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Craig Roberts, Chiropractor, Grass Valley CA
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Low Back and Pelvic Stabilization

The following exercises are designed with three goals in mind.  First, they will teach you different positions in which you can hold your pelvis and low back to minimize strain on damaged tissues.  Second, the will teach you balance and control in these positions—a healthy low back and pelvis depends as much on a well coordinated nervous system as anything else.  Lastly, they will develop and teach you to use your “core” muscles.  These are the muscles that provide support and control for your joints and posture.  Practice the basic versions of exercise thoroughly before moving on to the more difficult versions.  Your practice should be demanding, but pain free.

Pelvic Range of Motion

Begin in a standing position.  Place your feet shoulder width apart and push your belly button forward while lifting your tailbone back and up.  By doing this, your low back should arch forward.  This is called an “anterior tilt”.  Next, try tightening your stomach and gluteal muscles, lifting your pubic bone toward your nose.  This is a “posterior tilt”.

Practice moving from an anterior to a posterior tilt several times, taking note of how each extreme feels. 

         ANTERIOR TILT                   POSTERIOR TILT 

   ant_tilt.jpg post_tilt.jpg

Now move to a kneeling or sitting position and repeat the same exercise, alternating between anterior and posterior tilts several times.  Try the same exercise again lying on your back with your legs bent and your feet on the floor.  During the posterior tilt you should feel your abdominals tighten and your low back press into the floor.  During the anterior tilt your low back will arch off the floor. 

Lastly, try the exercise lying flat on your back with your legs flat too.  It will be harder in this position to perform a good posterior pelvic tilt due to the weight of your legs pulling your pelvis into the anterior tilt.  You will need to engage your abdominal muscles and gluteals strongly to achieve the tilt.

You can also practice performing these tilts while seated on a gym ball.  The gym ball will add a need for balance that is good for your training.

 

The Neutral Pelvis

To begin practicing the neutral pelvis, lie in on your back with your legs bent and your feet on the floor.  Practice the anterior and posterior tilts as described above.  Next, find a position where your low back is in a comfortable position between these two extremes.  If you have low back pain look for a position where the pain is minimized.  If you do not have low back pain simply find the most comfortable position.  While holding this “neutral” position, place your index fingers just inside the pelvic bones to the sides of your abdomen (the anterior superior iliac spines).  As you make the following contractions your fingers will be alert—trying to sense a firming up of the muscles below.

Do a “Kegel” contraction.  This is a squeezing of the genitals as if you are trying to stop a flow of urine.  Are the muscles under your fingertips activating?  If not, you can try simultaneously pulling your belly button up and in toward the back of your neck.  If you are still having trouble keep practicing.  It is simply a manner of teaching your brain how to activate the muscles.  At first it is often difficult to hold the contraction.  Keep practicing at this level until you can hold the contraction for ten seconds.  Next, contract the gluteals (“butt” muscles) and your abdominal muscles.  Good, now try to do it while breathing!

Keeping your pelvis in the “neutral” position while keeping those muscles (the transverses abdominus, gluteals, and abdominals) active is the Neutral Pelvis.  Learning to do this properly is vitally important to everything that follows, so be sure that you spend time learning to do it correctly.

Once you feel comfortable practicing the neutral pelvis in the lying position as described above, practice standing, sitting or kneeling, and lastly, lying on your back with your legs straight out.  You can also practice the neutral pelvis while going from sitting to standing and standing to sitting.  In all of the following “tracks”, begin with some anterior and posterior tilts, then practice the neutral pelvis and maintain it throughout the exercise.  By doing this you are training your nervous system to activate you core muscles and maintain stability during movement.

 

Bridge Track

(Note:  During the Bridge track the posterior tilt is more beneficial than the neutral pelvis if it can be done pain free.  When doing the posterior tilt in this exercise maintain the same contractions as described for the neutral pelvis above.  If the posterior tilt causes pain, find your neutral position and perform the exercise in that position.)

Lie on your back with your knees bent and your feet on the ground.  Practice a couple of anterior and posterior tilts, then the neutral pelvis.  Be sure that your fingers are monitoring the muscles just inside your hip bones.  Activate the abdominals and the gluteals.  Slowly lift your pelvis up off the ground into a bridge.  Go only as high as you can while maintaining the neutral pelvis and not allowing your back to arch.  Be sure that you keep the transverses abdominus active all the way up, then all the way down.

