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What is Anterior Pelvic Tilt? Causes, Symptoms, and Solutions

There are a few types of pelvic tilt and they all have one thing in common: misalignment of the pelvis. How you fix anterior pelvic tilt, posterior pelvic tilt, or lateral pelvic tilt varies from case to case, but most of the time they have very similar causes. 

Anterior pelvic tilt (also referred to as APT or hyperlordosis) can be difficult to identify, and it is suggested that anywhere from 75-85% of people that have anterior pelvic tilt don’t show any symptoms.

Treating APT can take some time and consistency, but it is very possible. 

But first, to help you identify if APT is the cause of your posture challenges or hip pain, let’s talk about what it is and some of the symptoms that will help you recognize it.

What is anterior pelvic tilt?

Anterior pelvic tilt is when the front of your pelvis rotates forward and the back of your pelvis rises. This shift in your pelvis changes your posture and can disrupt the kinetic chain of your body, leading to other alignment issues in your back, neck, legs, and knees. 

Pelvic tilt or a twisted pelvis of any kind can cause a lack of stability and mobility, poor posture, and some loss of motor control depending on the activity. Your hip flexor muscles are also impacted by this change in pelvis positioning. 

Sometimes tight hip flexors are a symptom of pelvic tilt, sometimes they are the cause, and sometimes they are both! 

Your hip flexor muscles, or iliopsoas, connect and attach to your pelvis and lower back. When the pelvis shifts, there is additional strain put on these muscles that can cause them to increase muscle tightness. 

Although the iliacus and psoas that make up the iliopsoas often are the most likely to be impacted by a pelvic tilt, the rectus femoris (in your thigh) and quadratus lumborum (in your abdomen) may also be influenced. 

All of these muscles impact your posture. That is part of the reason why hyperlordosis becomes most obvious with bad posture or posture changes. 

When you have a neutral pelvis, there will still be a slight forward tilt and healthy curvature in your lower spine. This natural tilt is why we have a small curve in the lumbar spine (lordotic curve). But once that tilt is more than 10 degrees in any direction, it becomes a diagnosable condition. 

While an anterior pelvic tilt is identified by a pronounced curve in your back, a flat lower back or lumbar spine is one way to identify a posterior pelvic tilt. Lateral tilts can be more difficult to see, but may be visible in the form of uneven shoulders or a waistline that appears tilted more to one side or the other.

Anterior pelvic tilt symptoms 

The two most obvious anterior pelvic tilt symptoms or signs include a bulging abdomen or an exaggerated lumbar spine curve. You may also notice that the waistline of pants or shorts are diagonal to the floor, angling downward instead of at the ideal horizontal angle. 

Some other anterior pelvic tilt symptoms include:

  • A muscle imbalance specifically regarding the quadriceps and low back dominance
  • Stiff or tight iliopsoas or hip flexor muscles
  • Weak abdominal muscles 
  • Difficulty activating glute muscles

Anterior pelvic tilt can worsen with time and if there is no intervention or treatment. As the pelvic tilt becomes problematic, it can lead to difficulty with some movements like squats and deadlifts when exercising. It can also cause a higher likelihood of knee and low back pain and injuries. 

Although these signs may seem somewhat obvious, identifying and treating APT always requires a formal examination. 

Why?

Some people are simply born with a tilted pelvis. Sometimes, trauma of some kind may have shifted a person’s pelvis, or tight muscles may have pulled their pelvis out of alignment. There are many reasons a pelvis could be tilted. An examination can help you understand why and call out any other treatment that may be needed. 

Anterior pelvic tilt causes 

Muscle imbalance is a common theme with anterior pelvic tilt. In fact, it could be a symptom or cause of APT. Other causes of include:

  • Genetics
  • Excessive sitting
  • Lack of physical activity 
  • Tight hip flexors (iliopsoas muscles)

Shortened, tight iliopsoas muscles are a major signifier of hyperlordosis (but again, can also be the cause of pelvic misalignment). And they are caused by everyday things like a lack of physical activity, long daily commutes, practicing sports, and even overstretching.

These day-to-day activities cause your iliopsoas muscles to become overworked or compressed in the same position for prolonged periods of time. As these weakened muscles stay in that position, they need to work extra hard to stabilize your pelvis and core, causing them to tighten.

And that tightness puts unnatural strain on your pelvic bone - causing more tightness, pain, muscle knots, and a forward pelvic tilt. 

As if that weren’t bad enough, while the pelvis is being pulled forward, it lengthens and weakens your hamstrings on the backside. And that creates even more muscle imbalance.

Anterior pelvic tilt test 

To determine if you have an anterior pelvic tilt, you should look for some of the common signs I mentioned earlier and get a diagnosis from a doctor. 

But if you’re just beginning to suspect you may have some pelvic misalignment, there is an easy test you can do at home. Doing this yourself or having a loved one do it will provide some clues about whether or not there is an unhealthy tilt in the pelvis.

Just remember what I said before: some people that have hyperlordosis may not have very obvious signs or symptoms of it so getting a professional medical opinion is always recommended. 

To do an anterior pelvic tilt test at home you should: 

  1. Stand in front of a mirror or have someone take a picture of you from the side.
  2. Locate the anterior superior iliac spine (ASIS) on the front of your pelvis. 

