How to Fix Posterior Pelvic Tilt

What is a Posterior pelvic tilt?

posterior pelvic tilt

A Posterior Pelvic Tilt is where the pelvis is rotated backwards from the ideal neutral position.

The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. For more information: Medical disclaimer.


Is Posterior Pelvic tilt Bad?

Having a Posterior Pelvic Tilt can significantly effect the rest of your posture. (… it can even lead to Thoracic Kyphosis!)

When your pelvis tilts backwards, there will be an associated flattening/rounding of the natural curve of the lower back (Hypolordosis).

Without a natural curve in your lower back, you may be placing your lower back at a higher risk of developing:

  • Disc bulges
  • Nerve issues
  • Muscular strains

Note: Having a pelvis that has the ability to rotate backwards is normal! However-  if your pelvis is stuck in this position, this is where issues can arise!

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When do people experience a Posterior pelvic tilt?

a) Sitting

sitting with posterior pelvic tilt

Do you slouch in your chair?

If you do, then your pelvis is most likely to be in a position of posterior tilt when sitting.

b) Squatting

squatting with posterior pelvic tilt

If your lower back tends to round whilst performing a deep squat, then your pelvis is most likely rotating backwards.

This is referred to as the “butt wink”.

c) Bending forwards

ppt bending

Think about the times when you are picking something from the floor, tying your shoe lace or even putting on your underwear.

Are you rounding your lower back?

If so, you have a Posterior Pelvic Tilt!

d) Standing

standing with posterior pelvic tilt

If you have a Sway Back Posture or Flat Back Syndrome, then you likely have a Posterior Pelvic Tilt as well.

What causes Posterior Pelvic Tilt?

If I were to blame just one thing, I would say: Sitting.

You are either sitting too much and/or sitting with bad posture.

(… And if I were to guess, I would say that you are probably doing both!)

Excessive sitting causes certain muscles that control the position of the pelvis to get tight/overactive and/or weak/inhibited.

As a result, there is an imbalance of the forces around the pelvis region causing a net force to tilt backwards.

Muscles involved with Posterior Pelvic Tilt

Tight/overactive Muscles:

 

  • Hamstring
  • Gluteal group
  • Abdominal

Weak/Elongated Muscles:

  • Hip flexor group
  • Lumbar spine erector group

(These are the muscles that will be addressed in the exercises mentioned below.)

How can you tell if you have Posterior pelvic tilt?

posterior pelvic tilt test

a) In Standing:

Place one finger on your pointy bone at the front of your hips (ASIS) and another on your pointy bone at the back (PSIS).

If you have a Posterior Pelvic Tilt: the finger at the front of your hip bone will be significantly higher in comparison to the finger on the pointy bone at the back.

(Note: Everyone has different shaped and sized “pointy bones”. This can influence the results.)

b) In Bending forwards, Squatting or Sitting:

Pay attention to the shape of your lower back.

If at anytime the lower back curves forward, then it is likely your pelvis is tilting backwards.

Posterior pelvic tilt Exercises

1. Releases

It is vital to stretch/release the muscles responsible for holding the pelvis in a posterior tilt.

(… the hamstring and abdominal muscles are usually the culprits responsible.)


a) Hamstring

releases for posterior pelvic tilt 

Instructions:

  • Place your hamstrings on top of a massage ball. (see above)
  • Use your body weight to apply pressure onto your hamstrings.
  • Make sure to cover the entire hamstring muscle
  • Do this for 60 seconds.
  • Alternate sides.

b) Gluteals

glute release

Instructions:

  • Place your gluteals on top of a massage ball. (see above)
  • Use your body weight to apply pressure onto your gluteal muscles.
  • Make sure to cover the entire muscle.
  • Do this for 60 seconds.
  • Alternate sides.

c) Abdominal (Lower)

abdominal release

Instructions:

  • Lie on your stomach.
  • Place a massage ball under the lower abdominal region
  • Gently circulate your body weight on top of the ball.
  • Be careful not to apply too much pressure.
    • (Do not squash your organs!)
  • Use deep breaths to help relax your muscles.
  • Hold for 60 seconds.

