Saggy Jeans and Tailfeathers: How Your Pelvic Positioning Affects Your Body

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Photo by Pixabay on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.

Besides needing a new wardrobe, why should I care about my flat bum?

The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.

The Flat Bottom. Only in the eye of the beholder?

Pelvic floor and tilt

The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.

Rib pelvic alignmentThe inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.

Do I have a flat butt?

Aside from the saggy jeans, the flat butts of the world have a few other correlations.

1. The Tailfeather Test: Stand comfortably and squeeze the gluts.

a. Neutral pelvis: Thigh bones rotate.

b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.

c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.

2. You bear weight more in the heels

3. Back of your rib cage is behind your pelvis

4. Your Thigh bones are angled so that your pelvis is front of your knees

5. Your lower belly pooch

6. You Sit with pressure more on the sacrum/tailbone vs. sit bone

7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.

9. You have Breathing and abdominal pressure problems

10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.

Is there a better fix than butt implants?

Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.

1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.

2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.

3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)

4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.

Good luck with the joy sparking!

How to Deal with Pelvic Floor Pain From Home

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Dear reader, 

As I sit down to write this, New York City is on PAUSE, many other cities around the world are on various forms of lock-down. As a planet, we are working to slow the spread of COVID-19, the condition caused by the novel coronavirus. Those of you who are working from and staying at home, your efforts are noble and life saving. We thank you. For those of you in pain, we see you and feel for how tough it can be to feel like you have to wait to get help. Hopefully in a short period of time this virus will have passed . Follow these simple tricks to get started on tackling your pelvic pain. 

 

Check In With Your Seat

Work from home setups can leave a lot to be desired. Designed for portability, but not ergonomics, our laptop computers can leave us curled up like little cashews or “c’s”. This position tucks our pelvis underneath us and can cause us to put extra pressure and compression through our pelvic floors, not to mention putting extra pressure on our spinal discs. Even if you only have a laptop, you can remedy this c position by imagining you are a puppy dog with a tail. You want to sit so you could wag your tail like a happy puppy. Now for some people this may actually feel a little worse, if it does, this is not the trick for you. Don’t worry I have more. 

If you can, use a portable mouse and keyboard to discourage your cashew sitting tendencies. Arrange your setup so your eye line falls just about in the middle of the monitor by elevating it on some books.  You should be able to access your keyboard with your elbows bent at 90 degrees.

Now it’s time to think about what you are sitting on. I recognize that those of us living in teeny tiny NYC apartments may not have a lot of options to think about. But keep in mind that pelvic floor pain can be counterintuitive and an overstuffed couch, may not be the best thing if your pelvic floor is overworking to stabilize your body while you are sitting. Likewise, your kitchen chair may be too firm. Play around, how does the couch cushion feel on the chair? Is a firmer seat better or worse? You may have to trial and error your way into a solution.

Move

This one is so important. Depending on where you are geographically, you may be allowed different degrees of movement. If you are currently allowed to leave your home for exercise, go for a walk. Besides breaking up the day, walking can decrease the pressure from all the sitting you have been doing, as well as increase blood flow to the pelvic floor. While the requirements for social distancing remain, ensure that you maintain a distance of 6 feet (about 2 meters) between yourself and other people and wear a homemade mask.

If you cannot walk outside, and even if you can, get up periodically throughout the day. Stretch out, do some gentle air squats if they feel good. Look for some free restorative virtual yoga classes. Movement is medicine. 

Just be Happy… Like a Happy Baby

I love this pose so much that I could write a love song to it. Honestly. It works to stretch not only your pelvic floor, but your entire posterior chain  (back of the body). 

The most traditional way to do it, is to lie on your back, bend at your hips and knees, so that your feet are in the air, and grab the outside of your feet. As you stretch bring your knees towards your armpits. Hold this pose for 10 deep, beautiful breaths.

Feel free to modify this pose. Grab on the back of your calves or behind your knees if you have tight hammies. Put a pillow between your abdomen and thighs to prevent any pinching in your hip. It’s honestly all good.

Breathe

Another super important tool in your toolbox. Deep slow breathing can calm your nervous system, which can help to decrease pelvic floor spasm and guarding. In fact, in a study by Van der Velde, it was found that stressful stimuli do cause an increase in pelvic floor tightening. Try 10 deep slow breaths throughout the day and note how you feel from both a pain and stress perspective.

We are OPEN and also offering Telehealth

For those of you who are ready to get started NOW. You can. We are currently offering office evaluations and treatments, and telehealth services. Both Corey Hazama PT, DPT and Amy Stein PT, DPT are doing in person visits and telehealth visits are available with Sarah Paplanus PT, DPT.  For more information contact Beyond Basics Physical Therapy at 212- 354-2622 or check out our website: http://www.beyondbasicspt.com

 

Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31

 

Pilates with Kierstin: The Plank

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Plank

Set Up: Start on all fours with the shoulders stacked on top of wrists, lats engaged, collar bones broad, and chin slightly tucked to create length through the back of the neck.

Execution: Inhale to prep, exhale to extend one leg at a time back into a full plank position. Abs and glutes engage while nothing in the upper body shifts. Create a sense of length from the crown of the head through the heels. Hold anywhere from 10 seconds to a minute maintaining proper form.

Focus: Three key focal points when performing a plank: 1. Be sure to not sink into the shoulders. Push away from the mat, broaden collar bones, engage lats and serratus (your side body), and keep the back of the neck lengthened. The upper back should be flat, not rounded. 2. Support the lower back. Abdominal engagement is critical in this exercise and includes knitting ribs together, drawing navel to spine, and creating a hollowed out feeling in the lower abdomen in order to achieve optimum support for the lower back. 3. Create a sense of length. Constant energy reaching through the crown of the head to the heels will give you a sense of lift making the plank feel lighter. P.S. Don’t grip the glutes, but engage them slightly for more support.

Importance: Planks are a killer full body exercise. Everything has to be on, including the brain, in order to execute this exercise correctly. Planks allow you to target shoulder stability, core strength in its entirety, and mental/physical endurance.

Modifications: To modify, keep knees under the hips, tuck the toes and hover knees off the mat. Focus on the same cues for full plank. To add a challenge, well… the options are endless! Try adding alternating leg lifts, mountain climbers, or walk down to forearms and back up to hands without shifting hips side to side.