Anterior Pelvic Tilt Exercises: What Actually Helps, and Uneven Hips

01What

What is anterior pelvic tilt?

The pelvis can tilt forward (anterior tilt), backward (posterior tilt) or sideways. In anterior pelvic tilt, the bony points at the front of the pelvis drop lower than the back, which increases the curve of the lower back (lordosis). The position is influenced by the muscles that attach to the pelvis: hip flexors and back extensors pull it forward, while glutes, hamstrings and abdominal muscles pull it back. A degree of anterior tilt is normal and varies widely between people. Herrington’s study of asymptomatic adults found anterior tilt to be the most common pelvic position.

02Check

How to check your pelvic tilt

• Stand side-on to a mirror in fitted clothing.
• Find the bony point at the front of the hip (ASIS) and the bony dimple at the back (PSIS).
• If the front point is noticeably lower than the back, you have anterior tilt; a difference of a few degrees is normal.
• Thomas test: lie on your back at the edge of a bed, hug one knee to the chest; if the other thigh lifts off the bed, the hip flexors may be tight.
• A physical therapist can assess posture, flexibility and strength more accurately.

03Causes

Causes

• Long periods of sitting, which keep the hip flexors shortened.
• Weak glutes and abdominal muscles.
• Strong or tight lower back muscles.
• Pregnancy and weight around the abdomen.
• Some sports such as gymnastics, dance and sprinting.
• Natural anatomical variation.

04Pain

Does anterior pelvic tilt cause back pain?

It is often blamed for lower back pain, but research shows only a weak link between static posture and pain. Many people with a pronounced tilt have no pain, and many with back pain have average posture. What seems to matter more is the ability to move the pelvis and spine, strength and endurance of the trunk and hip muscles, and overall activity. Exercises that improve control and strength can help back pain whether or not they change the tilt. See our guide to lower back strain for acute pain.

05Exercises

Anterior pelvic tilt exercises

• Posterior pelvic tilts: lying on your back, flatten the lower back into the floor by tilting the pelvis, 10–15 times.
• Glute bridges: squeeze the glutes and lift the hips, 3 × 12; progress to single-leg.
• Dead bug: lying with knees and arms raised, lower opposite arm and leg while keeping the back flat, 3 × 8 each side.
• Front plank with pelvic tuck: 20–40 seconds, keeping the pelvis slightly tucked.
• Kneeling hip flexor stretch: tuck the pelvis before shifting forward, 30 seconds each side.
• Hamstring curls with a ball or band, 3 × 12.
• Squats and step-ups with a neutral spine.
• Do strength work three times a week and stretches daily.

06Stretches

Helpful stretches

• Kneeling or standing hip flexor stretch.
• Quad stretch standing or lying on your side.
• Child’s pose for the lower back.
• Cat–cow to practise moving the pelvis through its range.
• Our guide to tight hip flexors has more options.

07Uneven

Uneven hips

Uneven hips, where one side of the pelvis sits higher than the other, are also common. A study of asymptomatic college athletes found that small pelvic asymmetries and leg length differences were frequent and not necessarily linked to symptoms. Causes include a small difference in leg length, scoliosis, muscle imbalance or habits such as standing with weight on one leg. Most cases need no treatment beyond balanced strength work. A shoe insert is sometimes used for a true leg length difference of more than about 1 cm. Persistent pain, a visible spinal curve or a large difference should be assessed.

08Daily

Daily habits that help

• Break up sitting every 30–45 minutes.
• Stand with weight evenly on both feet.
• Avoid excessive arching when lifting overhead.
• Include walking, cycling or swimming in your week.
• Build glute and core strength progressively.

09Cases

Three common situations

• Office worker with a sway in the lower back and tight hips: hip flexor stretches, bridges and regular breaks help both comfort and posture.
• Gymnast with lower back pain on arching: needs assessment for stress injuries before exercises.
• One hip looks higher in photos: usually minor; a physical therapist can check leg length and muscle balance.

10Summary

Key points to remember

• Some anterior pelvic tilt is normal.
• The link between tilt and back pain is weaker than often claimed.
• Glute, core and hamstring strength plus hip flexor stretches improve control.
• Uneven hips are common and usually minor.