Posterior Pelvic Tilt – Causes, Symptoms, and Treatment

pptQ: What Causes Posterior Pelvic Tilt?

A: Posterior pelvic tilt is caused by seated jobs, faulty abdominal training, poor muscle balance, poor posture, and pregnancy.

When the pelvis tilts backwards over 15 degrees exaggerates the characteristics of bowed out lumbar spine and an accentuated lumbar curvature. The causes weak abdominal muscles and tight glutes.

Posterior pelvic tilt is specifically caused from:

  • A single event trauma such as a sports injury or a car accident
  • An event during pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the fibrocartilage.
  • Spinal wear and tear during prolonged periods of sitting (like truck driving or computer desk jobs.) It is quite common to have postural related stress on the spine from job related duties/computer usage etc.
  • Slouching. Bad posture may feel good temporarily, but it goes against a genetically determined ideal pattern and leads to problems later in life.
  • Slip and fall
  • The structure is misaligned and it doesn’t cover all the way and the patient walks in such a way that causes uneven weight distribution or abnormal distribution to the hip joint
  • Being 20 pounds or more overweight, which exerts postural pressure on the skeletal system and causes the spinal column to tip out of alignment
  • Repetitive trauma such as jumping running and any kind of action that involves repetitious axial trauma to the hip joint (example would be someone who plays basketball with a lot of layups, who jumps and lands on one leg) Therefore, bicyclists, ballet dancers, and gymnasts are at increased risk for posterior pelvic tilt.

is the kind of thing that can gradually cause posterior pelvic tilt to develop the hip but the other possibility is gradual wear and tear of the hip joints from age. Posterior tilt is usually accompanied by excessive kyphosis of the spine.

How to Prevent Further Posterior Pelvic Tilting:

  • Always push large objects rather than pulling them.
  • Constantly paying to your posture and correcting it should help.
  • Wear comfortable, well-made shoes. Caution: the higher the heels of your shoes, the more risk of backache!
  • Change positions in your chair every 30 minutes, and get up to stretch every 50 minutes. Don’t stay in same position for long periods.
  • Never lean forward without bending your knees.
  • Lift with your legs, arms and abdomen, not with your back.  Avoid lifting anything heavier than twenty pounds. To work near the ground, squat rather than bending at the waist.
  • Don’t sleep on your stomach.  Instead, it’s best to sleep on your back. Sleep on a firm mattress with your head elevated on a pillow, and some like a small pillow under their knees. A pillow under your hips/pelvis will also create a posterior pelvic tilt to alleviate low back pain and separate the lumbar facets.
  • Maintain healthy weight through regular anaerobic exercise. Anaerobic activities good for the back include exercycle or cycling, walking, rowing, stretching. Activities such as hiking, swimming and dance can supplement the corrective exercise and strength training, which will teach you how to move better, preventing further postural deviation in the hip.
  • Begin a gentle yoga routine. The pelvic tilt and the pelvic lift are two yoga movements commonly performed to alleviate lower back stress and help improve posture. All yogic exercises should be performed on a clean mat, a carpet or a blanket covered with a cotton sheet.

Other Causes of Posterior Pelvic Tilt Include:

Bad Sitting Posture


Slouching in a deep chair or sofa, just like slumping over a desk or table, distorts your spine. In different ways, puts stress and strain in the wrong places (stretching some ligaments and muscles unduly, tensing others to compensate), therefore jamming some vertebrae together while pulling others out of place.

In sitting as well as standing, the same basic rules of posture apply from the hips upward, to the trunk and head, both supported by the spine and its interconnecting musculoskeletal structure.

images (12)Treatment: The base of the spine should be at the rear of the chair seat (which should be flat and straight), and your back against chair back, which should fit the natural, gentle spine curves.

The stomach should be flat and firm (not relaxed outward), shoulders straight and head high. In other words, stretch up and sit tall!

Sitting All Day

Posterior Pelvic Tilt happens If you are sedentary either by choice or perhaps you injured yourself or has something happen where exercise regular exercise makes it difficult to do.