2. Stretches


Test for tight hamstrings:

hamstring length test

You should be able to sit on the ground with your back up against the wall whilst keeping your legs completely straight. (… whilst maintaining a normal lower back arch)

If you can’t, it is likely that you will have tight hamstrings.


a) Hamstring

posterior pelvic tilt stretches

Instructions:

  • Stretch Upper and Lower hamstrings:
    • Upper: Whilst standing, place a slightly bent knee in front of you.
    • Lower:  Whilst standing, place a straight knee in front of you.
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the respective region of your hamstrings.
  • Hold for 60 seconds.
  • Alternate legs.

b) Gluteals

glute stretch

Instructions:

  • Lie on your back with your knees bent and feet on the floor.
  • Place your left ankle on the right knee.
  • Grab your right knee and pull towards your chest.
  • Aim to feel a stretch on your left glute.
  • Ensure that you arch your lower back to increase the stretch.
  • Hold for 60 seconds.
  • Alternate sides.

c) Abdominal stretch

abdominal stretch

Instructions:

  • Lie on your stomach.
  • Place hands on floor directly under shoulders.
  • Straighten your elbows.
  • Arch backwards.
    • Be careful if you have lower back issues.
  • Aim to feel a stretch across your lower abdominal region.
  • Breathe and expand your stomach as you stretch.
  • Hold for 60 seconds.

3. Joint mobilization

Tight hip joints can make it very difficult to maintain a neutral pelvic alignment.


a) Posterior capsule stretch

posterior hip capsule stretch

Instructions:

  • Assume the position as seen above.
  • Make sure your knee is directly underneath your hip joint.
  • Maintain the lower back arch throughout movement.
  • Push your hips backwards.
  • Feel a deep stretch in the back of your hip.
  • Hold for 30 seconds.
  • Repeat 3 times.

b) Hip traction (Leg bent)

hip joint traction

Instructions:

  • Lie on the floor in the position as shown.
  • Anchor a thick resistance band to a stationary object.
  • Flex your hip to 90 degrees.
  • Wrap the resistance band as high up into the hip crease as possible.
  • Move your whole body further away from the anchor point.
    • This to create tension on the band.
  • Hold onto your knee with your hands.
  • Keep the hip completely relaxed.
  • Hold for 1-2 minutes.
  • Alternate sides.

c) Hip Traction (Leg straight)

traction of hip

Instructions:

  • Lie on the floor.
  • Instruct a friendly helper to firmly grasp your ankle. (see above)
  • Relax your leg as your assistant pulls your foot away from you.
  • Aim to feel a pulling sensation in the hip.
  • Hold for 30 seconds.
  • Repeat 3 times.

4. Activate the inhibited muscles

The muscles that are responsible for reversing the Posterior Pelvic Tilt are not being recruited.

Wake up your sleeping muscles!


a) Sitting knee lifts

(This is to activate the hip flexor muscles.)

sitting hip flexion

Instructions:

  • Sit up right.
  • Whilst maintaining the arch in your lower back, lift your knee up as high as possible.
  • Do not let your pelvis rotate backwards.
  • Hold for 5 seconds.
  • Alternate for 15 repetitions each.
  • Progression: Use resistance bands between your feet.

b) Superman

(This is to activate the lower back muscles.)

lower back exercises

Instructions:

  • Lie on your stomach.
  • Stretch out your arms in front of you.
  • Lift your upper body and legs off the floor.
  • Aim to feel a contraction of the muscles in your lower back.
  • Hold for 5-10 seconds.
  • Repeat 30 times.

5. Strengthening exercises

a) Pelvic tilt (in 4 pt kneel)

strengthening exercises for posterior pelvic tilt

Instructions:

  • Assume 4 point kneel position. (see above)
  • Arch your lower back as you tilt your pelvis forward.
  • Aim to feel a contraction in the muscles of the lower back.
  • Hold for 10 seconds.
  • Return to neutral spine.
  • Repeat 30 times.

b) Pelvic tilts (in sitting)

how to pelvic tilt

Instructions:

  • Sit on an exercise ball or a chair.
  • Sit upright. Think long and tall throughout the spine.
  • Proceed to tilt the pelvis forward.
  • Aim to feel a contraction in the muscles of the lower back.
  • Hold for 10 seconds.
  • Repeat 30 times.

 

c) Sitting pelvic tilts (with resistance band)

Instructions:

  • Place a resistance band around your waist. Tie other end to a stationary object behind you.
  • Sit on an exercise ball or chair.
  • Sit upright.
  • Proceed to tilt the pelvis forward.
  • Hold for 10 seconds.
  • Repeat 30 times.

 

d) Hip flexion with neutral pelvis

4 pt kneel hip flexion

Instructions:

  • Assume the position as seen above.
  • Make sure that your pelvis is in a neutral position.
  • Engage your core muscles.
    • Think about a) drawing your belly button in and b) gently tensing your abdominal muscles.
  • Bring your knee up to your chest whilst maintaining a slight arch in your lower back.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Alternate legs.

e) Standing pelvic tilts

anterior tilt of pelvis

Instructions:

  • Whilst standing upright – tilt your pelvis forwards.
  • Try not to move your torso or legs.
  • Repeat 20 times.

6. Maintain a neutral pelvis

You can perform all the above exercises, BUT… if you do not apply it to the positions you adopt for most of the day, then your posterior pelvic tilt will continue to exist.

