The Anterior Pelvic Tilt: Symptoms, Test and Exercises to Correct Your Posture

The amount of time we spend sitting has increased substantially over the past decade.

The surge in technology we have witnessed in recent times has resulted in us spending much more time sitting in front of our mobiles, TV and computers screens.

The need to move, to stand up and walk, has decreased.

The unfortunate thing is that this has a negative impact on our bodies and particularly for our posture.

When we sit too much our pelvis is held in unnatural and unhealthy positions for much longer than is healthy.

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 low back pain, muscle stiffness, and decreased range of motion.

In this article, we’ll look at one of the most common pelvic imbalances experienced by adults today: the anterior pelvic tilt.

We’ll discuss how an anterior pelvic tilt occurs and what treatment options are available to correct this imbalance.

We’ll also provide you with a few simple exercises that can be performed at home to alleviate an anterior pelvic tilt.


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 (pelvis) tipped forward to one side.

It is this forward tilt of the pelvis that causes other muscle imbalances in the body.

Since the pelvis is tilted forward, this causes the hip flexors to become increasingly short and tight, as the distance between the pelvis and the front of the hips is shortened.

Over time the hip flexors will remain this way and continue to pull the front of the pelvis down.

Since the back of the pelvis is tilted up (higher), the lower back muscles shorten because of the decreased length and become tight. As a result, the lower back will become arched and the butt may start to stick out.

Further ramifications are weak hamstrings, glutes and core muscles.

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

Lower Crossed Syndrome

While more research is needed in order to determine the exact cause of anterior pelvic tilt, scientists believe that this postural problem is exacerbated by a condition known as lower crossed syndrome (there is also a condition known as upper crossed syndrome which affects the upper body).

In order to understand how lower crossed syndrome contributes to anterior pelvic tilt, you’ll need to consider the anatomy of the pelvic region.

The pelvis and hip bones are supported by a number of muscles and ligaments that stabilize the lumbosacral region of the body and allow for a full range of motion of the hip joints.

These muscles and ligaments include:

  • lower abdominals
  • gluteals
  • hamstrings
  • hip flexors
  • thoracolumbar extensors.

Lower crossed syndrome is the result of the weakening and lengthening of the gluteal muscles and lower abdominals, and the simultaneous tightening and shortening of the hip flexors and thoracolumbar extensors.

When viewing the human body from the side, this muscle imbalance creates a cross-crossed pattern, hence the term “lower crossed.”

If left untreated studies show, lower crossed syndrome can lead to postural changes such as hyperlordosis of the lumbar spine, increased flexion of the hips, and an anterior tilt of the pelvis.

While there are several known causes of lower crossed syndrome and the resulting 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.

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?

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).

Anterior Pelvic Tilt vs. Posterior Pelvic Tilt: What’s the Difference?

Anterior pelvic tilt is often confused with another common postural misalignment known as posterior pelvic tilt, or swayback.

It is important to understand the difference between the two muscle imbalances in order to properly diagnose and correct an anterior pelvic tilt.

Posterior pelvic tilt is basically the opposite of anterior pelvic tilt.

Whereas anterior pelvic tilt is characterized by the shortening of the hip flexors and the lengthening of the hip extensors, a posterior pelvic tilt is characterized by the tightening of the hip extensors and the lengthening of the hip flexors.

This results in a backward tilting of the pelvis.

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.


Anterior Pelvic Tilt Treatment Options

Professional treatment of anterior pelvic tilt typically involves chiropractic adjustment, physical therapy, massage, or a combination of all three therapies.

Your doctor will prescribe an individualized treatment plan based on the severity of your condition.

Below, we’ll take a brief look at each of these courses of treatment.

Chiropractic adjustment

Chiropractors use a number of manual techniques to adjust the alignment of the spine, alleviate pain, and restore range of motion to the muscles, ligaments, and joints.

Physical therapy

The goal of physical therapy is to bring better balance to the muscles that support the pelvic region. When treating anterior pelvic tilt, a physical therapist will focus on exercises that strengthen weak, lengthened muscles (such as the gluteals and lower abdominals)while relaxing tight, shortened muscles (such as the hip flexors and thoracolumbar extensors).

Massage

Massage therapists use a variety of manual techniques to treat anterior pelvic tilt, including deep tissue massage and myofascial release.

These techniques not only help relax tight muscles, but they also improve circulation throughout the body, thereby improving muscle performance.


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 while stretching and relaxing the hip flexors, thigh muscles, and lower back muscles has 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 we have to reverse everything that 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 correct 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. By doing so you’ll see increased benefits from your stretching.

Rolling the Hip Flexors

To start, we’ll focus on rolling out the hip flexors which have become short and tight from all that sitting.

It is the tightness in the hip flexors that are pulling the pelvis down causing the anterior pelvic tilt.

To roll our your hip flexors get a foam roller and place it on the ground. Lie on top of it and place it above the 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 Out the Quads

Next, you want to roll our your thigh area.

Again using a foam roller, apply pressure on your thighs whilst on your front. Slowly roll your quads up and down the roller whilst creating motion with your arms.

