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Anterior Tilt Causing Pain? Try These Anterior Pelvic Tilt Tests

last updated November 2 0 comments

Introduction

An anterior pelvic tilt is one of the most common problematic posture deviations that we see in our clinics today. With tight hip flexors (like the psoas major) being stuck in sitting positions for hours daily and not being active like prior generations, the pelvis often gets stuck in the anterior tilt position.

While anterior pelvic tilt is a natural movement that we should all be able to do, it’s when the pelvis is tilted forward and stuck that it becomes a problem of poor posture. Below, we've included some anterior pelvic tilt tests for you to find out how well you can move.

When the pelvis tips down in the front, the lower back normally extends and the buttocks stick out (think belly button pointing down towards the floor). And when fixed in this position, a range of anterior pelvic tilt symptoms from low back pain, sciatica, hip painknee pain, and foot pain, to other associated symptoms such as constipation, urinary incontinence, swelling in the legs and midsection, and so on, often appear.

Sitting for long periods of time is often the main cause. In addition, a lack of physical activity, muscle imbalance, and even other posture deviations in the body often lead to anterior tilt of the pelvis.

Is anterior pelvic tilt common?

An anterior pelvic tilt is one of the most pervasive posture dysfunctions due to the pelvis and hips serving such a critical role in so many of our activities. Every time you try to sit down, stand up, walk, bend over, etc, the pelvis is tasked with supporting your spine while simultaneously synergizing with your hips and legs. Indeed, a functional pelvis is required to move dynamically from a stabilizer to a mobilizer in our common physical tasks.

The best way to fix anterior pelvic tilt is to restore your muscle balance by doing posture-corrective exercises and stretches regularly. (And the anterior pelvic tilt test below will help recognize if this applies to you.) Performing regular posture exercises will help prevent various chronic pain issues from occurring in the future and help with the health of many other body systems (digestive, lymphatic, etc).

The Problem with Anterior Pelvic Tilt

Anterior pelvic tilt is one of the most prevalent and problematic posture dysfunction patterns. Sadly, it is often overlooked and discounted as the possible source of many pains and health issues that we see first hand in the clinic.

At the same time, a standing posture screen observation of anterior pelvic tilt is not necessarily definitive without assessing the underlying functional movement of the pelvis, hips, low back, and beyond.

Nevertheless, a wide range of symptoms often appear in conjunction with anterior pelvic tilt postures that exhibit decreased range of motion and dysfunctional movement patterns.

What is Anterior Pelvic Tilt?

An anterior pelvic tilt is when the front of the pelvis lowers and the back of the pelvis rises. This is usually accompanied by lumbar lordosis (or excessive extension in the lower back). If you imagine that the pelvis is a bowl filled with water, then as the pelvis tips anteriorly the water spills forward.

Anterior pelvic tilt side by side

Assessing pelvic tilt includes finding the anatomical landmarks on the front and back of the pelvis. These include the anterior superior iliac spine and the posterior superior iliac spine respectively, and can be palpated and observed as level, having an anterior tilt, or in a posterior tilt. Since the pelvis has a right and left side, the tilt of each side may also be uneven.

Is anterior pelvic tilt normal?

Anterior tilt of the pelvis is a natural movement that everyone should be able to do relatively easily. When you stand up from sitting in a chair, the pelvis tips forward to move your weight over your feet. And when you walk, alternating phases of anterior and posterior pelvic tilt from the neutral position are supposed to dynamically occur with each alternating step. When daily activities such as these cause pain, it’s usually a sign that the pelvis is not moving as it should.

Easily observed in a standing posture assessment, anterior pelvic tilt isn’t considered problematic until we try and move the pelvis from that position. And if the pelvis is “stuck” due to muscle imbalances, this state of anterior pelvic tilt immobility is where we link issues with balance, stability, range of motion, pain symptoms, and other related health issues.

Common activities that involve anterior pelvic tilt include:

  • Walking and running. When your leg extends behind you, the same side of the pelvis goes into anterior tilt. And when your leg reaches forward, that same side of the pelvis is supposed to go into posterior pelvic tilt.
  • Standing from a sitting position. Functionally, the pelvis should roll forward to move your center of gravity over your feet and get in position to support your spine as your hip extensors engage.
  • Squatting or bending down. When you initiate a squat, your bottom should stick out as you hinge at the hip joints.
  • Assuming an athletic ready-stance. Whether you‘re playing golf, softball, basketball, pickleball, jiu-jitsu, or any number of other sports, lowering your center of gravity (as you do in a squat) will require the pelvis to move over the top of the hip joints.