Most posture problems encountered in persons who use wheelchairs in a seated posture for extended periods are related to sacral sitting due to posterior pelvic tilt.

In terms of postural alignment, all sitting is wreaking havoc with our spinal health, and throwing many of us into a prolonged and exaggerated posterior pelvic tilt (where the tailbone is tucked under and the lower back is rounded).

After sitting for long periods, postural muscles or to turn off – same thing with gluteus muscles muscles of the leg and hip flexor. When muscles are inactive and not exercising, they tend to atrophy or shrink in size. And sometimes changes the dynamics of your joints posture, causing pelvic tilt.

images (12)Treatment: If you are a sedentary worker, as millions of Americans are, use an ergonomic chair that helps you maintain correct posture at all times. Be sure to get up out of that chair (correctly) at intervals to stretch your spinal column and strengthen your muscles.

Get off the elevator several floors below your own and walk up final flights of stairs, head and chest up, spine in perfect alignment. Don’t pull yourself up by the handrail; it’s best to lean forward and up, pushing yourself from one stair to the next by the springy leverage of your hips, legs and feet.
If your daily activities are primarily those of running a household, home or office you will find your day easier and less fatiguing if you use some of these exercises during your day.

Also, take breathers at intervals to stretch your spine and feel to strengthen unused muscles. No amount of exercise routines or stretches will help you correct your posture if you go to work and sit continuously for 6 hours a day, or slouch over the computer/watch T.V equally as long!

Being Overweight

In the last 60 years, the American diet has deteriorated and caused us to be obese and malnourished, with low energy and weak, slumped spines.

The more excess weight your body has to carry around, the more pressure there is on your joints and the harder they have to work, producing more wear and tear and eventually, pain!  There is a frequent correlation between being overweight and suffering from varied forms of arthritis.

1,300 pounds of pull are exerted on your spine and sacroiliac joints simply to maintain an erect posture, and almost the entire weight of your vital organs is borne by the spine, so excess fat usually results in chronic backache.

images (12)Treatment: A healthy, diet full of protein (not carbs) keeps your weight under control, and maximizes your body’s ability to heal itself.

Eat more beans, raw nuts, and seeds (such as sunflower, sesame, pumpkin), brewer’s yeast, wheat germ, soy beans, sprouts, tofu, soy protein powders, whole grain cereals, and soy and protein supplements.

By living a healthy lifestyle, establishing a regular regimen of diet and exercise that keeps your metabolism in proper balance. Metabolism is the intricate process by which your body converts food to energy. When you take in more fuel (food) than you burn up in energy (activities), the excess is stored as fat in the less used body areas.

Car Rides

Long car rides can harm your back as well. The culprit is the phenomenon of whole body vibration. It’s a risk factor for lower-back pain, says Dr. Malcolm Pope, director of the Iowa Spine Research Center.

images (12)Treatment: Simple steps you might take are: when the road gets rough, slow down (speed generally magnifies the effect of bumps), stop to stretch every hour of a long drive and, upon arrival, rest fatigued muscles a few minutes before unloading luggage.

Lifting Heavy Objects

A heavy shoulder bag can punish your back, too. Putting extra weight on your shoulder unbalances you and, to compensate, many people twist their spines, says rehabilitation specialist Dr. Karen Rucker of Virginia Commonwealth University. It’s best to take out things you really don’t need. holds true also for shopping bags.

images (12)Treatment: A strong abdomen can decrease stress and strain on the lower back and prevent injuries such as a compressed or slipped disc from lifting heavy loads and staying in a flexed position for too long.

Focus on strengthening your abdominal muscles with crunches to tighten up and strengthen the core that pulls posterior tilt backwards back into neutral.

Incorrect Breathing Techniques

Nearly all the people who I have seen with APT and/or lower back pain demonstrate paradoxical breathing, which means their diaphragm and ribs move up when they breath in during normal relaxed breathing.

Breathing incorrectly causes the muscles in the back to become over-developed. Until you address the breathing issue those erector spinae may continue to be rock hard and switched on.

