We don’t really think about how we stand and walk—it’s just how it’s done, right? Poor posture, however, can cause constriction of movement and pain in the back, legs, arms, and hips.
In addition, poor posture can affect:
- Circulation (1)
- Digestion (2)
- Heart function (3)
- Neck pain (4)
- Psychological stress (5)
- Respiration (6)
- Varicose veins (7)
It’s not uncommon for misaligned posture to result in either an anterior pelvic tilt or posterior pelvic tilt.
The Importance of Posture
Here’s what the Kansas Chiropractic Foundations says this about posture:
“Posture ranks right up at the top of the list when you are talking about good health. It is as important as eating right, exercising, getting a good night’s sleep and avoiding potentially harmful substances like alcohol, drugs, and tobacco. Good posture is a way of doing things with more energy, less stress, and fatigue. Without good posture, you can’t really be physically fit.” (8)
Posture means not only your body’s position when you stand but in whatever position you may be when sitting, lying down, bending, crossing your legs, and exercising. A great many of us spend much too much time sitting, especially at work. If we are not mindful of our bodies’ positions as we go through our days, we can get under- and over-used body parts stuck in uncomfortable positions.
A condition that’s predictably developed over the years is “iHunch/text neck/iPosture”. It’s the tendency to hunch over an electronic device (smartphone or tablet), extending the neck and rather heavy head forward over said device. The “dowager’s hump” that appears in later life as the result of repeated undue strain on the upper back, neck, and head position is now manifesting in teenagers from their posture while using their electronics. (9)
What is Anterior Pelvic Tilt?
The pelvis and hips are at the midpoint of the body and affect balance and whole-body movement and mobility. You can feel the effects of a tilted pelvis (either forward or backward) in a variety of uncomfortable ways.
Simply put, an anterior pelvic tilt is a position in which your pelvis is tilted forward from your spine, causing your glutes to push backward. A slight tilt forward is common in both sexes and isn’t a physiological problem. Pain and other issues can occur if the angle of tilt is usually greater than ten degrees from the spine.
At that point, excess stress is put on the lumbar (lower) spine, resulting in discomfort and other issues over time. The opposite of an anterior pelvic tilt is a posterior pelvic tilt in which the pelvis angles backward from the spine.
What Causes a Tilted Pelvis?
The constriction or weakening of muscles that support the pelvis can pull its position in one direction or the other. (10) Abdominal muscles keep the spine and pelvis in alignment in the front by pulling the pelvis up; back muscles below the lumbar spine balance their action at the rear to pull it down.
The primary muscles that support the pelvis include:
- Lumbar erectors
- Quadriceps (rectus femoris in particular)
- Gluteus maximus
If the hip flexor group of muscles is over-used by remaining in one particular position (e.g., sitting for long periods), the muscles can lose flexibility, the rear muscles supporting the pelvis weaken, and an anterior pelvic tilt can ensue over time.
Other factors that contribute to pelvic tilt include:
- flat feet
- head and neck position
- nervous system activity in the pelvis and lower back that influence muscle behavior
Anterior Pelvic Tilt Test
So how do you know if you have a tilted pelvis? If you experience chronic lower back, leg, or neck pain, there’s a chance that it’s due to your posture. See the illustration below for the differences in postures.
If you stand and move just your buttocks backward, you’ll feel the muscles in the front of your pelvis and in the lower back pull. If you move the opposite way and press butt in and pelvis forward, you’ll feel the tension in your lower abdominals and butt.
Looking sideways in a long mirror, you can see if your upper abdomen and buttocks stick out—these are signs of an anterior pelvic tilt. Or take the quick test below.
- Does your stomach stick out or is it flat?
- Are your hips pushed forward and straight or are they sticking out behind you?
- Do you have any of these symptoms: Back pain hip pain, knee pain, or shoulder pain?
- Is your lower back more straight or arched?
If you’ve answered that your stomach is flat, your hips are straight, you don’t experience any of the symptoms listed and your lower back is straight, then your pelvis is in its natural position. However, if you’ve answered that your stomach sticks out, your hips sticks out behind you, your experience the symptoms and your back is arched, then you likely suffer from an anterior pelvic tilt. If your answers fall into both categories, it may be time to fix you posture to avoid problems in the long run!
How to Correct an Anterior Pelvic Tilt
Fortunately, the cause of pelvic misalignment is most often fixable by stretching and strengthening the right muscles to put everything back to where it’s supposed to be. Because it’s so common (especially among runners), health and athletic professionals have devised pelvic tilt exercises to help you target the involved muscles to get your posture straightened out.
1. Lying Pelvic Tilt
Often we don’t realize that our pelvis is angled forward. To highlight this and gently practice moving the pelvis into a posterior position, the easiest way is by lying on your back on the floor.