Even if you’re stuck in an anterior pelvic tilt posture, you may be able to do the above activities currently without pain. However, your mobility, flexibility, strength, and power out of these positions will be greatly diminished if the pain doesn’t cause you to stop first. When people are stuck in a posterior pelvic tilt, the activities listed above become more difficult as well.

pain sitting posture

What Causes Anterior Pelvic Tilt?

An anterior pelvic tilt often results from sitting for long periods of time, lack of physical activity, muscle imbalance, or other poor posture dysfunctions that accentuate forward pelvic tilt.

1. Excessive Sitting

Sitting for long periods of time puts the muscle groups around the hips, pelvis, and back in a flexed position without a lot of activation. At the hips, the main muscle imbalance is between the hip flexors (e.g., the psoas major, iliacus, and rectus femoris of the quadriceps group) that shorten and the hip extensors (such as the hamstrings and glutes) that elongate. In the lumbar spine, muscle imbalance occurs between the spine flexors (abdominal muscles) and the spine extensors (including back muscles like the erector spinae and multifidi).

Since these muscle groups are effectively locked in short and long positions for prolonged periods, they start to adapt to the position they are used in over time.

2. Lack of Physical Activity

With a lack of movement, the muscles of the legs, hips, pelvis, and spine don’t get the benefits that come from exercise. A sedentary lifestyle not only makes muscle groups weaker but also allows the supporting structures (ligaments, joints, bones) that rely on good stress and activation to weaken as well.

The body locks into an anterior pelvic tilt as a strategy to create stability when there is a lack of strong, balanced muscle groups. Walking, as mentioned above, is helpful to get the pelvis moving into anterior and posterior pelvic tilt positions as the big leg, hip, and pelvic muscles flex and extend with each step.

3. Poor Posture

Because our body works as a whole, poor posture in one area leads to posture problems elsewhere in the body.

Tech neck, for example, doesn’t stop at the head or neck. Instead, the forward flexion of the neck and upper back often leads the rest of the spine to counter-balance with excessive lordosis and anterior pelvic tilt in an exaggerated S-curve of the spine. (Of course, the body uses other problematic posture strategies to balance as well.)

When posture deviation such as tech neck, thoracic kyphosis, or others cause imbalance, the brain coordinates with the body to create balance as needed. In this balancing act of the body, muscles compensate by becoming overactive whereas others become inactive and weak.

4. Muscle Imbalance

Muscle imbalances occur for different reasons — from pregnancy to neurological issues. By far, however, the majority of cases we see with clients coming into our clinics are due to one or more of the reasons described above. Lifestyle and the repetitive actions we perform daily play major roles in how well our muscles will or will not be balanced.

Sometimes, even when active, we unintentionally perform repetitive actions that strengthen the muscles that create this posture deviation. If you sit for work, sit to commute, sit to eat, sit to relax, and then choose activities in the gym like cycling or sitting strength training exercises, how do you expect your body to respond? That’s right, you adapt to sitting!

Can I work out with anterior tilt?

Common strengthening exercises like deadlifts, squats, push-ups, glute bridges, or lunges may be done entirely while in an anterior pelvic tilt — without ever going to a posterior tilt or hip extension. A lack of hip joint extension is usually compensated for by the pelvis tipping anterior. Of course, injuries are more likely to occur when altered mechanics such as this are present. When your body is supposed to move in a certain way but your postural dysfunction disallows it, you're likely to feel the consequences sooner or later.

Additionally, you might be (or have been) an athlete in a sport that required strong hip flexors. The strong iliopsoas and accessory hip flexor muscles help generate powerful movements to drive the legs forward in sprinting, jumping, kicking, and so on. For many sports where opening up the anterior hip into extension isn’t required, the compensation and eventual adaptation often shows up as anterior pelvic tilt.

It's best to correct your posture and function prior to working out if you can.

Don’t despair! Anterior pelvic tilt CAN be corrected!

What Problems Can Anterior Pelvic Tilt Cause?

