Pelvic Tilt: What Is It and How Do You Correct It?

Lateral, posterior, and anterior pelvic tilt - how do they impact your training and performance? Designing programs that aim to improve body alignment and posture is crucial for rehab, performance, and results. The goal of corrective exercise is to enhance the general well-being of an individual by improving functional movement through either exercise or soft tissue mobilization. Read on to learn more about misalignment of the pelvis and how you can use corrective exercises to fix it.

What is Pelvic Tilt?

The leading cause of movement dysfunction is muscle imbalance. Pelvic tilt is a common contributor to lack of mobility, stability, posture, and motor control. Pelvic tilt is the positioning of the pelvis in relation to the body. If your pelvis is out of positioning, it is usually tilted one way or another and can lead to many other disruptions in the kinetic chain.

In a lot of pelvic tilt issues, the hip flexor and hip extensor muscles are heavily influenced. Since these muscles attach to the pelvis and lower back you can expect other pelvic region muscles to tense up. These muscles include but are not limited to the psoas major, rectus femoris, and quadratus lumborum. These muscles affect the low back region and contribute to either good or poor posture. 

You want to help your clients avoid any further issues that can arise with pelvic tilts, including pelvic floor dysfunction (1). Once the ability to control the muscles of the pelvic floor is lost, it can cause many other things to go wrong within the body. This is because the pelvic floor muscles aid in organ function through muscle contractions.

It is important to implement corrective exercise into a client’s program to create a more durable body and fix current movement dysfunctions. Corrective exercise can help improve performance, restore performance, and reduce the risk of injury – starting helping more clients with the ISSA’s Corrective Exercise Specialist course!

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Types of Pelvic Tilt Issues

The three most common types of pelvic tilt issues are anterior, posterior, and lateral pelvic tilts. If you know that pelvic tilt is the positioning of the pelvis in relation to the body, you can then understand that each type of pelvic tilt indicates the direction that the pelvis is fixed in.

It is crucial that when identifying a client's pelvic tilt, you view these positions the correct way. The terminology at first can often confuse many fitness professionals and clients if not explained properly. 

What is Anterior Pelvic Tilt?

This is when the front of the pelvis rotates forward and the back of the pelvis rotates up. An anterior tilt, along with the other types of pelvic tilt issues, impact spine health and could be a direct result of inactivity or how a client sits. Excessive sitting causes hip flexors to tighten, which causes a change in the position of the pelvis. If the hip flexors take over spinal stability you compromise pelvic alignment. This is commonly seen during pregnancy. This muscle imbalance coincides with weak abdominal and gluteus maximus muscles. In this case, we can refer to it as pelvic crossed syndrome or lower crossed syndrome (2).

What is Posterior Pelvic Tilt?

Issues for posterior tilt are the opposite of anterior pelvic tilt issues. This is where the front of the pelvis tilts up and back, while the bottom of the pelvis rotates under the body. Just like anterior pelvic tilt, the spine is in a compromised position and the issue would benefit from corrective exercise. Tight hamstrings are one of the biggest contributors to posterior pelvic tilt issues.

What is Lateral Pelvic Tilt?

Each pelvic tilt is unique. A lateral pelvic tilt is when the pelvis shifts side to side, so much that one hip is higher than the other. This leads to unilateral muscle imbalances throughout the body. 

The erector spinae muscle group often affects this tilt and should always be addressed in this situation. To allow our lumbar spine to be in a neutral position, the pelvis should sit in line with our shoulders. One side should never be higher than the other. 

Common Causes of Pelvic Tilt Issues

How does your pelvis get out of alignment? Pelvic tilts do not just appear from nothing. They develop through certain movements and even inactivity. Finding where these imbalances lie and knowing how they can become worse can help your clients achieve better results.

Hip Flexors

Anterior pelvic tilt is a result of tight hip flexor muscles. When a muscle tightens, it shortens. When hip flexors shorten, hip extensors loosen up or lengthen. Hip flexor muscles like the iliopsoas, sartorius, and rectus femoris attach to the pelvis and the lower back. Due to the origin and attachment sites of these muscles, their key role is in bending the hip. Excessive sitting and poor posture keep the hips in a flexed position for a prolonged period. Bending at the hips will cause the front of the pelvis to rotate forward and the back of the pelvis to rotate upward. This body position makes someone prone to an anterior pelvic tilt.

