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Fact checked by Kirsten Yovino, CPT Brookbush InstituteFACT CHECKED
October 16, 2022
These days, between desk jobs, commutes to work, and a general desire to sit on the couch and binge-watch the latest Netflix drop, most of us find ourselves sitting for a good portion of the day. Unfortunately, sitting for long durations is a leading cause of anterior pelvic tilt, which 85% of men and 75% of women have to some degree1.
While many of us exhibit some form of anterior pelvic tilt, it may be mild enough that it never causes an issue. For some, it's present due to genetics, while for others, like powerlifters, it's the body's way of adapting to lifts. Another less-than-stellar adaptation is when the body sits too much, resulting in muscles that are short and tight.
If not dealt with, this muscle tightness and shortness will only continue to worsen, causing more imbalances and significant pain. If you're dealing with pain due to anterior pelvic tilt, or you don't yet have symptoms but are concerned you have it, it's important to correct the issue as soon as possible.
In this post, we will give you the tools to understand anterior pelvic tilt, how to fix it, and improve your movement, strength, and flexibility.
This article will cover:
The pelvis and pelvic region is a complex of bones that supports the abdominal organs and athletic movements. Imagine the pelvis as a bucket of water. When anterior pelvic tilt occurs the bucket is tipped forward with water spilling out the front. Everyone's genetics are different, but the majority of people have a slight tilt. It becomes an anterior pelvic tilt when it’s more than 5 degrees for men and 10 degrees for women.
The pelvis gets pulled into this position due to an imbalance within the surrounding muscles. It is a combination of some muscles being weak, and consequently, the opposite muscles being tight. Weak abs, including the rectus abdominus, transverse abdominus, internal and external obliques, as well as the glutes, specifically the gluteus maximus, medius, and minimus, often coincide with tight spinal erectors and tight hip flexor muscles.
As the sartorius, iliopsoas, and rectus femoris, which make up the hip flexors, become short and tight, they pull the pelvis forward. The tightened hip flexors will remain tight and continue causing the anterior pelvic tilt until the issue is fixed. Sitting for long periods is the leading cause of short and tight hip flexors. Stretching and strengthening exercises for the hip flexors are essential to help prevent this from occurring.
This tightening is called reciprocal inhibition. This means one side must relax to accommodate the contraction on the opposite side. The same happens when spinal erectors are tight due to weak abdominal muscles. This tug of war pulls the lumbar spine into a curve, causing the abs to bulge forward.
Let's return to our bucket of water reference. With anterior pelvic tilt, the bucket is pulled forward, spilling out of the front. Now with posterior pelvic tilt, the bucket tilts backward, spilling down the back of your pants.
A posterior tilt is also caused by a muscle imbalance and the same reciprocal inhibition effect we discussed above. But in this case, the abs and hamstrings are tight and the low back, deep core muscles, hip flexors, and glutes are weak.
Both require the same techniques to fix, but each tilt requires paying attention to different muscle groups. In addition, both are severely affected by daily poor posture, resting positions, training methods, and lifestyle.
Whether that bucket is spilling water out of the front or the backside, there's one thing for certain: You must fix your muscle imbalances, so your spine and health do not suffer further.
The short answer is no, you cannot have both. Most tilted pelvis cases are going to have the pelvis either pulled forward or backward. However, there is one scenario that semi resembles having both anterior and posterior pelvic tilt.
A lateral pelvic tilt is caused by a neuromuscular pattern, which means you use one side of your body more than the other. For example, this is common for basketball players after spraining an ankle. With lateral pelvic tilt, one side of your body is hiked up higher than the other. This causes a twisting or rotation of the pelvis. So, in theory, it is somewhat like having a posterior pelvic tilt on one side and an anterior pelvic tilt on the other and then adding a twist on top of it.
The difference is that lateral pelvic tilt is not caused directly by a pelvis and muscle tissue. It is often part of something more significant within the body, like the ankle sprain we mentioned. It also can be due to dysfunctional breathing patterns in the diagram.
There are some simple ways to test to see if you have an anterior pelvic tilt. The first is a noticeable low back arch and protruding stomach. Some people will naturally have this anterior pelvic tilt and have no issues, but when it is pronounced, you will notice it immediately.