Since you have most likely had your Posterior Pelvic Tilt for some time now, your body is going to try and go back to it as a default setting. You need to resist this!


Be aware of your pelvis position.

Maintain a neutral pelvis throughout the following positions:

a) Sitting

“Sit on your sit bones”

Instructions:

  • Whilst sitting, place your hands underneath each buttock cheek.
  • Tilt your pelvis forwards and backwards.
  • Feel for a pointy bone prominence.
    • These are your sit bones.
  • To position your pelvis properly: Sit directly on top of the pointiest part of the sit bone.

Most people will tend to let their tail bone tuck underneath and sit behind the sit bones.

b) Hip hinge (aka bending forward)

hinging

Instructions:

  • From a standing position, hinge forward from the hips.
  • Make sure to keep your back completely straight.
  • Only bend forward as far as you can maintain neutral pelvis.
    • Tightness in the hamstring region should be the limiting factor to your movement.
  • Repeat 20 times.
  • To progress: Hold onto a weight.

c) Squatting

sit to stand squat

Instructions:

  • Stand sideways to a mirror so that you can monitor the curvature of your spine.
  • Practice squatting as deep as you can go.
  • Only squat to a depth without letting your lower back bend forwards.
  • Maintain neutral pelvis.
  • Repeat 20 times.

d) Walking

When walking – be mindful of the position of your pelvis.

If it is comfortable, try to maintain a more neutral pelvis. (… but don’t force it!)

 

7. Other things to address

If you have tried all of the above exercises and you still have a Posterior Pelvic Tilt, you may need to consider addressing the following postural issues:


a) Sway Back Posture

sway back posture posterior pelvic tilt


b) Flat Back Posture

flat back posture posterior pelvic tilt


8. BONUS tips

Sitting with a Posterior Pelvic Tilt:

a) Use a lumbar support in sitting

This will maintain the natural lumbar curve and discourage the pelvis from slouching.

b) When sitting – keep hips higher than knees

sitting tips

If your knees are higher than your hips, it is very difficult to sit with proper posture.

Consider:

  • Increasing the height of the chair.
  • Using a kneeling chair
  • Using a seat wedge cushion.

c) Large belly size and sitting

If you tend to have a large stomach, this will create a physical block between your pelvis and thighs which can lead to the pelvis being placed in the wrong position.

If you fall into this category, I suggest that you sit from a slightly higher chair so that there is adequate space at the front of the pelvis.

d) Avoid sitting on soft couches

Couches are usually too soft, too low and too deep to provide adequate support for your pelvis.

e) Driving

Adjust your car seat appropriately to ensure you sit with good posture.

 

Standing with Posterior Pelvic Tilt:

a) Do NOT butt/abdominal grip

This basically means to avoid over tensing your glutes and/or abdominal muscles whilst you are standing. Relax!

b) Do not push your hips forwards

Avoid resting your hips in the forwards position.

This will encourage the pelvis to tilt backwards.

Sleeping position:

a) How should I sleep to correct Posterior Pelvic Tilt?

If you sleep on your back, place a small rolled up towel underneath the arch of your lower back.

This will help maintain the arch required to keep the pelvis in a more neutral position.

Other:

a) Bend your knees when lifting objects from the floor

This will help keep your back and pelvis in a more neutral position.

b) Avoid overdoing reverse curls

Abdominal reverse crunches will tend to encourage a posterior tilt of the pelvis.


What to do next

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!

244 thoughts on “How to Fix Posterior Pelvic Tilt”

  1. Hello Mark,

    I am definetely sure that I have posterior pelvis tilt but only one side. Is this possible to have one sided posterior pelvis tilt? Also, that side’s hip flexor muscle is very weak.

    The thing I discovered lately is my Rectus Femoris on the same side take over Psoas muscle. So I have 2 questions;

    1_ What can I do to neutralize posterir pelvic tilt only for one side?
    2_ How can I isolate Psoas or minimize the recruitment of other muscles instead of Psoas?
    – I learned a movement which you tie your ankle and hip al together (like bending knee) and do hip flexion when lying down. Does this eliminate rectus femoris since it elongates the muscle?

    Reply
  2. Mark, you don’t know how much impact you’ve made on me. I’ve sat all my life. Although I exercise often, when I sit down and work, I’ve never been able to maintain steady focus for long periods because I get uncomfortable sitting. Before, I would go home and just crash because of headaches, tight and overactive back and neck muscles. Now, much less. Since learning sitting posture I feel so much better. Energy levels have gone way up. It’s amazing how bad posture has robbed me of my energy. When I go home, I still have plenty of energy to be productive.

    Thanks a million!

    Reply
    • Whoa! What an awesome comment you left here, Kevin.

      Great to hear that you have more energy after fixing your sitting posture. Hope the exercises continue to help you out!

