Anterior Pelvic Tilt: Symptoms, Anatomy, Causes, and How to Fix It

What is Anterior Pelvic Tilt?

Anterior pelvic tilt is a common postural deviation where the front of the pelvis lowers, and the back of the pelvis rises. (Think of what happens when you stick your belly out in front and bottom out in the back.) Tight hip flexors and weak glutes or abdominals typically cause an anterior pelvic tilt and an exaggerated lower back curve. Additionally, other posture deviations and muscle imbalances can cause or be caused by anterior pelvic tilt.

anterior pelvic tilt posture image

Synonymous Posture Terms

  • Anterior tilt
  • APT
  • Forward pelvic tilt
  • Lower crossed syndrome

The Anatomy and Biomechanics of Anterior Pelvic Tilt

anterior pelvic tilt from tight hip flexors

With tight hip flexors, anterior pelvic tilt can be a compensation pattern to mimic true hip joint extension. It's better to fix the body going into the exercise versus trying to fix it during a demanding exercise, where injury can occur.

Skeletal and Muscular Structures

The dynamics of anterior pelvic tilt revolve around our skeleton's hip, pelvic, and lumbar region. The lumbar spine, pelvis (hip bones), sacrum, and coccyx undergo an increase in the anterior tilt angle in this condition, observable in the sagittal plane of motion (or side views). Specific local muscle groups primarily influence this shift in skeletal orientation, though APT also occurs as compensation for, or in combination with, other postural deviations.

Overactive or tight hip flexors, namely the rectus femoris, psoas, and iliacus muscles (together called the iliopsoas), typically drive this excessive tilt. Other hip flexors, such as the tensor fascia latae (TFL), sartorius, gluteus medius (anterior fibers), gluteus minimus, adductors, and pectineus, are also involved. In addition, muscles of the back, such as the quadratus lumborum (QL), erector spinae, and latissimus dorsi, can lift the rear of the pelvis or create more spine extension resulting in APT. Overactivity in these muscles often signifies strength, leading to imbalances and potential issues over periods of time.

On the other end of the spectrum, weak, underactive, and/or elongated abdominal muscles, gluteus maximus, and hamstrings also play significant roles. When muscles are underactive or weak, they are less able to support and balance the opposing forces of their counterparts.

The Neuromuscular Component: More than Stretching and Strengthening

The neuromuscular concept that helps to understand these muscular dynamics is called reciprocal inhibition. This term refers to the natural process in our bodies where activation of one muscle (in this case, the hip flexors) leads to the relaxation or inhibition of its opposing muscle group (here, the glutes and hamstrings). So, strong or overactive hip flexors can contribute to weak or underactive glutes and hamstrings, and vice versa, creating a cycle that can lead to or exacerbate anterior pelvic tilt. So, if you’re looking for how to fix anterior pelvic tilt, the neuromuscular component requires going beyond simple stretching of the extensors and doing hip flexor stretches.

Asymmetrical patterns of APT, where the right and left sides of the pelvis are unevenly tilted, have become more common over the years. This right and left side imbalance is often a sign of one-sided dominance, creating a dysfunctional path to additional problems. For example, if your right leg is dominant, this can lead to stronger, tighter muscles on that side — usually the side with more anterior pelvic tilt.

anterior pelvic tilt posture dysfunction

Joint Movements

Alongside the skeletal and muscular structures, how our joints move significantly contributes to the development and consequences of anterior pelvic tilt. As the anterior tilt angle increases, it puts undue stress on our lower back, hips, and knees, leading to altered joint movements and potential discomfort or pain.

The constant tug-of-war between overactive and underactive muscles affects the pelvis's tilt and impacts the myofascial lines running up and down the body. These lines, which connect muscle groups and affect joint movements, are disrupted by the muscular imbalances seen in anterior pelvic tilt - from the top of the head to the bottom of your feet.

In essence, anterior pelvic tilt significantly affects our body's natural harmonious movements, leading to consequences throughout the musculoskeletal system. Understanding and addressing these underlying skeletal, muscular, and joint dynamics is essential for resolving anterior pelvic tilt.

Postural Deviations Commonly Found with Anterior Pelvic Tilt

Frequent postural deviations accompanying anterior pelvic tilt include:

  • Hyperextended knee
  • Forward head posture
  • Lumbar hyperlordosis (excessive inward curve of the lower back)
  • Increased thoracic kyphosis (excessive outward curve of the upper back)
  • External knees or internal knees
  • Knock knees

What are the Symptoms of Anterior Pelvic Tilt

People with anterior pelvic tilt dysfunctional posture patterns exhibit various symptoms affecting their daily lives. These symptoms often include:

  • A forward tilt of the pelvis that is visible when looking at the body from the side
  • Lower back pain or discomfort
  • Increased curvature of the lower back (also known as lordosis)
  • Tightness in the hip flexors
  • Weakness or under-activation of the glutes, core, and abdominal muscles
  • Difficulty with certain movements or exercises due to limited range of motion in the hips