Another way to check is to find your hip bones in the front of your body and your backside. If you feel that they are uneven and tilted, that’s a telltale sign. Another way similar to that is the belt or waistband test. If you look at your belt or waistband and see that one side is higher than the other, that’s another likely sign that you have an anterior pelvic tilt.
These are all fairly easy and effective ways to tell if an anterior pelvic tilt is present. But, the most telltale indicator will be the Thomas test, a simple physical therapy test to see if your hips are uneven. Here is how you perform it:
Briefly mentioned earlier, the reciprocal inhibition effect is the main culprit for anterior pelvic tilt. When one side of the muscle shortens, the other lengthens. This should happen naturally with no issues. So why does this wreak havoc on the pelvis?
Let's take a look at 3 factors that cause and worsen anterior pelvic tilt.
Posture is the No. 1 cause of muscle imbalances leading to anterior pelvic tilt. In a society that tends to focus on moving less and using technology more, sits for long periods, and embraces minimal daily movement, it's a recipe for anterior pelvic tilt disaster.
We spend most of our day at work, sit in the car on our commutes to and from the office, and then hit the couch to binge-watch Netflix in the evening. Sitting for long periods like this shortens the hip flexors because the glutes are inactive (you may sit on them, but you're not using them!). In fact, they cannot do much for you when you sit on them, so they are essentially turned off.
Now it’s important to mention that muscles cannot turn off like a light switch, so think of it more so as your brain has a more challenging time connecting to them to feel their work. A good way to prevent this from happening is to actively work on your posture. Check out these posture-improving steel mace exercises for some fun posture techniques!
The same happens with the spinal erectors as they work overtime to keep the spine upright, and as a result, the abdominal muscles weaken. All of this will lead to a curve in the lumbar spine, hence, anterior pelvic tilt. As soon as those discs aren’t stacked in the correct position, the house's frame cannot accurately support the load anymore. It may stand for a while, but you know there will be a foundational issue eventually.
As some of your muscles begin to shorten and become inactive, this will further increase and worsen anterior pelvic tilt by changing your movement patterns (typically without you realizing they've been changed).
For example, let's say you've just sat at work all day and then also sat in the car on your hour-long commute home. You hit the gym on your way home (coming off about 10 hours of mostly sitting), and you're ready to get after it. However, your shortened muscles are going to cause a slew of issues as you jump into squats. This is because your hamstrings and glutes may not be firing correctly, and your low back could be overloaded from the imbalances.
All of this leads to potentially injuring your lower back while squatting, in addition to working your glutes far less than they should actually be working. It’s relatively hard for most lifters to properly feel their glutes during a squat. It’s even harder with anterior pelvic tilt.
The same rule applies to lifts that don't even focus on the lower body. In a standing overhead press, a pull-up or pull-down, or even an incline dumbbell bench, the resulting arch in your lower back from APT can make it hard to impossible for maintaining a flat spine during these lifts.
You likely won't catch the problem right away, either. All of the lifts we just mentioned will likely feel correct for a long time, and you'll probably continue seeing results for a while. But as your anterior pelvic tilt worsens and your movements continue to change (incorrectly), injuries will follow.
This brings us back to our house reference from earlier. Over time, you will likely see something in the foundation break down due to too much stress distributed improperly around the body.
As mentioned briefly, the main culprits of anterior pelvic tilt are the muscles that become imbalanced and pull on the hips and spine. The shifted pelvis, tight spinal erectors, weak abdominal muscles, tight hip flexors, and weak glutes and hamstrings all contribute to lordosis.
Lordosis is when those muscles lack the tension to cooperate and keep the spine in its safe and healthy position. The lower lumbar begins to curve, and your body will look like you are pushing your butt and stomach out. This is directly going to lead to lower back pain and create anterior pelvic tilt2.
So again, returning to the foundation of the house reference, when lordosis is present, it will hurt the lower back, as well as the knees and ankles, due to the shifting of the house's foundation.
Besides lower back pain and a general curved look to your body, anterior pelvic tilt will trigger issues throughout the body.
