Reactive Lumbo-Pelvic Control Program

One of the most common postural dysfunctions seen is the anterior tilted pelvis associated with an increased lordosis. A list of compensations and adaptations such as thoracic kyphosis, hyper-extending knees, hamstring over activity, abdominal insufficiency, mechanical low back pain, etc. are often then attributed to the central postural dysfunction of the pelvic tilt.

However, it is probably quite unfair to blame the pelvis for this “chain” of dysfunction as its position is generally dictated by the length, tension and activity of the structures that surround it. It is merely being pulled into this shape, and its position can be a structural “symptom” of the muscle imbalances, fascial shortening and adaptations that are present.

This combination of postural tilt and imbalance often leads to an overall poor expression of core control and dynamic function. Examples of the problems are over active and potentially tight hip flexors, shortened, in-elastic thoraco-lumbar fascia and tight lat dorsi.

In trying to correct this dysfunctional pattern, there is no doubt that targeted stretches may significantly help, but often these fail as:

1. The stretch may appear to be gaining length when in fact all it is doing is pulling the pelvis into more tilt.
2. Length may be achieved; however, the postural strength in opposing/surrounding muscle groups may have been neglected... the pelvis is still free to “sag.”
3. The is a strong element of motor re-learning and re-patterning required to maintain this sort of postural correction, and this is often overlooked.

The following corrective pathway concentrates on using reactive sensor-motor technique, or what is sometimes called reactive neuromuscular training. It sounds complex, but it revolves around a simple principle. The exercises, if performed correctly, will dictate that there is an element of self correction facilitated by them. This self correction is essentially automatic and reactive and not consciously driven by voluntary recruitment. It appears that motor control and selection is performed within the domain of the “subconscious,” and it therefore makes sense that some of our training is also performed “subconsciously.” Common techniques used in reactive motor training are to position the body or use resistance forces that, if overcome automatically, recruit our target muscle groups and facilitate postural positional change... in this case, a stable pelvis with a more neutral/level tilt. Another technique demonstrated here is to use a resistance that pulls the athlete into his dysfunction, allowing him to feel and resist it (with his inhibited or weak groups). The exercise selection and positioning dictates that overcoming this resistance will create the correct automatic postural response.

The aim should be to blend reactive motor technique into exercises with a strong functional profile. In this case, the exercise pathway moves quickly to work the athlete in standing and single leg stance in order to take advantage of normal proprioceptive, gravity driven and positional characteristics.

Preparation Stretching

Figure 1 Figure 2  Figure 3

Start the pathway with targeted flexibility. In this case, we are using pre-positioning and feedback from a stick or wall to maintain alignment while the hip flexors and lats are stretched.

Figure 1 shows a hip flexor kneeling lunge stretch. Maintain stick vertically down spine, draw in abdominals to facilitate some posterior pelvic tilt. Hold the tilt as the lunge is performed.

The athlete is performing a wall lat stretch (see Figure 2). Stand one foot’s distance from wall, sit back into wall while engaging head, spine and buttocks. Draw in abdominals to facilitate some posterior pelvic tilt. Maintain this posture as arms are driven overhead to press back of hands against wall. Draw hands closer together on stick to progress stretch.

Figure 3 shows a similar action to above while seated against wall (sacrum engaged to wall). Soles of feet together, abduct knees and push down to floor as stretch is performed.

Supine Extension Control

Figure 4 Figure 5  Figure 6

In Figure 4, the athlete has performed a bilateral arm raise with a single leg extension. Both lats and the right hip flexor are lengthened. The characteristic reaction of the “core” is seen with the lumbar spine hollowing and the lower rib cage flaring upwards. In athletes demonstrating anterior “shear” imbalance, this reaction will be excessive.

With knees bent, the athlete slides hands under a heavy ball/barbell, etc (see Figure 5). Push to elevate the ball but do not lift from floor. This action will facilitate the abdominals to contract to reflexively stabilize/brace the thorax along with a producing a posterior pelvic tilt, clearly seen in Figure 5.

Athlete then positively extends one leg down flat to the floor with ankle dorsi-flexed (see Figure 6). Pelvis angle control is auto-facilitated by the ball lift action but can be actively encouraged if necessary. Lordosis and abdominal release is minimal. Return the leg and repeat on opposite side. Monitor for asymmetry.

Reactive Tilt Control (Waist Resistance)

Figure 7 Figure 8

A loop of strong exercise band is placed around the athlete and onto a weight bar/stick/bodybar. The athlete pushes the bar forwards, creating a tension that effectively drives into an increased lordosis (see Figure 7).

The athlete is instructed to reactively resist against this force into an opposing tilt until a more neutral pelvic posture is held. This is an example of feeling and opposing dysfunctional forces with reflexive recruitment. Hold for a count of 10 and repeat 10 times.

Figure 9 Figure 10  Figure 11 Figure 12

In Figures 9-12, the athlete pushes the bar forwards while maintaining the tilt corrected position (the shorts waistband stays level). At the same time, one arm is elevated into a pure extension reach overhead. Pelvic posture with associated abdominal facilitation must be maintained.

Notice how in this sequence of images, initially the athlete struggles to maintain form with the head flexing, trunk rotating, shoulder externally rotating and elbow flexing. A “false” and compensated range is demonstrated. With repetition, control is achieved until in the final image, posture, alignment, timing and pelvic position are held.

