Low Back Pain While Riding? You Might Have an Anterior Pelvic Tilt
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There’s no way around it: lower back pain sucks. What’s even worse, though, is how common low back pain is among cyclists. And the longer the ride, the higher the odds of experiencing those aches, according to research.
Cycling itself—particularly the posture we maintain on the bike—pretty much sets us up to experience low back pain at some point in our riding lives. That is, unless we take steps to prevent it.
Here’s where it gets interesting: Many times, the root cause of low back pain doesn’t stem from the back, but actually from our pelvis. Specifically, it starts with the angle of our pelvis.
Think of the pelvis as a bowl: If the bowl is tipping forward, the pelvis is in what’s called an anterior tilt. An anterior pelvic tilt causes lumbar hyperextension, otherwise known as overarching of the low back. And this postural distortion often leads to low back pain, both on and off the bike.
What is an anterior pelvic tilt and what causes it?
“An anterior pelvic tilt is caused by tension in the iliacus muscle [a small muscle of the hip flexor] which pulls your pelvis forward. Because this particular muscle is so commonly tight in cyclists, anterior pelvic tilt is rampant,” says Christine Koth, M.P.T., author of Tight Hip Twisted Core: The Key To Unresolved Pain.
“When you are on the bike, in a bent-over position, your hip flexor muscles are shortened. Short muscles have a more difficult time doing their job, yet, these hip flexor muscles are ultimately responsible for keeping your pelvis and spine stable as your legs are maneuvering the pedals,” Koth explains. “Having to work extra hard, and in a shortened position for hours on end, leads to the body’s desire to hold tension and increase stiffness in these muscles. The iliacus’ role in cycling is primary and its opportunity to become tight is almost a given.”
The illiacus isn’t the only muscle to contribute to the anterior pelvic tilt though, Koth adds. “The psoas muscle [another, larger hip flexor muscle], which connects to your spine, is much more responsible for spinal stability than pelvic and hip stability, yet tension in this muscle does develop quite often in cyclists,” she says.
The tensor fasciae latae, or TFL, a smaller muscle further away from the hip joint than the psoas or illiacus, which helps translate force from the hip down to the feet and helps stabilize the knee joint, can also contribute to an anterior pelvic tilt.
Finally, a quad muscle called the rectus femoris, can pull the pelvis into an anterior tilt. “Although this muscle can feel sore from a day on the bike, its contribution to an anterior tilt is more due to the fact that it becomes so strong in relation to other muscles that its relative stiffness increases and can pull the pelvis forward,” Koth explains.
Another main contributor to developing tight hip flexors and an anterior pelvic tilt? “Our desk jockey lifestyle,” says Jay De Jesus, P.T.A., physical therapy assistant at Robbins Rehabilitation East and former pro mountain bike racer. “Modern humans sit so much during their lifetimes—at work, driving, watching TV. [Cycling] is an exaggerated seated posture with a forward bend much of the time,” he explains.
What does an anterior pelvic tilt mean for cyclists?
Riding and living day-to-day with an anterior pelvic tilt can not only set us up for a sore low back, but it can also derail our cycling performance. “When your body is held in an anterior tilt, it affects the mechanics of your entire body, from your head to your toes,” Koth says. “For example, there are strength effects. An anterior tilt will lengthen the hamstring and glute muscles, resulting in more difficulty generating the strength that they’re capable of having. The same thing happens with the abdominal muscles.”
Because of the body position in an anterior pelvic tilt, it’s difficult to engage the abs and maintain a strong, proper pelvic position in the saddle, Koth says. This typically puts more pressure on the pelvic floor, increasing the risk of problems in that area. Not being able to maintain core activation also puts more pressure on the hands and wrists, risking issues like aches or numbness in those areas, too.
“When the pelvis is tilted forward, you lose some of your hip flexion range of motion and the alignment of the femur [thigh bone] is more internally rotated,” Koth continues. “This affects how deep you can lean forward on the bike and affects the mechanics of your knee and foot with that inward spiral movement of the femur.”