The femur will begin to rotate internally, causing knee valgus. This means the knee is turned away from the body’s midline. Because of this, the tibia will rotate internally. The next stop on the train is the ankle. This will cause the ankle to turn in just like the knee, placing loads of stress on the foot's arch and resulting in flat feet.
Back and hip pain, as well as tightness, maybe your body's first signal that something is going on with the pelvis. And the resulting knee, foot, and ankle problems are going to be much more challenging to deal with. Just remember, when something affects your entire chain in this way, everything must be fixed.
It’s important to note that in the same way the severity of anterior pelvic tilt may be linked to genetics, the time it takes to correct the issue is also connected to genetics. For some people, it may take as little as six weeks3. However. for others, it can take much longer, depending on how severe their case is. This show the importance of correcting the issue as soon as you notice it. The worse it gets, the longer it will take.
Also keep in mind that fixing anterior pelvic tilt does not mean you are trying to move your spine back to a completely vertical position. As mentioned, most people will have a tilt to some degree; it’s about getting it back to a position that doesn’t cause issues for the rest of your body.
Lifters, for example, who follow powerlifting programs may have an APT due to the positioning of their bodies to successfully perform their lifts. If they can move pain-free and aren’t having issues, we can chalk the shifting up to an adaptation to their lifestyle and training methods.
The final verdict is yes, anterior pelvic tilt can be corrected. And remember, the goal isn't to eliminate it entirely but to get it to a place where you are pain-free and can lift correctly.
You can correct anterior pelvic tilt by following proper stretches and exercises. In addition, massage can provide a lot of benefits to the affected muscles.
Let's take a closer look at how to use stretching, exercise, and massage to help anterior pelvic tilt.
Stretching your short and tight muscles, particularly emphasizing the spinal erectors and a good hip flexor stretch, will provide some length and relief to those areas. When stretching, it's important to hold your stretch for at least 30 seconds to give the muscles enough time to lengthen.
But before you dive into stretching constantly, it’s important to remember that the hip flexors may be short because they are tight and need to be stretched, or they may be short in response to having a weak core, which requires them to step in and assist in supporting the spine.
You will need to keep an eye on the results your body is getting or not getting from stretching. If you are not getting any relief, it may be time to ditch some stretching for more strength exercises to fix the imbalances.
This leads us to...
Strengthening your core, glutes, and hamstrings is the most crucial tool for fixing anterior pelvic tilt. This helps strengthens the posterior pelvic tilt enough that it pulls your pelvis in the other direction, back to a normal and safe position.
Strengthening exercises, like the lying pelvic tilt (more on this later), help rebuild your body's foundation. As you progress and move toward strengthening your core and glutes through movement, you will have better intentions toward major compound exercises like squats and deadlifts. For strengthening exercises, think of full-body tension moves like planks or hollow rocks, which will strengthen your core with better movements and spinal rigidity.
Once you strengthen your imbalances and activate inactivated muscles, you should be able to safely perform squats and deadlifts, further strengthening those muscles and feeling their work in the correct positions. This will directly lead to strengthening your spinal alignment lost due to lordosis. The mind-muscle connection is crucial for ensuring your muscles are activated and working as they should.
Using soft tissue treatment to help with tightness in the affected muscles can be helpful. A massage therapist can target the tight hip flexors and spinal erectors to help provide some length and relief. You can also perform massage ball movements and manual therapy exercises.
Massage by itself may not be a fix. You likely will leave feeling better for a few days, but the affected movement patterns that caused the issue in the first place will quickly cause the tightness and pain to return.
However, when massage is used in conjunction with stretching and strengthening, it will help fix your issue in less time.
When correcting anterior pelvic tilt, first start with foundation-building exercises to better understand your pelvis' positioning. Then focus on training the muscles and movements needed to balance and strengthen the weak muscle groups. We recommend beginning with lying pelvic tilts, and slowly progressing your way through this list of exercises.
Lay on the floor with your legs bent, and push your low back into the floor. As you push your spine into the floor, you'll feel your hips rock toward your head. This movement is a starting point for correcting the curve in the spine and helping with a neutral pelvis.
