Anterior Pelvic Tilt - How To Fix Your Asymmetries

Today we’ll cover the infamous anterior pelvic tilt. I see a lot of questions about anterior pelvic tilt (APT) as it’s a pretty big buzz word used by physical therapists, chiropractors, massage therapists, and personal trainers (pretty much anyone in the health and movement industry). We’ll discuss what it is, if it’s really all that bad, and I’ll give you some exercises to try out.

TLDR;

APT is a position of the pelvis that occurs in the sagittal plane. This position is often labeled to be the cause of many ailments such as “bad” posture and low back pain. In reality, the APT is an innate part the human skeletal positioning. It occurs in ~50% of our walking cycle and allows for more energy efficient movement compared to our ape relatives. The true issue with an APT is being stuck in the position or lacking control over the APT. This leads to increased reliance on the low back, quadriceps, and hip flexor musculature due to the inability to achieve a posterior pelvic tilt (PPT) and true hip extension. Using exercises that bias the pelvis toward a PPT and influencing the nervous system can teach an individual how to properly control the pelvis and the APT that accompanies movement at the skeletal structure. How to test for an APT: Modified Thomas Test, Posture Assessment, Functional Squat. Exercises to try: 90-90 Hip Lift and Sink Squat.

Want to watch a video version of this blog? Check it out below!

What Is Anterior Pelvic Tilt?

“A short-arc anterior rotation of the pelvis about the hip joints, with the trunk held upright and stationary.” - Essentials of Kinesiology for the Physical Therapist Assistant (Third Edition)

An anterior pelvic tilt is when the pelvis rotates forward and downward toward the floor. This movement occurs with co-contractions between the spinal extensor and hip flexor musculature. The APT also occurs with general relaxation and gravity pulling downward on the body. Now, to appreciate the anterior pelvic tilt, we must also look at the opposite motion that occurs at the pelvis. The opposite of an anterior pelvic tilt is a posterior pelvic tilt. This is a backward rotation or tipping back and down toward the floor (think your back pockets sliding down toward the back of the knees). A PPT occurs via co-contractions of the abdominals and hip extensor musculature. This movement takes effort and does not occur with relaxation or gravity. These pelvic tilts and their corresponding muscles are shown in the image below.

Posterior Pelvic Tilt Muscles (Top Down)

• Concentric A.K.A. Shortening

  • Abdominals

  • Gluteus Maximus

  • Hamstring Musculature

• Eccentric A.K.A. Lengthening

  • Spinal Erectors

  • Quadratus Lumborum

  • Latissimus Dori

  • Tensor Fascia Lata

  • Quadriceps

Anterior Pelvic Tilt Muscles (Top Down)

• Concentric A.K.A. Shortening

  • Spinal Erectors

  • Quadratus Lumborum

  • Latissimus Dori

  • Tensor Fascia Lata

  • Quadriceps

• Eccentric A.K.A. Lengthening

  • Abdominals

  • Gluteus Maximus

  • Hamstring Musculature

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Does Anterior Pelvic Tilt Matter?

Anterior and posterior pelvic tilts occur in the sagittal plane. This plane makes up the majority of motion and is where walking, running, and general locomotive activities live. Basically if you didn’t have pelvic tilt abilities, you’d have some wild and crazy movement compensations throughout the rest of the body (we’ll talk about that, I promise).

Is Anterior Pelvic Tilt Bad?

Now, a lot of folks demonize the anterior pelvic tilt. But why, Kyle? Well I’m glad you asked! Anterior pelvic tilt can potentially be detrimental to your static standing posture. It just doesn’t look great to our societal standards of “good posture.” It typically causes increased lordotic and kyphotic curvatures up the spine as well as the gnarly forward head and rounded shoulders that accompany.

But if you thought your static posture was bad, an anterior pelvic tilt is probably most detrimental to our movement capabilities. It limits the use of your glute, hamstring, and abdominal musculature due to these muscle being unable to find proper leverage during movement activities. Then you’re stuck using hip flexors, quads, and your low back for the majority of your movement tasks. Okay, so now that I’ve officially fear mongered you into the potentially negative effects of an anterior pelvic tilt, let’s dial it back.

“The human body is naturally biased toward an anterior pelvic tilt.”