- Lie on your back, hands at your sides, with your knees bent and hip-width apart. Feet should be flat on the floor at 45° angles away from your body.
- Press your lower back down into the floor, drawing your belly button towards your spine.
- Hold this position for 10 seconds, then relax for several seconds.
- Repeat 10 times.
2. Standing Pelvic Tilt
This exercise almost identical to the Lying Pelvic Tilt exercise but with your back against a wall instead of on the floor. You may find it more effective to control the position of your lower back while standing in order to become accustomed to doing so while you walk and stand throughout the day.
- For the first few times you do this exercise, stand with your back flat against the wall.
- Press the lower back against the wall while keeping your shoulders and hips against the wall and knees straight.
- Hold the position for 10 seconds then relax and repeat 10 times.
3. Hip Hinge Pattern
This pelvic exercise focuses all muscle flexion and extension on the hip joints. In this way, muscles at both the front and back of the pelvis are stretched and contracted to engage essential muscle balance. It’s important to keep the spine straight, in a neutral position, throughout the exercise to prevent strain and target the desired muscles. Core muscle strength is required to maintain the spine’s position so concentrate on that while doing the exercise.
- With your back to a cable machine, stand with your feet hip-width part.
- Hold the rope attachment in front of your hips with the cable traveling through your legs.
- Bend at the waist and sit your hips back until your torso is at a 45-degree angle.
- Take a few steps forward to get more resistance in the cable.
- Keeping your back straight, bend at the hip and bring your back parallel to the ground.
- Explosively extend your hips to stand up to the starting position.
To perform this exercise properly, be mindful of the following:
- Use a slightly wider stance than normal and think about pushing the knees out.
- Don’t revert to a squat pattern. Sit back into the “stretch” or hip hinge pattern. It’s not an up and down motion but rather a back and forth motion.
- Push your hips or hamstrings back as if you’re trying to tap a wall with your butt. Keep doing so until your hands are past your knees. Many lifters make the mistake of “crowding their groin” and omit the whole reaching-through portion.
- Maintain a neutral spine at all times. That means to maintain the natural curvature of your upper and lower back by not allowing the upper back to round while the lower back stays arched.
- Your head follows the hinge. This ensures a packed or chin-tucked pattern throughout. In this way, you’re less likely to hyperextend the neck and cause undue stress.
4. Do the Plank Challenge
Planks are an all-around exercise, strengthening the core and back. Keep your body straight, in a neutral position. Keep elbows under your shoulders, legs and back straight, head in line with your spine. If new to this exercise, you may start with a half plank and work your way up to a full plank. Watch the videos below on how to properly do planks.
- Start with your belly to the ground, keeping your feet at hip’s width apart and your palms beside your chest at shoulder’s width apart. This starting position should resemble a push-up position.
- Lift yourself up, placing your weight on your toes and lower your arms one at a time so that your forearms are touching the ground. Your weight should be distributed equally on your toes and forearms.
- Keep your back straight with your head facing the ground, tightening your core and buttocks.
Common Mistakes To Avoid:
- Allowing your hips, head, or shoulders to drop, this can compress your vertebrae, putting pressure on discs in your spine and causing shoulder and hip joint inflammation.
- Placing your hands too close together, which creates internal rotation and instability at your shoulder joint.
- Holding your breath, which causes a build-up of lactic acid in your muscles, which causes pain.
5. Side Stretch
This stretch engages the abdominal and back muscles. You’ll feel the pull in the hip flexors and upper glutes as well.
- Stand tall with your back straight and your core engaged.
- Bring your arms above your head and press your palms together. Take a deep breath in.
- Bend laterally at the hip and slowly bring your upper body to the right side as you exhale.
- Hold for a few breaths and slowly return to the starting position.
- Repeat on the other side.
- Hold the stretch for a minimum of 30 seconds. As you become more familiar with the movements, try to work your way up to holding for 1-2 minutes.
- If you already have pain in your lower back area, take care when performing the exercise. Adjust the stretch if necessary and do not over-stretch.
- Relax your muscles as much as you can. This allows for a deep stretch.
- Make sure you feel the stretch from the side of your torso.
6. Lower Abdominal Leg Lower
This pelvic exercise works the abs to strengthen their support of the hips and back. Keep a posterior pelvic tilt against the floor.
- Start lying on your back with both legs lifted straight in the air.
- Attempt to lower both legs down to the floor while keeping the knees straight until the lower back begins to arch off the ground.
- Only lower the legs as far as you can without the back lifting up.
- Return to the starting position and repeat for 2 sets of 20 repetitions.
7. Bridge with Leg Kicks
This exercise works the hamstrings and gluteus muscles. Keep the hips elevated and straight throughout to avoid strain on the back and engage the targeted muscles.
- Begin lying on your back with both knees bent.
- Lift your hips and lower abdomen into the air as high as you can, keeping your back straight.
