Anterior pelvic tilt. It is often a buzzword tossed around. Fun fact: anterior pelvic tilt is NOT a diagnosis! So if it isn’t a diagnosis, then what exactly is it? And I’m sure you’re thinking, ‘Then why am I always told I need to fix it!?’ Rest assured, I will address all of your questions on this topic here. I want you leaving this page understanding why a forward pelvic tilt, most of the time, isn’t something you should worry about. This post will go over what a pelvic tilt actually is, review the common misconceptions around pelvic tilt, and explain why you probably don’t need to fix your anterior pelvic tilt (or might need to fix it).

**This is not medical advice. Please consult your medical provider for more information.

What is Anterior Pelvic Tilt?

Anterior pelvic tilt refers to the position of the pelvis. There are two bony prominences you need to know about to determine if you have a pelvic tilt. Place your hands on the front of your hips. The bony prominent in the front part of your hip is what is called your anterior superior iliac spine (ASIS). Now wrap your hands around to the back side of your pelvis. There is a bony prominence back there, too, on either side of your tailbone. This is called your posterior superior iliac spine (PSIS). If you turn sideways and draw a line from your ASIS to your PSIS, this imaginary line will show the tilt of your pelvis. If the line is straight, this is a neutral pelvic tilt. A line that tilts down towards the ASIS is an anterior pelvic tilt. A line that tilts down towards the PSIS is a posterior pelvic tilt.

Imagine your pelvis is a bowl full of water. If you hold the bowl in front of you and tilt it forward, water will pour out of the front of the bowl. This is the same orientation as the anterior (forward) pelvic tilt. It is as if you pelvis is rotating forward or anteriorly. Now holding the bowl, you tilt it backwards. Water pours out of the back of the bowl towards you. This is what is referred to as posterior pelvic tilt. Your pelvis is rotating backwards or posteriorly.

Common Misconceptions About Anterior Pelvic Tilt

Numerous misconceptions can cloud our understanding of what anterior pelvic tilt is and our approach to managing or correcting it. Let’s discuss the common misconceptions around this topic.

1. Anterior pelvic tilt is NOT a diagnosis.

Lets repeat this for the people in the back. Anterior pelvic tilt is NOT a diagnosis. It simply refers to the position or alignment that the pelvis is in. Now, when physical therapists talk about a forward pelvic tilt, most of us will be referencing something called lower cross syndrome. It’s a common pattern typically found which works to explain how anterior pelvic tilt comes about. The pelvis tilting forward is produced by the hip flexors becoming tight, as well as overactive lumbar extensors which contribute to more arching in the lumbar spine. On top of that, glutes and hamstrings are typically weak and the abdominal muscles are also weak and/or overly lengthened. This cross pattern theorizes contributing factors to the anterior tipping of the pelvis.

2. Anterior pelvic tilt is bad.

No, this is not bad. In fact, having a slight anterior pelvic tilt is actually a natural and normal posture to be in. In fact, there are some individuals who have more anterior tipping of their pelvis than others and don’t experience any pain or other symptoms. All bodies are different. The position of the pelvis is going to also be somewhat dependent on it’s relation to other body regions. What might be your normal posture may not be the same for someone else.

3. Anterior pelvic tilt is related to my back pain.

The answer you will hear from every physical therapist: It depends. As discussed earlier, lower cross syndrome theorizes how anterior pelvic tilt becomes present. Can tight hip flexors be related to your back pain? Yes. Can you have back pain, tight hip flexors, and not present with an anterior pelvic tilt? Also yes. Can you present with a strong anteriorly tipping pelvis and have absolutely no back pain? Yes.

This study found that low back pain incidence was more related to age as opposed to the position of their pelvis. This cross-sectional case-control study found that there was no positively associated relationship between low back pain and pelvic asymmetry. And this study found that the force production of the abdominal muscles is not associated with lumbar lordosis and pelvic inclination in standing posture.

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4. Anterior pelvic tilt requires a pelvic adjustment or correction.

Having a slight anterior pelvic tilt is a normal and naturally occurring posture for most individuals. As as just previously discussed in the point above, countless studies have found no relationship between pelvic position and low back pain. So, does an anterior pelvic tilt require a pelvic adjustment? The answer is no. Your anterior pelvic tilt has more to do with proprioception and sensorimotor training—more on this later.

