Posterior Pelvic Tilt

What is Posterior Pelvic Tilt?

Posterior pelvic tilt refers to a condition where the pelvis rotates backward, causing the lower back to flatten and the hips to thrust forward. This alteration in pelvic positioning can lead to a cascade of musculoskeletal imbalances and discomfort.

Typically, the pelvis is in a neutral position when standing, allowing for an even distribution of weight and proper alignment of the spine and lower extremities. However, a posterior pelvic tilt disrupts this equilibrium, often resulting in reduced lumbar curvature (lordosis), tight hamstrings, and weakened hip flexors.

The top of the pelvis is moved forward in an anterior pelvic tilt. Spinal extension is increased by the anterior tilt.

A condition known as posterior pelvic tilt occurs when your pelvis shifts away from its neutral position and toward the rear. The anterior part of the hips tilt up and back in this pelvic posture, while the tailbone is tucked beneath the torso. A flat back is the outcome of the lumbar lordosis, or rounding of the lumbar spine, caused by the posterior pelvic posture.

A posterior pelvic tilt is a hip motion characterized by a small range and closed chain in which the pelvis rotates posteriorly around femurs that are immobile.

When the front of the pelvis falls relative to the rear of the pelvis, this is known as the anterior pelvic tilt. For example, this happens when the hip flexors shorten and the hip extensors extend. The posterior pelvic tilt occurs when the front of the pelvis rises and the back of the pelvis descends. For instance, this occurs when the hip extensors, especially the gluteus maximus, the main hip extensor, shorten and the hip flexors lengthen.

A force pair generated by the hip extensors and abdominal muscles causes a posterior pelvic tilt.

Lateral pelvic tilt, which is linked to scoliosis and individuals with varying leg lengths, is the term used to denote tilting to the right or left. It can also occur when one leg is bent while the other is straight; in this scenario, the hip on the bent leg may descend towards the ground together with the femur.

When the right side of the pelvis is higher than the left, this condition is known as the left pelvic tilt.
When the left side of the pelvis is higher than the right, this condition is known as the right pelvic tilt.

Body imbalances are frequently the result of inactivity, particularly for those who spend most of their days sitting down. This inactivity is a factor in:

• Tight and weak leg muscles.
• Reduced tendon length around the pelvic bones.
• Imbalanced properly.
• Bad positioning.

Causes of posterior pelvic tilt:

Most frequent: Bad posture when sitting
You have a higher chance of developing a posterior pelvic tilt if you sit incorrectly, even if you spend the whole day sitting down. The natural curve of your spine is distorted when you spend the whole day slumped over at your desk, putting unnecessary pressure and tension on all the wrong places. The result is a weakening of the back and hip flexor muscles. Additionally, the abdominal, gluteal, and hamstring muscles all become quite tight.

Other causes consist of:

Abnormal Posture while Standing
Appropriate sitting posture is not as crucial as correct standing posture. When standing, if you notice that your shoulders hunch and your lower back round, you may have a posterior pelvic tilt posture. Your abs will probably feel shorter and your upper body will probably be tilting back more.

Taking up/Transporting Heavy Things (Like a Baby!)
A posterior pelvic tilt posture may also occur if you are carrying heavy things for extended periods. When you attempt to use your hips to hold the “heavy object,” your tailbone typically tilts forward. Your back gets longer as a result, while your stomach muscles get shorter. This will eventually result in severe poor posture.

Incorrect Exercise Program
You may be increasing your risk of posterior pelvic tilt if your workout regimen emphasizes building your hamstrings, abdominal muscles, and gluteal muscles. A flattening of the natural curvature in the lumbar spine can result from overdeveloped abdominal muscles pulling the pelvis posterior to the counterbalancing back muscles.

Position for Sleeping.
A pelvic tilt may occur if your mattress or sleeping posture interferes with your spine’s natural curve.

reasons for the posterior pelvic tilt that are muscular.
A posterior rotation of the pelvis may result from tight abdominal muscles, either alone or in conjunction with tight hamstrings.

Symptoms of Posterior Pelvic Tilt:

When your pelvis tilts backward, away from its neutral position, it is referred to as posterior pelvic tilt. The hips’ anterior (front) parts tilt up and back in this pelvic posture, while the tailbone is tucked under the torso.

A flat back is caused by rounding of the lower spine, which is the result of the pelvis positioned posteriorly, or forward.