Once you feel comfortable with the above exercise (it may take a week or so) you can practice “marching”.  To do this, practice the bridge as described above with the following modification:  while you are in the up position slowly lift one foot just off of the floor.  During this motion do not allow you torso to tip or twist—imagine that except for the leg that is raising you are “cast in stone”.   Alternate legs as if you are marching, and remember—maintain the neutral pelvis and the muscular contraction.

Once you are comfortable with this you can practice fully straightening each leg during the march.

Lastly, the truly ambitious can go on to “pumps”.  This exercise not only teaches you control and core activation, it is actually a strengthening exercise.  The hamstrings and gluteals receive quite a load!  This should only be done once you are comfortable with the previous exercises.  To perform it do the following:  lie on your back with your left leg bent with the foot on the floor, and your right leg flat on the floor.  Imagine a rod inserted through the heel of the right leg up through the leg and torso.  The angle of the right hip does not change throughout the exercise.  Perform the neutral pelvis and slowly push up into the bridge using only the left leg.  Do not allow the torso to twist and be sure to maintain the muscular contraction inside your hip bones.  Slowly lower and raise yourself several times.  Switch legs and enjoy!

 

Quadruped Track (Table Pose)

This track has the advantage of training not only the low back/pelvis region, but also the upper back/shoulder region.  By simultaneously training both you will strengthen subconscious pathways in you nervous system that integrate the two.

Begin in an all-fours position, practice a couple of anterior and posterior tilts (“cat/cows” from yoga).  Find the neutral pelvis and activate the stabilizing muscles (transverses, abdominals, and gluteals).  Imagine that your trunk is cast in stone as you slowly raise your left leg.  Do not allow your hips to twist or drop or your back to arch.  Lift your leg only as high as you can without arching you back.  Maintain those contractions!  Slowly alternate legs.

Next, give your legs a rest and work with your arms.  Practice the neutral position and activate the stabilizing muscles.  Keep your neck in line with your spine as you slowly raise your right arm—trying to bring your arm up next to your ear with the elbow straight.  Reach only as high as you can without twisting your torsos or lifting the shoulder.  Maintain the neutral pelvis.  Slowly alternate arms.  The very, very advanced student may try raising both arms at once (just kidding).

Once you feel comfortable with the leg and arm exercises independently (about a week or so), try combing them.  Maintain the neutral pelvis and all contractions as you slowly lift your right arm and your left leg—don’t allow your torso to twist.  Maintain all contractions as you lower both limbs back to the floor, then repeat with the left arm and right leg.  Set a goal of achieving ten of these exercises on each side (while alternating).  Remember not to go too far too fast—quality is better than quantity!

 

Dead Bug Track

The beginning phases of this exercise are similar to the Bridge Track above.  If you have been practicing the Bridge Track you may progress to the more complex variations of this track quickly.

With this pose you want to do a posterior tilt if it is possible to do so comfortably.  Lie on your back with both legs bent and your feet on the floor.  Perform a posterior tilt, pressing your low back into the floor.  Perform the transverses abdominus contraction, the gluteal contraction, and the abdominal contraction.  Now slowly try to lift one foot off the floor while keeping the low back pressed into the floor.  Bring your foot back down and try your other foot. 

 

Once you are comfortable with this try straightening one leg, keeping your heel about one foot off the floor.  Be sure to keep you low back pressed into the floor.  Now try the other leg.  Next, as your straighten your right leg, bring your left leg into your chest.  Alternate, straightening your left leg and bringing your right leg into your chest.  As you alternate do not put your feet down.  Keep your low back pressed into the floor.

 

Lastly, add your arms.  As your right leg straightens out, bring your right arm straight over your head so that your forearm is next to your ear.  Then, as you bring your right leg into your chest, lower your right arm to your side while simultaneously straightening your left leg and bringing your left arm over your head.  Alternate sides, and aim for a goal of one minute of continuous “dead bugging” without shaking.

 

Side Bridge (Half-Moon Pose)

 

This is a three stage track.  Begin by lying on your side with your legs straight out.  Prop yourself up on your elbow and hold your body straight—not allowing your pelvis to sag or roll forward.

  side_bridge.jpg

Next, try the pose with your down-arm straight.  This adds some gravitational and balance challenge.

straight_arm_side_bridge.JPG
 

Lastly, try lifting your up top leg.  This works the side-muscles in both sides of your low back/pelvis/hips.

open_side_bridge.JPG