If you want something more advanced, you can use something smaller than a foam roller such as a small massage ball (softball or lacrosse ball works well).

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 flexors except you want to tilt your body at 45 degrees.

Once you’ve located the TFL slowly roll around this area.


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:

  1. TFL
  2. Rectus Femoris (centre of thigh/quad)
  3. Lats

What’s interesting about this video, is that it includes targeting the lats to target the tightness in the lower back.


2. Stretches to Fix Anterior Pelvic Tilt

After foam rolling and releasing the tight muscles, you can now move onto 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 core squeezed tight which will automatically cause your pelvis to draw into a neutral position.

If you prefer to try another stretch or want a greater variety, see this page on hip flexor stretches.

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.

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 in your lower back as if you were pulling your spine apart at the ends.

We’d also recommend adding some stretch routines from our page on the best stretches for the lower back. If you also have pain as a result of your anterior pelvic tilt, this page will be highly beneficial.

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.


3. Strengthening Exercises

The next section targets strengthening the muscles that are weak.

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.

The core should be counteracting the downwards pull of the hip flexors, but because it’s weak, 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.

For more exercises, see this page on how to strengthen a weak core.


Strengthen the Glutes and Hamstrings

This section targets weak glutes and hamstrings.

Glute Bridge

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 and your legs hop sixth apart. 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.

Donkey Kicks

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.

If you’d like to add additional methods to work solely on your hamstrings, then see this page on further exercises for the hamstrings to add to your routine.

Squats

Performing squats can help strengthen the gluteals, hamstrings, and quadriceps.

Perform this exercise by starting 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; check out this page on how to activate your glutes.


Editor’s Own Experience with an Anterior pelvic tilt

A year ago, the concept of an anterior pelvic tilt was totally unknown to me (however after doing some research it is, in fact, a very common posture disorder). I knew I had bad posture, but I was unaware that there are terms for each type of posture disorder.

I thought each person had their own unique posture types that they were born with, and there was little one could do to change it. The fact that I didn’t know that posture could be corrected, goes to show how clueless I was about how the human body works!

It wasn’t until I started researching and paying more attention to my daily posture that I realised I had an anterior pelvic tilt.

Since I discovered I had an anterior pelvic tilt I have now almost totally fixed it through the usual prescription of exercises that are given such as strengthening the core, increasing glute strength and increasing flexibility in the hips.

There is a lot more to fixing an anterior pelvic tilt than simple undertaking a set of exercises that target these things. For me, the challenge was doing these exercises with correct form and activating the ‘dead’ muscles.

The Glutes

Without correct form and waking up the dead muscles you’re not going to fix your anterior pelvic tilt, in fact, there’s a big chance you’ll only make your anterior pelvic tilt worse.

If the muscles that have gone to sleep continue to not activate then improvements will be minimal.

People with an anterior pelvic tilt will likely have very weak glutes or they may not even be firing at all. When you do any glute exercises such as those mentioned in this article you must get the mind-muscle connection working.

In other words, make sure your glutes are firing.

I’d advise you to read our article on glute amnesia otherwise known as ‘dead-butt syndrome.’

When you begin to start to work your glutes properly, then improvements will follow.

The Core

If you have an anterior pelvic tilt you want to make sure that whenever you are doing core exercises, or any exercises for that matter, that you maintain proper pelvic alignment.

For instance, when I was doing the plank I would arch my lower back and never realise it. In other words, I was maintaining my anterior pelvic tilt (with the lower back curve) during my planks.

What may help is to try to put your pelvis into a posterior pelvic tilt position when you’re in a plank until your anterior pelvic tilt is fixed. By doing so, you’ll begin to activate the areas of the core that weren’t firing before.

Similarly, when doing crunches or lower ab work go for the same posterior pelvic tilt position and take out the arch in your back by pushing your lower back as hard as you can into the ground.


Preventing an Anterior Pelvic Tilt

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.

It’s pretty much known that today’s society is sitting more than any other generation.

Office workers are spending more time at their desks and we’re also spending much more time sat down in front of digital screens watching non-stop entertainment.

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.

Whilst 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. The first time you ever try working standing up, it will feel very strange.

Gradually over time, you get used to it and it will become extremely comfortable to work standing up. You may find that you never want to go back to sitting!

Not only does a standing desk help prevent an anterior pelvic tilt, but may also help with forward head posture and rounded shoulders.

If you’re interested in getting a standing desk, see our post on the best affordable standing desks.

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.

It may not be feasible for you to get a standing desk, perhaps your boss does not allow it, but 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.

By standing up frequently, you are preventing your muscles from becoming too ingrained in their current seated position.

Stand up to go to the bathroom on one 20 minute interval, then the next one that comes around grab yourself a glass of water. 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.

Additionally, consider getting an ergonomic kneeling chair or a lumbar support for your office chair which may promote better lower back posture.

People with an anterior pelvic tilt will usually sit in a posture with their lower back arched and their pelvis tilted forward.

This video shows how you should be sitting if you do have an anterior pelvic tilt.

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.


Conclusion

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 curvature of the lower spine.

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.

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  1. Michelle 29/03/2018
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