The anterior pelvic tilt is becoming more and more well known in modern times and not in a good way.
The amount of time we spend sitting down in front of our screens has increased substantially over the past decade and we are no longer as active as we used to be.
For this reason, many of us have developed an unnatural tilt of the pelvis which can make us look like we have a belly when we don’t, and even worse it is a common source of lower back pain.
As the primary attachment point for the thigh, back, and abdominal muscles, the pelvis plays a crucial role in how well you are able to sit, walk, run, and bend.
When this important structure is thrown out of balance, a number of postural problems can occur, leading to back pain, muscle stiffness, and decreased range of motion.
The good news is an anterior pelvic tilt can be fixed through corrective exercises and stretches which we will cover in this post.
We’ll also discuss how an anterior pelvic tilt occurs and what treatment options are available to correct this imbalance.
Let’s get started!
What is an Anterior Pelvic Tilt?
Anterior pelvic tilt, or APT, is a common postural misalignment characterised by a forward rotation of the pelvis.
In other words, the front of your pelvis will be tilted forward (which is what anterior means) and downwards.
If you were to look at yourself from the side, having an anterior pelvic tilt means that the front of your pelvis will be lower than the back (the opposite being a posterior pelvic tilt).
Imagine that a see-saw represents your pelvis.
If you imagine looking at a see-saw from the side, someone with normal posture will have the see-saw balanced in the middle, however, someone with an anterior pelvic tilt will have the see-saw tipped down at the front.
It is this forward tilt of the pelvis that causes other muscle imbalances in the body.
While there are several known causes of an anterior tilt of the pelvis – such as injury to or overuse of the hamstrings, gluteals, hip flexors, and hip extensors – the most likely culprit is a sedentary lifestyle and too much sitting.
Sitting for prolonged periods of time without proper lumbar support causes the hip flexors to tighten and shorten, thereby drawing the pelvis forward.
At the same time, the hamstrings, gluteals and core muscles lengthen and weaken, further contributing to an exaggerated curvature of the lumbar spine.
Here’s a summary of the muscular imbalances of an anterior pelvic tilt:
- Tight hip flexors
- Tight quads/thighs
- Tight lower back
- Weak glutes
- Weak hamstrings
- Weak core
It is important to note that some degree of anterior pelvic tilt is normal; in fact, research indicates that as many as 75 to 85 per cent of adults exhibit an anterior pelvic tilt with no noticeable symptoms.
Severe and longstanding cases of anterior pelvic tilt, however, are associated with a number of symptoms, which we’ll discuss in further detail in the next section.
What Are The Symptoms of anterior pelvic tilt?
Aside from the muscular imbalances described above, there can be other symptoms associated with an anterior pelvic tilt.
Most people with mild to moderate pelvic anterior tilt will not notice any pain, discomfort, or decreased range of motion.
If left untreated, however, severe cases of anterior pelvic tilt can increase the amount of pressure placed on the vertebrae of the lower spine, leading to symptoms such as:
- Low back pain – Anterior pelvic tilt causes the hip or iliac bones to rotate forward. This can lead to low back pain due to excessive lordosis (inward curving) of the lumbar region.
- Groin pain – The forward flexed angle that is characteristic of anterior pelvic tilt places excess pressure on the anterior hip structures, resulting in groin pain.
- Muscle stiffness – Anterior pelvic tilt is associated with a tightening of the pelvic and thigh muscles – specifically the hip flexors and quadriceps. Tightness of the lower back muscles is also often seen in individuals with anterior pelvic tilt.
- Femoroacetabular impingement (FAI) – Anterior pelvic tilt may cause the femoral head to rub abnormally against the acetabular socket. This occurrence, known as Femoroacetabular impingement (FAI), may be a contributing factor in the development of osteoarthritis of the hip as studies show.
- Postural changes – Anterior pelvic tilt can lead to structural changes in the lower back region which, in turn, increases one’s risk of developing knee pain, lower back pain, disc degeneration due to excess pressure on the L4 to L5 segment of the lumbar spine (1).
How to Test for an Anterior Pelvic Tilt
One way to determine whether you have anterior pelvic tilt is to perform what is known as the Thomas test, a method of diagnosis named after British orthopaedic surgeon Hugh Owen Thomas.
This test is used to rule out conditions that are frequently misidentified as anterior pelvic tilt, such as hip flexion contracture and psoas syndrome.
To perform the Thomas test:
- Lay down on a table with your legs hanging over the edge of the table at the knee.
- Next, bend the knee of one leg and pull it in toward your chest, using both arms to keep your leg in place.
- If the back of your resting leg lifts off of the table as you perform this movement, you have an anterior pelvic tilt.
For an alternative way of testing for an anterior pelvic tilt, see the video above.
Corrective Exercises to Fix an Anterior Pelvic Tilt
Most of the time an anterior pelvic tilt can be fixed without seeking professional treatment through corrective exercises you can perform at home.
Performing exercises at home that are geared toward strengthening the core, gluteal, and hamstring muscles.
