Pelvic tilt, also called pelvic misalignment, is often caused by a muscle imbalance and can cause lower back and hip pain. Learn the different types of pelvic tilt, what causes it, and how to correct it with physical therapy exercises.
What is Pelvic Tilt?
Your pelvis, or pelvic girdle, is a basin-shaped set of bones that connects your lumbar spine to your legs. It supports your abdominal organs and balances your trunk. Pelvic tilt happens when the positioning of the pelvis is tilted out of the normal alignment. An increased pelvic tilt angle happens with anterior tilting, and a decreased pelvic tilt angle is aligned with posterior tilting.
Anterior, posterior, and lateral pelvic tilts are named for the direction in which the pelvis is abnormally pointed. In the anatomical world, the word “anterior” refers to the front of the body, and “Posterior” refers to the back of the body.
Anterior Pelvic Tilt
Anterior pelvic tilt occurs when the bottom of the pelvic bone tilts back and upward. The flared top part of the pelvis rotates forward, causing an exaggerated curve in the lower back. Someone with anterior pelvic tilt may look like he’s walking with his belly pushed out.
Anterior pelvic tilt involves tightness in the hip flexors and weak abdominal and gluteus muscles, which can happen with excessive sitting and lack of physical activity. It can result in lumbar lordosis, an exaggerated arch in the lumbar spine. Individuals with anterior pelvic tilt tend to have shortened quadricep, erector spinae, and psoas muscles.
Anterior pelvic tilt issues can increase during pregnancy, though some rotation is normal. The pelvis rotates forward to accommodate a growing fetus and facilitate delivery. Normally the pelvis will revert to the standard position about a month after childbirth.
Posterior Pelvic Tilt
With posterior pelvic tilt, the pelvic bone rotates upwards, and the lower part is pulled forward, while the upper part is pulled backward. Someone with posterior pelvic tilt might look like he is standing with his hips thrust forward and spine curled.
Posterior pelvic tilt is often caused by chronic poor posture and excessive sitting. It is associated with tight hamstrings and weak abdominal muscles. It can also be caused by an injury or aging as muscles lose mass and strength.
If you feel like your tailbone is always sticking out or feel pain in your lower back and hips after sitting for long periods of time, you may be experiencing posterior pelvic tilt. It can also put excessive pressure on the lumbar spine.
Lateral Pelvic Tilt
The pelvis is tilted to the left or right side with a lateral pelvic tilt. A sideways pelvic tilt will make one hip look higher than the other and is named for the higher side (for example, a left lateral tilt). The sufferer may feel like one leg is longer than the other, which is sometimes the cause.
Though structural causes may be the culprit, a lateral pelvic tilt is often caused by muscular tightness on one side of the pelvis due to functional changes. The abdominal and back muscles are associated with this issue. A lateral pelvic tilt can cause unilateral muscle imbalances all over the body.
What Causes Pelvic Tilt
Pelvic tilt can be caused by structural issues, functional issues, or a combination of both. It may result from your body’s biomechanics and daily habits, an acute injury, or just from aging.
Structural problems like uneven leg lengths, flat feet, spinal scoliosis, lumbar spinal stenosis, a herniated disc, and sciatica can cause a tilted pelvis. Degenerative spinal changes and muscle deterioration associated with aging are also factors.
A muscle imbalance can also cause pelvic tilt. Weakness on one half of your body counterbalances tightness on the other, making your pelvis tilt in one direction or the other.
Like many functional issues, this muscle imbalance is often a result of inactivity.
Day-to-day habits that are common contributors to pelvic tilt are:
- Excessive sitting
- Incorrect posture
- Slouching or sitting in a hunched position (like when working on a computer)
- Wearing high heels or other improper footwear
- A sedentary lifestyle
Muscles that Affect Pelvic Tilt
Many muscles connect the pelvis to the femur. These muscles stabilize the pelvis and lower back and also enable leg mobility.
These include the hip muscles such as the iliacus, psoas major, rectus femoris, and quadriceps muscles that run along the front of the thigh. When you lift your leg toward your torso or bend at the waist. Tight hip flexor muscles can cause anterior pelvic tilt.
These include the adductor magnus, gluteus maximus in your buttocks, and the hamstring muscles that run along the back of your thighs. When these are tight, it can cause posterior pelvic tilt.
A weak core can result in anterior or posterior pelvic tilt and often factor into back issues. Imbalanced quadratus lumborum muscles in the abdominal wall can cause lateral pelvic tilt. Tight QL can cause anterior pelvic tilt.
