Written by Travis Halena | ACSM CPT
Fact checked by Kirsten Yovino, CPT Brookbush Institute
FACT CHECKED
Hip tilt, a medical term that refers to the hips tiling backward or forward, is a problem that affects a considerable portion of the population. In fact, you may have a posterior pelvic tilt, which is when your pelvis tilts backward, and not even realize it.
Posterior pelvic tilt can affect everything from your muscles to your posture and flexibility, as well as your ability to properly perform exercises. Correcting a posterior pelvic tilt requires the use of stretching, strengthening, and massage, but the good news is it is fixable.
We're going to teach you everything you need to know to identify and treat posterior pelvic tilt.
This article will discuss:
- What is a posterior pelvic tilt?
- What is the difference between posterior and anterior pelvic tilt?
- Signs and causes of posterior pelvic tilt
- How to fix posterior pelvic tilt
- Best posterior pelvic tilt exercises, stretches, and massage techniques
- How long does posterior pelvic tilt take to fix?
What is a Posterior Pelvic Tilt?
Sitting and technology use are prevalent issues these days. Our glutes are inactive from sitting all day, and our thumbs are overly strong from typing on computers and phones. Meanwhile, the outsides of our hands and wrists are weak, and our shoulders are internally rotated and slouched from sitting on the computer. All of these upper body postural issues and movement patterns lead to imbalances that manifest as pain in the body.
With a posterior pelvic tilt, the hips are tucked up and in. To put it into perspective, if your pelvis was a bucket of water, the water would splash out of the backside due to hip placement, the result of shortened or weak hip flexors (make sure hip flexor strengthening exercises are part of your routine!), weak glutes, low back muscles, and tight abdominal muscles.
This causes the lumbar spine to pull into lumbar lordosis, which is when your lumbar spine curves inward1. This further puts your body at risk for structural imbalances and possible injuries.
To summarize, posterior pelvic tilt is when your pelvis tilts backward instead of remaining in its neutral position. Muscle imbalances, daily postures, movements, and anatomical genetics play a role in why this happens.
What is the difference between posterior and anterior pelvic tilt?
Both hip tilts come from the same area, the pelvis, but cause problems in opposite manners. An anterior tilt results in the pelvis being pulled forward, and a posterior tilt is when the pelvis is pulled backward. These both result in some muscles being tight and shortened and some muscles being weak.
A posterior pelvic tilt results from imbalances in the core and legs. This pulls the pelvis backward. The hamstrings, glutes, and abdominal muscles are tight, while the quadriceps, psoas, and low back muscles are weak. (Don't forget those psoas exercises!)
An anterior pelvic tilt is a result of the same imbalances. The difference with anterior pelvic tilt, however, is that the tight muscles are the hip flexors and the erector spinae. The weak muscles are the glutes, abdominal muscles, and hamstrings.
Both hip tilts result from poor daily posture, genetics, training methods, and lifestyle.
How can you tell if you have posterior pelvic tilt?
There are some simple tests to tell whether you have posterior pelvic tilt, including the eye test. If you look in the mirror and it appears as though your butt is tucked up and in, your low back is flat while your upper back and head are rounded forward (we love steel mace exercises for posture improvements!), it's likely you have a posterior pelvic tilt.
The hip test is another technique you can use. Find your anterior hip bones in the front and the posterior hip bones in the backside, feeling if the pelvis is tucked forward or backward. If you can see that it is tipped forward or back, in the case of posterior tilt it will be backward, you have a hip tilt. The same goes when looking at the waistband of your pants or belt.
The most efficient way to actually test it is the Thomas test. Here is how to perform it:
- Lay flat on your back on a table
- Grab both knees and bring them into your chest while keeping everything in contact with the table
- Let go of one side and extend at the hip until your thigh touches the table.
- If your thigh touches the table while your knee is bent and nothing rotates outwards or inwards, you don’t have a posterior pelvic tilt.
What Causes a Posterior Pelvic Tilt?
There are three main causes of posterior pelvic tilt. Two are fixable, while the other is out of your control.