By concentrating on belly breathing on a kneeling position, you can increase some degree of back extension and reduce upper back flexion without actively stretching your spine.

images (12)Treatment: Learning to breath correctly is the first step towards correcting posterior pelvic tilt, forward shoulders, and forward head.

During inhalation, push your belly out against the quads to make sure that you aren’t breathing into the supplemental respiratory muscles (e.g., sternocleidomastoid, scalenes, pec minor) we don’t want to use.

Brace and breath, pushing your stomach out ad you breath in. Holding the brace while breathing out.

Repeat exercise several times a day for 2 minutes each, trying to arch with the rhythm of each breath.

Incorrect Exercise routines

Some people considered to be at risk for posterior pelvic tilt are gym-goers who over-focus on developing glutes (their buttocks), abdominal muscles, and hamstrings.

In summary, these lifters overly-tilt their pelvises forward in order to allow the hamstrings to produce more force to compensate for weak gluteus maximus muscles that aren’t strong enough to finish off hip extension and provide sufficient posterior pelvic tilt torque to stabilize the pelvis (and therefore spine).

images (12)Treatment: Strengthen the posterior pelvic tilt movement pattern (as coach Contreras is a big advocate of) and ingrain good movement patterns in the gym and daily life are the keys to dealing with posterior pelvic tilt.

It may sound redundant, but sometimes you need to hear it a few times: optimal pelvic alignment means better posture, optimal muscle recruitment, better lifts, and better health.

Exercises To Correct Posterior Pelvic Tilt

Pelvic tilt exercises can help remedy poor posture by strengthening the muscles of your lower back and abdomen.

If you have a slight posterior pelvic tilt focus on exercises that strengthen your glutes and stretch out your hip flexors to bring your pelvis toward a more posterior position:

images (14)Sway your pelvis back and forth until it is tilting forward then try doing exercises that involves stretching the quadriceps muscle and strengthening your hamstring muscles in the back tight end.

The aim in each case is to adopt a gentle tilt in the direction specified, and then use your muscles to hold that position while performing the exercise – they are designed to ‘destabilise’ your pelvic tilt.

images (14)Glute bridges and hip thrusts are also great options to strengthen your glutes. Posterior pelvic tilts and leg raises are really great for working out all the important gluteus maximus muscles.

New mothers especially benefit from bridging as it helps strengthen the muscles of the pelvic floor and abdominals, which are often stretched and weakened from labor and delivery.

images (14)Strengthen the quadriceps muscles stronger with barbell squats, lunges, and step ups. Lunges are particularly good because they break the work into two separate legs, allowing for even more focus on the correct muscle group.The shorten them and hold your tilt back to neutral.

At the same time you need to stretch those hamstring muscles to allow that to happen once you get your pelvis back to neutral with the hips.

images (14)Posterior pelvic tilt hip thrusts, american deadlifts, and other exercises that strengthen the posterior pelvic tilt movement pattern and weak muscle groups (especially glutes and abdominals) are also great additions.

images (14)Probably the best known exercise for posterior tilt is the plank (or front bridge), in which you brace your body just off the floor, balanced on elbows and toes.

Plank exercises can also help prevent or reverse postural deficiencies, including lordosis and posterior pelvic tilt. Plank exercises help increase flexibility in posterior muscle groups throughout your body.

images (14)Individual resistance exercises are a necessary approach for the effective and fast strengthening of the pelvic posterior tilt muscles in case of LBP with excessive lordosis.

images (14)Pilates is a conditioning program that aims to stretch and strengthen muscles as well as correct muscular imbalances. New York Pilates suggests doing pelvic tilts and lunges to counteract a posterior pelvic tilt that causes the hip flexor muscles to tighten excessively.

In   position, you won’t find the tremendous spinal flexion and posterior pelvic tilt torques that you see during squats and deadlifts, but nevertheless the erectors typically fire very hard during these movements, creating high muscle forces and therefore spinal extension and anterior pelvic tilt torques.

images (14)For the more advanced lifters out there, progress by incorporating a posterior pelvic tilt at the top of exercises traditionally performed with a neutral pelvis.

images (14)Exercises that rotate the pelvis anteriorly will be much more effective in correcting the pelvic imbalance than reaching for the toes and attempting to force the back down (which has the added negative of a high risk of back injury).