A posterior pelvic tilt puts a great deal of tension on the lower back, much as an anterior pelvic tilt causes the lower back to arch inward. One kind of pain that might ultimately come from this is sciatica or pain that runs down the back of one’s thigh or glute.

Shortened tendons around the pelvic bones, weak and tight leg muscles

• imbalanced properly
• bad positioning
• Decreased Thoracic Lordosis
• Lower Back Pain
• Knee pain or hip pain combined

Any of these factors may result in a posterior pelvic tilt. This is the moment when your upper body turns back and your glutes tuck inward.

Posterior Pelvic Tilt leads to:

• Your whole posture is impacted because your neck and upper back are forced forward in an attempt to correct the improper pelvic position.
• A forward head posture and a more rounded shoulder, often known as thoracic kyphosis, are common symptoms of posterior pelvic tilt.
• The compressive strain on the mid and lower back will gradually rise due to posterior tilt. Due to the unequal loading of the spine caused by this increased compression stress, problems such as disk prolapse or disk herniation may result.
• In addition, the lumbar curve’s rounding places undue strain on your spine and raises the risk of hip, back, and leg pain. It may even have an impact on your confidence levels and how well your clothing fits you.

How to Diagnose Posterior Pelvic Tilt?

Your physician will examine you physically and keep an eye on you.

Thomas test

Take a seat on a table. The legs must be hanging off the table at the knees.
Raise one leg to your chest while bending at the knees. If the pelvis is not positioned correctly, the back of the resting leg will lift off the table.
If the leg in rest needs to be turned or stretched in any manner to keep it from rising off the table, a pelvic tilt is recommended.

Negative Test: When your thigh touches the table with its back, there should be no gap between it and the surface.
No Space.

Positive Test: If there is remaining space between your thigh muscle and the table even after straightening your leg, you may have posterior pelvic tilt.
Space.

Investigation: 

x-ray
The pelvic tilt is one of the elements that determines the unique pelvic orientation. Anteroposterior pelvic radiographs are used to measure the distance between the mid-section of the sacrococcygeal joint and the upper border of the symphysis pubis.

Treatment of Posterior Pelvic Tilt:

After starting symptomatic medical treatment and using a mix of physical therapy and posture-correcting exercises, surgery is the final recommended course of action in cases with severe symptoms.

Medical Treatment:

Pain can be reduced by anti-inflammatory medications.
Over-the-counter pain relievers include acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB), and naproxen (Aleve).

Physical Therapy Treatment of Posterior Pelvic Tilt:

Correcting Posterior Pelvic Tilt via Stretching and Strengthening.

The ideal strategy for treating a posterior pelvic tilt is to balance the muscles that are responsible for the pelvis’ abnormal alignment. To restore the flexibility of too-tight muscles, stretching is required. On the other hand, weak muscles require strengthening.

Stretches/Releases to Correct Posterior Pelvic Tilt:

Rebalancing the muscles that are causing the abnormal pelvic position is the most effective technique to repair a posterior pelvic tilt. Restoring the flexibility of muscles that have been too tight requires stretching.

The primary regions in need of stretching are the hamstrings and stomach/abs. Strengthening is mostly needed in the lower and middle back, as well as the hip flexors and quadriceps.

Stretches and Releases to Adjust Pelvic Posterior Slant:

• Static hamstring stretch

Extended durations of standing and sitting can lead to a hamstring strain, which can exacerbate unfavorable postures such as posterior pelvic tilt. Stretching will cause your hamstrings to lengthen, which will support your body in maintaining a more neutral pelvic position.

To execute, sit down in a hard chair. Step forward and stretch your left leg. Bend forward and reach for your toes until you feel a slight stretch. Slowly return to the starting position. Repeat on your right side. Try to complete 3 repetitions on each side.

Take caution: If you extend the stretch too far, you risk pulling a muscle in your back. Take care not to go overboard. Try transferring this exercise on the floor if sitting in a chair is too challenging for you.

• Abdominal Press Up (Cobra Pose)

Bhujangasana
Your constricted abdominal muscles will extend and become more pliable with the aid of this stretch, which will enable a more neutral pelvic posture.

How to do it:

• Start by resting on the ground with your hands flat at shoulder level. – Gradually press your hands up to lift your shoulder off the floor until you feel a little stretch.
• Exhale as you press further into the lumbar extension to extend your range of motion.
• Aim for five times through.