1. Chronic poor posture:
Posture is often the result of how you sit and stand throughout the day. Slouching and poor posture reinforces poor body biomechanics, and the more we practice slouched, slumped-over positions, the more likely our body is to return to this form.
This means your body shifts due to imbalances and time spent hunched over at a desk. Over time, this pulls your pelvis into a tilt. These postural changes carry through to our exercise. Squats and deadlifts are great for strengthening the exact muscles responsible for posterior pelvic tilt.
But if your body has poor movement patterns, you may have trouble activating the major lower body muscles needed to correct posterior pelvic tilt, particularly the glutes. This will lead to eventual injury.
2. Muscle imbalances:
Tightness in the glutes, hamstrings, and abdominal muscles pulls the pelvis into posterior rotation. The muscles that must be strong to move your pelvis into the correct position, which includes the quads, hip flexors, and low back, are too weak to do so.
Poor posture makes a muscle imbalance even worse. The worse your posture and imbalances, the poorer your ability to effectively move. And so the cycle continues.
3. Genetics:
Almost everyone's hip will have a tilt, but some will have more of a tilt than others based on genetics. You could even have a slight tilt with no pain or issues, although this is rare.
You could have a slight tilt that's easily corrected or an extreme one that takes longer to fix. This is, unfortunately, sometimes simply the luck of the genes draw and what your body type is like. It doesn’t mean you are doomed. It just means you may have more work to do.
What problems can posterior pelvic tilt cause?
One of the more visible problems with posterior pelvic tilt is how much your upper back changes to try to compensate for your compromised spine and abdominal position. As your back flattens, it puts your lumbar spine in a dangerous position, making it tougher to absorb the shock of outside forces on the body. This can also lead to sciatica, which can be quite painful.
Someone with an extreme posterior pelvic tilt may have an extremely rounded upper back, causing their head and neck to stick forward. They'll have weak glutes, with hips that are tucked up and in. The spine is unevenly loaded as a result, which can lead to herniation.
Another common problem it can cause is a butt wink at the bottom of a squat, a result of a flattened back and spine. At the bottom of the squat, it will look like someone bounces or springboards a bit off the bottom of the rep as their hips tilt back and their low back arches to begin the movement's ascent. This can be quite dangerous for the low back.
Can you fix posterior pelvic tilt?
Any hip tilt can be corrected. Some people may be lucky enough to fix it in a few weeks, while it may take others months. And an unfortunate group of posterior pelvic tilters may spend much longer resolving the issue due to genetics or a significantly worse imbalance.
Concentrate on better posture and fix muscle imbalances through stretching and hip mobility exercises, strengthening, and even massage. These concepts will help your tight muscles lengthen and loosen while becoming stronger, and your body will start to remember the correct way to hold the pelvis, helping it move back into the right position.
If you think of correcting posterior pelvic tilt as fixing multiple movement patterns, you will have much more success correcting the issue because you'll realize several things, and not just one particular, need to be changed.
The easiest way to start correcting posterior pelvic tilt? Move more and sit less.
How to fix posterior pelvic tilt
Repeat after us: strengthen, stretch, massage, repeat. These are the 3 things you'll want to continue doing to help fix your posterior pelvic tilt.
Here's a closer look at each.
1. Strengthening exercises:
Strengthening exercises will focus on activating your weak quads, hip flexors, and low back muscles. Lunges, supermans, bird dogs, glute ham raises, and banded psoas marches (standing, plank position, and on your back) will all help strengthen these areas.
Lunges will target the glutes and quads. Supermans and bird dogs will hit the low back muscles. The glute ham raise will strengthen the low back, glutes, and hamstrings together. Finally, psoas marches will strengthen your hip flexors in three positions to help bulletproof your body.
2. Stretching:
Since the hamstrings, glutes, and abdominal muscles are short and tight, they will need to be stretched to provide some length and relief. Standing or seated hamstring stretches can help relax the muscle, but be sure to keep an eye on if it’s actually improving. Sometimes hamstrings can be tight due to weakness, so if you constantly stretch them without improvement, focus more on strength through hamstring exercises instead.