Proper body alignment is an essential part of your overall bodily functioning and health. An anterior pelvic tilt is one of the most common posture misalignments that is seen clinically (65-75%). Having it doesn‘t necessarily mean you will have pain right away. Pain and limitations related to anterior pelvic tilt will depend on many factors such as lifestyle, activities, how tightly you’re stuck, and your overall health.


While most people who seek out posture correction are suffering from unresolved chronic pain and/or musculoskeletal limitations, there are a number of additional issues related to anterior pelvic tilt as listed below.

Major Concerns

  • Low Back Pain, Sciatica, Disc Herniation
  • HIp Pain, Hip Impingement, Groin Pain
  • Knee Pain, Patellar Tracking Issues
  • Lumbar Spine Arthritis & Compression
  • Pelvic Floor Disorders
  • Hip Arthritis & Degeneration, Femoroacetabular Impingement Syndrome (FAIS)
  • Ankle or Foot Pain
  • Circulation issues (e.g., varicose or spider veins)

Additional Concerns

  • Tight muscles around the pelvis, hips, and legs
  • Low back tension and instability
  • Weak glutes, Weak abs, Weak back
  • Urinary incontinence, Frequent urination
  • Constipation, Bowel Movement Trouble
  • Swelling around legs, thighs, hips and midsection (lymphatic system)
  • Reduced Breathing & Respiratory Health
  • Distended stomach or "pooch belly"
  • Problematic, poor posture above and below the pelvis

Take the first step towards your posture transformation today! Schedule a discovery call with a trained, experienced Posture Therapist.

pelvic tilt test

Anterior Pelvic Tilt Tests

As we discussed earlier, anterior pelvic tilt is associated with imbalances in muscle groups above and below the pelvis. While some people are hypermobile and may be able to work around limitations, most with anterior pelvic tilt dysfunction will find the following functional tests difficult to accomplish.

The four exercises below represent normal functions of the human body that only become difficult when your body is stuck in posture dysfunction. While going through these, pay attention to your range of motion and the quality of your movement. Does your body shake? Is the movement or pattern seem uncomfortable and foreign versus relaxed and familiar? Does your body want to cramp or seize up?

Remember that if you have pain with any of these, you should stop immediately and seek medical assistance as needed. If you're pregnant, have a lumbar fusion, or have any other condition that prevents you from moving your pelvis or lumbar spine as described below, skip them.

1. Standing Wall Tilt Test

This first anterior pelvic tilt test is a tough one for most people. Follow the instructions below on setting up in the starting position and then try to perform the movement described. Start with your heels against the wall and if you can't flatten all the way, try moving your feet away from the wall. Not too far, though, as you'll already be doing test #2!
Move back and forth from the starting position to the other a few times. How is the movement? Is it choppy or smooth? Difficult or easy? Does your lower back round or stay arched?

wall test neutral

Standing Wall Tilt: Starting Position

Start by walking your feet out so that your ankles are under your knees. Make sure you have grip with shoes or a yoga mat!
Then lower your hips so that you're close to parallel to the floor with your thighs. Feel whether there's any arch in your low back in this position.

Wall test flat

Standing Wall Tilt: Flattened

Attempt to press your low back flat into the wall. You should feel your low back pressing flat into the wall. If you can't sense your back flattening, try placing your fingers behind your low back to feel if there's any space. And, if you find that you can't flatten your back into the wall, it's likely you're stuck in an anterior tilt.

2. Wall Sit Test

If you're a skier, then you likely know this one well! But quad strength is only part of the equation when it comes to pelvic function. Pay attention to how your legs feel when in the starting position versus when you flatten your back completely. Can you feel the difference?
Be sure you're wearing shoes or using a yoga mat for your feet to grip!

wall sit arch

Wall Sit: Starting Position

Start by walking your feet out so that your ankles are under your knees. Make sure you have grip with shoes or a yoga mat!
Then lower your hips so that you're close to parallel to the floor with your thighs. Feel whether there's any arch in your low back in this position.

wall sit flat

Wall Sit: Flattened

Next, attempt to press your low back flat into the wall. You want to feel whether your low back is pressing flat into the wall. If you can't sense your back flattening, place your fingers behind your low back to feel if there's any space. And if you can't flatten your back into the wall, it's likely you're stuck in an anterior pelvic tilt.

