Is a Posterior Pelvic Tilt Acceptable during the Bridge Exercise?

Bridges are commonly prescribed during the rehabilitation process for patients with low back pain or lower quarter dysfunction. Many practitioners prescribe the bridge exercise for gluteus maximus muscle strengthening. Interestingly, several EMG studies have shown that the double limb bridge has relatively low gluteus maximus and medius activation (the single limb bridge has shown higher EMG activity). Regardless, this exercise can be a great starting position for individuals with acute symptoms or those having difficulty with lumbopelvic disassociation.

When performing the bridge, I always monitor the patient's movement pattern from start to finish. Watching the movement provides insight into the patient's pattern of muscle activation. From my clinical experiences, many patients with weak gluteus maximus muscles struggle to use their glutes as the prime mover during this exercise. They tend to hyperextend the lumbar spine prior to raising the hips off the table. The hyperextension forces the pelvis into an anterior pelvic tilt, increasing lumbar paraspinal activation. This same movement pattern often recreates the patients symptoms. If the anterior pelvic tilt (APT) recreates symptoms, is it acceptable to cue a posterior pelvic tilt (PPT) during the bridge?


Pelvic Tilt Review

Anterior and posterior pelvic tilts are a necessary component of proper lumbopelvic mechanics. As the body moves into a posterior tilt, the lumbar spine flexes and there is a loss of lordosis. During an anterior tilt, the lumbar spine extends and the natural lordotic curve increases. Individuals with sacroiliac joint pain or low back pain often lose the ability to perform these movements. One movement is not superior to the other, but rather it is more important to be able to control the transition from an anterior to posterior tilt. By controlling the po

 
 Anterior Pelvic Tilt

Anterior Pelvic Tilt

 Posterior Pelvic Tilt

Posterior Pelvic Tilt

 

While promoting a PPT during the bridge exercise or other hip extension movements is not always ideal, the pelvic motion is not inherently bad either. The argument can be made that a PPT is not a functional position for gluteal activation. I agree! However, a PPT will allow the gluteal muscles and/or hamstrings to work harder. If the goal is more glute activation, then a posterior tilt will do the trick! Additionally, this cue can be beneficial for individuals who have difficulty isolating the lumbar spine from the hips. If a patient consistently hyperextends the lumbar spine when the hips extend, then starting in slight lumbar flexion is acceptable. Introducing a PPT early in the rehab protocol when cueing the bridge exercise allows patients to move their pelvis in a non-threatening manner.

 
 

While a PPT is acceptable early in the plan of care, retraining lumbar spine neutral should be the goal as the patient improves body awareness. Also, it is important to think about exercise progression- supine double limb bridge to the single limb bridge, then progress to standing lumbopelvic exercises such as the hip hinge and deadlift.

Take Home Points

1) A posterior pelvic tilt will help clients activate their gluteus maximus if they are consistently over extending from the lumbar spine.

2) Quickly progress to a braced neutral lumbar spine position once the patient demonstrates improved body awareness.

3) Once symptoms decrease and the desired movement pattern is attained, gradually progress to more functional movements.


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