The seated figure four stretch, the world's greatest glute stretch, can help loosen tight glute muscles. This will allow them to be strengthened correctly during movements like lunges and squats. Cobra pose or the doorway stretch will immediately help stretch out tight abdominal muscles.
Like the hamstrings, it’s crucial to keep an eye on if you see any improvement with excessive stretching. If things do not seem to improve, try more core stability exercises for the abs, like RKC planks, pull-throughs, and banded hip thrust variations to strengthen the glutes.
When stretching, it's important to hold the stretch for at least 30 seconds, ideally repeating each one 2-3 times. This gives the muscles enough time to lengthen.
3. Massage therapy:
You can see a massage therapist, and they can target the tight areas we've discussed. This can be highly effective and helpful, but there are two things to keep in mind. One, it can be expensive to get massages every week.
Two, all the massages in the world won't amount to much if you are getting them but not also implementing stretching and strengthening. You may feel good and open up for a couple of days, but if your movement patterns don't change, neither will your posterior pelvic tilt.
If you cannot see a massage therapist frequently, you’re still in luck. Manual therapy using trigger points is something you can do before every gym session.
Say your glutes are feeling extra tight before a workout. You can sit on a lacrosse ball in a figure four stretch, fight that extra tight knot, and work it out yourself. Yes, this will be a bit painful, but once you get it to release, it’s more than worth it. Foam roller exercises can also be helpful for this.
If something is really tight, first release it with massage or trigger points, then stretch the muscle if you feel it needs it (and you are seeing improvements through doing this). Finally, strengthen it once it’s freed up so you can move through a full range of motion.
Best Exercises for Posterior Pelvic Tilt
Ready to correct posterior pelvic tilt? These strengthening exercises are essential for fixing the issue. Add them to your leg workout for best results.
1. Lunges:
Any lunge variation, from a forward lunge to a lateral lunge, will strengthen the glutes, quadriceps, and to a smaller extent, the hamstrings, which are responsible for half of the imbalance causing posterior pelvic tilt.
When performing lunges, keep an eye on controlling the movement and your range of motion. If you feel limited by an extra tight area, you may need extra massage and stretching time to open it up.
Keep in mind if you are moving through part of your range of motion that is weak, it may also present itself as pain. This doesn’t always mean something is tight. It means your brain is trying to protect you from a weak area. If the pain isn't due to tightness, it may be an indication that you need to strengthen it.
2. Glute Bridges:
The glute bridge is another fantastic exercise for strengthening the glutes. Remember that the glutes can also appear tight because they are weak. You could even make this exercise more challenging by turning it into a single-leg bridge.
Raise the left leg straight in the air, performing a glute bridge with your right leg. Complete your reps and switch legs.
3. Glute ham raises:
Glute ham raises (or glute ham raise alternatives) strengthen the entire posterior chain as these muscles work together to perform the exercise. The low back, glutes, and hamstrings all function during this movement, making it a vital addition to your rehab program. Your gluteal muscles will love this move!
4. Dead bugs:
The dead bug is a core exercise that focuses on strengthening the deep core muscles of the abs and lower back. These muscles are all responsible for connecting your upper and lower body movements.
If they are strong and working correctly, your spine and pelvis are in a good position. It also is going to be a great move for your hip flexors.
To do this, start with your knees bent and your arms extended straight up. Depending on your strength, you can keep your arms still while you alternate lowering and straightening each leg. Or, you can simultaneously lower one leg and the opposite arm behind you.
5. Leg raises:
The leg raise is another core exercise that will help strengthen your abdominal muscles and the quads. Yes, it’s mainly an ab exercise, but when you focus on contracting the quads to maintain a good position, they work together with the abs.
6. Compound lifts:
It's important to first focus on the exercises listed before this one, so you understand how your posture and movements work.
Once you've mastered those, it’s time to add significant strength-building compound movements like the squat and deadlift. These are the moves that will build strong leg muscles.
