What a great video this was. This is the first time that I've seen anybody address relation beetwen glute muscles and piriformis. A year ago I started training my weak glutes from too much sitting because all of the videos on youtube said so but instead of that piriformis pressed on my sciatic nerves on both sides at the same time. I could barely walk for two months. And first 2 weeks I was basically bedridden.. Nobody ever says that you need to release that pirifomis before strenghtening glutes.
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Always cool to have at least some of my methods confirmed by a true professional. Great video, Brent!
Brent, thank you very much for this incredibly informative video. I recently took on a client that has this dysfunction. I'd been developing a plan to correct their dysfunction, involving release of the Biceps Femoris and Piriformis, and the client noted that when they foam rolled their adductors, they were super tight, so we were working on that as well. We were working on glute activation as a priority. It's a great feeling to know that I was on the right track for release/activation work. You've taught me well! Thanks again for lighting the fire in so many of us. You've done more for my business than I could tell you! Thank you!
+Mo Kazmi You were certainly close Mo, maybe just missing a little bit of the "Why?" that would have lead you to the rest of the muscles in this dysfunction.So happy to help, and we have no intention of stopping.Dr. B2
Just wanted to give appreciation for your video. I understand from some other comments that it's not intended as "Fix it yourself" information, but I've found it incredibly useful. And I'll add details in case anyone else with a similar issue stumbles across this: I've been basically crippled and near bed ridden for almost 3 months now, with both a GP and a Neurologist not having any idea what the problem is and eventually just saying "maybe it's weight". I tried to explain to them how the pain was in a strange spot and felt deep and focused in certain areas but it was ignored, and now from your video I've looked things up and almost certain it's the piriformis. They'd also dismissed my descriptions of sciatica and nerve issues in my legs because the leg reflex test seemed fine, but it seems that's not uncommon with the piriformis being tight (Piriformis Syndrome). And while I don't have a way to measure it, doing the hip flexion test creates pain in the pelvis/lower back. And when I tried doing general lower back and glute exercises to see if that would help, I'd feel better and improve for a little while and then suddenly while doing a small front bend or leaning over it would feel like a spasm would go through my lower back in the pelvis area and I'd be crippled again; which seems explained by not releasing the piriformis first. They have me going in for an MRI because L5/S1 thinning was the only thing that seemed out of place, but they indicated it was more a shot in the dark than anything else. I'm guessing now, that this was perhaps caused by sitting in an improperly sized chair over long periods of time, daily. I'm above 6' 5" and most chairs aren't built for that, so I'd have to shift my butt forward a little and lean back into chairs to be comfortable. So that means my pelvis would be tucked in under me. And now, off to go try some things with this new information...
Thank you for both appreciating what we do and giving kudos for the information... I am grateful that we have given you a resource to atleast try and improve your situation. Hopefully you can get yourself to a point where strengthening and maybe physical therapy will be able to get you back to your original function. Dr. B2
Brent,Just wanted to say a massive thank you! Your video's (this one especially) has helped me understand the mechanics behind the "butt wink" which has been a massive dilema for me for years now. Always told "you gotta squat ass to grass" by the majority of the fitness world, when the reality is that can & has done some damage.I am a training sport & injury massage therapist, you just dont get this level of knowledge & explaination anywhere so i am forever thankful you take the time to record these videos! I really apprciate it!!Cheers!!
Glad I could help Jamie, Thank you for the support, and I hope you will check out all that we have to offer at BrentBrookbush.com. Spread the word, tell your colleagues, and keep the company growing. The more members on the site, the more we can invest in producing better content, faster. Dr. B2
i appreciate how you were able to make this so accessible! you used technical terminology but the concepts and logic were so clearly laid out, even i (attendee of one (1) gen anatomy class in college) was able to follow :D thanks for this vid!!
This is the best video on this subject that I have come across. I like how you connected the corrective measures to performance, especially the part about adding back that eccentric loading. It seems that the majority of people could benefit from strengthening their glutes, and I appreciate the insight on piriformis coming into play during clams.. Your videos put a lot of what is lectured on in university into practical application. Thanks Brent!
That's our goal Calvin... Practical Education! It always makes me ecstatic to read a comment like yours. A comment that re-affirms we are meeting our company mission ;-) Thanks for that, Dr. B2
Great Video Brent, Thank You!!! You have such a great teaching gift. You break things down in such an easy to understand way. I am really enjoying your site and am learning so much to help my clients. Your passion is contagious!
Thanks Julie, Really happy our vision is coming together... it has been years in the making and we have so much more planned ;-) Thanks you so much for the support and I hope you will help us spread the word about BrentBrookbush.com. Dr. B2
Very educational and clear....my teachings and practice has been in line to this. Now with this vid i can more so elaborate or breaking down on the movement as you taught, much appreciated thanks Brent.
Kwadwo Odinga, So glad I could help you expand your knowledge and improve your communication with clients, that's awesome. Check out everything we have to offer at BrentBrookbush.com when you get a chance. Dr. B2
Giving her dorsiflexion is actually pretty insightful. I've found that at least 50% of my clients lack normal dorsiflexion, which puts them in a squatting disadvantage from the get-go. I would be interested in your top ankle dorsiflexion treatments (myofascial work, antagonist work, static stretching with PNF etc.). I'm in the process of figuring out which work best for my clients.
I am in 100% agreement with you. You could look at our Lower Leg Dysfunction Model here for more - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/lower-leg-dysfunction/ Generally speaking we would release and lengthen the calf and fibularis muscles, mobilize the talus, and activate the invertors. If you are licensed then we also recommend release of the long toe extensors and flexors, IASTM when appropriate, and mobilization of the tib/fib and various talor joints. Hope that helps.
I just found your channel and I couldn’t be more excited! I teach about postural dysfunction at a university and train a group of interns how to assess and correct muscular imbalance patterns. I’ve also been a personal trainer for many years. I currently have a client with this issue and it’s fascinating because it’s the first time I’ve worked with someone who has it to this degree. It was even evident when doing assisted dips. He couldn’t “untuck”. What’s interesting is that he also has a lateral pelvic tilt and his TFL is so tight on his right leg that it’s very hard for him to extend his leg behind him when he walks because of the stretch. My question actually has to do with ankle mobility. He has very limited dorsiflexion and that is clearly also contributing to the issue of him feeling like he is falling back when squatting. Are these commonly found together?
Whoa, I've been through a lot of physical therapy over the past seven years and you just explained more than any PT has told me. Well... I am a veteran and go to the VA, I'm thinking I should just go and pay for my own therapy.
I hate to hear that, but I get it. I have been to the VA in NY and they are a good institution with good care, but I think you will find that the best PTs will be going to cash pay more and more. Insurance companies are pretty mean to us with their reimbursements. With that being said... don't assume you have to pay out-of-pocket. Maybe show this video to the PT you like at the VA, they may really dig it and be able to bring some of this into your treatment plan. And... before you go cash pay, make sure to thoroughly vet the people you are considering. Hope that helps, Dr. B2
Thanks, I didn't really like my PT here in Austin VA but the one they sent me to in San Diego was great. I'll have to do some research and find one near me now.
thankyou that was brilliant as a trainer myself i am always hungry for knowledge and welcome it. Thankyou again wishing you infinite happy healthy days🤸🏻♂️🏋🏼♀️🏂⛷🏋🤾🏽♂️⛹🏼♀️🤸🏾♀️🏌🏽♀️🏋🏼♀️🤽🏾♀️🤸🏻♂️
Amazing!!!! When u talked about bracing that is exactly how I bend over to pick up,, this is the first time iv ever had it explained.. I have a window cleanin business which makes me stretch and use all the front muscles, which makes it hard to walk everythings so tight
Hi Brent Thanks for the video. The scientific explanation of the posterior pelvic tilt problem is appreciated. However, isn't there a combination of exercises to fix this problem? How about a video on these specific exercises? Thanks again
Thank you for this video! 🙏🏻 If possible, can you plz also do videos on the *’Excessive Forward Trunk Lean’* during the overhead squat assessment, and the *’Head Juts Forward’* compensation during the Push/Pull assessment? I couldn’t find any videos on these specific compensations. I’d like to understand why these compensations are happening, but also how to fix them. I need to know more about what stretches could be done for the tight muscles, and what strengthening exercises could be done for the weak muscles. I would really appreciate some guidance on how to better understand these specific compensations 💖
You are describing forward head posture, which is not a sign on the Overhead Squat Assessment. Ideally, identifying forward head posture during a static or dynamic assessment would be followed by range of motion assessment. Dr. B2
Hey @chariots8x230! Hope the studying is going well. We just recently added our business to Google my Business, would you mind leaving a quick review? g.page/r/CR1LsEAZ5W6AEBM/review
+Yisrael Dubin Ya... his video has been a long time coming Yissy... but you know we will keep working through the volumes of information that apply to our practice. Dr. B2
Fantastic video Brent! I really liked the clarification about the glutes. I have a flat back posture, I did the exercises and I feel a lot better. My thoracic spine is flat, do you have a video on flat back ? I would appreciate a lot if you give me some exercises or something. I went to the PTs but they did not help me I do not want to sound disrespectful but the PTs in PERU the only thing that they do is apply laser, ultrasound etc..
