If you learn nothing else, you must learn how to do pelvic tilts in various positions! Learning to integrate this movement pattern into your daily life and use with exercises is the key to decreasing your low back pain.
So what ARE pelvic tilts? There is ANTERIOR pelvic tilt and POSTERIOR pelvic tilt.
EXERCISE #1:
Anterior pelvic tilt is a way to put the "arch" back in your low back. With prolonged sitting in slouched postures and repeated bending throughout the day, our backs are forced to round quite a bit. How does this hurt our low back? It pulls on our back muscles, over-stretching the muscles that run up and down our spine on either side, making them weak. It also tends to make our discs bulge (the cushioning between our vertebrae), which can pinch nerves causing excruciating pain and numbness/tingling, and leg weakness.
So to begin to strengthen the back muscles and teach the back how to position in "neutral spine" throughout the day, you must start with ANTERIOR PELVIC TILT.
To perform this movement, first lie face up with both knees bent. Then gently place each hand on the bones on the front of your pelvis on each side, then slowly arch your low back while feeling those front pelvic bones and your abdomen move slightly towards the ceiling and down towards your feet (see second picture below).
Symptoms that are ok to feel is a tightening in your back muscles. If you feel any increase in your low back pain or an increase in the area you normally feel in your buttock/leg/foot symptoms (can be tightness, pain, numbness/tingling/burning) - then make the movement much smaller. You do NOT want to trigger your symptoms, only back tightness.
In the beginning, repeat this only 5-10 times, 2-3x/day (with repetitions if you notice your "pain spot" more, you must stop... even if you have not performed 5-10 repetitions). Some people, in the beginning, can only do 2 or 3 reps before increased pain, but by practicing this over the next few days, WHILE not pushing through increased pain, you will notice you can do more and more reps.
EXERCISE #2:
Now it's time to practice Posterior Pelvic Tilts - this is a movement that is helpful to learn to flatten your back. This will come in handy if you have pain with standing/walking. To perform this movement, start in the position above (face up with both knees bent), with your hands gently on both pelvic bones in the front. Next, gently pull IN your lower abdominals while gently rocking your pelvis to flatten your low back against the bed or floor. You should feel those front pelvic bones gently move towards your head as you pull your abs in (see first image above).
Symptoms that are ok to feel are: tightening in your abdominals and maybe pulling in your back muscles. If you feel any increase in your back pain or buttocks/leg/foot symptoms, do not pull in abdominals as much and do not tilt pelvis as much (this may feel like your are barely moving in the beginning, but it's a start... you do not want to push through pain and flare your symptoms up!). Do this 5-10 reps, 2-3x/day also or as your symptoms allow.
EXERCISE #3:
Finally, after you have practice both anterior and posterior pelvic tilts (arching and flattening), I want you to practice finding Neutral Spine (see last picture above) - this is the position between the two extremes where you feel your low back symptoms the least. You have a small arch in your low back. Practice moving back and forth between anterior and posterior pelvic tilt then make the tilts smaller and smaller until you find the position your back is the "happiest" (least amount of symptoms). This will take practice.
Some Notes:
Starting position: both knees should be pointing towards the ceiling bent and should be the same height (if one knee looks higher, it's because that foot is closer to your body). You want symmetry on both knees.
Perform the pelvic tilts smoothly and slowly (no fast jerky movements). The slower the better. This teaches your body how to move with control and allows you to pay attention to what your symptoms are telling you. If you move too quickly, you will push through pain easily and flare your symptoms up. Think about going TO THE EDGE of increased symptoms without INTO the symptoms. With practice, this will become easier
Do not skip over this lesson! The ability to perform these exercises easily, with control, and increased body awareness is fundamental to getting on top of your low back pain! In future posts, I will be asking you to pelvic tilt in different positions to find your "neutral spine" -- which will allow you to position and move throughout your day with less pain PERMANENTLY.
If you DO notice increased back pain overall after a day or two of doing this exercise, take a break for a few days until your symptoms go back to your "baseline". Then TRY IT AGAIN, but more gently, slowly, with smaller movements, and less reps. Your patience will pay off in the long run!
Take your time with this exercise. It will become "automatic" in time, with practice, I promise. Good luck!
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