• Piriformis stretch

An external rotator of the hip, the piriformis muscle can tense up after extended periods of sitting. Stretching this muscle will enable the hip to move normally, which aids in achieving a neutral pelvic posture.

How to do it:

• Put your right ankle over your left knee to start. Then, grab your left knee and draw it in toward your chest for a few seconds, until your right gluteal muscles stretch. Repeat on the other side. Try to complete three repetitions on each side.

• Doorway Stretch (Bilateral Pectoral stretch)

Since sitting makes the abs and chest extremely tight, the doorway stretch will help release tension in those areas.

• The correct way to accomplish this is to line up your hands and elbows with a doorframe.
• Gently push open the door until you feel a stretch.
• Take a few seconds to hold this last position, then take a few more to get back to the beginning.
• Do this three times.

• Glutes Release

Prolonged sitting can cause your glutes, or buttocks, to become extremely tight. By releasing tension in that area, massage therapy can assist the pelvis return to its proper position.

How to carry it out:

• Sit on the ground with your knees bent in the beginning.
• Place a massage ball beneath your right buttock and lay your hands behind your back on the floor.
• Raise your right leg off the floor and roll on the ball in tiny circles, paying special attention to the sore spots.
• Use your left side for this workout.

Strengthening exercises for Posterior pelvic tilt

• Lunges:

Your quadriceps will get stronger with lunges. It may be possible to rectify a posterior pelvic tilt by strengthening these muscles.
Start by placing your feet together; – Step your left leg out in front of you; – Bend your left leg to a 90-degree angle (your right knee should contact the floor at this point)  To return to the beginning position, push up on your left leg. Repeat on your right. Try to complete three sets of ten lunges on each side.  When in the lunge position, make sure your knee doesn’t go past your toe because this puts more strain on your knee.

• Superman:

Superman assists in correcting improper pelvic position by strengthening your lower back and glutes, which are linked to your pelvis.

The exercise may be performed as follows:
Lay on your stomach on the floor with your arms extended in front of you; – Slowly raise your chest off the ground and attempt to hold this posture for 30 seconds; – Slowly return your body to the beginning position; – Try to complete three repetitions.

• Standing Hip Flexion

hip flexor
In addition to helping to rectify the muscular imbalance associated with posterior pelvic tilt, this exercise also serves to strengthen the hip flexors and improve your balance.

How to carry out:

• Starting with your feet slightly apart and your hands placed on your hips (you can use the back of a chair for support if necessary), shift your weight to your left leg and lift it slowly, bending your right leg to a 90-degree angle. Lift your knee as high as you can, aiming to have it parallel to the floor or slightly higher. As you progressively drop your leg without touching the floor, hold the final posture for three seconds. Try to perform ten repetitions on each side.
• In addition to helping to address the muscular imbalance associated with a pelvic tilt, this exercise also serves to strengthen the hip flexors and improve your balance.

How to do it:

• Start with your feet slightly apart and your hands on your hips (you can use a chair’s back for support if necessary). Transfer your weight to your left leg, bending it slightly at the knee.
• Lift your right leg slowly, bending the knee to a ninety-degree angle. – Lift your knee as high as you can, aiming to place it either slightly above or parallel to the floor. Maintain the end posture for three seconds before lowering your leg gradually without touching the ground. Try to finish ten reps on each side.

• Leg Raises

Leg raises assist in strengthening your hip flexors, which become incredibly weak due to the pelvic posterior tilt.

How to do it:

• Place yourself lying on the ground, legs extended straight.
• Contract your core muscles to slowly raise your legs off the ground while maintaining your arms straight at your sides.
• Return your legs to the beginning position slowly.

• Rowing

All of the main back muscles, such as the rhomboids and trapezius, are strengthened by this exercise, which will aid in regaining your shoulders.

How to carry it out:

• To start, wrap your Theraband around a stable piece of furniture (you may wrap it around your feet if you don’t have any solid furniture).
• To assume the beginning posture, hold the ends of the Theraband with your palms facing each other and stretch your arms straight.
  Keep your arms close to your body and avoid bending forward or backward. Pull the ends of the Theraband towards you as you bend your elbows and slide them slightly behind your chest by pressing your shoulder blades together.
  As soon as your hands touch your torso, stop tugging.
• Maintain this posture for a little while before straightening your arms to go back to the beginning position.
  Try to complete three sets of ten reps.