Riding and living with an anterior pelvic tilt over time can cause more than annoying pains and performance limitations. It can also cause long-term damage to the area of the body that hurt to begin with: the low back. “In addition to lower back pain, a chronic anterior pelvic tilt may contribute to degenerative disc issues,” says De Jesus. “That is why hip flexor stretching and upright posture [off the bike] are so important.”
So what can you do about an anterior pelvic tilt?
First, off, don’t freak out! “[An anterior pelvic tilt] can absolutely be corrected through targeted stretching and exercises,“ says De Jesus. Exercises like planks and side planks, bird dog and bridging—all of which emphasize proper spinal alignment—can help address the issue. De Jesus suggests doing these daily, or at least a few times a week.
In addition to these regular strength exercises, consider how you warm up for your ride. If you just grab your bike and head out the door, it’s time to, instead, prep your body for the work it’s about to do so you can focus on better spinal alignment and sidestep aches.
“Think of it this way: You want to make sure your muscles are relaxed and your bones are aligned before you start using them,” says Koth. “Because cyclists do have such a high risk of development of an anterior tilt, any cyclist’s preparation routine should involve addressing or preventing an anterior tilt,” says Koth. “I would recommend releasing tension in the iliacus prior to every ride. It would make such a big difference in how you feel on the bike and how much you enjoy your experience.”
As with most things, correcting an anterior pelvic tilt and preventing the low back pain that comes with it is a long game. “The practice of postural balance and righting it is a lifelong endeavor to self-correct our bad postural habits,” says De Jesus. “You get out what you put in.”
5 Exercises to Address an Anterior Pelvic Tilt
Here are some of our favorite exercises to mobilize and release the low back and hip flexors. Add these moves to core strengthening exercises and hip flexor stretches for a comprehensive approach to correcting an anterior pelvic tilt for more powerful and pain-free miles.
1. Segmental Cat Cow
Start on all fours with hands directly under shoulders and knees directly under hips, spine neutral. Drop the tailbone and begin to arch the spine, isolating one vertebrae at a time, until you are in a full arched “cat” position. Drop the head when you reach the neck. Go slowly and move mindfully; learning to isolate each segment of your spine will take practice. When you reach a full arch, initiate the opposite action, starting with the tail bone and reverse the spinal position, again one vertebrae at a time. Repeat 3-5 times, breathing deeply.
2. Lumbar Cat Cow
This movement is similar to the segmental cat/cow except it isolates the lumbar spine (low back). Start on all fours with hands directly under shoulders and knees directly under hips, spine neutral. Focus on mobilizing only the lower back, initiating a pelvic tilt from the tailbone, while keeping the upper back neutral. Focus on moving the pelvis through the full range of the movement, going slowly and mindfully. Repeat 3-5 times, breathing deeply.
3. Quadruped Pelvic Tilts With Band
This movement builds on the lumbar cat/cow by adding light resistance. Start on all fours with hands directly under shoulders and knees directly under hips, spine neutral. Place a long resistance band across the low back, holding onto one end in each hand. Focus on mobilizing only the lower back, initiating a pelvic tilt from the tailbone, while keeping the upper back neutral. Focus on moving the pelvis through the full range of the movement, going slowly and mindfully, and feeling the intensity of the move against the resistance band. Repeat 3-5 times, breathing deeply.
4. Supine Pelvic Tilts
Lie faceup with legs bent and feet planted flat on the floor about hip-width apart. Slowly arch the low back, gently pressing the tailbone into the floor and tilting the pelvis as far forward as possible. Then, reverse the motion and scoop the pelvis into a posterior tilt, gently pulling the tailbone up towards the ceiling. Move slowly, trying to isolate each vertebrae of the lumbar (low) spine. Repeat 3-5 times, breathing deeply.
5. Seated Pelvic Tilts
Sit tall on a stability ball or chair. Use your core to tilt pelvis forward, then backwards, moving slowly and maintaining upright posture in the upper back. Move slowly with your breath, and finish by holding pelvis in neutral. Repeat 3-5 times, breathing deeply.
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