+Wyatt Steed Agreed, White boards are awesome! We have a video on the lateral pelvic tilt; however, we refer to this as an "Asymmetrical Weight Shift" and the video is part of our exclusive content for members of BrentBrookbush.com. Check out the site, I think you will enjoy it - brentbrookbush.com/ Dr. B2
Hey Brent, Just wanted to say I absolutely LOVE your videos! Thank you SO much for making them! Your tip @ 11:43 helps me get a step closer to figure out my own buttwink issues and even how to assess them! I didn't however get the word that you used? Hip goniometry? Also I searched your channel and it seems that the playlist it was on has a lot of videos either deleted or just private right now. Is there any way I can check out the goniometry video?
So, yes, the word is hip goniometry, hip flexion goniometry to be more precise. All of those videos are available on BrentBrookbush.com. In fact, we have grouped them into a few articles which have been pre-approved as courses for continuing education credits. Membership to BrentBrookbush.com is just 19.99/month, check it out. Dr. B2
Thanks Susana, We have a ton of exercise and corrective strategies at BrentBrookbush.com TH-cam is just a small sample of what we have to offer. Dr. B2
Once again a great video Brent. If we activate and the hip flexors will be detrimental ? Or we only activate the hip flexors if the low back rounds in the overhead squat assessment ? Thank you
+George Koutsis Hey George,There is really no dysfunction that would give impetus to "activating" the hip flexors. There is some research that may suggest that psoas activation is appropriate, but this is different than trying to activate all hip flexors and may require some specialized techniques. Low Back Rounds (Posterior Pelvic Tilt), would seem to suggest hip flexor weakness, but it is a bit more complicated than that. Start with your release and lengthening techniques for the piriformis, biceps femoris and adductor magnus and let me know how that works out. Dr. B2
Wow Brent, thanks a lot for that !! I have very complicated situation, right pelvis side is posterior tilt, left pelvis is anterior tilt. I don’t have any idea comment fixed it. Right Side Hip is very tight, Magnus and Biceps Femoris extremely tight, hip flexor weak. Left pelvis anterior tilt, tight hip flexor, weak Piriformis and Maximus , knees pain both side. Can you make a video about it ?
Thanks Resistance Quest,Really appreciate it. Hope you will check out all that we have to offer at BrentBrookbush.com - bit.ly/1o4OCD6 Sincerely, Dr. B2
Very nice video! I first saw your videos today and I find them very well explained. I have a question for you. I have the opposite problem of what is shown in the video, meaning that I have a tendency towards a pronounced hip flexion and anterior pelvic tilt with a hyperlordosis while I'm squatting, which leads to a diminished knee flexion. The weird thing is that I have tight piriformis, harmstrings and extremely tight adductors. How is that possible? It seems like I have to force myself into a posterior pelvic tilt to achieve proper form, how is that possible? By the way, not sure if you already made a video on this issue, but I see a lot of people squatting with excessive hip flexion (probably due to over-activation of the erector spinae amongst many other things) but if not, I think it would be a good idea! Thank you I'll keep watching your videos.
Hey Thierry, We do have a video on "Excessive Lordosis (Anterior Pelvic Tilt)" at BrentBrookbush.com. Keep in mind that "tight" is just a feeling, that muscles can be "pulled long" and feel tight, or become adaptively shortened and "tight". In your case you are being "pulled long" and tight. I would try release techniques for your hamstrings, piriformis and adductors... but DO NOT stretch them. Try release and stretching your hip flexors, and add some glute activation. Dr. B2
Why do you want the same spinal angle as lower leg angle. The entire point of a low bar squat is to keep your shins almost vertical and have more forward lean to engage the posterior chain more. Weightlifters always try to overhead squat (in a snatch for example) with the most shin angle they can while minimising trunk lean. Are you saying that powerlifters and weightlifters (professional squatters) can't squat properly?
Hey Bob, You have to separate lifting as a sport from lifting for performance and function. In most sports and activities we want to optimize the contribution of all joints, including the ankle. The parallel tibia/torso angle is a means of ensuring optimal balance, extensibility and contribution from all of the muscles of the lower extremity. If you need to experiment with other forms and techniques for your lifting/strength sports, just be aware that there may be certain risks involved (as there are with all sports). Dr. B2
Cause is probably to strong a word, I suppose it could be part of dysfunction of the lumbo pelvic hip complex that could also be correlated with prolapse. Dr. B2
This is a great video (as they always are!) using this one on one will be tremendously helpful. I'm concerned about group classes. I do a lot of 'sit and stands' on the Bosu and the box. Not sure how I would control individual excessive ROM. Would you recommend omitting this from my programs or is there a cue/modification that I can use to appropriate the movement?
Group classes are a challenge, but I am sure that a little cuing and some quick one-on-one attention as you walk around the room will be sufficient. Especially for your regulars. If you teach a little each time they come in, it will make this a lot easier in the long run.Dr. B2
+Irate People I am not so sure about that Irate People, Although we had courses in clinical decision making, orthopedic assessment and therX in school, I don't remember ever seeing an effective "solutions table" that broke down any postural dysfunctions into long/short, over-active/under-active, arthrokinematics dyskinesis, etc... Further, I believe this particular description of the muscle activity related to a posterior pelvic tilt is in fact, original. Obviously, the concepts are not, but it has taken me many years of practice and study to create a succinct solutions table for this fairly rare dysfunction. Dr. B2
Where would be a good place to get help for posterior pelvic tilt in Rochester NY area? I have this problem. Have had back spasms for years. The trauma to my glutes has made me traumatized about bending over and I am definitely bracing.
+D34tho Great question D34tho. My target audience is human movement professionals and students looking for adjunct and continuing education. This is not intended as a "Fix it Yourself" instructional video for the general consumer. I think that the use of video to help individuals address there own issues is a compelling idea... it's just a bit out of the scope of this business. Thanks for your questions, Dr. B2
Brent Brookbush I see. I am personally interested in being in as optimal functional body as I can be. I have a pretty bad posture and I think understanding this stuff is important to me rather than getting the instructions only. Keep up the good work.
Keep studying, nothing says you cannot use what you learn... and even though my materials might be intended for professionals does not mean you could not become a certified personal trainer, learn from our information and use it on yourself ;-)
For the first time I feel like I understand what is going on with my anatomy. I did a lot of slouching for years at my desk job and slept on my stomach, I attribute these to the posterior tilt. The problem is I continued to do heavy lifting and now have disc injuries and to guard my back I am constantly in this undesired position. Is there hope for me to reverse what seems like my new natural posterior posture? If so, what kind of timeline are we talking about if I religiously stretch and attempt to correct?
Aaron Foye Hi Aaron, I’m a NASM CES trainer. Before you want to do any static stretching program you want to do SMR on your overactive muscles (approx 30s) BEFORE you do static stretching (approx 30s).
Hey Giovanni, That is because youtube is only a sample of our more than 400 videos, 500 articles and 70+ online courses. You can learn more about correcting an APT here - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/lumbo-pelvic-hip-complex-dysfunction-lphcd/ Full access does require a membership. ($19.99/month) Dr. B2
If you have Melissa's heels elevated on a foam roller, isn't that giving her plantar flexion and NOT dorsi felxion? What is the cause of Melissa's lack of plantar flexion? Did she injure her tibial tendon? Curious because I have the same problem.
