I love getting questions. One recent question was so great, I had to share it with you!
“What I’ve noticed is that a neutral pelvis looks very different on each individual body. What are your suggestions for assessing new clients who don’t understand what neutral alignment looks and feels like? How do you as the instructor familiarize yourself with an individual’s anatomy? Neutral alignment (which is synonymous to ideal posture) is not one size fits all.”
Let’s start by clarifying that anatomical neutral is the same as neutral pelvis in the STOTT PILATES Pelvic Principle. That said, all of us have postural habits and many of these habits are not neutral posture. A client may come in with a habit of anteriorly tilting the pelvis. This habit is what has become natural for this individual but it is not anatomically ideal or neutral. Our goal is to access the client’s posture and then attempt to help them strengthen both their muscles and their awareness of neutral position.
Palpate the Bony Landmarks
Everyone’s body will look slightly different. Some people have dense tissue or musculature in their glutes, hips, and abdomen. You cannot accurately gauge a neutral pelvic position by the amount of space beneath the lower back or the “flatness” of the belly.
In postural analysis, you’re taught to look at and palpate bony landmarks. This is really the only way to get a sense of an individuals skeletal alignment. So practice finding those bony landmarks.
Finding Neutral Pelvic Placement
Laying in a supine position is a good place to start to find neutral. From supine, neutral position is when the ASIS and pubic synthesis are level in the horizontal plane, the lumbar spine has an anterior convex curve, and there is no tension in the lower back.
Begin by asking your client to find their ASIS. Then find the pubic synthesis. Ask your client to place the heels of their hands on their ASIS and their fingertips on the pubic synthesis. In neutral, the hands create a triangle that is flat and parallel to the floor. One image would be that you could balance a teacup and saucer on this triangle.
Next, have the client rock their pelvis, tipping towards the pubic bones (more anteriorly tilted) then towards the belly button (more posteriorly tilted) exploring the movement available. Neutral is somewhere in the middle of these two extremes.
When finding neutral in a prone position, the ASIS and the pubic synthesis should still be level in the horizontal plane. The client should feel their pubic synthesis and ASIS in equal contact with the floor.
Many clients will feel their ASIS on the floor but not their pubic synthesis. This typically indicates excessive extension through the lumbar spine. Alternatively, some clients will not feel the ASIS making contact with the floor. In both circumstances, you may need to place padding under the ASIS to bring the pelvis level and into a neutral prone start position.
Hands and Knees
Finding neutral in a four-point kneeling position is similar to laying prone. The ASIS and the pubic synthesis should still be level in the horizontal plane, but now the client does not have the same direct feedback from the floor. You will need to help your client more with visual and tactile cues to help them feel their neutral pelvic alignment.
With the hips flexed at a right angle, a client may be tempted to subconsciously adopt the posture they use sitting at the computer or driving. Finding neutral pelvic position here will require greater awareness.
In a side lying position an active neutral pelvic position may prove even harder to find and maintain. Look for the ASIS to be directly stacked on top of each other in the vertical plane and a neutral anterior convex curve of the lumbar spine. The knees, hips, ribs, and shoulders are stacked and the body is in one long line.
Also watch that the waistline is engaged slightly off of the floor. The image of a mouse house underneath the waist can help keep the distance between the ribs and the pelvis the same on both sides.
For new clients, laying on the back can be interpreted as a resting position. But in general, neutral should be an active position (unless the individual already has ideal posture). The aim is to bring awareness to the constant low level work of the deep support musculature, especially the transversus abdominis and pelvic floor. Tell your clients about these muscles. Help your client understand their action and importance. Explain how neutral pelvis will also require a bit of mental concentration at the beginning but overtime it will become second nature. And finally discuss the benefits of learning to perform daily activities in neutral pelvis.
Practice Makes Perfect
Determining a new client’s neutral pelvis takes practice. A good understanding of anatomy and postural analysis are also key. Try the steps above with 15-20 different people. Find people of different ages, shapes, sizes, and genders.
Helping clients discover the power of neutral pelvis will take some time and usually doesn’t happen immediately. Both the teacher and the student will need to be patient on this journey. The goal is to consistently help your clients deepen their understanding of the “Whys“ and “Hows” of neutral pelvis. It’s essential to dedicate a significant amount of your practice teaching time towards guiding a client into their neutral pelvis. This practice time will be a balance of studying and reviewing your anatomy, palpating bony landmarks, and cueing.
Keep your comments coming.
And as always, thank you so much for reading.