Best Stretches for Posterior Pelvic Tilting
Find your zen while fixing posterior pelvic tilt with these 4 great stretches.
1. Cobra pose:
The cobra pose stretches out the tight abdominal muscles and is great for relieving lower back pain. It’s essential to relieve these muscles and give them the ability to lengthen, since they have been stuck in a shortened position for quite some time.
If your abs are constantly tight, then the low back will not be able to move forward and out of its lordosis position.
2. Superman stretch:
Another stretch that is great for targeting and relieving the low back, glutes, hamstrings, and abs is the superman stretch.
To perform this stretch, lay on your stomach with your arms extended in front of you and your legs extended behind you. Lift them off the ground, as high as you can, hold for a few seconds, and slowly lower down.
3. Seated hamstring stretch:
Tight hamstrings can lead to pulling the pelvis down and into a posterior pelvic tilt. Make sure to stretch your hamstrings to allow them to lengthen. Doing so will prevent them from pulling so hard on the pelvis.
To do this, sit on the ground with your legs straight in front of you. This is the starting position. Keep your back straight. Reach toward your ankles, grabbing behind your feet if possible. You should feel this stretch run through the back of your hamstrings.
4. Pigeon stretch:
This will work wonders for opening up your glutes and the outer part of the hip. Stretching these muscles will help make it easier to maintain a neutral pelvic position. Extend one straight leg behind you, with the other bent in front, keeping your hips forward.
Posterior Pelvic Tilt Massage
Three great massage techniques include seeing a massage therapist, using foam rolling, or manually releasing trigger points through a lacrosse ball or Thera cane.
- Massage therapist: If you can see a massage therapist even a few times, it can definitely help with the tight areas. The hip flexors are notorious for being more difficult to release by stretching or trigger points, so a massage therapist can be a huge help.
- Foam rolling: This is something you can do on your own before every workout. Using a foam roller, you can hit all the tight muscle groups and help warm up for your workout. Proceed with caution if you have never used it before, as it may be a bit painful, but it will get better each time.
- Lacrosse ball or TheraCane: Massage ball movements are great for manually releasing your trigger points. Remember, release first, then stretch, then strengthen.
How long does posterior pelvic tilt take to fix?
The realistic answer is that it depends. It depends on how extreme your posterior pelvic tilt is. It also depends on your understanding of your movements and posture. You will progress more quickly if you have more knowledge and experience in biomechanics and movement. If you are brand new and struggling with how to get started, you may want to hire a trainer to help.
What’s important to reiterate is that posterior pelvic tilt can definitely be fixed. It could be corrected in as little as a few weeks or, in more severe cases, months. The sooner you start implementing stretching, strengthening, and massage, the faster you can correct your tilt.
How often should you do Posterior pelvic tilt exercises, stretches, and massage therapy?
You need to remember that you are not adding a “pelvic tilt day” to your routine. This isn’t like you have been neglecting chest exercises and need to add a chest day to your workout split. Instead, approach this as including a posterior pelvic tilt strategy in your routine every day.
Each day, take note of your posture and correct it whenever you slouch or find yourself hunching over. Releasing and stretching an extra-tight area before any workout is helpful. Remember not to over-stretch, as you don’t want the muscles to be too relaxed before strengthening them.
Each workout can also take the same approach. Focus on your posture during each movement. Small strengthening or activation exercises before big ones can be beneficial. Dead bugs and bird dogs can be used as a warm-up, hip thrusts before a squat, banded external rotation before your pulling exercises, and so on.
The key is to tie it all together. You should now understand what posterior tilt is, how to identify and fix muscle imbalances, and how to implement strategies to correct it.
And remember the best way to correct it: Move more, and slouch less!
Related: What is Anterior Pelvic Tilt & How Do You Fix It?
References:
- “Posterior Pelvic Tilt - an Overview | ScienceDirect Topics.” Sciencedirect.com, 2019, www.sciencedirect.com/topics/nursing-and-health-professions/posterior-pelvic-tilt.
Travis Halena
Author