Hey Molly, The heel rise puts her in a plantar flexed position, which gives her more total dorsiflexion range from the top to the bottom of her squat. So if she is feet flat, she may have 10 degrees of dorsiflexion before she cannot dorsiflex anymore (allow her tibia to come forward). But, if we put her on a heel lift she has that 10 degrees, plus the 15 or 20 degrees of plantar flexion she was put in. So, in essence she know has 25 or 30 degrees of dorsiflexion range to work with. Remember, in this video, the heel rise is only there because without it she could not demonstrate the dysfunction. She does not have this dysfunction, nor is the heel rise necessary to see this dysfunction in someone who has it... I say that several times in the video. Posterior pelvic tilts and inadequate forward leans are rare... we had to modify to make this video happen. If you want to see dysfunctions related to dorsiflexion restriction see "Feet Flat", "Feet Turn Out", "Excessive Foward Lean" and "Knees Bow In" Dr. B2
Is it possible that if I trained for too long with a posterior pelvic tilt that I have also developed a winged scapula and serratus weakness or tightness? Thank you for your explanation in the video, it helped a lot. I always thought working on the glutes are a no go when you have an posterior pelvic tilt.
hey brent. i have a client who have PPT and Upper crossed syndrome. he had a lot of back pain when performing differents exercises like front squats, shoulder lateral raise, etc. what do you recommend me to do?
Start with release and stretching of the piriformis, biceps femoris and posterior fibers of the adductor magnus, follow that with psoas activation and integration and let me know how it works out. Dr. B2
Hi Brent, I hope i can get some help from you on a patient i am working with. He is a T2 incomplete spinal cord injury who also demonstrates Left SI joint pain. Today when i assessed him, i found he has tenderness in adductor msl, medial hamstring and overactive piriformis. I am surprised to see the exact presentation that you have explained in your video . He has significant pain in Left SIJ with hip flexion past 80-90 degrees . What would be a good tape position for this pain .
I would try release techniques for the posterior adductor magnus, piriformis, and biceps femoris, followed by some neural glides (modified slump), and glute activation. You could try kinesiotape... taping the glute max may help inhibit the adductor complex. As neural dysfunction can lead to some very tricky symptoms and responses to intervention the most important thing to do is to reassess often (after every technique if you have to), and take notes what works and what doesn't. I recently had a partial spinal cord patient that responded terribly to any mobilizations of the lower extremity (including gentle longitudinal distraction), but release work does wonders. It doesn't always make sense, but if you are taking notes and building the most effective routine for your patient you should continue to make progress.Dr. B2
Great vid i'm a physical therapy student from Suriname, I gotta question. How is it possibile that the small muscle groups like the m.piriformis, m.adductor magnus are synergistic taking the work over of a big muscle like the gluteal muscles? Keep up the good work a lot of good information you have! And i'm in love with melissa😍
That is a great question, and to be honest there is no definitive answer at this point. I can tell you that the adductor magnus is not small, in fact it is one of the largest muscles in the body, but this does not answer the bigger question. One thing to consider is that when we are discussing activity of muscles, inhibition, hypertonicity, synergistic dominance, etc... these terms are relative. That is, synergistic dominance of the adductor magnus over an inhibited gluteus maximus does not mean that the gluteus maximus shut off, it just is not firing hard enough, and the adductor magnus is now firing a bit harder. In this way, it is better to think of muscles on a dimmer switch, than simply "on/off". Dr. B2
Hey M, I think this is a matter of sufficient motor recruitment for a given pattern. The stress of most daily activities should not require "bracing". That is, reaching for a pencil you dropped, climbing stairs and opening your bedroom door should be sufficiently matched by "drawing in" alone. "Drawing in" may even be enough for strength endurance training (12 - 20 rep training). If you have to brace for these "lower intensity" activities, it may be a sign that your intrinsic stabilizers are not sufficiently recruited or conditioned, and that your global movers have become "synergistically dominant." Dr. B2
what about the hip flexors (moslt psoas), erector spine, internal rotators ,or the vastus group. would those need strengthening or maybe not the hip flexors if Sitting all day.
Hi Danial, we actually have several videos on the Overhead Squat Assessment including one about anterior pelvic tilt. You can also find all of our videos at BrookbushInstitute.com
Hahahaha this is so funny, I do brace when picking up stuff, I straight up brace hard then do a single leg lunge to pick up plates from the dishwasher 😅😅 And my adductors and piriformis to get really tight!
what a great library of videos doc, it especially helps to know you really know your stuff! thank you for spreading good content, just the time alone I spent 'researching' my movement patterns and problems/solutions, I can see the 199$/yr being worth it and something Id consider spending in the future for sure
Thank you Noor, really appreciate it. And, now with our "Human Movement Specialist (HMS) Certification" launched and included in the website... you have a great goal to work toward. Dr. B2
Hey Jedi, That was not the point of this video. The heel rise is there because it was the only way that Melissa could demonstrate the compensation patterns. Both "inadequate forward lean" and a "posterior pelvic tilt" are rare.... so finding a way to demonstrate this issue was tough. For purposes of this video, please ignore the heel rise. Dr. B2
thanks for the reply. i understand that the heel rise wasn't the purpose of the video, you mentioned that couple of times in the video. that heel rise, though, acted as cue to bring up a question that i had about the ankle mechanics for a long time. pardon me for going off topic. let me reiterate the question i asked previously with an analogy. let me know if that analogy is correct: in a standing dumbell curl, the biceps are recruited most intensely at the lowest point, when the db is about to be raised from the thigh position. the reason for that is that the biceps are at the stretched position.......is the same idea with the heel raise, so that at plantar flexion position, it'll be harder for the muscles responsible for dorsiflexion to recruit, thus strengthening it more.
No, not necessarily. Thinking about length/tension relationships is a great way to increase your understanding of motion, but at the bottom of a squat your plantarflexors, knee extensors and hip extensors should all be in a lengthened position. Your dorsiflexors are not recruited as movers (except maybe to initiate motion), as your being pushed into plantarflexion by gravity. We also have to consider that the hardest point of a curl may not be the bottong, but when the arms are parallel to the floor and the largest moment arm has to be overcome. Dr. B2
Hi, Quick question. Could you explain further how the biceps femoris plays a role in posterior tilt of the pelvis? I ask only because conceptually when I think about the eccentric phase of a squat I think knee flexion and hip flexion..so I think shorten at one end lengthen at the other.....would not the adductors be the "main" contributor to the tilt unless we get into hip socket depth and function? Hope this doesn't come across as a "challenge" it's just me trying to gain better perspective.
+Kelley Podsen Great question Kelley, Consider this... a muscle cannot lengthen and shorten at the same time. In essence your biceps femoris is going to accommodate the total length needed from origin to insertion. Under normal circumstances I could not tell you with certainty whether the hamstring is lengthening, shortening or staying the same length during an eccentric phase of a squat, due to the paradox of knee flexion/hip flexion that you noted. But, I can tell the when the biceps femoris is over-active it may contribute to excessive posterior tilting of the pelvis by "pulling" harder than it should on the ischium, or potentially "restricting" the hip from achieving optimal hip flexion. It may be easiest to visualize what an over-active biceps femoris would do to the pelvis in static standing, and then try to imaging that continuing through out the eccentric phase of the squat. Dr. B2
I forgot to mention that, despite not having a PPT, I do have tight hamstrings, loose hip-flexors and weak glutes (maybe tight as well, not sure). Do you still recommend to treat it as an APT?
I think it is worth a try, providing you are going to re-assess using a reliable assessment. Weak glutes, loose hip flexors and tight hamstrings are not the result of reliable tests.... they are feelings that cannot be trusted anymore than you can be trusted to diagnose yourself. This is fact that all of us have to accept... feelings are not facts, feelings themselves can deceive and bias our view, most assessments require the eyes of an unbiased 3rd party.
...lumbar flexion when youre leaning forward? man i must be out of practice...i thought flexion was engaging the muscle... like doing a backwards bridge? can you flex your lower back while bent over forward?