Stretching and relaxing the hip flexors, thigh muscles, and lower back muscles have been found to help return the pelvis to a neutral position, thereby reducing low back pain and preventing further distortion of the lower spine.
Steps to Fix an anterior pelvic tilt
To correct an anterior pelvic tilt you need to reverse all the muscle imbalances it has caused.
Here’s a quick summary of what you will need to do in no particular order.
- Release and stretch the tight hip flexors
- Release and stretch the quads/thighs
- Stretch the lower back
- Strengthen the glutes
- Strengthen the hamstrings
- Strengthen the core
Undergoing corrective exercises and stretching of the muscles above should help reverse an anterior pelvic tilt, however, you want to pay particular attention to strengthening the core and glutes, as well as stretching tight hip flexors.
Below, we’ll look at a few simple exercises that can be done at home to fix anterior pelvic tilt before considering more invasive treatment options, such as painkillers or surgery.
1. Releasing (self-massage) the Tight Muscles
Before you start stretching anything, you may want to first work on doing some myofascial release which we will cover in this section.
By doing so you’ll see increased benefits from your stretching.
Foam Rolling the Hip Flexors
The first step is to foam roll or massage the hip flexors which have become short and tight from all that sitting.
It is this tightness in the hip flexors that are pulling the pelvis down causing the anterior pelvic tilt.
To foam roll your hip flexors:
- Place the foam roller on the ground and lie on top of it
- Place the foam roller above your quad.
- Roll around this small area, placing pressure on the roller.
- You can also rotate your body gently from side to side to roll them out further.
Foam Roll the Quads
Next, you want to roll out your thigh area.
Again using a foam roller:
- Apply pressure on your thighs using the foam roller.
- Slowly roll your quads up and down the roller whilst creating motion with your arms.
- Switch sides
Roll out the TFL
To loosen the hips further you’ll want to roll out your Tensor Fascia Lata (TFL) which is a hip flexor muscle.
It’s much like rolling out your hip flexor muscles except you want to tilt your body at 45 degrees.
Once you’ve located the TFL slowly roll around this area.
Foam Rollers and Massage Tools
You may likely find that you need something more penetrative than a regular foam roller as it doesn’t dig deep enough into the hip flexor muscles.
You can either get a more advanced foam roller with ridges or use something smaller like a massage ball.
Related: Best foam rollers
Related: Best massage balls
All-in-one Anterior Pelvic Tilt Foam Rolling Routine
Alternatively, you can try the foam rolling routine from the video above. It covers how to foam roll the following muscles:
- Rectus Femoris (centre of thigh/quad)
This video also targets the lat muscles to target tightness in the lower back.
2. Stretches to Fix Anterior Pelvic Tilt
After foam rolling and releasing the tight muscles, you can now move on to stretching them.
Hip Flexor Stretch
The stretch shown in the video above is the main stretch you will want to try to address the problem of an anterior pelvic tilt.
Whilst doing the above stretch, make sure to keep your glutes and abdominal muscles are squeezed tight which will automatically cause your pelvis to draw into a neutral position.
Related: How to stretch the hip flexor
Stretch Out the Lower Back
In addition to focusing on lengthening your spine throughout the day, you should add some lower back stretches to your daily routine which will not only help put your pelvis into a neutral position, but will also help with back pain.
There aren’t too many stretches that work on the lower back, however, a simple ‘child’s pose’ can do the trick (shown in the video above).
Take care to not arch your lower back but instead focus on creating length as if you were pulling your spine apart at the ends.
By stretching out the lower back you can begin to lengthen the short and tight lower back muscles which contribute to an anterior pelvic tilt.
Related: Best stretches for your lower back
3. Strengthening Exercises
The next section targets strengthening the muscles that are weak and need to be strengthened to pull your pelvis into a neutral position.
Strengthen the Core: Planks
The plank exercise is the number one exercise to tackle an anterior pelvic tilt.
Someone with an anterior pelvic tilt will usually have a weak core and abdominal muscles.
The core should be counteracting the downwards pull of the hip flexors on the pelvis, but because it’s weak in someone with an anterior pelvic tilt, it allows the front pelvis to be pulled down.
Holding yourself in a plank position is the number one way to strengthen your core.
For an anterior pelvic tilt sufferer, you may even want to hold your plank with a slight posterior pelvic (pull the pelvis towards the elbows) tilt to dramatically strengthen the core.
Strengthen the Core: Pelvic tilt
It may sound counterintuitive to perform pelvic tilts in order to correct an anterior pelvic tilt, but this exercise has been found to be effective in strengthening the abdominal muscles while relaxing tight lower back muscles.
To perform a pelvic tilt:
- Lie down on your back with your feet flat on the floor and your legs bent.
- Tighten your abdominal muscles and pull your navel in toward your spine.
- This should cause your pelvis to raise up toward the ceiling.
- Next, tighten your hip and gluteal muscles, and tilt your pelvis forward.
- Hold this position for 3 to 5 seconds before returning to a neutral position. Repeat this exercise 5 to 15 times.