• Foam rolling for calves (relaxation)

• Self-myofascial release, commonly referred to as foam rolling, is comparable to receiving massage therapy. This stretch is excellent for releasing tenseness in several body parts following an exercise. Sports goods retailers on the internet carry foam rollers. The fascia, or connective tissue beneath the skin, is broken up by foam rolling, which is essential for healthy mobility. While foam rolling may be applied to any part of the body, focusing on your legs can help reduce posterior pelvic tilt.
  Lying on your side, place the foam roller under your calf area.
• Slowly move the foam roller up your calf, focusing on any “hot spot.” This area feels tighter or more tense than usual.
• Change legs and repeat the motion.
  For better pelvic concentration and benefits, roll the foam roller up the back of your leg while lying on your back.
• Roll the foam toward your glutes and up your hamstrings. Select a warm spot to sit and focus your rolling there. Change legs and repeat.
• In the end, shift the foam roller to your back and roll it up, pausing to concentrate on any particularly tense spots.
• Foam rolling can feel soothing and act as a kind of massage, even if you could occasionally experience pain. You may also use foam rolling around your middle back and give yourself a massage on your spine.

• The glute bridge

• This exercise targets the muscles in the buttocks and hamstrings.
• The feet should be hip-width apart.
• Tighten your abdominal muscles so that your back is flat on the ground. Throughout the workout, keep the muscles in your abdomen (stomach) active.
• Breathe out and lift your hips off the ground, aligning your upper body and thighs in a straight line.
  Taking a breath, slowly lower your body to the floor.
  Ten to twenty times, repeat.

• The plank

Even though it can appear difficult at first, the patient should attempt to maintain the plank position for as long as they can, up to one minute.
The plank exercise works the muscles in the back and abdomen.
Place your face down on a workout mat.

• Place your hands on the mat, palms down.
• Tighten the muscles in your abdomen and thighs.
• After lowering your upper body and thighs to the floor, gradually lift them into a push-up position. Keep your body rigid and upright.
• Make sure the entire exercise makes use of the stomach (or abdominal) muscles.
• For as long as you can, try to stay in the plank position—up to 60 seconds. Lower your body to the ground gently.

Modifications to Sleeping

• To help you sleep with appropriate posture:
• Keep away from sleeping on your stomach.
  Place a little pillow below your knees if you prefer to sleep on your back.
• A pillow should be placed between your knees if you are a side sleeper.
  Put a little cushion or wrapped towel beneath your back’s arch if you sleep on your back.
  Verify that the cushion and mattress suit the natural curve of your spine.

Posterior Pelvic Tilt While Sitting

• Whether you sit all day at work or just a lot of it, it’s important to make sure that:
• You are sat on a posture-supporting chair.
  Your choice of workstation or table should enable you to sit upright and prevent slouching.
• You may either utilize an integrated lumbar support chair or use a pillow for this type of assistance.
  You make the effort to move around and stretch, especially if you spend a lot of time seated.

Complications of Posterior Pelvic Tilt:

Pressure is increased on the lower back bones by a posterior pelvic tilt (reliable source). Not only may this pressure cause tension in the muscles of the neck, but it can also lead to muscular tiredness.

• lower back pain.
• Hip and knee inward rotation.
• Hip Pain
• knee pain.
• Sciatica is caused by strain on the hip flexors.

Prevention

Keep away from lengthy stretches of sitting. People who work at desks or in other occupations where they must sit for extended periods of time should Take regular breaks to walk or stretch.
Take part in regular exercise. It’s crucial to have a comfortable, healthy workstation with the ideal desk, screen, and chairs.

Conclusion

An abnormal posture in which the pelvis is inclined backward is called a posterior pelvic tilt. The primary cause of it is a muscular imbalance that affects your body, activities, everyday posture, and work habits. The imbalance is between the muscles in your legs and core.

The range of symptoms, which include low back pain, stiffness in the hamstring and abdominal muscles, and slouched posture, depends on the severity. Exercises that target weak muscles and stretch tight muscles are the mainstay of treatment, along with changes to one’s sleeping position and sitting posture.

FAQs

References

• Patel, D. (2022, July 14). Posterior Pelvic Tilt – Cause, Symptoms, Treatment, Exercise. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/posterior-pelvic-tilt/
• Physiotherapist, N. P. (2023, December 25). Posterior Pelvic Tilt: Cause, Symptom, Treatment, Exercise. Mobile Physiotherapy Clinic. https://mobilephysiotherapyclinic.in/posterior-pelvic-tilt-exercise/