Tons of exercises actually... in fact, I would not consider a deadlift very specific for increasing glute med and max strength. Check out these videos: Glute Activation Circuit - th-cam.com/video/U6VsTA011hU/w-d-xo.html Ultimate Glute Bridge - th-cam.com/video/0Y8iKA4nv-8/w-d-xo.html
Brent Brookbush Thank you so much Brent! Actually i'm searching activating glute max/med without activating deep lateral rotators. I have very limiter hip IR. Any ideas? Thanks for your time again
This would be specific to noting the sign on the Overhead Squat Assessment. Chances are if you have a true posterior pelvic tilt, it will also be obvious in this assessment. Dr. B2
Brent Brookbush would you be able to do a video on posterior pelvic tilt for people who always have it? There’s a lot of information on anterior but not posterior. Much appreciated if so
Hi I have one hypo and one hyper SIJ and squat with an upright back. Can you guide me as to why that is wrong and what to do as forward lean is painful
This is the common compensation pattern for the SIJ. You should start working on the solution for Asymmetrical Weight Shift and see if that starts to improve your symptoms. Dr. B2
hello sir I have a question, I dont know what problem I have but everyone seeing me tells me that why do hyperexpand your chest when you walk, but at that time its totally relaxed postion, and I have Rib flares, I am doubting its anterior pelvic tilt,I don't have access to physiotherapist , so can I mail you pics of my pelvic and you tell me particular exercise ??
Hey Denish, I am happy to set up a time to do an online consultation, but I do charge for my time. If this is something you are interested in please e-mail me, Brent@BrookbushInstitute.com
Hey Brett it me again lol, just recently when ever I perform a bench press for some reason my anterior deltoids seem to fire way too much that its kinda burns to do the movement and the next day my serratus ant is sore which really baffles me. I just started to work on the post delts and relesase the pecs today and plan on doing but how does my serratus get so invoved? Anything you would recommened
+Sawoop !! Not really the right video for this question,I would suggest looking into my article on Upper Body Dysfunction and start trying to build yourself a better warm-up routine days you are working on upper body strength - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/upper-body-dysfunction-ubd/?from=294Sincerely, Dr. B2
Question B2: How is the Piriformis overactive in a posterior pelvic tilt? From my experience, I've seen the piriformis pull clients into an anterior pelvic tilt. Does it have to do with it fighting to neutralize the internal rotation caused by the Adductor Magnus?
Well Dan, That is a bit complex, It actually is not responsible for hip flexion or hip extension so it does not directly contribute to an anterior or posterior pelvic tilt. It's role in a posterior pelvic tilt seems to be related to the accompanying excessive external rotation of the femur (knees bow out), and role in a muscle synergy described in the video as the "synergists of external rotation)". Further, it's attachment to the sacrotuberous ligament would be involved in restriction nutation of the sacrum via increase tension of the sacrotuberous ligament. Dr. B2
l agree that doing something is better than doing nothing, but ALL sport is damaging. The only movement which isn't, Is gentle walking that is undertaken with much consideration as to the method.
+Scott Brooks We actually breakdown all signs on the overhead squat with recommendations for corrective exercise on - brentbrookbush.com/ The membership is 12.99 a month, but I think you will find it well worth it. Here is an article that would help with your specific questions - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/solutions-table-overhead-squat-assessment/ Sincerely, Dr. B2
Hey Brent, I've heard some other DPTs (Aaron Horschig for example) state that shortness of the hamstrings have nothing to do with a posterior pelvic tilt, due to the fact the hamstrings shorten with knee flexion in a squat, so the hamstrings don't actually change length... They say it's caused by the femoral head reaching its maximal hip flexion range. What are thoughts on this? th-cam.com/video/Thz_I1Bg5n8/w-d-xo.html Here's Aaron Horschig's video on "butt wink"...
I would say he is more right than wrong based on what you are telling me, but he is not taking into consideration that the muscle may not be short, but it is over-active. Over-activity can include "pulling too hard, too early" regardless of length. The BI lists these muscles as "long/over-active" in most dysfunctions, implying that you should release these muscles but not stretch them. From what I have noticed in practice, hip fexion range of motion has much more impact on a posterior pelvic tilt than the compensatory behavior of the hamstrings alone. Dr. B2
I thought i have no butt because of flat back and posterior pélvic tilt, but this woman has as good developed glutes. So there Is no hope to build butt fixing the lack of lordosis. So sad
Really Justin... you are so board in quarantine that you are looking for outlines in clothing on TH-cam? How pathetic are you? This is an education channel, I am sorry I did not where a trash bag to cover myself. SMH
If you watched the entire video I mention that I had to put the half roll under her heels so that she could demonstrate a rare compensation that she does not actually have. A Posterior Pelvic Tilt and/or an inadequate forward lean are rare and I was unable to find a model with the compensation before filming this video. Dr. B2
Yes Dinesh, Although we have to again redefine the butt wink as a normal posterior tilt that occurs at the end of hip flexion range of motion during a squat. With that being said, someone can "walk around" with an anterior pelvic tilt, and then tilt under when they get to the bottom of their squat. If the posterior pelvic tilt is a compensation pattern that is noted in standing or early in the decent of a squat than it is a compensation pattern and this is not likely to occur with an anterior pelvic tilt. Dr. B2
What a great video this was. This is the first time that I've seen anybody address relation beetwen glute muscles and piriformis. A year ago I started training my weak glutes from too much sitting because all of the videos on youtube said so but instead of that piriformis pressed on my sciatic nerves on both sides at the same time. I could barely walk for two months. And first 2 weeks I was basically bedridden.. Nobody ever says that you need to release that pirifomis before strenghtening glutes.
Always cool to have at least some of my methods confirmed by a true professional. Great video, Brent!
+MATĚJ ŠULC Thinking Fitness
Great minds think alike Matej ;-)
Brent, thank you very much for this incredibly informative video. I recently took on a client that has this dysfunction. I'd been developing a plan to correct their dysfunction, involving release of the Biceps Femoris and Piriformis, and the client noted that when they foam rolled their adductors, they were super tight, so we were working on that as well. We were working on glute activation as a priority. It's a great feeling to know that I was on the right track for release/activation work. You've taught me well! Thanks again for lighting the fire in so many of us. You've done more for my business than I could tell you! Thank you!
+Mo Kazmi You were certainly close Mo, maybe just missing a little bit of the "Why?" that would have lead you to the rest of the muscles in this dysfunction.So happy to help, and we have no intention of stopping.Dr. B2
Just wanted to give appreciation for your video. I understand from some other comments that it's not intended as "Fix it yourself" information, but I've found it incredibly useful.
And I'll add details in case anyone else with a similar issue stumbles across this:
I've been basically crippled and near bed ridden for almost 3 months now, with both a GP and a Neurologist not having any idea what the problem is and eventually just saying "maybe it's weight". I tried to explain to them how the pain was in a strange spot and felt deep and focused in certain areas but it was ignored, and now from your video I've looked things up and almost certain it's the piriformis. They'd also dismissed my descriptions of sciatica and nerve issues in my legs because the leg reflex test seemed fine, but it seems that's not uncommon with the piriformis being tight (Piriformis Syndrome). And while I don't have a way to measure it, doing the hip flexion test creates pain in the pelvis/lower back.
And when I tried doing general lower back and glute exercises to see if that would help, I'd feel better and improve for a little while and then suddenly while doing a small front bend or leaning over it would feel like a spasm would go through my lower back in the pelvis area and I'd be crippled again; which seems explained by not releasing the piriformis first. They have me going in for an MRI because L5/S1 thinning was the only thing that seemed out of place, but they indicated it was more a shot in the dark than anything else.
I'm guessing now, that this was perhaps caused by sitting in an improperly sized chair over long periods of time, daily. I'm above 6' 5" and most chairs aren't built for that, so I'd have to shift my butt forward a little and lean back into chairs to be comfortable. So that means my pelvis would be tucked in under me.
And now, off to go try some things with this new information...
Thank you for both appreciating what we do and giving kudos for the information... I am grateful that we have given you a resource to atleast try and improve your situation. Hopefully you can get yourself to a point where strengthening and maybe physical therapy will be able to get you back to your original function.
Dr. B2
I feel like I just watched a video on the different spells in Harry Potter...
