Does Anterior Pelvic Tilt Cause Lower-Back Pain?

Anterior pelvic tilt refers to a perceived misalignment of the pelvis. 

Some associate it with an array of undesirable symptoms, such as poor posture and back, hip, and knee pain, which is why many look for guidance on how to fix anterior pelvic tilt.

Others think anterior pelvic tilt is a benign variation of normal human anatomy that can’t (and shouldn’t) be corrected using a program of anterior pelvic tilt exercises and stretches. 

What is anterior pelvic tilt?

What causes it?

And should you try to fix it?

Get evidence-based answers to these questions and more in this article.

What Is Anterior Pelvic Tilt?

Anterior pelvic tilt (APT) refers to a posture where your pelvis tilts forward so that when viewed from the side, the front of your pelvis is lower than the back.

A good way to imagine this is to think of your pelvis as a bucket filled with water. If you have APT, water would pour out of the front of the bucket when you’re standing upright. 

Anterior vs. Posterior Pelvic Tilt

Your pelvis can also tilt backward so that the back of your pelvis is lower than the front when viewed from the side.

This posture is referred to as posterior pelvic tilt (PPT). 

Again, imagine your pelvis is a bucket filled with water. If you have PPT, water would pour out the back of the bucket when standing upright. 

Here’s an illustration showing the difference between these types of pelvic tilt and a neutral pelvis:

What Causes Anterior Pelvic Tilt?

In the 1980s, researcher Dr. Vladimir Janda theorized that prolonged sitting leads to Lower Crossed Syndrome, a condition in which weak gluteus maximus and abs cause tightness in the hip flexors and erector spinae (lower-back muscles) that “pulls” your pelvis into APT.

While there’s little evidence this theory is correct (something Janda’s website acknowledges), it remains the most widely accepted explanation for APT.

Many personal trainers, physiotherapists, and health bloggers repeat this theory as if it were a proven fact, but currently it’s just a hypothesis.

Anterior Pelvic Tilt Symptoms

Some believe that imbalances in the muscle groups associated with Lower Crossed Syndrome and APT cause the following symptoms:

• A tilted pelvis
• A curved lumbar spine (lower back), known as lumbar lordosis
• Protruding abdomen
• Hip flexor muscle pain and/or tightness
• Lower back pain and/or tightness
• Knee joint pain
• Increased risk of back, hip, and knee injury

Do I Have Anterior Pelvic Tilt?

The simplest way to determine whether you have APT is to inspect your side profile in the mirror.

If the front of your pelvis is lower than the back, you have APT.

However, this method can be challenging for some, as they unintentionally alter or adjust their posture while closely examining how they stand.

If this is true for you, the Thomas test is a good alternative.

To perform the Thomas test:

1. Sit on the edge of a high table or bench.
2. Lie back so that your legs hang off the table at the knee.
3. Pull your right knee to your chest using your hands for assistance while bending your right knee.
4. Pay attention to your left leg. If your left hamstring or glute lifts off the table, you likely have APT. If your left leg remains in contact with the table, your pelvis is neutrally aligned.
5. Switch legs and repeat the process. 

Should You Try to Fix Anterior Pelvic Tilt?

Countless blog articles and videos online detail how to “fix” APT.

Most recommend two courses of action:

1. Anterior pelvic tilt exercises to strengthen your “weak” glutes and abs
2. Anterior pelvic tilt stretches to loosen your “tight” hip flexors and lower back

However, fixing anterior pelvic tilt using this type of program isn’t necessary or beneficial for most people. 

There are several reasons for this.

First, APT probably doesn’t cause back pain. Evidence of this comes from studies showing people with and without lower-back pain have comparable spine curvature and similar pelvic tilt angles. 

In fact, some studies suggest that people with lower-back issues have less of a curve in their lower back than healthy people. 

Additionally, studies show no association between changes in pelvic tilt or lower-back angle and lower-back pain.

(Check out this article if you’d like to learn more about what does cause low-back pain.)

Second, studies show that weak abs and glutes and tight hip flexors don’t contribute to pelvic tilt or lower back curvature. 

Third, research shows the number of hours you spend sitting daily doesn’t affect lumbopelvic (relating to your lower back and pelvis) posture.

Fourth, most people (75-to-85%) have APT and the majority have no symptoms. That is, it’s a perfectly normal characteristic of posture that’s largely asymptomatic. (And if the majority of people have ATP, it belies the idea that this is some kind of problem. Perhaps people with neural pelvic tilt should be doing exercises to correct their posture?)

And fifth, research shows exercise and stretching programs that focus on lower-back and hip flexor stretches are largely ineffective.

In other words, if you have APT . . .

• It’s not the reason you have lower-back issues
• You don’t have muscle imbalances
• You don’t have it because you sit for too long each day
• You’re completely normal
• Futzing around with isolation exercises, resistance band stretches, and foam rollers won’t help

As such, it’s probably not something you should worry about fixing. It’s just another immutable and inconsequential aspect of your physiology, like your shoe size or hair color.

That said, if you lift weights, pronounced APT may make it slightly more difficult to perform certain exercises comfortably (such as the deep squat). 

If that applies to you, being more mindful of your posture while lifting may help make these exercises more comfortable, and possibly reduce your risk of injury.

How to Fix Anterior Pelvic Tilt While Weightlifting

Here’s a simple two-step process you can use to maintain proper form while weightlifting regardless of your level of ATP:

1. Learn to brace correctly: Taking a deep breath into your belly before you perform an exercise and holding it throughout your set creates pressure inside your abdomen that helps stabilize your torso against heavy loads and prevents your spinal cord from bending. If you want to learn how to breathe correctly while weightlifting, check out this article:                                                                                            The Complete Guide to the Valsalva Maneuver
2.  Use effective cues: A weightlifting cue is a mental mantra you recite while weightlifting that draws your attention to a particular aspect of your form. When performing exercises that require you to maintain a neutral spine (e.g., the squat and deadlift), use the cue “Ribs down.” 

Imagining bringing your sternum and belly button toward each other helps prevent you from extending your back and ensures your spine remains in a safe position. 

FAQ #1: What’s the best posterior pelvic tilt fix?

Most people don’t need to worry about fixing anterior pelvic tilt. It’s a normal characteristic of posture that’s typically asymptomatic.

If APT prevents you from performing exercises like the squat and deadlift comfortably and through a full range of motion, focus on breathing and bracing correctly and using the cue “Ribs down” to ensure your spine doesn’t arch excessively.

FAQ #2: Should you wear an anterior pelvic tilt brace to fix anterior pelvic tilt?

No. 

Most people don’t need to “correct” APT because it poses no risk to their health, so there’s no need to wear an anterior pelvic tilt brace. 

FAQ #3: How can I fix anterior pelvic tilt while sleeping?

Some people experience lower-back discomfort while lying on their back, and think this may be caused by having ATP. 

It’s not clear if ATP is the cause of this (many people without ATP can also have back pain while lying supine), but in either case you can try this fix:

Put a pillow or rolled towel under your knees while lying on your back. This changes the position of your pelvis and helps take stress off of your lower back.