Does Addressing My Pelvic Tilt Matter?

The answer to almost everything you ask a physical therapist is, “It depends.” The same goes for whether you should address your anterior pelvic tilt. The answer is it depends.

You will find your true answer based off of your symptoms and presentation. If you do have anterior pelvic tilt, is it directly contributing to issues causing your pain? Only then will you be able to answer this question.

As discussed earlier, having a slight anterior pelvic tilt is normal. If you have no pain and you are not struggling with any activities of daily living, then no, you do not need to address your pelvic tilt. Even if you do have some pain, is it coming from the anterior pelvic tilt, or is it coming from somewhere else? Most likely, the pain is coming from somewhere else.

You may be thinking that a pelvic tilt is the reason for your pain. Looking at lower cross syndrome, it is common to find that the lumbar extensors pull the lower back into a more arched position. Tight hip flexors or weak abs and glutes might also contribute to this. However, poor body awareness or movement patterns are most likely the contributing factor to your pain. If you perform a squat and this causes back pain and you present with an anterior pelvic tilt, your problem is not coming from the anterior pelvic tilt. Your pain is coming from your poor movement patterns. Instead, what you need to work on is your neuromotor control—using the right muscles and not using the wrong ones, which contributes to the poor movement patterns.

What If I Need to Fix My Pelvic Tilt?

Most people who experience low back pain and who present with an anterior pelvic tilt may benefit from hip flexor stretches and core and glute strengthening. But what happens when they go to stand or perform a squat? You’ll typically see the anterior tilt show right back up. Why is this? It’s because you haven’t trained your postural awareness, proprioception, or movement patterns. You can stretch and strengthen all you want, but as soon as your move, your body is going to do exactly what it is used to doing. That means it will hold your pelvis with an anterior tilt because that is what you experience as “normal.”

What you have to do instead is retrain how your body moves. Retrain the body to use certain muscles. Reteach new movement patterns that it isn’t used to. Learn where different parts of your body are in space and become aware of your posture. This is where the true change happens.

When to Seek Professional Help

If you are experiencing back pain, hip pain, or pain elsewhere and aren’t sure what is causing it, starting with a physical therapist could be beneficial. They can evaluate where your pain is coming from. Movement analysis can be very beneficial for determining if what you are dealing with is of musculoskeletal origin. A physical therapist will be able to tell you what is generating the pain and provide a treatment plan. If your pain is something that cannot be addressed through physical therapy, they can also help guide you to what may be your next best step. And if your attempts at exercises and stretches have led to no improvement in your symptoms, we need to figure out what is driving your pain.

If you are not experiencing pain but are concerned with your pelvic tilt, you can still reach out to me for a posture and movement analysis. Seeking help is a proactive step to ensuring your health and questions are addressed.

Other Helpful Articles Related to Posture

• What is the Correct Sitting Posture?
• Understanding the Connection Between Foot Posture and Back Health
• A Complete Guide and Mobility Routine for Desk Workers
• What You Should Know About Tech Neck: Relieve the Pain
• How to Fix Rounded Shoulders

References

James W Youdas, Tom R Garrett, Kathleen S Egan, Terry M Therneau, Lumbar Lordosis and Pelvic Inclination in Adults With Chronic Low Back Pain, Physical Therapy, Volume 80, Issue 3, 1 March 2000, Pages 261–275, https://doi.org/10.1093/ptj/80.3.261

Król A, Polak M, Szczygieł E, Wójcik P, Gleb K. Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2017;30(4):699-705. doi:10.3233/BMR-140177

Levangie, Pamela K. DSc, PT. The Association Between Static Pelvic Asymmetry and Low Back Pain. Spine 24(12):p 1234-1242, June 15, 1999.

TL;DR

Anterior pelvic tilt refers to the forward rotation of the pelvis, a common and natural posture. It’s not a medical diagnosis and doesn’t inherently cause pain or issues. Misconceptions suggest it is harmful or directly linked to back pain. However, many individuals with pelvic tilt experience no discomfort. Addressing it is typically unnecessary unless accompanied by pain or functional limitations. Oftentimes, its association with pain is not due to the pelvic tilt, but instead, from movement faults.