Brent,Just wanted to say a massive thank you! Your video's (this one especially) has helped me understand the mechanics behind the "butt wink" which has been a massive dilema for me for years now. Always told "you gotta squat ass to grass" by the majority of the fitness world, when the reality is that can & has done some damage.I am a training sport & injury massage therapist, you just dont get this level of knowledge & explaination anywhere so i am forever thankful you take the time to record these videos! I really apprciate it!!Cheers!!
Glad I could help Jamie,
Thank you for the support, and I hope you will check out all that we have to offer at BrentBrookbush.com.
Spread the word, tell your colleagues, and keep the company growing. The more members on the site, the more we can invest in producing better content, faster.
Dr. B2
i appreciate how you were able to make this so accessible! you used technical terminology but the concepts and logic were so clearly laid out, even i (attendee of one (1) gen anatomy class in college) was able to follow :D thanks for this vid!!
This is the best video on this subject that I have come across. I like how you connected the corrective measures to performance, especially the part about adding back that eccentric loading. It seems that the majority of people could benefit from strengthening their glutes, and I appreciate the insight on piriformis coming into play during clams.. Your videos put a lot of what is lectured on in university into practical application.
Thanks Brent!
That's our goal Calvin... Practical Education!
It always makes me ecstatic to read a comment like yours. A comment that re-affirms we are meeting our company mission ;-)
Thanks for that,
Dr. B2
Great Video Brent, Thank You!!! You have such a great teaching gift. You break things down in such an easy to understand way. I am really enjoying your site and am learning so much to help my clients. Your passion is contagious!
Thanks Julie,
Really happy our vision is coming together... it has been years in the making and we have so much more planned ;-)
Thanks you so much for the support and I hope you will help us spread the word about BrentBrookbush.com.
Dr. B2
Very educational and clear....my teachings and practice has been in line to this. Now with this vid i can more so elaborate or breaking down on the movement as you taught, much appreciated thanks Brent.
The Breaking down to my clients
Kwadwo Odinga,
So glad I could help you expand your knowledge and improve your communication with clients, that's awesome.
Check out everything we have to offer at BrentBrookbush.com when you get a chance.
Dr. B2
Brent Brookbush thanks much will do
"My ass is just too tight" that was funny
Every once in a while I come up with a good joke ;-)
Dr. B2
Giving her dorsiflexion is actually pretty insightful. I've found that at least 50% of my clients lack normal dorsiflexion, which puts them in a squatting disadvantage from the get-go. I would be interested in your top ankle dorsiflexion treatments (myofascial work, antagonist work, static stretching with PNF etc.). I'm in the process of figuring out which work best for my clients.
I am in 100% agreement with you. You could look at our Lower Leg Dysfunction Model here for more - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/lower-leg-dysfunction/
Generally speaking we would release and lengthen the calf and fibularis muscles, mobilize the talus, and activate the invertors.
If you are licensed then we also recommend release of the long toe extensors and flexors, IASTM when appropriate, and mobilization of the tib/fib and various talor joints.
Hope that helps.
I just found your channel and I couldn’t be more excited! I teach about postural dysfunction at a university and train a group of interns how to assess and correct muscular imbalance patterns. I’ve also been a personal trainer for many years. I currently have a client with this issue and it’s fascinating because it’s the first time I’ve worked with someone who has it to this degree. It was even evident when doing assisted dips. He couldn’t “untuck”. What’s interesting is that he also has a lateral pelvic tilt and his TFL is so tight on his right leg that it’s very hard for him to extend his leg behind him when he walks because of the stretch. My question actually has to do with ankle mobility. He has very limited dorsiflexion and that is clearly also contributing to the issue of him feeling like he is falling back when squatting. Are these commonly found together?
Whoa, I've been through a lot of physical therapy over the past seven years and you just explained more than any PT has told me. Well... I am a veteran and go to the VA, I'm thinking I should just go and pay for my own therapy.
I hate to hear that, but I get it. I have been to the VA in NY and they are a good institution with good care, but I think you will find that the best PTs will be going to cash pay more and more. Insurance companies are pretty mean to us with their reimbursements.
With that being said... don't assume you have to pay out-of-pocket. Maybe show this video to the PT you like at the VA, they may really dig it and be able to bring some of this into your treatment plan.
And... before you go cash pay, make sure to thoroughly vet the people you are considering.
Hope that helps,
Dr. B2
Thanks, I didn't really like my PT here in Austin VA but the one they sent me to in San Diego was great. I'll have to do some research and find one near me now.
thankyou that was brilliant as a trainer myself i am always hungry for knowledge and welcome it. Thankyou again wishing you infinite happy healthy days🤸🏻♂️🏋🏼♀️🏂⛷🏋🤾🏽♂️⛹🏼♀️🤸🏾♀️🏌🏽♀️🏋🏼♀️🤽🏾♀️🤸🏻♂️
Amazing!!!!
When u talked about bracing that is exactly how I bend over to pick up,, this is the first time iv ever had it explained.. I have a window cleanin business which makes me stretch and use all the front muscles, which makes it hard to walk everythings so tight
Hi Brent
Thanks for the video. The scientific explanation of the posterior pelvic tilt problem is appreciated. However, isn't there a combination of exercises to fix this problem? How about a video on these specific exercises?
Thanks again
We have covered them all, and it would be several videos.
Dr. B2
@@brentbrookbush9505
Would have been nice to include them by mentioning them and including the links to the videos. Can you please provide here? tia
@@pamm2230 Pam I am sorry, that is more information video than would fit in this comment box.
bruh this video is fire
Thank you for this video! 🙏🏻
If possible, can you plz also do videos on the *’Excessive Forward Trunk Lean’* during the overhead squat assessment, and the *’Head Juts Forward’* compensation during the Push/Pull assessment?
I couldn’t find any videos on these specific compensations. I’d like to understand why these compensations are happening, but also how to fix them. I need to know more about what stretches could be done for the tight muscles, and what strengthening exercises could be done for the weak muscles.
I would really appreciate some guidance on how to better understand these specific compensations 💖
You are describing forward head posture, which is not a sign on the Overhead Squat Assessment. Ideally, identifying forward head posture during a static or dynamic assessment would be followed by range of motion assessment.
Dr. B2
Hey @chariots8x230! Hope the studying is going well. We just recently added our business to Google my Business, would you mind leaving a quick review? g.page/r/CR1LsEAZ5W6AEBM/review
Awesome!! Been looking forward to this since that CES workshop!! Thank you Brent!!
+Yisrael Dubin Ya... his video has been a long time coming Yissy... but you know we will keep working through the volumes of information that apply to our practice.
Dr. B2
+Brent Brookbush
Beautifully said!
Awesome video. Throughly explanined. I love using the band for tactile cueing as well.
+fc Henn Thank you Fc,
The band is definitely a great little discovery. Appreciate the kudos,
Dr. B2
Thank you Brent! I appreciate your demonstrations and clear, professional explanations.
Thank you Mel,
Appreciate your comments as we work so hard to make everything we do clear, comprehensive and concise.
Dr. B2
Fantastic video Brent!
I really liked the clarification about the glutes. I have a flat back posture, I did the exercises and I feel a lot better.
My thoracic spine is flat, do you have a video on flat back ? I would appreciate a lot if you give me some exercises or something. I went to the PTs but they did not help me I do not want to sound disrespectful but the PTs in PERU the only thing that they do is apply laser, ultrasound etc..
Best video I've seen on the subject. All hail white boards! It would be great to see a video on lateral pelvic tilt from you also!
+Wyatt Steed Agreed, White boards are awesome!
We have a video on the lateral pelvic tilt; however, we refer to this as an "Asymmetrical Weight Shift" and the video is part of our exclusive content for members of BrentBrookbush.com. Check out the site, I think you will enjoy it - brentbrookbush.com/
Dr. B2
This is deep..
I was slightly chubby and had a belly, and adopted the posterior pelvic tilt as a means of hiding my belly bump
Interesting... certainly not the common compensation, but thank you for sharing.
Dr. B2
Hey Brent,
Just wanted to say I absolutely LOVE your videos! Thank you SO much for making them!
Your tip @ 11:43 helps me get a step closer to figure out my own buttwink issues and even how to assess them!
I didn't however get the word that you used? Hip goniometry?
Also I searched your channel and it seems that the playlist it was on has a lot of videos either deleted or just private right now.
Is there any way I can check out the goniometry video?