“This makes us far more efficient from an energy system view (AKA we burn less calories making us awesome)”

The human body is naturally biased toward an anterior pelvic tilt. When walking, your pelvis is in an anterior pelvic tilt ~50% of the time and a posterior pelvic tilt ~20% (Lewis, C. et al. 2017). The anterior pelvic tilt was a key component in human evolution and our ability to walk upright. The anterior pelvic tilt changes the leverage capabilities of the hip extension / hyper extension. This actually makes us more efficient movers compared to our ape relatives far more efficient from an energy system view (AKA we burn less calories making us awesome) (Pontzer, H. 2017).

How To Fix Anterior Pelvic Tilt

Ahhhh now I finally gotcha. I lured you into my knowledge trap just to prove my biased point. Muhahaha! But really, if you’ve gotten this far you already can tell where this is going.

You can’t simply “fix” or get rid of your anterior pelvic tilt. It’s a part of our innate anatomical structure. Unless you really wanted me to do some crazy illegal surgery, that I have no business doing, it’s impossible. Sorry you read all this to learn absolutely nothing.

Wait, come back!

Let’s do this.

Let’s change our communication.

I can help you fix a “stuck” or “excessive” anterior pelvic tilt. That’s a lot easier and less invasive than your planned illegal surgery (dude, you’re crazy and I like it!).

So to get out of this excessive or stuck anterior pelvic tilt, we need to learn how to posteriorly pelvic tilt as as previously talked about (see I wouldn’t waste your time reading all that unless it was important). Mastering the posterior pelvic tilt helps to strengthen the hip extension musculature and learn to control your anterior pelvic tilt

Remember, APT actually helps us with hip extension during movement, but if you lack control over it, you’re just going to use hip flexors, quads, and low back muscles). You naturally fall into anterior pelvic tilt and that’s a good thing. It makes you efficient. I just want you to be able to control that fall and be able to jump in and out of that pelvic positioning depending on the task you’re doing (e.g. running, squatting, walking, movement in general).

How To Know If You’re “Stuck” In An Anterior Pelvic Tilt

We now know that everyone has an anterior pelvic tilt but the real issue is if you’re stuck or the tilt is excessive. Here’s a couple of ways to check and see if you’re stuck.

Subjective Assessments -

• You feel your weight in the toes of the feet

• You sense that your hamstrings are “tight”

• Your hamstrings cramp with certain activities (e.g. bridging)

• You feel tightness in your low back

• You can’t feel the heels of your feet on the ground when standing

• You can’t feel abdominals with activity (e.g. planks)

• You lay on your back, legs straight out and you can’t get your low back flat

These are all things you may “feel” or have experienced. They maybe ways to check if you are stuck in this position but they’re kinda hard to measure or retest.

Objective Assessment -

Modified Thomas Test -

• If this test is positive, it really tells you that you have some “tension” and lack of hip extension.

• My only problem is that some folks, in particular yogis, will have a negative finding due to increased tissue flexibility. Yet when assessing posture they have a clear APT. That would mean they’re flexible (yay!), but they may lack control of the musculature at the pelvis.

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Functional Squat Test

• This is my go to test and is really easy.

• The goal is to squat hip width apart while holding a posterior pelvic tilt

• This is a test I recommend for my yogis or people that are super flexible because it test the control aspect of the anterior tilt during movement in the sagittal plane.

• If you have an APT, this is going to be really tough because you’ll run out of real estate at the hips. Basically if your hips are anteriorly rotated, you’re already relatively flexed at the hip, thus you have less room to flex the hip up while squatting down.

• If you can get to parallel or ass to grass with this test, you’re in business.

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Posture Assessment

• Super easy, just take a photo of yourself from the side.

• Make sure you’re completely relaxed.

• You’re looking at the hips to see if they are dropping forward and down to the floor as seen in the 8/9/18 photo.

• The lumbar spine may also have a bit ore exacerbated curvature.

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Anterior Pelvic Tilt Exercises

Alright, so you now know we just need to learn how to control your anterior pelvic tilt. We do that by influencing the nervous system and putting you in positions where the muscles that help you achieve a posterior pelvic tilt get leverage. If you don’t know what I mean by “influencing the nervous system”, go read my blog post: Good Posture - What Is It?