Focus on strengthening the quadriceps muscles and stretching the core muscles the opposite at your tilt. These two muscles contribute to counter-balance the posterior pelvic tilt and help return it to it’s neutral position. In short focus on exercises that pull that posterior tilt backwards into neutral.

Consult a physical therapist or health care professional before attempting to self-treat pain or tension with the pelvic tilt or lift. The National Osteoporosis Foundation recommends working with a physical therapist who can help you learn to work and move in ways that will prevent your kyphosis from getting worse and hopefully correct the problem as well.

Surgery for Posterior Pelvic Tilt

Most functionally caused pelvic tilt is correctable with various manual therapies if corrections take place before permanent damage is done. Some advanced pelvic joint trauma will not respond to conservative type treatments and orthopedic surgery might become the only option to stabilize the joints.

In extremely advanced cases of joint deterioration, sometimes the only option is surgery. There has been a good deal of success with these procedures, and research is advancing the practice almost constantly.

The first kind of surgery is called osteotomy, in which damaged bone and tissue are removed and the joint is restored to its proper position.

Next are joint replacement surgeries, which can be either partial or complete, cemented or uncemented.

Your board certified orthopedist can help you to determine which is best for you, and we always recommend that you get at least three opinions before committing to any invasive surgery. The following illustrations show what is involved in total joint replacements.

Anatomy of Posterior Pelvic Tilt


The muscles involved in a pelvic thrust are also known as the core muscles, which include the gluteals and hamstrings, along with the muscles of the low back, the abdominal muscles, and the muscles of the pelvic floor.

If you have posterior tilt your lumbar spine is flattened. The body tries to balance itself so when the pelvis is not a neutral position is either anterior-posterior that it affects how your hip joints contact the pelvis.

Hip adductors, posterior pelvic tilt results in internal rotation of the femur.
If your posture is such that you have posterior pelvic tilt it puts more pressure, causing pain on part of the femur head.

If you have posterior pelvic tilt like most of the way is can be distributed in part of the femur head. If you have a high tilt with your hip high on the on the and low for the , then you’ll have most weight-bearing on part of the femur head which is unnatural.

The strongest correlation between pelvic tilt and one of the six parameters for both men and women was the distance between the upper border of the symphysis and the sacrococcygeal joint.

Signs of Posterior Pelvic Tilt

Some of the clinical signs associated with posterior pelvic tilt are: low or absent tone in the trunk muscles; limited hip flexion; abnormal tone in the trunk and/or lower extremities (e.g. extensor spacticity); pathological reflexes in the lower extremities or trunk; decreased lordosis; tight hamstrings; increased thoracic kyphosis (as shown above); and decreased pelvic/lumbar spine range of motion.

Symptoms of Posterior Pelvic Tilt

In my chiropractic clinic, I deal with a lot of people with posterior pelvic tilt, but not all the people I have observed in have back pain, but most do. I also see mainly in women, again, mainly because I probably see more women with back pain and in classes, but also I just don’t see anterior pelvic tilt in many men.

If allowed to go uncorrected the outcome is chronic lower back pain, disc degeneration , disc herniation or disc bulge , sacroiliac joint pain , muscle strain, pain in hip, and facet syndrome as well as other conditions that may cause spinal pain. Permanent damage from pelvic tilt can take place in the ligaments, joints, disc material, and bones.

According to Chris Gellert, MPT, posterior pelvic tilt compresses the dura and blood vessels of nerve roots, potentially creating lower extremity nerve problems.

Over time, posterior pelvic tilt can cause accelerated pitting and osteoarthritis in your hip joints so the idea is if you have any determine if you have anterior pelvic tilt or post your tilt.  Disc degeneration or lumbar disc bulge can also result from a pelvic tilt.