Common Pains and Limitations

Due to the muscle imbalances at the hips, pelvis, and lumbar spine, the following symptoms and common injuries can occur:

  • Low back pain
  • Hip pain
  • Sciatica
  • Degenerative hip or knee
  • Arthritic hip or knee
  • Tight hip flexors
  • Tight groin muscles
  • Tight lateral hip muscles and tight IT band
  • Elongated, weak hamstrings
  • Elongated, weak glutes
  • Tight quadriceps
  • Tight hamstrings and hamstring strain
  • Knee pain
  • Foot pain
  • Plantar fasciitis

Long-Term Risks and Issues

If left unaddressed, an anterior pelvic tilt can lead to more serious physiological and musculoskeletal issues over time, including:

  • Chronic lower back pain: This is due to the constant strain and overextension in the lower back muscles.
  • Hip pain and reduced mobility: Tight hip flexors can limit the range of motion in your hips and cause discomfort.
  • Knee pain: The altered alignment of the hips can put undue stress on the knees, potentially leading to pain and degenerative conditions.
  • Poor posture: Anterior pelvic tilt can contribute to a more hunched or slouched posture over time.
  • Increased risk of injury: Muscle imbalances and altered body mechanics can increase the risk of injury, particularly in the lower back, hips, and knees.
  • Musculoskeletal disorders: Long-term anterior pelvic tilt can result in conditions like osteoarthritis, disc herniation, and sciatica.
  • Diminished physical performance: Muscle imbalances can affect your ability to perform certain physical activities or sports.
  • Poor leg circulation: With APT dysfunction, tight hips and groin muscles can disrupt proper blood and lymph flow.
  • Digestive and pelvic floor issues: As the pelvis is designed to support the internal organs, APT creates susceptibility to issues such as constipation, bloating, incontinence and urinary incontinence, hernias, and prolapsed organs.

Understanding these symptoms and potential long-term risks is key in recognizing the need for intervention and treatment to correct anterior pelvic tilt.

What Causes Anterior Pelvic Tilt?

anterior pelvic tilt common in today's society

Today's APT is often seen without true lumbar lordosis. Instead, we commonly see the apex of the lumbar curve move up to the upper lumbar and low thoracic segments of the spine (L1-T12 junction).

Factors leading to an anterior pelvic tilt often include a sedentary lifestyle with excessive sitting, poor posture, and a lack of posture-focused strength training or a variety of lifestyle activities that work the glutes, hamstrings, and abdominal muscles. This often leads to tight hip flexors and weak glutes, creating a muscle imbalance that pulls the pelvis into an anterior tilt. It can also be caused by walking or standing habits, where the person habitually thrusts their hips forward or has an excessive arch in the lower back.

Athletes that do strengthening exercises for the hip flexors without proper balance or use APT as a mechanical advantage in their sport may benefit through specificity. However, these gains often have negative consequences due to muscle imbalances, injuries, and pain. High-performance athletes benefit from posture therapy and movement coaching during and after their sports to ensure their body recovers and is restored to balance for long-term health.

Posture Terms Related to Anterior Pelvic Tilt

  • Neutral Position: The ideal pelvis alignment without excessive forward or backward tilt.
  • Posterior Pelvic Tilt: The opposite of anterior pelvic tilt, where the back of the pelvis drops and the front of the pelvis rises.
  • Lordosis: The excessive inward curve of the spine, typically seen in the lower back with anterior pelvic tilt.
  • External Knees
  • Internal Knees
  • Hyperextended Knee
  • Flexed Knees
  • Knock Knees
  • Flat Feet


To wrap things up, an exaggerated anterior pelvic tilt is not just a matter of posture; it's linked to a laundry list of potential troubles. It may sound surprising, but this postural misalignment often leads to lower back pain, hip and knee discomfort, tight hip muscles, compromised circulation, and a range of injuries due to restricted mobility. It can even speed up hip or knee degeneration or lead to femoroacetabular impingement. The good news is you can regain control over your musculoskeletal health by understanding the root causes and learning the right corrective exercises.

At Activ8 Posture, we've seen firsthand how posture therapy can do wonders in managing and reversing anterior pelvic tilt. It offers a balanced approach, focusing on stretching the tight areas like your hip flexors and lower back muscles and strengthening those weakened muscle groups, such as your glute maximus and abs.

If you're experiencing symptoms of anterior pelvic tilt, know that we are here to assist you. You do not need to endure unnecessary discomfort. We strongly believe that you can effectively manage and even reverse your condition by properly combining strength training, targeted stretching exercises, and actively maintaining good posture. Our personalized posture therapy has already helped numerous individuals correct their anterior pelvic tilt, and we encourage you to explore how it can also benefit you. Why not see how we can make a difference for you?


 Make the first step on your journey to improved musculoskeletal health by scheduling a FREE Consultation & Posture Assessment. Our team of postural therapists is dedicated to providing personalized advice and effective treatment strategies that cater to your unique needs.

Your well-being is our priority. Let us guide you towards a healthier, pain-free life. Book your appointment now!

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