So, yes, the word is hip goniometry, hip flexion goniometry to be more precise. All of those videos are available on BrentBrookbush.com. In fact, we have grouped them into a few articles which have been pre-approved as courses for continuing education credits. Membership to BrentBrookbush.com is just 19.99/month, check it out.
Dr. B2
This is the Best video explaining this condition! Thx. A lot!....I would like to see a video showing the proper exercises to treat this problem.🤗
Thanks Susana,
We have a ton of exercise and corrective strategies at BrentBrookbush.com
TH-cam is just a small sample of what we have to offer.
Dr. B2
Thx. Dr. ....I am not a student, I have this problem, went to physical therapy but I don't seem to find complete relief for my condition. Thx. 😔
Thank you, Melissa
Once again a great video Brent. If we activate and the hip flexors will be detrimental ? Or we only activate the hip flexors if the low back rounds in the overhead squat assessment ?
Thank you
+George Koutsis Hey George,There is really no dysfunction that would give impetus to "activating" the hip flexors. There is some research that may suggest that psoas activation is appropriate, but this is different than trying to activate all hip flexors and may require some specialized techniques. Low Back Rounds (Posterior Pelvic Tilt), would seem to suggest hip flexor weakness, but it is a bit more complicated than that. Start with your release and lengthening techniques for the piriformis, biceps femoris and adductor magnus and let me know how that works out.
Dr. B2
Wow Brent, thanks a lot for that !! I have very complicated situation, right pelvis side is posterior tilt, left pelvis is anterior tilt. I don’t have any idea comment fixed it. Right Side Hip is very tight, Magnus and Biceps Femoris extremely tight, hip flexor weak. Left pelvis anterior tilt, tight hip flexor, weak Piriformis and Maximus , knees pain both side. Can you make a video about it ?
Excellent and comprehensive video
Thanks Resistance Quest,Really appreciate it. Hope you will check out all that we have to offer at BrentBrookbush.com - bit.ly/1o4OCD6
Sincerely,
Dr. B2
You know what Brent? Why ass is just too tight...
LMFAO this made my day
Very nice video! I first saw your videos today and I find them very well explained. I have a question for you. I have the opposite problem of what is shown in the video, meaning that I have a tendency towards a pronounced hip flexion and anterior pelvic tilt with a hyperlordosis while I'm squatting, which leads to a diminished knee flexion. The weird thing is that I have tight piriformis, harmstrings and extremely tight adductors. How is that possible? It seems like I have to force myself into a posterior pelvic tilt to achieve proper form, how is that possible? By the way, not sure if you already made a video on this issue, but I see a lot of people squatting with excessive hip flexion (probably due to over-activation of the erector spinae amongst many other things) but if not, I think it would be a good idea! Thank you I'll keep watching your videos.
Hey Thierry,
We do have a video on "Excessive Lordosis (Anterior Pelvic Tilt)" at BrentBrookbush.com. Keep in mind that "tight" is just a feeling, that muscles can be "pulled long" and feel tight, or become adaptively shortened and "tight". In your case you are being "pulled long" and tight. I would try release techniques for your hamstrings, piriformis and adductors... but DO NOT stretch them. Try release and stretching your hip flexors, and add some glute activation.
Dr. B2
Pls can you show the correct way of doing squats for people who are not athletes.
This is great but I don't know all of these technical names
Why do you want the same spinal angle as lower leg angle. The entire point of a low bar squat is to keep your shins almost vertical and have more forward lean to engage the posterior chain more. Weightlifters always try to overhead squat (in a snatch for example) with the most shin angle they can while minimising trunk lean. Are you saying that powerlifters and weightlifters (professional squatters) can't squat properly?
Hey Bob,
You have to separate lifting as a sport from lifting for performance and function. In most sports and activities we want to optimize the contribution of all joints, including the ankle. The parallel tibia/torso angle is a means of ensuring optimal balance, extensibility and contribution from all of the muscles of the lower extremity.
If you need to experiment with other forms and techniques for your lifting/strength sports, just be aware that there may be certain risks involved (as there are with all sports).
Dr. B2
Thank you your videos, very useful for teaching yoga. :)
Hey sirr... fan of urs.. remember !!!!! Physio (india) ????..
We greatly appreciate your continuous support @MsMohini!
Can this cause lower muscle prolapse with time?Thanks. Was trying to correlate .
Cause is probably to strong a word, I suppose it could be part of dysfunction of the lumbo pelvic hip complex that could also be correlated with prolapse.
Dr. B2
Thank you for responding.Will go through more video from you to help myself.Stay blessed
Amazing video
Thank you! We're so glad you found this helpful!
This is a great video (as they always are!) using this one on one will be tremendously helpful. I'm concerned about group classes. I do a lot of 'sit and stands' on the Bosu and the box. Not sure how I would control individual excessive ROM. Would you recommend omitting this from my programs or is there a cue/modification that I can use to appropriate the movement?
Group classes are a challenge, but I am sure that a little cuing and some quick one-on-one attention as you walk around the room will be sufficient. Especially for your regulars. If you teach a little each time they come in, it will make this a lot easier in the long run.Dr. B2
Good summary of the standard physical therapy curriculum. Nothing new if you are already a PT.
+Irate People I am not so sure about that Irate People,
Although we had courses in clinical decision making, orthopedic assessment and therX in school, I don't remember ever seeing an effective "solutions table" that broke down any postural dysfunctions into long/short, over-active/under-active, arthrokinematics dyskinesis, etc...
Further, I believe this particular description of the muscle activity related to a posterior pelvic tilt is in fact, original. Obviously, the concepts are not, but it has taken me many years of practice and study to create a succinct solutions table for this fairly rare dysfunction.
Dr. B2
+Brent Brookbush
haha, this is great!!
Where would be a good place to get help for posterior pelvic tilt in Rochester NY area? I have this problem. Have had back spasms for years. The trauma to my glutes has made me traumatized about bending over and I am definitely bracing.
your videos are always great
+M Akhtar Thanks M,Really appreciate that.
Many more to come.
Dr. B2
I waiting, your style is good don't change it please
Great video!
+Damien Edmondson Thanks DamienDr. B2
Who's your target audience? I find your content to be advanced.
+D34tho Great question D34tho. My target audience is human movement professionals and students looking for adjunct and continuing education. This is not intended as a "Fix it Yourself" instructional video for the general consumer. I think that the use of video to help individuals address there own issues is a compelling idea... it's just a bit out of the scope of this business.
Thanks for your questions,
Dr. B2
Brent Brookbush I see. I am personally interested in being in as optimal functional body as I can be. I have a pretty bad posture and I think understanding this stuff is important to me rather than getting the instructions only.
Keep up the good work.
Brent Brookbush me
Keep studying, nothing says you cannot use what you learn... and even though my materials might be intended for professionals does not mean you could not become a certified personal trainer, learn from our information and use it on yourself ;-)
Thanks Brent. I'm taking Fitness Professionals course glad I saw this video :-)
For the first time I feel like I understand what is going on with my anatomy. I did a lot of slouching for years at my desk job and slept on my stomach, I attribute these to the posterior tilt. The problem is I continued to do heavy lifting and now have disc injuries and to guard my back I am constantly in this undesired position. Is there hope for me to reverse what seems like my new natural posterior posture? If so, what kind of timeline are we talking about if I religiously stretch and attempt to correct?
Aaron Foye Hi Aaron, I’m a NASM CES trainer. Before you want to do any static stretching program you want to do SMR on your overactive muscles (approx 30s) BEFORE you do static stretching (approx 30s).
Hey Brent, I searched your channel for a video that adresses the Anterior Pelvic Tilt dysfunction but I didn't find any. How should I correct an APT?
Hey Giovanni,
That is because youtube is only a sample of our more than 400 videos, 500 articles and 70+ online courses. You can learn more about correcting an APT here - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/lumbo-pelvic-hip-complex-dysfunction-lphcd/
Full access does require a membership. ($19.99/month)
Dr. B2
If you have Melissa's heels elevated on a foam roller, isn't that giving her plantar flexion and NOT dorsi felxion? What is the cause of Melissa's lack of plantar flexion? Did she injure her tibial tendon? Curious because I have the same problem.