To find the ASIS find the top of your hip bone or iliac crest. Put your hand on the top of the hip bone and follow that down until you come to a bony ridge on the front of your hip bone. Mark this somehow or have someone hold their hand on it while you do the test.

  1. Locate the posterior superior iliac spine (PSIS) on the back of your pelvis. 

Start with your hand in the dimples of your low back right where your spine goes into your sacrum. To find your PSIS, move an inch out to the side until you find a little bony protrusion. Make sure you mark this spot as well.

  1. With both the ASIS and the PSIS marked so you can see their location, stand sideways in the mirror or have someone take a picture. This allows you to see the angle or level of the PSIS in relation to the ASIS. 

If the PSIS is a lot higher up (more than 10 degrees), then you have an anterior tilt. It can be hard to tell the exact angle when just looking in a mirror, but if you have an obvious tilt it will be visible. 

When you go to a doctor or physical therapist for your examination, they will likely do an exact measurement to determine the angle of the pelvic tilt. It will allow them to determine the severity of the tilt and how to best address things moving forward. 

How to treat anterior pelvic tilt

Luckily, anterior pelvic tilt can be treated through a variety of exercises and a training routine to realign the pelvis and balance out the muscles. 

With consistency and a targeted training plan, correcting your pelvic tilt is possible. However, to understand how severe the issue is and how long a treatment may take, it is often most effective to do this process with the guidance of a physical therapist.

Some of the most effective exercises to use when correcting an APT are those that target the abdominals and glutes, such as: 

  • Squats
  • Glute Bridges
  • Band Walks
  • Dead Bugs
  • Planks
  • Side Planks

It is important that when you do these exercises that you focus on your form. You can do them in front of a mirror to watch yourself.

And, when you choose to exercise one side, you must also remember to exercise the other to maintain balance. That also applies to when you work your abdominals - don’t forget to exercise your backside as well.

It’s all about balance!

Since your muscles are such a factor in the cause of an APT, addressing the tightened hip flexors is also necessary. Stretching can be beneficial to a point, but it will not be able to actually release the muscle tension. 

To do this, you need to use muscle pressure release. 

Unfortunately, due to the location of your iliopsoas or hip flexor muscles, it is hard to perform a pressure release of these muscles on your own. A physical therapist is trained to provide this sort of muscle release, but for best results it also needs to be done more consistently. 

So, what’s the solution?

You can achieve a pressure release of the hip flexor muscles at home using the Hip Hook. With just 10 minutes or less a day, you can relieve muscle tightness in the hard-to-reach psoas and iliacus muscles. 

The Hip Hook alone is not the sole answer to your anterior pelvic tilt issue, but it can play an integral role in realigning your pelvis by helping to balance out your muscles and preventing the iliopsoas muscle from pulling the pelvis out of alignment further.

Frequently asked questions about anterior pelvic tilt

What problems can a tilted pelvis cause?

Beyond impacting your posture, and general comfort in the pelvic region, an anterior pelvic tilt can lead to pelvic floor dysfunction. 

Since a pelvic tilt of any kind is often influenced by the muscular imbalance and tension around the pelvis, your ability to control the muscles of the pelvic floor can be lost. This can lead to other issues due to the connection between the pelvic floor muscles and some organ function. 

Because of the connection between APT and tight hip flexor muscles, it is not uncommon for people that have an APT to experience hip flexor pain while sitting, squatting, running, cycling, and while performing other daily activities. 

Is anterior pelvic tilt painful?

Anterior pelvic tilt isn’t often associated with specific pain. However, due to the misalignment of the pelvis, it can cause a kinetic chain effect that creates pain in other parts of the body such as the hips, lower back, and knees. 

How long does it take to fix anterior pelvic tilt?

The length of time it takes to correct an APT depends on the severity of the problem and varies for each person. That is why a personalized training and treatment program is recommended for anyone that is working to correct their hyperlordosis. 

Are there other types of pelvic tilt?

While ATP is a common type of pelvic tilt, it is not the only type. Two other types of pelvic tilt are posterior pelvic tilt and lateral pelvic tilt. 

Posterior pelvic tilt is essentially the exact opposite of ATP and is when the front of your pelvis rises and the back of the pelvis drops. 

Lateral pelvic tilt is when your pelvis shifts from side to side. So, one side of the pelvis would be higher than the other. 

Can a chiropractor correct pelvic tilt?

If your pelvic tilt is severe, then visiting a chiropractor may help improve your treatment process but it should not be the only method of treatment you seek. 

A chiropractor may be able to help shift your spine back into alignment and influence some pelvic alignment as well, but cannot fix ATP fully, as it’s not solely a bone issue. Without correcting muscle tightness and muscle imbalances, your problem with hyperlordosis will persist.

By Christine Koth . Mon Nov 15

Author Bio

Uncovering the cause of your pain is my mission. As a bestselling author and holistic physical therapist with decades of experience, I have helped countless people, just like you, recover from long-standing issues. I've discovered a major cause of pain hidden in the hip and this has lead to my "Iliacus Queen" and hip expert status. I'm here to help you discover causes like this. It doesn't have to be complicated to live a pain-free life. We can do this. I look forward to supporting you on your healing journey.