Neutral Spine and Pelvis by Paul Kevin Smith
What is the neural position of the spine and pelvis, and why should we be concerned about it? When we are in neutral alignment — that is, when there are slight inward curves to the lower lumbar area, cervical area, and slight outward curves of the sacrum and thoracic area –, we achieve optimal posture; whether we are standing, sitting, or are positioned to start an exercise movement. This is critical, because when we are in a neutral position of the spine, we place the least amount of stress on the cartilaginous discs that cushion between our vertebrae.
If we perform exercises or daily movements in positions that deviate from the neutral position, we put pressure on the discs, which could lead to injury, such as bulging or herniation of the disc.
For example, think of performing a heavy deadlift with the spine flexed into a forward-bended position, shoulders rounded. The pressure going into the lumbar discs during the lift could potentially cause herniation, which in turn could press on a nerve exiting the spinal cord, causing pain or weakness along the path of that nerve.
If a person stands with an exaggerated inward curve to the lumbar area, that is called hyperlordosis. If a person stands with an exaggerated outward curve to the thoracic area, that is called hyperkyphosis. If the spine deviates laterally in a “C” or “S” shape, that is called scoliosis (which may be addressed in a future blog post).
Pelvic alignment in relation to neutral spine
An easy way to check for neural pelvic alignment is to place the hands on the front of the pelvis, feeling for the bony landmarks. When in neutral position, the two front ridges of the”hip bones” (anterior iliac spines) and the front of the pubic bones should all be on the same plane (parallel to the facing wall if standing, or parallel to the floor if lying). In addition, when lying on one’s back on the floor in neutral spine and pelvis, there would typically be room to slide one or two fingers between the low back and the floor, but not the whole hand.
Neutral position of the pelvis supports the neutral position of the lumbar spine, and reduces tension at the sacroiliac joints at the back of the pelvis. If the front of the hip bones tilts forward beyond the pubic bones, that is called anterior pelvic tilt, which may be accompanied by a hyperlordotic lumbar spine. If the front of the pubic bones tilts forward beyond the hip bones, that is called a posterior pelvic tilt, which may be accompanied by a flattened low back curve. Beyond just having postural awareness and adjusting the angle of the pelvis when we find it is out of neutral, we can analyze which strengthening and stretching exercises may correct a habitually anteriorly- or posteriorly-tilting pelvis.
Corrective movements and strengthening exercises for misalignment
For an anterior tilt of the pelvis:
- Perform strengthening exercises 2-3 times per week, 2-3 sets of 12-15 reps. Muscles to target would be the abdominals, such as doing ab mat sit-ups, and the gluteals, such as bridges with a posterior pelvic tilt.
- Muscles to stretch (3-7 times per week) for anterior tilt would be the hip flexors (as with a low lunge held for 20-60 seconds on each side), and the low back extensors (such as 10 repetitions of cat stretch moving into child’s pose).
For a posterior tilt of the pelvis:
- Perform strengthening exercises 2-3 times per week, for 2-3 sets. Target the hip flexors (with exercises like 12-15 reps of lying straight leg lifts, being careful not to arch the low back away from the floor), and the low back extensors (such as with unsupported cobra, holding in position for 30 seconds per set).
- Muscles to stretch (3-7 times per week, 20-60 seconds) for posterior tilt are the abdominals (such as relaxing into a supported cobra) and the hamstrings (such as doing a lying hamstring stretch with a band around the foot).
If we practice finding neutral posture when we are sitting and standing throughout the day, we will be more likely to maintain that position during exercises. If you know you tend to have an anterior pelvic tilt with hyperlordosis, or a posterior pelvic tilt with a flattened low back curve, doing the above exercises may help to correct that. Being mindful of neutral position when doing other exercises should help to reduce our risk of injury to the spinal discs.