Pelvic tilts are common during pregnancy and are essential to delivery. During pregnancy be sure to perform pelvic tilt exercises that help strengthen the core and surrounding muscles. Don’t forget that post-pregnancy corrective exercises are just as important.

Hamstrings, Glutes, and Abs

The opposite happens for a posterior pelvic tilt. Tight hamstrings and glutes pull the bottom of the pelvis underneath the body when the front of the pelvis tilts up and back. Tight abdominal muscles pull the pelvis up, while weak lower back muscles do not respond. This creates a posterior pelvic tilt issue. 

Quadratus Lumborum

If you’ve ever heard a client say they have one leg shorter than the other, then you might have a client with a lateral pelvic tilt. A lateral pelvic tilt can make one leg appear shorter than the other. In most instances, the quadratus lumborum is the main muscle responsible for creating and correcting a lateral pelvic tilt. 

The quadratus lumborum muscle lies deep within the abdominal wall and attaches to both the pelvis and lumbar spine. The key role of this muscle is lateral bending—bending from side to side. This helps stabilize the pelvis. As this muscle gets tighter on one side of the spine it will begin to pull the pelvis up on the other side, creating a lateral pelvic tilt.

To prevent pelvic tilt in your clients you must first understand proper positioning of the pelvis. Be proactive in assessing your clients to see if they have a pelvic tilt or if they show signs of one. As a fitness trainer, you should know if a tilt is present so you can prescribe a proper workout routine encompassing the right corrective exercise.

How to Design a Corrective Exercise Program to Correct Anterior Pelvic Tilt

First, determine what pelvic tilt a client has. Next, provide your client with an explanation of what you discover about their pelvis and the surrounding anatomy. To confirm your professional decision about their pelvic tilt you can perform a test to make sure your findings are correct. This helps build trust between you and your client and helps in designing their corrective exercise program to fix their pelvic tilt.

The Thomas Test is one of the most popular pelvic tilt tests for anterior pelvic tilt. For this test, have your client lie flat on a table with their legs hanging off the edge at the knees. Then have your client pull one leg into their chest using both arms. If the leg that is flat comes up off the table then your client has an anterior pelvic tilt.

After you identify anterior pelvic tilt or lower crossed syndrome, create a program that aims to loosen the hip flexors and quadriceps. Along with loosening these muscle groups, the program should encompass core and glute strengthening exercises putting the pelvis into a more neutral position.

Anterior Pelvic Tilt Exercises

Use these corrective exercises when designing a program that addresses anterior pelvic tilt:

• Lying Posterior Pelvic Tilt - Core and glute strength

• Lying Glute Bridge - Glute and hamstring strength

• Half-Kneeling Hip Flexor Stretch - Release tight hip flexors

• Bird Dog - Strengthen glutes and core stability

• Plank - Glute and hamstring activation adjusting pelvis towards a more posterior position, better than sit-ups because they support proper posture and encourage proper alignment of the spine

• Single-Leg Reverse Hypers - Glute strength

• Dead Bug - Core and hip stabilization to align the pelvis

• Quad Foam Roll - Myofascial release technique for quadriceps and rectus femoris

• IT Band Foam Roll - Release the tensor fascia latae (3) and iliotibial band

How to Design a Corrective Exercise Program to Correct Posterior Pelvic Tilt

Can you fix posterior pelvic tilt? First, determining if a client has posterior pelvic tilt issues can be as simple as examining the natural lower back curve a client should have. You can identify a posterior pelvic tilt when there is no natural curve in the lower back. You can even check to see where the posterior superior iliac spine is in relation to the anterior superior iliac spine.

The posterior superior iliac spine sits at the back of the pelvis found by feeling for the two bony landmarks in the lower back region. The anterior superior iliac spine is in the front as shown below. If the two in relation are almost horizontal to one another, then this can be a sign of posterior pelvic tilt as they should have a slight decline from front to back.