      Thanks for letting me know!

      Mark

      Reply
  3. Mark, hi great website! I have had sciatica pain for the past two months. An X-ray done showed I have a pelvis tilt, my right side hip is higher than the left. I went to an acupuncturist twice. The pain I have is when attempting to get comfortable falling asleep or staying asleep for the full night. The nerve feels like a severe cramp and does not let me sleep whether I’m lying on my good or bad side nor on my back. What exercises/stretches do you recommend and what to do to get a full nights rest. Thank you for your time.

    Reply
    • Hey Isaiah,

      Do you have a disc bulge that may be irritating the sciatic nerve?

      You will need to get a CT or MRI scan to determine this.

      If you do, I have some simple exercises that might help you out on this blog post:

      Bulged Disc Exercises.

      (If you are in a lot of pain, you might need to do just stick with 1 or 2 of the basic exercises and slowly progress as tolerated)

      Mark

      Reply
  4. Hi Mark! One struggling to improve hip flexion due to tfl. I also have very limited knee extension.
    Would lying knee extension exercise while hip flexed improve hip flexion due to rectus femoris being a biarticular muscle?I’ve tried for some weeks and seams so but I would like to know if my thought is right. Thanks!

    Reply
    • Hi Charles,

      Do you mean you are have limited hip flexion range?

      If you experiencing a pinch at the front, it could be due to hip impingement.

      See post: Hip Impingement.

      Limited knee extension is usually due to some sort of hamstring/popliteus/calf tightness and/or a knee joint problem.

      Mark

      Reply
  5. Thanks a lot Mark for answering my other question. Just one follow up. You mention using a kneeling chair. I don’t have a kneeling chair, but I can get my office chair pretty high. My question is if I should sit with my legs like on a kneeling chair? Basically with the feet under my butt (instead of in front of me) and feet alsmost vertical? When I sit I often get tightness/pain in the front of my knees and I wonder if it could be the sitting position.

    Reply
    • Hey Thomas,

      If you tuck your feet underneath you whilst sitting on a chair, this places your knee in more flexion which can compress (or pull on) some structures at the front of the knee. This might be the reason why you get a bit of tightness at the front.

      The kneeling chair will place more pressure on your knees so it is probably not recommended if you have existing knee issues.

      Mark

      Reply
  6. Thanks a lot for all the instructions! One thing I’ve been wondering. Can tight hamstrings and glute come as a result of forcing the lower back and pelvis into a posterior pelvic tilt? So more like the other way around than what is usually said with tight hamstrings and glutes causing a posterior pelvic tilt.

    Reply
    • Hi Thomas,

      Yes – as hamstrings are used to posteriorly tilt the pelvis, prolonged periods of this pelvis position can result in hamstring tightness.

      It works both ways.

      Mark

      Reply
  7. Hi Mark! thanks for the site it’s incredibly useful. I have a diagnosed Posterior PT but I’m having a very hard time activating my hip flexors. Everytime I try to do any hip flexors exercise my TFL takes all the work. Besides I would very much like to know how to activate my psoas but after trying everything I can’t even feel it.
    Thanks!

    Reply
    • Hello Manu,

      It is quite common to get the TFL to take over during hip flexion.

      My suggestion: Make the exercises easier. eg. instead of lifting your knee up whilst sitting, you can do this same exercise whilst lying on your back with feet supported on wall.

      Mark

      Reply
    • Hey Pippo,

      If there is any tightness in the adductors, it would most likely be the posterior section of the adductors. (right next to the medial hamstrings)

      You can release/stretch this area similarly as you would with the hamstrings.

      Mark

      Reply
  8. Hi Mark–

    Thanks for these blog posts! I have really bad posterior pelvic tilt (cannot hinge forward in pancake at all, even when raised on blocks, and struggle in pike pose too). However, when running I was told that I have flat/heavy feet and my knees collapse inwards. Is this a case of muscle weakness or tightness, and which exercises would you most recommend?

    Thanks,
    Jess

    Reply
  9. No I actually have a slight swayback posture, that’s why I’m trying to understand why my perineum pain disappear when I do a posterior pelvic tilt and wish you could help

    Thanks

    Reply
    • Hi Louis,

      Due to the many factors that will contribute to your symptoms, it is probably best to get an in-person assessment by a pelvic floor specialist or perhaps someone well-versed in PRI.

      If a posterior tilt helps, then it is probably be due to its effect on the musculature that make up that area of the body. The pelvis position can influence the ability of certain pelvic floor muscles to engage or relax.

      Mark

      Reply
  10. Hey Mark,
    First thanks for all your help,

    I feel a tightness in my perineum when I’m standing, and I noticed that when I put my pelvis in a posterior tilt position on purpose, it relieves the pain, could you help me indentifying the problem?

    Reply

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