Hey Molly,
The heel rise puts her in a plantar flexed position, which gives her more total dorsiflexion range from the top to the bottom of her squat. So if she is feet flat, she may have 10 degrees of dorsiflexion before she cannot dorsiflex anymore (allow her tibia to come forward). But, if we put her on a heel lift she has that 10 degrees, plus the 15 or 20 degrees of plantar flexion she was put in. So, in essence she know has 25 or 30 degrees of dorsiflexion range to work with.
Remember, in this video, the heel rise is only there because without it she could not demonstrate the dysfunction. She does not have this dysfunction, nor is the heel rise necessary to see this dysfunction in someone who has it... I say that several times in the video. Posterior pelvic tilts and inadequate forward leans are rare... we had to modify to make this video happen. If you want to see dysfunctions related to dorsiflexion restriction see "Feet Flat", "Feet Turn Out", "Excessive Foward Lean" and "Knees Bow In"
Dr. B2
what if you have a posterior r ilium and anterior l ilial rotation
Is it possible that if I trained for too long with a posterior pelvic tilt that I have also developed a winged scapula and serratus weakness or tightness? Thank you for your explanation in the video, it helped a lot. I always thought working on the glutes are a no go when you have an posterior pelvic tilt.
hey brent. i have a client who have PPT and Upper crossed syndrome. he had a lot of back pain when performing differents exercises like front squats, shoulder lateral raise, etc. what do you recommend me to do?
Start with release and stretching of the piriformis, biceps femoris and posterior fibers of the adductor magnus, follow that with psoas activation and integration and let me know how it works out.
Dr. B2
Brent Brookbush hey Brent, thanks so much for answering. I'll try it!
Hi Brent, I hope i can get some help from you on a patient i am working with. He is a T2 incomplete spinal cord injury who also demonstrates Left SI joint pain. Today when i assessed him, i found he has tenderness in adductor msl, medial hamstring and overactive piriformis. I am surprised to see the exact presentation that you have explained in your video . He has significant pain in Left SIJ with hip flexion past 80-90 degrees . What would be a good tape position for this pain .
I would try release techniques for the posterior adductor magnus, piriformis, and biceps femoris, followed by some neural glides (modified slump), and glute activation. You could try kinesiotape... taping the glute max may help inhibit the adductor complex.
As neural dysfunction can lead to some very tricky symptoms and responses to intervention the most important thing to do is to reassess often (after every technique if you have to), and take notes what works and what doesn't. I recently had a partial spinal cord patient that responded terribly to any mobilizations of the lower extremity (including gentle longitudinal distraction), but release work does wonders. It doesn't always make sense, but if you are taking notes and building the most effective routine for your patient you should continue to make progress.Dr. B2
Do you have a video link to the deadlift w/post pull?
Great vid i'm a physical therapy student from Suriname, I gotta question. How is it possibile that the small muscle groups like the m.piriformis, m.adductor magnus are synergistic taking the work over of a big muscle like the gluteal muscles? Keep up the good work a lot of good information you have! And i'm in love with melissa😍
That is a great question, and to be honest there is no definitive answer at this point. I can tell you that the adductor magnus is not small, in fact it is one of the largest muscles in the body, but this does not answer the bigger question.
One thing to consider is that when we are discussing activity of muscles, inhibition, hypertonicity, synergistic dominance, etc... these terms are relative. That is, synergistic dominance of the adductor magnus over an inhibited gluteus maximus does not mean that the gluteus maximus shut off, it just is not firing hard enough, and the adductor magnus is now firing a bit harder. In this way, it is better to think of muscles on a dimmer switch, than simply "on/off".
Dr. B2
Hi Brent. Please help me, I have very tight adductors Magnus and Biceps Femoris, it causes me patella pain because leg is very tight.
Could you please clarify why you want to avoid core bracing/stabilizing during functional lifting/reaching?
Hey M,
I think this is a matter of sufficient motor recruitment for a given pattern. The stress of most daily activities should not require "bracing". That is, reaching for a pencil you dropped, climbing stairs and opening your bedroom door should be sufficiently matched by "drawing in" alone. "Drawing in" may even be enough for strength endurance training (12 - 20 rep training). If you have to brace for these "lower intensity" activities, it may be a sign that your intrinsic stabilizers are not sufficiently recruited or conditioned, and that your global movers have become "synergistically dominant."
Dr. B2
Or perhaps a maladaptive movement
what about the hip flexors (moslt psoas), erector spine, internal rotators ,or the vastus group.
would those need strengthening or maybe not the hip flexors if Sitting all day.
Please do a video for anterior pelvic tilt
Hi Danial, we actually have several videos on the Overhead Squat Assessment including one about anterior pelvic tilt. You can also find all of our videos at BrookbushInstitute.com
Hahahaha this is so funny, I do brace when picking up stuff, I straight up brace hard then do a single leg lunge to pick up plates from the dishwasher 😅😅
And my adductors and piriformis to get really tight!
Thanks Noor,
Glad you appreciated the analogy. Hope I have a few more you will enjoy tucked away in our content at BrentBrookbush.com.
Dr. B2
what a great library of videos doc, it especially helps to know you really know your stuff! thank you for spreading good content, just the time alone I spent 'researching' my movement patterns and problems/solutions, I can see the 199$/yr being worth it and something Id consider spending in the future for sure
Thank you Noor, really appreciate it. And, now with our "Human Movement Specialist (HMS) Certification" launched and included in the website... you have a great goal to work toward.
Dr. B2
when the heels are off the ground the feet look like plantarflexed. what is mechanics of dorsiflexion really?
Hey Jedi,
That was not the point of this video. The heel rise is there because it was the only way that Melissa could demonstrate the compensation patterns. Both "inadequate forward lean" and a "posterior pelvic tilt" are rare.... so finding a way to demonstrate this issue was tough. For purposes of this video, please ignore the heel rise.
Dr. B2
thanks for the reply. i understand that the heel rise wasn't the purpose of the video, you mentioned that couple of times in the video. that heel rise, though, acted as cue to bring up a question that i had about the ankle mechanics for a long time. pardon me for going off topic.
let me reiterate the question i asked previously with an analogy. let me know if that analogy is correct: in a standing dumbell curl, the biceps are recruited most intensely at the lowest point, when the db is about to be raised from the thigh position. the reason for that is that the biceps are at the stretched position.......is the same idea with the heel raise, so that at plantar flexion position, it'll be harder for the muscles responsible for dorsiflexion to recruit, thus strengthening it more.
No, not necessarily.
Thinking about length/tension relationships is a great way to increase your understanding of motion, but at the bottom of a squat your plantarflexors, knee extensors and hip extensors should all be in a lengthened position. Your dorsiflexors are not recruited as movers (except maybe to initiate motion), as your being pushed into plantarflexion by gravity.
We also have to consider that the hardest point of a curl may not be the bottong, but when the arms are parallel to the floor and the largest moment arm has to be overcome.
Dr. B2
How can you avoid the posterior pelvic tilt in the squat iF you do not have a lumbar lordosis anatomically?
Butt Wink would be a cool nickname.🤣
Hi doc, how do we make an appointment to see you?
Hi,
Quick question. Could you explain further how the biceps femoris plays a role in posterior tilt of the pelvis? I ask only because conceptually when I think about the eccentric phase of a squat I think knee flexion and hip flexion..so I think shorten at one end lengthen at the other.....would not the adductors be the "main" contributor to the tilt unless we get into hip socket depth and function? Hope this doesn't come across as a "challenge" it's just me trying to gain better perspective.
+Kelley Podsen
Great question Kelley,
Consider this... a muscle cannot lengthen and shorten at the same time. In essence your biceps femoris is going to accommodate the total length needed from origin to insertion. Under normal circumstances I could not tell you with certainty whether the hamstring is lengthening, shortening or staying the same length during an eccentric phase of a squat, due to the paradox of knee flexion/hip flexion that you noted. But, I can tell the when the biceps femoris is over-active it may contribute to excessive posterior tilting of the pelvis by "pulling" harder than it should on the ischium, or potentially "restricting" the hip from achieving optimal hip flexion.
It may be easiest to visualize what an over-active biceps femoris would do to the pelvis in static standing, and then try to imaging that continuing through out the eccentric phase of the squat.
