How to Fix Posterior Pelvic Tilt (UPDATED 2020)

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.

Why does it need to be addressed?

Having a Posterior Pelvic Tilt can significantly effect the rest of your posture. (… even up into the upper back and neck!)

When your pelvis tilts backwards, there will be an associated flattening/rounding of the natural curve of the lower back. (… also referred to as a loss of lumbar lordosis)

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

  • disc bulges
  • nerve issue
  • 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 posture 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

butt wink

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.

The main cause

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!)

Which Muscles cause Posterior Pelvic Tilt?

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.

Tight/overactive Muscles:

  • Hamstring
  • Gluteal group
  • Abdominal

Weak/Elongated Muscles:

  • Hip flexor group
  • Lumbar spine erector group

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

How do I know if I have a 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”.

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

hamstring release 

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:

L sit

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

hamstring 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 capsule release

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)

Video from Generation Care Centre.

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)

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)

how to do a 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)

tilt in sitting

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

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!


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)

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

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 posterior pelvic tilt


8. BONUS tips

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

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) Bend your knees when lifting objects from the floor

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

d) Avoid overdoing reverse curls

Abdominal reverse crunches will tend to encourage a posterior pelvic tilt.

e) Do NOT butt/abdominal grip

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

f) When standing – do not push your hips forwards

Avoid resting your hips in the forwards position.

This will encourage the pelvis to tilt backwards.

g) Avoid sitting on soft sofas

There is no support for your pelvis on these!

h) Driving

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


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!

210 thoughts on “How to Fix Posterior Pelvic Tilt (UPDATED 2020)”

  1. My daughter had back surgery several years ago. She also had a total hip replacement twenty years ago. Recent xrays showed a tilted pelvis. Hip and back are both fine. She does not help with anything and will not lean over to clean her cat box. She sits in her job and at home. Should she be doing these exercises with her history? Should she be moving more and helping with housework? I am 78 and she is 58. I do the lawn and all housework. Look forward to hearing from you.

    Reply
  2. Hey Mark!

    Amazing information as usual. I’ve been working on my standing anterior pelvic tilt and other ailments every single day the last 3 months and its finally dramatically better, I’m starting to naturally pass the wall test. My question is when I sit or bend over my pelvis wants to go into a posterior tilt, I hardly ever have to sit, I’m standing all day long, but when I “sit properly” my lower back tires out extremely quick. Would it be wise to add some of these stretches/exercises to my routine or would that hinder the progress I’ve made with my standing APT? Also, I’m way more flexible everywhere except my groin and hip flexor areas, butterflys are the only real stretch I’m making little progress in, any suggestions?

    Thank you very much,

    Ryan

    Reply
    • Hey Ryan,

      If your lower back tires after sitting for a long period of time, you might want to ease off 20-30% of your correction.

      Remember- we are not trying to jam our back stiff to keep good posture.

      If you are still having issues, consider doing some lower back endurance training (eg. superman holds)

      In regards to your stretches, try holding them for longer as opposed to doing many 3-4 sets of 30 seconds.

      Mark

  3. Hello, Mark and thanks for your good work. I have been diagnosed with hypolordosis, probably related to aging of my spine, arthritis, stenosis, etc. etc. etc. (!!). I know that your flatback exercises are primarily for those with postural rather than structural problems such as mine. Nonetheless, I am desperate to avoid surgery. I workout every day and since my hypolordosis symptoms have worsened, I am trying hard to integrate specific movements to address the flatback problem with the hope that even though it can’t change structural, perhaps dealing with the muscular problems will help, even slightly. I also feel being proactive in this way — even if not guaranteeing improvement — will be psychologically helpful to me. I would be hugely grateful is you could suggest which of the many exercises you discuss for hypolordosis are the most important for beginning. Not a single practitioner I have seen (including physical therapists, orthopedic docs and (ugh) spinal surgeons have addressed my hypolordosis in any meaningful way. Thank you for being someone who gets it. I feel lucky to have found you.

    Reply
    • Hello Anita,

      The exercises specifically I recommend for a flat back are in this blog post: How to Fix Flat back posture.

      I would strongly encourage you to get very good at the “segmental cat/cow exercise” (have a quick search on youtube for this)

      In the event your back is fused, you will need focus your attention on all of your other joints in your body that you do have control over and get them stronger as much as you can.

      Mark

  4. hello i have Posterior pelvic tilt whilst sitting and bending and squatting and i have Anterior Pelvic Tilt and Swayback whilst standing With upper cross syndrome In the upper body What is the strategy to correct all of these poor posture

    Reply
  5. Hey Mark. I was told my my other doctor that I know pain at the top of my knee cap due to PPT. I just started the excersize as described and already feeling better but the pain comes and goes. How long would u say it will take for the pin to be gone after I retrain my spring curvature?

    Reply
  6. I cant do the posterior capsule stretch on my right side because it puts a massive stretch on the front right side of my hip region where the tfl muscle is and because of that i cant even get in the proper position to do the stretch. On the left side it is not tight. I also feel the Pelvic tilt (in 4 pt kneel)
    Only on the right side of my back. Any idea wat the problem could be?

    Reply
    • Hi Erik,

      It might be due to a lack of external rotation in your hip.

      [see image]

      If you don’t have hip external rotation, it will be difficult to get into the said stretch.

      Mark

    • Hi mark,

      It turns out you are 100% right. I have a right rotated pelvis, but wich exercises from this blog (PPT) would you recommend me to keep doing? Hopefully not all of them anymore 😉😅. Thank you for all the help btw, it is very much appreciated.

    • Hey Erik,

      I usually recommend to do all of them in the initial stages.

      Reason behind this is that you can see/feel which exercises your body responds to the most. From here- you can focus on the select few.

      Mark

  7. Hi Mark,

    Some advice in this page and your swayback posture page seem to be at odds with each other (e.g. “avoid tensing glutes unnecessarily” on this page and “Strengthen gluteal group” on swayback page).

    Is there a big difference between PPT and Swayback?
    How can I tell which one I have? Or is both likely?

    Reply
    • Hey Ross,

      Sway back posture refers to the pelvis being IN FRONT of the ankles and encompasses a range of postural deviations. It will occur with a posterior pelvic tilt.

      You can strengthen your glutes. This is different to overly tensing them when they should be relatively relaxed.

      Mark

  8. Hi,

    I’m having trouble understanding how to tilt your pelvis forward, such as the pelvic tilt in sitting. It feels like I’m just pushing my lower spine forward.

    Reply
    • Thanks. I’ll take a look at that.
      Also, when I try to do the hinging and hamstring stretch, it feels like I’m just bending from the middle of my back and lower back remained curved.

    • Hi Jon Yee,

      You might have a super tight upper hamstring. This will make it hard to maintain a neutral lower back arch when hinging.

      If this is the case – I would release and stretch out that upper hamstring until it becomes easier.

      Mark

    • Do you have any recommendations of stretches for upper hamstring? I was thinking of sitting on a tennis or lacrosse ball on a hard surface to roll it out.

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