Posterior Pelvic Tilt Pain – What Causes Painful Pelvic Tilt?

Q: I feel pain in my leg when I go up stairs…I think I have posterior pelvic tilt pelvis tilt(never officially diagnosed.) Why is my pelvic tilt causing me pain, and what can I do to get rid of the pain in my leg?

A: The fact that you feel pain when you lift your leg to go up the stairs tells me it isn’t your psoas that is causing the pain, it’s a tight quadratus lumborum (posterior lumbar muscle), tight glutes (as you already knew) and your hamstrings are contracted (a side effect of your pelvis rotation). These are all symptoms of posterior pelvic tilt, which also creates a feeling of pinching or pain in the lower back.

The pain may remain static, e.g., in one place such as the front of the pelvis, producing the feeling of having been kicked; in other cases it may start in one area and move to other areas.

What Causes the Pain?

Excessive APT causes painful jamming of your facet joints and excess tension in the lumbar erector muscles.

Pain also occurs because hamstrings are generally, but not always, tighter than they should be in folks with APT because they are not as stretched in the typical seated posture.

In one case, the hamstrings will feel tight simply because they are constantly being lengthened and tugged, in the other case they are actually tight. If you are frequently sitting, your hip flexors shorten, and the body adaptively shortens these muscles into this new position.

If you are indeed in APT the quads at they attach proximally at the hip are going to be a little short and stiff from poor positioning so your feel some quad burn because they are getting lengthened and working in this new alignment.

We often feel symptoms/pain in the muscles when there is some spinal dysfunction, but also realize that the muscle system is very important to overall health, and that dysfunction there should be addressed.

From personal experience (I suffer from anterior pelvic tilt, forward shoulders and a bit of a vulture’s neck) I feel that first inhibiting overfacilitated or shortened muscles and then strengthening their weak antagonists helps the most.

Exercise to Relieve Posterior Pelvic Tilt Pain


One of the most common postural adaptations that I see on a day to day basis is posterior pelvic tilt. The key to relieving the pain of posterior pelvic tilt is

  1. fix your breathing
  2. train the core for anti-extension and anti-rotation with a stable pelvis and
  3. train unilaterally in half-kneeling and tall-kneeling positions to drill good pelvic position.

This will create a slight bend in your knees and a posterior pelvic tilt that will alleviate the jamming of the lumbar facets, which are a common pain generator when lying flat.

Here are some exercises you can do:

  • Walking will strengthen your abdominals, obliques, hamstrings, glutes while at the same time stretching the quad, hip flexor and gently lengthen the lower back if you walk with an upright posture.
  • Furthermore, sit ups would work well for improving APT for this population as it also would strengthen APT torque production.
  • Swayback during presses, pulldowns, and a wide range of other exercises goes hand in hand with APT, and in combination with quad dominant lifting, poor glute involvement, and knee drift (squats) this poor alignment strengthens muscle groups that are already strong and set you up for injuries.I promise that with these 3 exercises you won’t have anterior pelvic tilt anymore and you’ll feel great doing these exercises.

Do them every day until you feel that you’ve gotten better in postural perspective, after that you can cut it down to maintenance, like 2-3 times a week.

Once you’ve got your pelvic position in check (which can take anywhere from a single workout up to several months), feel free to defer the drills to post-workout for cool-down and maintenance purposes.

If you’re in excessive APT, then I recommend you abandon your current routine and stick solely with the exercises and stretches mentioned in this article for 8 solid weeks.

Different Tilts, Different Pains

Normally when I ask a person with APT to lean back in standing (multi segmental extension) they can do it and there is no pain, and all sorts of McKenzie extension positions don’t make any difference to pain in those with back pain (pain could stay the same, go away, get worse, or not be a problem on that particular day).