Dr. B2
Well, the thing is I have a swayback: hips shift forward instead of going into an anterior or posterior pelvic tilt. Got anything for me?
Treat it as an anterior pelvic tilt... that should help.
Dr. B2
I forgot to mention that, despite not having a PPT, I do have tight hamstrings, loose hip-flexors and weak glutes (maybe tight as well, not sure). Do you still recommend to treat it as an APT?
I think it is worth a try, providing you are going to re-assess using a reliable assessment.
Weak glutes, loose hip flexors and tight hamstrings are not the result of reliable tests.... they are feelings that cannot be trusted anymore than you can be trusted to diagnose yourself. This is fact that all of us have to accept... feelings are not facts, feelings themselves can deceive and bias our view, most assessments require the eyes of an unbiased 3rd party.
So how do we fix it
...lumbar flexion when youre leaning forward? man i must be out of practice...i thought flexion was engaging the muscle... like doing a backwards bridge? can you flex your lower back while bent over forward?
Dude's got some hot hands!
What is the name of the video you mentioned?
Hi Brent, is there any other exercise for glute max/med rather than deadlift? I can't do it at home
Tons of exercises actually... in fact, I would not consider a deadlift very specific for increasing glute med and max strength.
Check out these videos:
Glute Activation Circuit - th-cam.com/video/U6VsTA011hU/w-d-xo.html
Ultimate Glute Bridge - th-cam.com/video/0Y8iKA4nv-8/w-d-xo.html
Brent Brookbush Thank you so much Brent! Actually i'm searching activating glute max/med without activating deep lateral rotators. I have very limiter hip IR. Any ideas? Thanks for your time again
Yes, watch the videos above and also release your tensor fascia latae and gluteus minimus before doing the exercises.
Brent Brookbush Thank you so much!
Does this apply to posterior tilt as my everyday stance or just during a squat?
This would be specific to noting the sign on the Overhead Squat Assessment.
Chances are if you have a true posterior pelvic tilt, it will also be obvious in this assessment.
Dr. B2
Brent Brookbush would you be able to do a video on posterior pelvic tilt for people who always have it? There’s a lot of information on anterior but not posterior. Much appreciated if so
@@aidanmackay3873 The solution would be the same as above. The reason you can't find info, is it is very rare to see someone with a PPT.
Dr. B2
Can tight quads be apart of the issue as well?
My gluteus are tight and I have this tilt. Using a roller on my ass has helped haha
Hey I made one video of one of my current pt
Can u please see to it tell me what can b done
Good video! :)
+IxToBz
Plenty more where that came from on BrentBrookbush.com ;-)
Dr. B2
It’s too confusing - too long
Hi I have one hypo and one hyper SIJ and squat with an upright back. Can you guide me as to why that is wrong and what to do as forward lean is painful
This is the common compensation pattern for the SIJ. You should start working on the solution for Asymmetrical Weight Shift and see if that starts to improve your symptoms.
Dr. B2
hello sir I have a question, I dont know what problem I have but everyone seeing me tells me that why do hyperexpand your chest when you walk, but at that time its totally relaxed postion, and I have Rib flares, I am doubting its anterior pelvic tilt,I don't have access to physiotherapist , so can I mail you pics of my pelvic and you tell me particular exercise ??
Hey Denish,
I am happy to set up a time to do an online consultation, but I do charge for my time. If this is something you are interested in please e-mail me, Brent@BrookbushInstitute.com
Little late to the party. But damn I wish I was his little helper:)
Will this heal necrossis of the hip pain
Hey Brett it me again lol, just recently when ever I perform a bench press for some reason my anterior deltoids seem to fire way too much that its kinda burns to do the movement and the next day my serratus ant is sore which really baffles me. I just started to work on the post delts and relesase the pecs today and plan on doing but how does my serratus get so invoved? Anything you would recommened
+Sawoop !! Not really the right video for this question,I would suggest looking into my article on Upper Body Dysfunction and start trying to build yourself a better warm-up routine days you are working on upper body strength - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/upper-body-dysfunction-ubd/?from=294Sincerely,
Dr. B2
@Brent Brookbush Where is your clinic located?
Hi Daniel, I'm located in NYC but our platform is online!
Lacks dorsiflexion?
Melissa😍😍😍
Question B2: How is the Piriformis overactive in a posterior pelvic tilt? From my experience, I've seen the piriformis pull clients into an anterior pelvic tilt.
Does it have to do with it fighting to neutralize the internal rotation caused by the Adductor Magnus?
Well Dan,
That is a bit complex,
It actually is not responsible for hip flexion or hip extension so it does not directly contribute to an anterior or posterior pelvic tilt. It's role in a posterior pelvic tilt seems to be related to the accompanying excessive external rotation of the femur (knees bow out), and role in a muscle synergy described in the video as the "synergists of external rotation)". Further, it's attachment to the sacrotuberous ligament would be involved in restriction nutation of the sacrum via increase tension of the sacrotuberous ligament.
Dr. B2
Oh god... when i see Knee squaters my knees hurt. But that modification with the heel rise it was suppose to fix it.
It was not a modification, it was part of an assessment.
Dr. B2
l agree that doing something is better than doing nothing, but ALL sport is damaging.
The only movement which isn't, Is gentle walking that is undertaken with much consideration as to the method.
We've done a video on EVERYTHING you need to know about ANTERIOR PELVIC TILT!! Check it out here! -->> th-cam.com/video/U4nL82iiIts/w-d-xo.html
Any tips on how to keep knees from caving in?
+Scott Brooks We actually breakdown all signs on the overhead squat with recommendations for corrective exercise on - brentbrookbush.com/
The membership is 12.99 a month, but I think you will find it well worth it. Here is an article that would help with your specific questions - brentbrookbush.com/articles/postural-dysfunction-movement-impairment/solutions-table-overhead-squat-assessment/
Sincerely,
Dr. B2
Does he mean plantarflextion??
Hey Brent, I've heard some other DPTs (Aaron Horschig for example) state that shortness of the hamstrings have nothing to do with a posterior pelvic tilt, due to the fact the hamstrings shorten with knee flexion in a squat, so the hamstrings don't actually change length... They say it's caused by the femoral head reaching its maximal hip flexion range. What are thoughts on this?
th-cam.com/video/Thz_I1Bg5n8/w-d-xo.html
Here's Aaron Horschig's video on "butt wink"...
I would say he is more right than wrong based on what you are telling me, but he is not taking into consideration that the muscle may not be short, but it is over-active. Over-activity can include "pulling too hard, too early" regardless of length. The BI lists these muscles as "long/over-active" in most dysfunctions, implying that you should release these muscles but not stretch them.
From what I have noticed in practice, hip fexion range of motion has much more impact on a posterior pelvic tilt than the compensatory behavior of the hamstrings alone.
Dr. B2
I thought i have no butt because of flat back and posterior pélvic tilt, but this woman has as good developed glutes. So there Is no hope to build butt fixing the lack of lordosis. So sad
I can't see because the words are hide
4:54 I'm gonna leave that one alone, way too easy. But #dresstotheright is always fun when you can see it.
Really Justin... you are so board in quarantine that you are looking for outlines in clothing on TH-cam? How pathetic are you? This is an education channel, I am sorry I did not where a trash bag to cover myself. SMH
@@brentbrookbush9505 Lol, I actually liked the video, and I thought you were hot. But please learn to spell I beg you. Its 'bored' and 'wear'.
You should show the posutre of the girl as she stands on the floor naturally
If you watched the entire video I mention that I had to put the half roll under her heels so that she could demonstrate a rare compensation that she does not actually have. A Posterior Pelvic Tilt and/or an inadequate forward lean are rare and I was unable to find a model with the compensation before filming this video.
Dr. B2
can a person have butt wink and anterior pelvic tilt at same time
Yes Dinesh,
Although we have to again redefine the butt wink as a normal posterior tilt that occurs at the end of hip flexion range of motion during a squat. With that being said, someone can "walk around" with an anterior pelvic tilt, and then tilt under when they get to the bottom of their squat.
If the posterior pelvic tilt is a compensation pattern that is noted in standing or early in the decent of a squat than it is a compensation pattern and this is not likely to occur with an anterior pelvic tilt.
Dr. B2
You could have been nicer to Melissa. Otherwise pretty good video. Thanks.