Cross Pelvic Syndrome

Understanding How Daily Life Contributes to Back Pain and Body Compensation

The following is a transcript of the video above

If I were going to ask you to walk back and forth without limping, but first ask you to put a rock inside your shoe and continue to not limp. You might try to walk without a limp, but what you would find pretty quickly is it's almost impossible for you to walk without limping that's because the pain that's coming from the bottom of your foot is setting a signal up to your brain that says, “Hey, inhibit all of these leg muscles, don't allow me to put pressure down on that foot.” It's compensation. It's something common everybody knows about, but you need to understand that not only does it work there, but pain inhibits muscles for when you're in back pain too. We're going to talk about that in this video.

A common pattern of muscle compensation in patients with lower back pain is known as cross pelvic syndrome, a term coined by Dr. Vladimir Janda. In this pattern, patients are seen to have overactive or tight lower back muscles, hip flexors, and hamstrings combined with weaker or inhibited glutes and abdominal muscles. This is a bit of a chicken or the egg scenario because researchers have not yet found if this precedes back pain or if it's a result of the back pain. But what is clear is that balancing these deficiencies can be an effective way of treating someone with this issue.

Now, if you think about it, one of the common pitfalls that people run into while trying to fix this is they can't get an opportunity to actually use the muscles that they need to because a lot of us are doing this all day (sitting). We're sitting with shortened hamstrings, shortened hip flexors, completely inactive abdominals and completely inactive glutes. So what is it that we need to do during the day to make sure that we're getting that regular level of engagement besides simply standing up or changing positions?

Now, one of the common issues that we run into when we're trying to treat somebody with cross pelvic syndrome is the idea that I need stretches and exercise to make these problems go away. I just used the phrases tight and weak, so that only makes sense, right? Well, unfortunately, we're skipping a step when doing that first.

We need to make sure that we take pressure or loading off of the irritated tissue. And usually that's done with changing up our daily movements with spinal hygiene and making sure that we have positions of respite for when we're in pain. Going straight to exercise is the wrong move. I'm going to show you some, but that's not where we need to start.

One of my favorite ways to both assess and train coordination between our glutes and core is with a single leg bridge. You essentially won't be able to do it correctly if you don't have sufficient core stability and glute stability. So it's a great way to screen for whether or not somebody has a deficiency on one side or the other while you're doing this drill. And also it's a great way to train up endurance for both of those issues. So I'm going to show you how to do that now.

(need video for context on this paragraph) So to do a single leg bridge, I want to make sure that my shins are basically as tall as they can be here. Heels, pretty close to my bottom. I'm going to lift my bottom off the floor. My, my body should be in a straight line here. It shouldn't be dipped like, so, and then I'm going to lift one leg up off of the ground while my hands are in the air. This is a pretty advanced move. And a failure can be seen by somebody who lifts their leg and has their hips rotate. Like, so.

A few closing thoughts on the single leg bridge. Whenever I have somebody in here, I'm asking them two questions. Can they do it? Yes or no. And does it hurt? Yes or no. Both of those are firm answers. It's a clear and obvious answer. Remember that exercising is completely inappropriate to be doing, including this drill, when you're in pain. It can be used for assessment purposes as I mentioned, but that means if it hurts then we don't do it and we have to back off a little bit and do something that's easier to take the pain away by changing how we move during the day.

Like I mentioned earlier, despite the fact that I showed you an exercise in this video, I hope your biggest takeaway is that we need to take pressure off of the spot that's irritated first before moving on to something like exercises to correct the movement problem, because we get into this cycle of pain where an accumulation of poor movement over time, which is what's happening with compensation, leads to biomechanical stress (i.e., stress on biomechanical parts of our body), leading to biomechanical inflammation, leading to pain and disability, and then progressive structural breakdown, like a disc herniation or facet arthritis.

(need video for context) And what ends up happening, if we get to the bottom of this is not stops there. We just get kicked back into this. Because again, now we have a disc herniation or facet arthritis, which creates pain of its own. And we have compensations because of that and on and on and on the cycle goes.

So we need to get in here and make sure that we're calming down the tissue first. That is the most important thing above and beyond stretches and exercises, calm that tissue down by having the proper movement tools in your belt during the day.

I wish I could stand up here all day and tell you all of the different things that you could do specifically for yourself to make sure that you're moving around appropriately. But unfortunately it just doesn't work that way. We have to be specific to your body, which is why firing from the hip and doing random stretches and exercises rarely helps everybody. It's cookie cutter and we need to get more specific. So in order to do that, we’ve got to book an assessment so that I can look through everything and see what you should be doing specifically for your body.

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