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Get in Neutral (This is NOT)

Updated October 23, 2024

Many of the common pregnancy-induced pains and injuries (such as diastasis recti, pelvic floor dysfunction, low back pain, SI joint painsymphysis pubis dysfunction, round ligament pain, and carpal tunnel pain) are largely driven by the shifts in your alignment that pregnancy often causes. The concept of neutral alignment may not seem like the sexiest topic when it comes to pre and post natal exercise, but it’s one of the most critical — especially when it comes to preventing pains and injuries, and expediting your postpartum recovery.

Read on to learn:

  • What Neutral Alignment Is
  • How Pregnancy Tends to Shift Your Alignment
  • How to Find Neutral Alignment in Your Body
  • Tips to Help You Move in Neutral (During Your Workouts & Everyday Life)

What is Neutral Alignment?

Neutral alignment describes a state in which the skeleton is vertically stacked (as you see in the photo below). Neutral alignment prevents undo tension from being placed on your muscles, tendons, and ligaments because your skeletal structures are holding your body upright. This translates to fewer aches and pains. Essentially, there are two criteria for being in neutral alignment:

  1. Vertical Stacking: You want to see a straight vertical line between 5 bony landmarks – ear, shoulder, hip, knee, and ankle — as noted by the vertical dotted yellow line below.
  2. Neutral Pelvis: Your rib cage should be stacked parallel on top of your pelvis, as noted by the yellow horizontal solid lines.

How Pregnancy Shifts Your Alignment

Unfortunately, the physical changes of pregnancy tend to pull you out of neutral alignment, as you can see in the photo below.

The typical alignment changes we see tend to see (including in the photo above) are:

  • Anterior Pelvic Tilt: As the belly grows, it often tips the pelvis anteriorly (forward), which creates an excessive arch in the low back. This is one of the reasons that low back pain is so common during pregnancy. It also increases the pressure on the abdominal wall and pelvic floor, which could exacerbate diastasis recti and pelvic floor dysfunction. 
  • Rounded Shoulders: A consequence of the lumbar lordosis (low back arch) is that the other curves in the spine will accommodate, often leading to an excessive forward rounding of the upper back, which causes the spine to appear rounded or “hunched.” This can be exaggerated by the weight of the growing breasts, and is one of the reasons that carpal tunnel pain can occur during pregnancy.
  • Shift in Center of Gravity: A non-pregnant person’s center of gravity (COG) is just below the navel. During pregnancy, the growing belly shifts the COG out and up. Some people may lean backward to counterbalance the weight in front, as you can see in the photo. This places even greater pressure on the low back.
  • Wider Pelvis: Hormonal changes during pregnancy increase the width of the pelvis to accommodate the growing baby and provide mobility for birth. A wider pelvis increases foot width, which means that gait and movement patterns will likely be altered, which can result in movement compensations.

How to Find Neutral Alignment in Your Body

Everyone’s body is different, so “neutral alignment” will look a bit different for each body. Remember the two criteria for being in neutral alignment are:

  • Vertical Stacking: straight vertical line between ear, shoulder, hip, knee, and ankle
  • Neutral Pelvis: Rib cage stacked parallel on top of the pelvis

There are a few strategies you can use to help you find neutral alignment in your own body (or in your client’s body). Remember that different strategies may work better for different people.

1. Free Standing

Begin by “standing up tall” in what you think is good alignment. Then, look in the mirror, and make any necessary adjustments to ensure you meet the two criteria discussed (vertical stacking and neutral pelvis). Note how this neutral alignment position feels, especially the adjustments you needed to make to achieve it. HINT: One helpful way to find neutral pelvis is to locate your ASIS (bony prominences in front of your pelvis) and imagine they are flashlights. Aim your lights straight ahead. If the lights point to the ground, you are in an anterior tilt (left photo). If they point to the sky, you are in a posterior tilt (right photo).

2. Wall Assistance

Using a wall can be helpful because you can receive tactile feedback. A wall also helps to measure change over time because the wall is fixed (as opposed to the positional details that your eyes might miss when performing the free-standing check). That said, the wall can be hard for some body types, especially those with more mass in the rear. So, use your judgment to see what works best. To use the wall, do the following:

  • Find vertical stacking: Touch the following points to the wall: the back of your head, shoulder blades, tailbone, and heels.
  • Neutral pelvis: With the bony points above touching the wall, place one hand in the space behind your lower back and the wall. Try to crush your hand by tipping your pelvis upward (shining flashlights to the ceiling). Then, give your hand some space by tipping your pelvis forward (shining your flashlights to the ground). Once you feel those end ranges, settle on a position in the middle.
3. Stability Ball Assistance

Sit on a large stability ball (AKA “birthing ball”) and begin tipping your pelvis forward and backward – rolling the ball forward and backward as you do this – to feel the end ranges of the anterior and posterior tilt. Then, settle in a place in the middle of the two end ranges so that your rib cage is stacked parallel on top of your pelvis. NOTE: Ensure your rib cage stays still as the ball moves, as sometimes it shifts in the opposite direction of the ball.

Tips for Moving in Neutral Alignment

Once you have found neutral alignment in a standing position, the goal is to try to maintain this alignment during movement (at least for the most part). To maintain neutral alignment during movement, ensure a straight line between ear-shoulder-hip so that your trunk moves as one unit. Here are some important activities to try to perform in neutral alignment:

1. Sitting

If you work in an office setting, or if you have a newborn, this is likely a position you spend quite a bit of time in. When sitting, try to keep a straight vertical line between your ear-shoulder-hip, as shown below. This will alleviate pressure from your back, neck, and shoulders. It also allows you to better access your critical deep core muscles, so it is a great first step to building a stronger core! TIP: If you spend a lot of time in this position feeding your baby, try to set up a supportive chair that allows you to sit in neutral alignment, but still be comfortable.

2. Bending Over

This is another activity you will likely do A LOT of as a new parent. Try to maintain that same ear-shoulder-hip alignment (as you see in the photos with the green check marks below) to protect your low back and abdominal wall.

3. Baby Carrying

Whether you’re carrying your little one in a car seat or baby carrier, do your best to maintain neutral alignment as well.

4. Working Out

It’s also important to focus on neutral alignment when working out, especially if you are lifting a load. Note the common anterior pelvic tilt shown below:

Also, try to avoid the common posterior pelvic tilt. NOTE: These alignment errors are not pregnancy-specific, but the stress to the core is typically greater during pregnancy due to the larger belly.

Of course, it is unrealistic to think that you can (or should) be in neutral alignment all the time. The body needs variety. So, we are searching for a balance between neutral and varied patterns. However, the greater the load that you are lifting, the more important it is for you to be in neutral alignment.

Train Safely and Effectively with our Pre & Postnatal Workout Programs

Now that you’ve learned how to move your body in neutral alignment, practice incorporating it into workouts. If you’re looking for a safe and truly effective workout program tailored to your body’s unique needs, check out our prenatal workout programs or postpartum workout programs delivered on the ProNatal Fitness app.

Are You A Health & Fitness Professional?

Are you interested in training pre & postnatal clients or supporting them better in your current line of work? Explore our ProNatal Professional Education & Certification to find courses, resources, and community to help you build your pre & postnatal fitness expertise.