In this exercise, the band provides a twofold reactive element. Pelvic control is facilitated as described previously, but also the action of pressing the bar forwards against a strong resistance recruits anterior chain muscle action and reciprocally inhibits posterior chain action. As the lats are part of the posterior chain, and if stabilized well at the pelvis (see above), there is a degree of reciprocal release that encourages further range of movement.

Figure 13 Figure 14  Figure 15

In Figures 13-15, the progression is to challenge pelvic control from below. The athlete adopts the bar pushed and corrected start position. Foot is placed on a medicine ball (see Figure 13). The leg is driven back into extension while the athlete is reflexively encouraged to hold tilt control by resisting the bar push lordosis force.

Do not expect a great range of femoral/hip extension, and a small degree of release into lordosis is likely (see Figure 14). Over compensated and imbalanced athletes are likely to want to squeeze into an obvious hyper-lordosis; however, resisting the band will give feedback and feel to maintaining a more neutral posture.

In Figure 15, the exercise is further progressed by adding elevation of the same side arm, an extremely tough pelvis control challenge that the above athlete shows good form in achieving.

Reactive Tilt Control (Knee Resistance)

Figure 16 Figure 17  Figure 18 Figure 19

In Figures 16-19 above, the reactive resistance is now placed at the knee with a long loop of strong band attached at a high angle to encourage a flexion “break” at the knee without excessive forward pull (topple). Take up a single leg stance. The athlete is encouraged to hold a core neutral posture with hands placed front and back for feedback.

In Figures 16 and 17, the athlete demonstrates a simple single leg dip while maintaining core and pelvic posture. The gluteal and lower posterior chain contribution is reflexively facilitated by the band resistance, with the abdominals also encouraged to “hold up” the pelvic position. This feeds into maintaining a more neutral pelvic tilt.

Once control is adequately demonstrated, posterior chain facilitation is enhanced by adding a dumbbell press forwards to the dip (see Figures 18 and 19). Gravity and the long lever arm will create a force that tilts the spine, pelvis and hip forwards, but the band facilitates an opposing reaction from the glutes and posterior chain. Maintaining the spinal angles and pelvic posture as the athlete dips and returns is both actively and reflexively encouraged. The athlete can both feel, and train under resistance, the control of his pelvic tilt.

Overhead and Waist Resistance

Figure 20 Figure 21

The previous exercises are going to provide a strong foundation that can be progressed into the advanced exercise sequence see above in Figures 20 and 21.

The athlete stands with a pulley system or band producing a high overhead posterior resistance, pulling both arms into overhead extension (this does not need to be excessive resistance!). A further strong band is fixed or held by the trainer/therapist around the waist.

Effectively, the athlete is challenged with a dichotomy of forces, being pulled into both extension and lordosis; however, reflexively resisting these forces will recruit the opposing muscle chains (particularly the abdominals and glutes). Simply standing with a neutral pelvic tilt but fully extended arms will be the first challenge to over come. Once stabilized, ask the athlete to positively drive one knee up high but maintain posture and alignment. The downward stance leg hip flexor is now lengthened and “learns” to function in this position underneath a facilitated neutral pelvis posture. Repeat on both sides gradually increasing knee drive height.

Figure 22 Figure 23  Figure 24

Once control is demonstrated, a forward press into the upper limb resistance is added (see Figure 22). With the athlete reactively facilitated by a co-contraction of the correct opposing stabilizing muscles, he can both feel, and train under resistance, neutral pelvic posture.

In Figure 23, the forward press anterior chain activity “pulls” from the stable base provided by the facilitated pelvis posture. While the pelvis maintains its orientation over single leg stance, the upward driving leg contributes its own confluence of forces; however, if the pelvic “platform” remains stable, its hip flexor has a base to pull from and can maintain a high knee raise. Sounding complicated, what this means in terms of movement is that the pelvis is not distorted into excessive anterior or posterior shear if the exercise is performed successfully.

Figure 25 Figure 26

Finally, the athlete is asked to perform a single leg dip while maintaining the start posture (see Figures 25 and 26 above). By holding posture, and resisting the displacement forces, a more neutral pelvic posture can be facilitated. Once again, expect slight but by no means excessive lordosis. If necessary, ask the athlete to push slightly harder into the overhead resistance to reflexively facilitate abdominal contribution to pelvic control.

Figure 27

The exercises can be performed with a broad band looped around the naval (see Figure 27). This seems to assist the athlete to both feel and facilitate a quality abdominal reaction and helps maintain “feel” for low lumbar posture.

Summary

• The motor learning aspect within this pathway means that repetitions should be kept low (six to eight reps on each side), but the quality and form of each exercise must remain very high. Fatigue may erode the quality of the exercise and motor learning response, as would the use of excessive resistance.
• Postural control can be rapidly facilitated but may take time to be maintained. The program can be performed two to three times per week for three to four weeks. The exercises then become useful techniques to use as part of a facilitating warm up/preparation before a more dynamic exercise session.
• Excessively lordotic posture is difficult to fully correct; however, even a degree of correction may reduce the soft tissue tensions and joint compressive forces that are associated with excessive lordosis.

References:

1. Clark, Mike. Essentials of Integrated Training Series. 2001-2003
2. Cook, Gray. Functional Movement Screening Exercise Progressions. 2005
3. Cook, Gray. Athletic Body in Balance. Human Kinetics, 2003
4. Norris, C. Back Stability. Human Kinetics, 2000
5. Page, Phil. The Janda Approach to Musculoskeletal Pain. www.Thera-BandAcademy.com, 2002-3