Once a client is found to have posterior pelvic tilt you need to address the issues by designing a corrective exercise program. This program should include loosening tight and overactive glutes, hamstrings, and abs. You must also consider strengthening the weak hip flexors and lumbar erectors.

Posterior Pelvic Tilt Exercises

Use these corrective exercises when designing a program for posterior pelvic tilt:

• Seated Hamstring Stretch - Stretches tight hamstrings causing the pelvis to tilt backward

• Superman - Strengthens weak gluteal muscles and lumbar spine

• Cobra - Loosens tight abdominals, great for stretching the psoas muscle (4) pulling your pelvis forward

• Leg Raises - Strengthen weak hip flexors

• Standing Hip Raises - Strengthen weak hip flexors

• Figure 4 Gluteal Stretch - Release tight glute muscles

• Good Morning - Encourage hip hinge movement and anterior pelvic tilt position

• Glute / Piriformis Foam Roll - Release tight glutes

• Hamstring Foam Roll - Release tight hamstrings

How to Design a Corrective Exercise Program to Correct Lateral Pelvic Tilt

Examine your client to see if one side of the pelvis is higher than the other. Look to see if the upper body leans one way more than the other. If this is the case, then the pelvis on the opposite side is likely shifted upward and turned that direction. With either side of the ilium being flexed the other side is extended, causing the pelvis to rotate internally or externally. 

The Trendelenburg test can confirm weakness in the hip abductors. To perform this test, have your client stand tall and lift one leg off the ground. If there is a significant drop in the hip of the leg on the ground, then the client tests positive. It proves the glutes on that side are not activating properly.

Looking for this asymmetry in a client is not hard to find and once discovered you can design a proper corrective exercise program. For lateral pelvic tilt issues, you need to target the weaker and tighter side of the body along with glute strengthening exercises. It is also imperative to have your client perform myofascial release techniques on the quadratus lumborum, erector spinae, and core musculature. Body balance is extremely important and each muscle balances another. With knowing this, you can understand how important unilateral corrective exercises are in a program created to address lateral pelvic tilt.

Lateral Pelvic Tilt Exercises

Use these corrective exercises when designing a program that addresses posterior pelvic tilt:

• Lying Reverse Leg Raises - Due to weaker hips, one sitting lower than the other, this will help strengthen the weaker side

• Standing Reverse Leg Raise (Glute Kick Back) - Strengthening the weaker side overtime will align back with other fixing the unilateral imbalance

• Clamshell Exercise - Helps strengthen the gluteus medius located on outer area helping stabilize your pelvis; creates more balance between inner and outer legs

• Quadratus Lumborum /Oblique Overhead Stretch

• Lying on Side Leg Lift - Strengthens the gluteus medius

• Foam Roll Lower Back/ Quadratus Lumborum - Release tight quadratus lumborum pulling on either side and erector spinae, lumbar spine

As always, make sure you know your scope of practice as a personal trainer. It is important to understand what you legally can do when dealing with your clients’ movement dysfunctions. 

Become the go-to expert for clients with muscle-related pain or movement limitations. ISSA’s Corrective Exercise Specialist course will help you learn how to guide clients to help them correct those dysfunctions and more. Begin expanding your business today! 

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References

1. Anthony, K. (2018, September 18). Pelvic floor dysfunction: Symptoms, causes, and treatment. Healthline. Retrieved January 25, 2023, from https://www.healthline.com/health/pelvic-floor-dysfunction

2. Lower crossed syndrome. Physiopedia. (n.d.). Retrieved January 25, 2023, from https://www.physio-pedia.com/Lower_crossed_syndrome

3. T, L. (2022, October 3). Tensor fascia latae muscle and the iliotibial band. Yoganatomy. Retrieved January 25, 2023, from https://www.yoganatomy.com/tensor-fascia-latae/

4. Sajko, S., & Stuber, K. (2009). Psoas Major: A case report and review of its anatomy, biomechanics, and clinical implications. The Journal of the Canadian Chiropractic Association, 53(4), 311-318. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796950/