Updated: Jan 9, 2021
Low back pain during running is common in the excessively anterior tilted, lordotic runner. If you went searching for evidence between this posture and low back pain, it would be scarce; but that doesn’t mean it doesn’t become sensitive and painful if a runner uses an anterior tilt as their only strategy – movement variability is good, and the ability to posterior pelvic tilt is essential for shock absorption.
Additionally, the ability to dissociate movement between the thorax and pelvis is critical to allow one to coordinate a running stride well and to share and distribute load throughout the body. Issues arise when this dissociation doesn’t exist and every time the thoracic spine or hip extends, the pelvis and lumbar spine go with them. These are all distinct segments and should have the ability to move independently of each other. Improving this relationship and coordination will increase ones movement variability, skill and coordination.
Initially, I want a runner to be able to dissociate thoracic extension and flexion from the pelvis. A good way to start is in an all 4 kneeling position – this position decreases the amount of moving parts, making it much easier to coordinate movement than standing. Can the individual hold a steady pelvis and move the thorax? Can the individual hold a steady thorax and anterior and posteriorly tilt the pelvis? If not, this has to be step one.
My second go-to is to utilise an external cue – a dowel – to help the runner learn how to posteriorly pelvic tilt whilst going into hip flexion and then back to neutral by extending the hip. Often, this ability to dissociate movement between the hip and pelvis is lost – every time the hip flexes (or perhaps extends) the runner anteriorly tilts the pelvis. Again, the pelvis and lumbar spine should be able to stay relatively still while the hip goes through range. The dowel hip hinge is a great way to teach this. Once this new motor pattern has been learnt I would add load via a deadlift.
Next I would look at adding in an ab wheel roll out. The goal here is to hold a posterior pelvic tilt while going from a hip flexion position towards a more neutral position at the hip. Basically this is teaching and strengthening the ability to dissociate hip extension from anterior pelvic tilt. This is a great exercise and can be progressed by taking the roller further away from the body if the control is still there.
A bird-dog teaches pelvis (and lumbar spine) dissociation from hip extension. The goal is to keep a 'neutral' pelvis and move the back leg into hip extension, trying to straighten the knee also. If the lumbar spine excessively arches, the individual has anteriorly tilted the pelvis and there is an inability to dissociate hip extension from anterior pelvic tilt.
These two exercises are starting to add some strength into the equation by decreasing the stability. The advanced bird dog adds in a large rotation component, which is also fairly specific to running.
The final exercise is aiming to keep a fairly stable thorax while getting some pelvic rotation and oblique strength. The goal is to get the knee towards each elbow joint, without rotating the upper back. During running the pelvis and trunk should counter-rotate. This exercise can help to strengthen that pattern.
So why train this neutral or posterior tilted pelvis position? Because in a lot of cases this movement pattern isn't being used. An excessive anterior pelvic tilter will often use that strategy whenever the hip goes into extension, or when the thoracic spine extends. There is nothing wrong with anterior tilt and an extended lumbar spine – it’s an essential movement. However, it shouldn’t be someone’s only option. Movement variability is key.
Once control and awareness is gained, I would progress this into squats, deadlifts and lunges. However, if you jump straight to these exercises without helping someone learn a new movement pattern, there will be no motor learning affect and the same habitual pattern will likely be used throughout all these strength movements - this is the opposite of movement variability.
It's my preference to teach movement variability and coordination first, and then add strength on top of this.
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Seay, J.F., Van Emmerik, R.E., Hamill, J. (2011). Low back pain status affects pelvis-trunk coordination and variability during walking and running. Clinical Biomechanics 26 (2011) 572–578
Evans, K., Tuttle, N. 2015. The importance of movement variability for performance and prevention of injury. 22(8). 358-360