3. Pelvic Tilt Test

Pelvic tilts seems like a straight forward exercise, but you'd be surprised at how many people cannot perform this movement! Yes, in our pro-sitting and sedentary society, pelvic functions such as rolling forward and backwards has become lost for many. And this isn't an age thing! We see hip, pelvic, and lumbar issues in all age groups with this one.

pelvic tilt arched

Pelvic Tilt: Starting Position

Start by lying on the floor with your knees bent. Allow your low back to arch. Place your hand under your low back to feel how much space is there at rest.

pelvic tilt flat

Pelvic Tilt: Flattened

Next, attempt to press your low back flat into the floor. Are you able to get your low back completely flat? Is there space that won’t flatten all the way?
You should feel your low back pressing flat into the floor. To feel if your back is arched or not, you can also place your fingers under the lower back to gauge if there's any space. And, if you can't flatten it, it's likely you're stuck in an anterior pelvic tilt.

4. Lying Supine Tilt Test

If you had trouble with the pelvic tilts with your knees bent, chances are that this one will be tough as well. However, if the pelvic tilts were easy, then you're likely to feel more difficulty with your legs extended in this exercise.

Lying Supine Arched

Lying Supine Tilt: Starting Position

Start by lying on the floor with your legs out straight. Relax your body and sense what your low back is doing. Is it arched?

Place your hand under your low back to feel how much space is there at rest. Is it flat or arched as you lie here? Do your legs want to turn out?

Lying Supine Flat

Lying Supine Tilt: Flattened

Now attempt to press your low back into the floor. Are you able to get your low back flat into the ground? Or is there a space that won’t flatten completely?
When you're tight in anterior tilt, you likely won't be able to get your back completely flat. If you can't feel your back pressing into the floor, place your fingers under your low back to feel if there's any space.

With these tests, hopefully, you can determine if your pelvis is stuck in an anterior pelvic tilt. If you have regular lower back pain, knee pain, hip pain, or other symptoms like a decreased range of motion in the hips, it may be related to the rigidity of your pelvis.

How to Fix Anterior Pelvic Tilt Naturally

To correct anterior pelvic tilt, some will advise you to go around tucking your pelvis under by engaging your gluteus maximus, hamstrings, and abdominal muscles. Don't do it!

While finding the mechanism and mobility through doing this posterior tilt motion is helpful, consciously holding a posterior pelvic tilt throughout the day is detrimental to your breathing, muscle balance, and way more mentally exhausting than it should be for good posture.

Breathe!

If you attempt to take in a deep diaphragmatic breath while tucking your pelvis, for example, you’ll find it is impossible. Trading healthy, diaphragmatic breathing, along with the oxygenation and relaxation that comes from triggering your parasympathetic system, is a big trade-off.

Instead, finding the underlying pattern of why you have anterior pelvic tilt and addressing the root cause is a healthier and more sustainable solution. Also, we believe that your posture should be more of the subconscious routines that stem from the proper training you do. If you have to think about it outside of your exercises to fix anterior pelvic tilt, then you're likely not doing the right stuff or need to keep working on correcting the muscle imbalances.

Below are some tips for combatting anterior pelvic tilt based on the causes discussed above. Of course, the best remedy is to have specific posture-corrective exercises that address the specific reasons for your anterior pelvic tilt. (And there’s more going on than just one poor posture deviation). Let us know if you’d like more guidance to help assess and fix your posture.

  • Combat excessive sitting by getting up and moving (not just standing) is the best remedy. Your muscles need to be reminded to go through their normal range of motion. Every time you walk, you flex and extend many of the muscles involved in a stuck pelvis. Depending on whether your anterior pelvis is due to tight hip flexors or somewhere else in your body, doing corrective exercises to balance your body during the day will help unlock your pelvis.
  • Overcome a lack of physical activity starting with awareness. Besides the obvious — move more! — start with monitoring how much activity you’re getting daily with a tracking device. With so many options available today (your smartphone, Apple or similar watch, the Oura Ring, Whoop band, etc), it’s easier than ever to count your steps. And if walking or being active hurts, then you need a program to help balance your body prior to taking on the mileage. A good posture-corrective program will help train your body how to move so that moving feels good.
  • Improve poor, problematic posture by getting a posture assessment will help you identify where your body is showing the need for correction. Everyone is unique in how they present in their postural dysfunctions and this means someone else’s exercises are not necessarily the right ones for you. Tap into a good program with someone who knows how to read your body and will give you proper guidance.
  • Correct muscle imbalances with a good guide. Similar to getting a posture screen, working with someone trained in functional movement along with posture therapy will help you address your body’s needs. Of course, all programs and professionals are not created equal so do your diligence to find the ones that listen well to your needs and gives you direct answers. Working proper muscle balance into your workouts, along with removing problematic posture dysfunctions, will help you improve performance and reduce injuries.