- Once you are in this bridged position, kick one knee straight out and hold for 5 seconds.
- Lower that leg down and kick and hold with the opposite leg.
- After kicking with both legs return to the start position and repeat for 2 sets of 10.
8. The Pretzel Stretch
This mobility exercise strengthens the hip muscles, piriformis, lower back, glutes, and quadriceps, opening the shoulders as well. As you get comfortable, try different variations.
- Begin lying on one side with your knees bent up to hip height. Support your head with a foam pad.
- Throw the bottom leg back and hold the ankle with the arm closest to the ceiling. Use your other arm to grab the knee of your other leg.
- Twist your torso towards the ceiling while holding your knee to the ground.
- As you exhale, twist deeper into your stretch. Hold for 3-4 breaths.
- Repeat with the other side.
9. Leg Circles
The groin muscles work together to support the hips and enable movement of the lower back and extremities. They connect the pelvis to the top of the thigh and inside of the knee for mobility and stability. Muscles of the groin are among those most often pulled and take a long time to heal. Regularly stretching will strengthen them, providing flexibility, better range of motion, and a decreased likelihood of injury. Do this dynamic stretch at the beginning of a workout to warm and loosen muscle and connective tissue.
- Stand with feet apart and lift 1 foot off the ground and in front of you. Make sure to point your toes.
- Keep your weight on the heel of the standing foot.
- Starting slowly, swing your leg forward, back, and behind you in one movement, drawing a big circle.
- As you begin to loosen up, start to pick up the pace and increase your range of
- Perform 20 times on each leg.
10. Knees to Chest Pose
In the context of anterior pelvic tilt, weak gluteal muscles transfer pressure to lower back muscles to pick up the slack in the maintenance of hip and core stability. This stretch will align the pelvis, release over-taxed back muscles, and stretch the glutes, relieving associated pain.
- Lie flat on your back with toes pointed to the sky.
- Slowly bend your knees and pull them towards your chest.
- Wrap your arms around your knees, or shins (whichever is most comfortable) and gently pull the knees toward your chest.
- Rock from side to side for a few breaths to loosen up your muscles.
- Hold your knees in tightly toward your chest and lift your head to bring your forehead to your knees.
- Hold for 20 seconds and slowly extend the leg to starting position. Repeat three times and follow up with three single-leg repetitions for each leg.
11. Hip Flexor Stretch
Part of the problem that results in anterior or posterior pelvic tilt is an imbalance of the hip flexor muscles with the glutes. In the case of anterior misalignment, the hip flexors are tight and flexibility is limited. This stretch will help release those muscles. Concentrate on the core and glute muscles as you stretch; you’ll feel the pull of the flexors in the front of your pelvis.
- Start in a half kneeling position with the left leg in front and the right leg behind.
- Engage your glute muscles while keeping your back straight until a stretch is felt in the front of the right hip and thigh. Further the stretch by engaging your core. If possible, shift your weight forward onto your left leg for a few inches.
- Hold the stretch position for 1 minute and then switch legs and perform the stretch on the other side.
- Repeat twice on each side.
12. Walk it Out
Walking is the most normal human activity. There’s nothing like a walk to set everything back into alignment, get you up out of the chair, and re-charge. From a muscle perspective, simple walking exercises activate your legs, back, pelvis, glutes, core, and shoulders. Form is important, so keep in mind the positions of your head, neck, and back as you walk.
13. Lower Back Release with Tennis Ball
Releasing lower back muscles will relieve pain, allowing you to sit and move properly to correct a tilted pelvis. And it just plain feels good. Here are two techniques for using tennis balls to relieve lower back and hip pain.
- Lie on your back on the floor. Place 2 tennis balls under your lower back between the bottom of your ribcage and your sacrum. Ease pressure when rolling over the spine.
- Move your pelvis from side to side, rolling the balls across your lower back. Slow down the movement over particularly tender spots.
- Continue for up to 5 minutes while taking deep breaths.
- Lie face up on a mat or smooth rug on the floor. Place a tennis ball on each side of your upper back just below where your neck attaches.
- Place the palms of your hands behind your head in a sit-up position and raise your head off the floor.
- Lower your chin toward your chest, then lift your hips off the floor so your body weight rests on the tennis balls.
- Slowly shift your weight so the balls roll up and down to relax the muscles on either side of your spine. Breathe deeply while stretching and continue for up to 4 minutes.
The primary contributing factor to the development of anterior pelvic tilt is a sedentary lifestyle: too much sitting and not enough moving. Strengthening and engaging muscles in and around the hips affect your entire body, including all internal systems. These exercises require little or no equipment and are low-impact; they can be performed regardless of your current physical condition.
As with any new exercise, start slowly and with care. Be conscious of your technique so you get the most out of it and don’t cause further injury.