posterior tilt at all, so trying to posteriorly tilt only gets me back to around normal).
    3. Increase in symptoms when I am lazy about my hip position and try to load the quad with the anterior tilt. Even something as insignificant as unlocking my knee a few degrees eccentrically to get the dog bowl off the floor results in significant discomfort or sharp pain(never can predict which) unless I actively tilt my pelvis posteriorly.
    4. If I stretch my hip flexors and quads I find it much easier to maintain proper position and move without pain, but the effect doesn't last long. I work an office job so other than training I am very sedentary, further supporting the idea that I have shortened hip flexors (including the rectus femoris which is where the pain is coming from distally).
    5. I can place quite a load on the knee IF the pelvic position is right. I can even front squat ass to grass without pain so long as I have my pelvis in the right place. I don't like front squats, and don't do them regularly, but of course we both know they place a greater moment arm on the knee than the LBBS, so if I can front squat without pain under proper pelvic control, I don't think the knee itself is the cause of the problem.

    That all being said, if you have any other ideas about what may be the underlying cause here, please let me know. If there are any particular things you want me to test/try, I can do so and report back.

    If you do agree that the APT is a problem, how do you suggest one go about creating a permanent change in subconscious in hip position?

    Thanks again.

  4. #4
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    Quote Originally Posted by Mitchell Smith View Post
    No-one told me that excessive lumber extension causes quad tendon pain, it's just been my observation through trial and error. In fact, I can't even fathom a mechanism for it. It's a mystery to me. I'm certainly open to other explanations, but to me it's quite clear that the APT is the underlying problem.
    It's not clear at all. First, you may in fact have a perfectly normal lumbar lordosis, since lordotic curves display a rather wide range of normal curvature. Second, absent a clear mechanism, which neither you nor I can explain, the only thing that may be clear is that you have both knee pain and a hyperlordosis, which absolutely does not either prove or even imply cause and effect. People have two things wrong all the time. I see no excessive lordosis in these videos, and you have not described your knee pain. Your wiggling your pelvis around may well be affecting your downstream knee mechanics, which then alleviates the knee pain.

    Sorry to tell you this, but knees sometimes hurt. If an exotic explanation satisfies you, fine with me, but be aware that lumbar flexion is not a solution for this problem.

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    Quote Originally Posted by Mark Rippetoe View Post
    People have two things wrong all the time.
    Well, you may be correct about that, which is why I said I was open to other explanations.

    Do you have any idea how my "wiggling my pelvis around" might be impacting my knee mechanics? Are you aware of any tests I could perform to try to isolate a cause here?

    All I know for sure is that if I consciously extend my lumbar spine, my knee hurts 100% of that time, when I attempt to flex my lumbar spine, even unloaded and sitting in a chair, the knee pain resides. When I don't do anything with my pelvic position, I have a minor ache all the time, altered movement patterns (avoidance of knee flexion) and can't load it without pain.

    Pain description:
    During normal daily activities (sitting, walking, doing yard work, whatever) there is a general...discomfort in the knee. I wouldn't necessarily call it pain.
    Under any eccentric knee flexion there is a sharp pain just above the patella on the right knee. Right where the tendon inserts on the top side.
    If squatting and not "wiggling my pelvis around", it feels like someone has a knife buried into the tendon, regardless of the weight on the bar.
    All pain and/or discomfort is alleviated in the presence of different pelvic position. Loaded or unloaded, standing or squatting, sitting or laying down. Can load maximally with no pain at all so long as the pelvic position is right.

    I see no point in trying to use the pain rating scale since it's far too subjective and most people are whiners anyway. I'll just say that anything I've described above as "sharp" is the kind of pain that makes you run from it. It's not the kind of pain you grit and bear unless you're in a real serious circumstance. There's no training through it.

    Quote Originally Posted by Mark Rippetoe View Post
    I see no excessive lordosis in these videos
    Do you see flexion in the home gym video? Watch right before the descent which is where I consciously set the pelvis and I maintain that position throughout the movement. Cueing myself to produce flexion is not necessarily the same thing as actually producing flexion.

  6. #6
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    There is an awful lot wrong with your squat that is far more likely to piss a quad tendon off.

  7. #7
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    This is the kind of thing that can't be fixed on the internet. Where do you live?

  8. #8
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    Is anterior pelvic tilt like “my glutes aren't firing”?

  9. #9
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    The opposite, but the effect is the same.

  10. #10
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    starting strength coach development program
    Anterior pelvic tilt is a movement.
    Hyperlordosis is a description of posture.

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