The next progression is performing these tilts from a standing position. It’s the same exercise but will now require some more help from the surrounding muscles to keep a good posture. Think about squeezing your glutes tight to help pull everything back.
A plank is a great core exercise, but it may reinforce bad positioning when done for long periods. This plank is a full-body tension plank that may be tough to do for longer than 10 seconds at first.
Squeeze your hands together while planking on your forearms to create tension in the upper body, and envision pinching a penny between your butt cheeks as you squeeze your glutes. Start with 10 seconds, bumping up your time when that starts to feel easy.
This version of the hip thrust, in which you lie down with knees bent, has been shown to help reduce anterior pelvic tilt as it helps strengthen the glutes, as well as the hamstrings to some extent4. The key is to not have an arch in your spine while performing the exercise.
To perform this move, your shoulders will lay flat on the ground with your feet elevated on a bench or box with a resistance band above your knees.
Getting into some more advanced movement patterns, the hip hinge is used in exercises like the kettlebell swing, Romanian deadlift, and good mornings. These hip hinge exercises are going to strengthen the low back, glutes, and hamstrings together as they work during these bigger compound movements.
Glute ham raises are also an excellent option for building this system of muscles, along with squats and traditional deadlifts. Don’t jump into these too soon. Master the initial exercises first.
An exceptional oblique exercise, the Pallof press is the final step for creating a solid core to protect your spine. These cable or banded exercises will help the body resist motion through anti-extension, flexion, or rotational movements. Rotational, flexion, and extension movements are great, but you must also strengthen the car's brakes. These do that effectively.
Strength exercises, when done correctly, are practical as mobility exercises. The problem is that some of your muscles may be too tight to allow you to get into the positions required. If you only strengthen some of the range of motion, you're still going to run into issues when strength training.
Enter: Static stretching! Stretching the hip flexors, glutes, low back, and hamstrings can help relax these muscles and give you a better chance of strengthening and controlling your entire range of motion when exercising.
Stretches like the couch stretch, knee to chest, warrior pose, and figure four stretch work great to loosen up these aggravated muscle groups. If using all three methods, the correct order of operations would be to release (massage or manual therapy), stretch, and then strengthen. But remember to keep an eye on the progress you're making with stretching. If you aren’t seeing results, you may need to focus more on strength.
Whether you see a massage therapist or are brave enough to sit through the pain of using a lacrosse ball to massage yourself, massage does have its place for helping fix your anterior pelvic tilt woes.
Using a lacrosse ball, Thera Cane, Pso-rite, or anything else you find works, like muscle scraping, can help provide some neurological relief to your tight muscles. This should feel like a knot relaxing a bit. If your muscle is wound up tight, it’s not going to be able to stretch or strengthen effectively.
Keep an eye on this as well, as sometimes poking and prodding your muscles too much can cause them to become painful and irritated. Don’t overdo it.
This will depend entirely on how long you've had your tilt, your genetics, and how effective your training plan is. It can be fixed in as little as six weeks, or if you have an excessive anterior pelvic tilt, it could take months if your body has twisted its way deep into its imbalances.
The key takeaway is that an anterior tilt can be fixed, and you now understand the tools needed for the job. Focus on improving movement patterns, and you will be well on your way to relief.
It's important to note that you are not adding an “anterior pelvic tilt day” to your workout split. Instead, focus on how to address anterior pelvic tilt by adding something in each day to help correct the issue.
Focus on your posture every single day. Take note of how you are sitting and moving throughout the day. Make conscious adjustments. These small shifts will add up over time and may be just, if not more, important than any of the other steps.
On your leg workout days, focus on preparing your body to go through your lifts. Use trigger points, stretch if you're feeling extra tight (but don’t overdo it before a workout as it relaxes the muscles), and use your postural strengthening movements correctly. A glute bridge and an RKC plank before your squat will help a ton.
Finally, focus on maintaining the correct posture during your movements. You are on the right track if you know what muscles you are working and what you need to keep your body from doing.
If you can implement all of the tips above, you will be successful at helping fix your anterior pelvic tilt. You should now understand what anterior pelvic tilt is, the muscles that are affected, how it affects your entire structure, and what to do about it.
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