Pelvis - Can you tell what is causing this misalignment? by Katy Bowman


Joan: OMG Becky, look at her back. It’s So Sway.

Becky: I know. Why’s she got to go around sticking that thing out?

Joan: She’s probably got low self esteem, ya know?

Becky: I know. She’s probably got a lot of back pain too, ya know? 
Yeah. She needs to tuck. that. thing. under. Ya know?

Joan: Yah. I know what you mean.

So, Aligned and Well wannabees — when you look at the picture above do you see:

A. A swayback

B. An anterior tilted pelvis

C. Hyperlordosis or hyperextension of the lumbar spine

D. All of the above

If you picked “all of the above” then you’re incorrect. Actually, the only correct answer here is A: Swayback. And that’s because swayback doesn’t mean any one particular thing — it’s just how spinal curvature looks to the eye. The term swayback should never be used clinically as it doesn’t have a precise definition (read: it doesn’t tell you anything about one’s pelvis or lumbar spine.)

The person in the picture (oh wait, that’s me!) actually has a neutral pelvis. How do I know? Because 1) I know the mathematical definition of neural pelvis* and 2) I put my body in this position for the picture. My spine, however, is not curved neutrally — but this is not because my pelvis is tilted forward, it is because my ribs are sheared forward.

Here’s a quick review on vertebral motion.

Let’s say the vertebrae start from this position:

When these guys extend, it look like this:

But what I’m doing in the picture above is NOT vertebral extension, it’s vertebral shear. Chances are you didn’t get this term in your anatomy courses. And, it’s not that surprising. Today’s university-level courses are still teaching an extremely oversimplified version of anatomy that leave out about 1/2 half of the muscle and joint actions. If you really want to learn the mechanical motions of the body, my recommendation is take a few courses on mechanics first. Once you can do basic physics, you’ll see volumes in your anatomy that you never knew was there.

Anyhow. This is what vertebral shear looks like:

Rib shear, as pictured above, is caused by the anterior (forward) displacement of the ribcage. This displacement causes the lower thoracic vertebrae to forward relative to the lumbar vertebrae below, creating what looks like hyperextension. Only it’s not hyperextenion. It’s not extension at all. It’s vertebral shear. Which might sound like a simple argument in semantics, only these are two entirely different physical motions that require entirely unique corrections.

It is extremely common to misread the first picture as excessive anterior tilt, especially if 1) one has no objective, mathematical definition of neutral pelvis and 2) one has no clinical and mathematical definition for a neutral ribcage.

Because the lumbar curve is created by how the pelvis and ribcage are positioned relative to each other, it would seem pretty important to know where these bones should be in space, ya?

Neutral pelvis*

Typically, I’m not a fan of neutral. There are no Swiss Coffee walls in my house. I’ve never been to Switzerland. My car (and my mind) are perpetually in gear. I am, however, a huge fan of le neutral pelvis.

Neutral pelvis is a term that gets thrown around a lot, but through my teaching all over the US this last year — to movement and therapy professionals no less — one thing is clear. Hardly anyone knows what neutral pelvis actually is – in terms of definition and, even worse, in terms of clinical definition.

Technically (and let’s be technical, shall we?), neutral pelvis refers to the three-dimensional position of the pelvic girdle.

The first two planes of “neutral” can be determined by placing your hands on the ASIS (Anterior Superior Iliac Spine), often incorrectly called your “hip bones.”

As you’re looking at the pelvis from the front (standing in front of a mirror), these points should be level, like the artificial horizon on an airplane.

If you now look down, each ASIS should be equally out in front of you, meaning, one half of your pelvis should not enter the room before the other. This is a difficult alignment to maintain if you are a salsa dancer or are particularly fond of twisting your hips when you walk. Not so good for the spine.

The final of your three dimensional alignment check requires a third point: your pubic symphysis, and for you to turn and evaluate yourself from the side. In a nutshell, a neutral pelvis from the side should stack the ASIS vertically over the pubic symphysis, so that a plane containing all three points is vertical.

Leonardo, this is why I love you so much. Not only does he have a perfectly drawn neutral pelvis, he also figured out that a neutral pelvis is only really neutral on a neutral thigh bone.

Legs not vertical? Then your perfectly positioned pelvis still needs tweaking! I was going to make you a video to show you how to test lower body alignment but why redo perfection? Here’s one of our certified graduates, the Alignment Monkey, showing you how to check from home:

Finding neutral leg, pelvis, and ribs is extremely important if you have a pelvic floor issue. Remember all that talk about tucking and untucking? This is what I was talking about. Most people tuck their pelvis and shear their ribs. Most people sit on their sacrum All. Day. Long. And, unfortunately, MOST people (80%) will experience a pelvic floor disorder in their lifetime. If you find neutral pelvis, you’ve got the perfect amount of tuckuntuck.

Thoracic shear

Just like neutral pelvis has an objective definition, so does a neutral ribcage. If you find that when your legs are backed up and in vertical alignment and your pelvis is in objective, measurable neutral, it’s time to get your ribs into position to allow for a neutral lumbar curve.

Aligning your ribs to your now neutral leg and pelvis is simple. You simply lower your ribs down until the front part of your lowest ribs move into the abdominal flesh — where they belong.

Now the front of your ribs are also in the vertical plane created by your neutral pelvis. And your lumbar spine is at the correct curve for your anthropometric dimensions.

Spinal curve is a tricky thing because although there is no absolute value of curvature that is appropriate for every person, there is a curve relative to one’s body parts that needs to be exact, in order to ensure proper vertebral loading. People get confused when you talk about absolute vs. relative measures because they misinterpret that anatomical variability means that there is no “one way” to be. Only there is. You just need to learn how to quantify a relative value — that is the objective points and geometrical positioning, relative to one’s own body parts.

Oh, and P.S. What you might find now is that your root issue (read: the major malalignment that you’ve been jutting and thrusting and lifting to hide) is the fact that your shoulder girdle is collapsing on itself. Can’t keep those ribs neutral because the shoulders are wrapped about the place? Now that you know what’s really going on in the body, whatcha going to do about it?