Erector Spinae Muscle Group
These muscles on either side of the back enable you to move the vertebral column. An imbalance can cause lateral pelvic tilt.
What are the Symptoms of Pelvic Tilt?
A slightly anterior pelvic tilt is normal. In fact, you could have a tilted pelvis and not even know it. One study found that 85% of males and 75% of females presented with an anterior pelvic tilt with no symptoms. Posterior tilt is less common.
A minor imbalance may be something you can live with. However, if any of the following symptoms are noticed, it could be a sign of an abnormal pelvic tilt:
- Hip pain
- Back pain, especially in the lumbar spine
- Gait or lack of mobility problems
- Leg problems like forced hip and knee rotations
The Thomas Test
You can do the Thomas test at home or with a sports medicine doctor to identify anterior pelvic tilt or tight hip flexors. A modified version can identify posterior pelvic tilt. While these are not definitive tests, they can be the first step toward diagnosis. To perform the Thomas Test:
- Lie flat on a table with your legs hanging over the edge.
- Bring one leg up, holding the knee and bending it until it reaches your chest.
- Repeat with the other leg.
If this body position requires you to lift your resting leg off the table, rotate your hips, or bend your back to lift the leg, this could signal an anterior pelvic tilt. If you see a gap between the table and your thigh, it could indicate posterior pelvic tilt.
How to Naturally Treat Pelvic Tilt
If a pelvic tilt results from functional issues, you can usually fix it with physical therapy and a corrective exercise program to fix the habits that caused the problem.
- Avoid prolonged sitting. When sitting at a desk at work, get up to walk around and stretch every 30 minutes. Underactive muscles can cause pelvic tilt.
- Practice proper posture. Whether sitting, standing or walking, keep your spine straight and your body in alignment.
- Get more exercise. Muscle activity can benefit your entire body and help your range of motion. Practice consistent stretching and strengthening activities daily.
- Chiropractic/Osteopathic adjustment. A chiropractor or DO can help rebalance your body and relieve muscle tension; however, this will not fix a tilted pelvis automatically.
Pelvic tilt can be treated naturally through stretching and strengthening physical therapy exercises. You can perform these pelvic tilt exercises at home or with the assistance of a medical professional. Your physical therapist can recommend the best exercises for your particular type of pelvic tilt, including ones for hip flexibility and leg strength.
Whether it’s for lateral, anterior, or posterior pelvic tilt, focus on strengthening exercises that stabilize the pelvis in proper alignment with attention to the correct form. Improper techniques could aggravate the problem instead of fixing it.
The first step to creating a physical therapy program is identifying what type of pelvic tilt you suffer from.
How to Help Anterior Pelvic Tilt
Anterior pelvic tilt is often associated with tight muscles at the front of your pelvis and weak muscles in the back. To get an anterior pelvic tilt back to a neutral position, work on stretches and exercises that loosen the hip flexors while strengthening the hamstrings, glutes, and abdominal muscles.
These strengthening exercises can also help with low back pain. They include:
- Pelvic tilts
- Hip flexor stretch
- Rear leg raises
- Glute Bridge
- Bird dog stretch
You can also use a quad foam roller or IT band foam roller to perform myofascial release on the tight hip flexor and quad muscles.
How to Help Posterior Pelvic Tilt
A posterior pelvic tilt is the opposite of an anterior pelvic tilt: the muscles in the front are weak while those in the back are tight. So, to correct a posterior pelvic tilt, focus on stretches and exercises that loosen tight glutes, hamstrings, and abs while strengthening weak hip flexors.
These exercises include:
- Leg raises
- Standing hip raises
- Cobra stretches
- Seated or standing hamstring stretches
- Figure 4 stretch
- Abdominal curl-ups
Like the above, tight hip extensor muscles can be loosened through myofascial release.
How to Help Lateral Pelvic Tilt
An exercise program to correct lateral pelvic tilt will focus on strengthening the weaker side of the body while loosening the tighter side to achieve better muscular balance. You should also use massage techniques on muscles like the quadratus lumborum.
Unilateral corrective exercises are imperative for fixing lateral pelvic tilt. These include:
- Reverse leg raises
- Reverse standing leg raises
- Step up/down
- Hip adductors
- Hip hike
- Side planks
- Oblique stretches
- Hamstring stretches
Lateral, anterior, and posterior pelvic tilts can throw off your spinal alignment to cause hip, leg, and lower back pain, as well as affect your posture and gait. But with physical therapy exercises, stretching, and massage, you can usually correct pelvic tilt.
With proactive treatment, you can get your pelvis back into a neutral position in as little as a few weeks, though it will depend on the cause and severity of your condition.