Strengthen the Glutes and Hamstrings
This section targets weak glutes and hamstrings.
There are many ways you can strengthen the glutes and hamstrings, and really any exercise is fine however the ‘Glute Bridge’ strengthens the hamstrings and the glutes at the same time.
To perform this exercise:
- Begin by laying on your back with your feet flat on the floor. Your arms should be at your sides, with your palms facing downward.
- Next, lift your pelvis until your upper body forms a straight line, making sure to keep your feet flat on the floor.
- Hold this position for 2 to 3 seconds, then slowly lower your hips to the floor. Repeat this exercise 8 to 12 times.
- Make sure to push your heels into the ground for better glute activation
Any exercise which helps increase strength in either the glute or the hamstrings should help with fixing your anterior pelvic tilt.
Donkey kicks also work well for strengthening the glutes and lengthening the hip flexors.
Performing squats can help strengthen the gluteals, hamstrings, and quadriceps.
To perform a squat:
- Start in a standing position with your feet shoulder-width apart.
- Next, bend your knees and lower your body as though you are going to sit in a chair.
- Be sure to keep your abdominal muscles contracted and your thighs parallel to the floor.
- Your back should be neutral, and your knees should not extend farther than your toes.
- Tighten your gluteal muscles while pushing back up to a standing position. Repeat this exercise 10 to 15 times.
You should also be aware that people with an anterior pelvic tilt may find it hard to switch on and activate their glutes.
If you are someone who does a lot of sitting, it is not uncommon for your glute muscles to no longer ‘fire’ when they should, but rather they take a back seat as other muscles take over the slack.
There is also the possibility of developing a glute imbalance where one glute muscle switches off whilst the other one continues to work as normal.
If you have an anterior pelvic tilt, it’s important to make sure that BOTH your glutes are firing properly as this could prevent you from fixing your anterior pelvic tilt.
Related: How to fix glute amnesia
How to Fix Anterior Pelvic Tilt: Prevention & Tips
The most obvious way to correct your anterior pelvic tilt is to identify the root cause and eliminate it.
If you don’t attack the issue that is causing it in the first place, all the stretches and exercises listed here will have little effect.
As you have seen the main issue is too much sitting and not being active enough.
If you have an anterior pelvic tilt and want to fix it, then you’re going to have to try and spend less time sitting.
Here are some quick hacks to get you standing more:
Get a Standing Desk
If you are someone who works at a desk all day, you can try to purchase a standing desk.
You can get some desks that electronically raise and lower depending on whether you want to be seated or standing.
While you don’t have to be standing all day to combat an anterior pelvic tilt, you can spend some moments of your day working on your feet.
Related: Best standing desks
Get a Back Stretching Device
There aren’t a whole lot of stretches for the lower back but one trick that may help is to get a back stretcher.
These devices can help in creating length in your back to help with the over-exaggerated arch.
Combining a back stretcher with daily back stretching may help fix your anterior pelvic tilt more quickly.
Related: Best back stretchers
Avoid Sitting for Long Periods of Time
If you have a desk job that requires you to be seated for most of the day, be sure to take frequent breaks to walk around and stretch.
You can counteract the muscle imbalances that develop from too much sitting by simply standing up at set intervals.
A good mark would be every 20 minutes or so.
Stand up to go to the bathroom at one 20 minute interval, then grab yourself a glass of water on the next and so on.
Switch things up and get creative!
If You Must Sit…
… then learn to sit properly.
If necessary, adjust the height of your work surface or office chair so that your computer screen, laptop, or tablet is at eye level.
People with an anterior pelvic tilt will usually sit in a posture with their lower back arched and their pelvis tilted forward.
The trick to find the correct sitting position is to squeeze your glutes and tense up your core.
What you’ll find is that your pelvis will move out of the forward tilt and into a neutral position.
How to Sleep with an Anterior Pelvic Tilt
As well as with sitting, there is a hack to help your anterior pelvic tilt whilst sleeping.
The trick is to place a pillow underneath your knees, which takes out the arch in your back.
For the science of why this works, watch the video above.
When addressed early, an anterior pelvic tilt is an entirely manageable condition.
The exercises included in this article should help you return the pelvis to a healthy position and relieve the low back pain associated with an exaggerated curve of the lower back (hyperlordosis).
Related: How to fix Hyperlordosis
However, keep in mind that it can take a lot of time and effort before your pelvis returns to a more neutral position.
This is not an issue that will be fixed the very next day.
As well as trying out these exercises and sitting less, you should also try to maintain a healthy weight and becoming more active.
Research suggests that a high body mass index (BMI) can increase an individual’s risk of developing anterior pelvic tilt.
It is thought that anterior pelvic tilt in obese individuals may be caused by an alteration of body composition due to an increased amount of abdominal fat.
Keep in mind that the information presented in this article is not intended to replace the advice of a medical professional.
If you’re experiencing chronic and severe pain due to misalignment of the pelvis, it’s a good idea to consult with your doctor to rule out an underlying issue.