The Solution for Anterior Pelvic Tilt

Anterior pelvic tilt is one of the most prevalent and problematic posture dysfunction patterns. Sadly, it is often overlooked and discounted as the possible source of many pains and health issues that we see first hand in the clinic.

At the same time, a standing posture screen observation of anterior pelvic tilt is not necessarily definitive without assessing the underlying functional movement of the pelvis, hips, low back, and beyond.

Nevertheless, a wide range of symptoms often appear in conjunction with anterior pelvic tilt postures that exhibit decreased range of motion and dysfunctional movement patterns.

Often, the following stretch and strengthen protocols are used to resolve anterior pelvic tilt. A word of caution to you, however, in applying these as the remedy: by only stretching or strengthening specific muscles, we may be missing the holistic or whole-body view of the problem (such as when another posture deviation is causing the anterior tilt).

With these stretch and strengthen combinations, be sure not to force your body to comply with these suggestions. If a muscle doesn't want to release, it's usually for good reason! Get some guidance as needed.

Stretch

  • Hip flexors
  • Quadriceps
  • Low back muscles
  • Hip external rotators
  • Hip internal rotators
  • Calf muscles

Strengthen

  • Glutes
  • Abdominals
  • Hamstrings
  • Quads

Conclusion: The Importance of Correcting Your Anterior Pelvic Tilt to Stay Out of Pain and Healthy

While having an anterior pelvic tilt observed in your posture analysis doesn’t always mean you’ll have low back pain or other specific symptoms, it is a sign of imbalances in your body that we often see leading to issues down the road.

In the clinics, we see a lot of people who exhibit anterior pelvic tilt that have any number of pain issues. This depends on what the rest of the body is doing in balance with the pelvic position. A few cases from clients we've seen with problematic anterior pelvic tilt dysfunction:

Samuel's Story

Samuel is a 27-year-old computer engineer that has never been physically active. He would get random pain in the knees and sacrum periodically, but mostly the issues were headaches and TMJ. His pelvis was asymmetrical with one side in anterior pelvic tilt and the other side of his pelvis posterior. As he corrected the imbalances in his body, his pains became less frequent and his biggest win was how much more confident he felt as his upper back rounding and shoulder position improved along with his pelvic tilt.

Sonia's Story

Sonia is a 53-year-old that loves to dance. She came in with arthritic hips, low back pain, and neck pain with an exaggerated anterior pelvic tilt and rigid lumbar spine. As her pelvis started to release from being stuck in an anterior tilt, her neck and back pain resolved. However, she was happiest about the regularity of her bowel movements from her pelvis being able to tip posteriorly (a problem she didn’t mention when she first came in).

Joe's Story

Joe is a 65-year-old that has remained active for most of his life through his physically-demanding occupation and enjoying outdoor activities such as walking, hiking, and biking. His posture screen did not show much of an anterior pelvic tilt, but it was rigid in its position. This, along with excessive flexion and tension in his upper back, led to compression and eventually stenosis in his lumbar spine. Unlocking his pelvis and lumbar spine helped relieve much of the tension that had built up over the years so he could again stand and walk without having to sit down from the pain.

These are just a few brief synopses of the many client success stories of those who came in with anterior pelvic tilt dysfunction. Each of their initial posture screens showed the pelvis tipping forward, and determining just how stuck their pelvis was in each case was instrumental in addressing their respective complaints. And just like with these clients, there are often additional benefits to fixing your posture that go beyond the given symptoms.

There’s a ton of information out there on anterior pelvic tilt. All cases are not the same, so be wary of generalizations that discount the importance of this posture dysfunction. In many cases, and especially in today’s society, addressing anterior pelvic tilt with specific posture-corrective exercises is a game changer — not only for pain relief but for added health benefits.

Not sure where to start?

Take the first step towards your posture transformation today! Schedule a discovery call with a trained, experienced Posture Therapist.

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