90-90 Hip Lift

Equipment:

1. Your floor

2. A chair or wall

3. (Optional) Pillow

4. (Optional) yoga block, ball, or towel between the knees

Set Up:

1. Lay down on your back with your legs at 90 degrees and feet against the wall

2. (Optional) Place a pillow under your head and neck

3. Place the hands on the lower portion of your ribs (where you feel them stick out a little)

4. Feel the heels of your feet pull down on the wall like your scraping paint (feel hamstrings)

5. Gently tuck your back pockets toward the back of your knees (posterior pelvic tilt) leaving belt line on the floor

6. Hold the yoga block between the knees with a gentle squeeze

7. Maintain set up throughout execution

Execution:

1. Exhale every spit of air you got in the tank out through the mouth

2. Feel your lower abdominals around your belt line turn on while the lower ribs fall down and back toward the spine

3. Hold breath at the end of the exhale with your tongue against the roof of your mouth for 3-5 seconds

4. Maintain abdominal tension and lower ribs down while silently inhaling through the nose with the tongue still against the roof of the mouth

5. Feel expansion throughout front and sides of the ribcage

6. Repeat for recommended sets and reps

Additional Tips:

1. When the abs or lower ribs start to move, that’s your cue to start exhaling again

2. Keep your neck and face relaxed when breathing

3. You may want to really squeeze the yoga block depending if we’ve done an assessment

4. Use a chair at home if you’re struggling to feel hamstrings

Why do this?

1. Potentially decrease stress and global muscle tone (down regulate the central nervous system)

2. Loosen up your back and neck

3. Learn to maintain internal pressure throughout thorax and abdomen

4. Decrease anterior pelvic tilt

Start with 3-5 sets of 5 breaths (exhale + inhale)

Sink Squat

Equipment:

1. Kitchen sink or something to hold onto

2. (Optional) yoga block, ball, or towel between the knees

Set Up:

1. Grab the sink or chair and stand about 1-2 steps away

2. (Optional) Place a yoga block between the knees

3. Squat down reaching your knees toward the base of the sink or chair

4. Feel all of your weight in your heels, but don't lift the toes off the ground

5. Attempt to keep your bottom directly under your head

6. (Optional) Hold the yoga block between the knees with a gentle squeeze

7. Maintain set up throughout execution

Execution:

1. Exhale every spit of air you got in the tank out through the mouth

2. Feel your lower abdominals around your belt line turn on while the lower ribs fall down and back toward the spine

3. Hold breath at the end of the exhale with your tongue against the roof of your mouth for 3-5 seconds

4. Maintain abdominal tension and lower ribs down while silently inhaling through the nose with the tongue still against the roof of the mouth

5. Feel expansion throughout the chest, sides of the ribcage, and upper/lower back

6. Repeat for recommended sets and reps

Additional Tips:

1. When the abs or lower ribs start to move, that’s your cue to start exhaling again

2. Keep your neck and face relaxed when breathing

3. Imagine the arms are meat hooks. They shouldn't be tense

4. Reach the knees as far as possible till heels start to lift. That's usually where you want to hangout in your set up

5. Less is more. Don't worry about going super low with this move

Why do this?

1. Potentially decrease stress and global muscle tone (down regulate the central nervous system)

2. Loosen up your back

3. Learn to maintain internal pressure throughout thorax and abdomen

4. Decrease anterior pelvic tilt

5. Improve squat

Start with 3-5 sets of 5 breaths (exhale + inhale)

The primary goal of these to exercises is to achieve a posterior pelvic tilt that sits stacked below the cranium. This can allow for the brain’s perception of where it is in space to readjust, while also promoting new length tension relationships of the musculature. Think about these exercises as full body PNF with some true diaphragmatic breathing sprinkled on top.

Summary

In conclusion, an anterior pelvic tilt isn’t to blame for your poor posture or pain. If there’s anything to take away from this post, it’s that a lack of movement variability (AKA things are stuck and can’t get unstuck) is what causes weird things to happen. You get those things moving by… well... moving and making the brain feel safe and in balance. Then load those positions up and get super strong!

Looking for help with your Posture? Schedule a free 20-30 minute Zoom call with me!

Citation -

Lewis, Cara L et al. “The Human Pelvis: Variation in Structure and Function During Gait.” Anatomical record (Hoboken, N.J. : 2007) vol. 300,4 (2017): 633-642. doi:10.1002/ar.23552

Pontzer H. “Economy and Endurance in Human Evolution.” Curr Biol. 2017 Jun 19;27(12):R613-R621. doi: 10.1016/j.cub.2017.05.031. Review.