I think one of the confusing aspects of conservative, exercise based programs for low back pain is there are a lot of opinions out there about what you should be strengthening and how you should be doing it. There is Yoga, Pilates, Functional Movement Assessments, Flexion programs, and Extension programs just to name a few. There are things I agree with and actually like in all of these different approaches. However, they all have their limitations and specific applications.
One of the more common exercises that physical therapists traditionally use for low back pain is the pelvic tilt. You can watch a video of it here:
Pelvic tilts were developed by Paul Williams, a Tennessee Orthopedic surgeon, in 1937, as part of a larger progression of exercise for low back pain. These exercises were initially meant to reverse an excessive lordosis (excessive inward curve of the spine) and take pressure off of degenerated discs.
Things have change since the 1930s and how we view, evaluate, and treat low back pain. For the most part, there are normal degenerative changes that occur in the spine after the 3rd decade of life that don’t correlate to pain, and not everybody has an increased lordosis causing pain.
Here’s my list of reasoning why you should probably quit doing a pelvic tilt:
1) Your spine is more stable with a slight lordosis and the lumbar multifidus, one of the primary muscles in the lower spine that we focus on for low back pain, is most likely to support your spine in slight backward bending. A flat spine limits the ability of the multifidus to support the spine
2) I do not see an advantage of stretching to the posterior spine ligaments, and perhaps, the posterior disc, for management of low back pain in the acute phase of a low back injury.
3) This exercise does not teach control. Turning on all of your large muscle groups to support your spine goes against the idea of localized muscle control. Pushing your spine into a table may make it “stable” for the exercise, but at what cost?
4) These principles don’t translate well into standing and dynamic exercises and activities.
The exception is if you have really bad lordosis or an obvious spinal stenosis problem, then yes, flexing and flattening your spine may be appropriate. But if you don’t have these problems, I do not see any advantage to this exercise. There are other types of exercises that may be more appropriate for what you need.
Not all exercises are all things to all people.