Certain cases of muscular weakness can lead to a disadvantageous tilt of the pelvic area, resulting in pain and a variety of other symptoms that must be remedied through careful exercise and stretching.
Fortunately for many, this disadvantageous tilt of the pelvis is easily remedied - even in cases where it tilts towards the ground, hence the term “anterior pelvic tilt” or APT.
Anterior pelvic tilt is remedied through improving the mobility and stability of the soft tissues surrounding the pelvis, as well as strengthening the hip flexors, glutes and hamstrings through resistance exercise.
Anterior pelvic tilt is a condition for an excessively forward-rotated pelvis, often due to injury or muscular weakness caused by lifestyle choices.
It is characterized by pain in the lower back, poor curvature of the spinal column, reduced range of motion of the hips and even compressed or bulging spinal discs when left untreated in the long term.
Determining whether or not you indeed have a case of anterior pelvic tilt can be difficult, and it is best to seek out the diagnosis of a medical professional if you suspect that anterior pelvic tilt is the culprit for whatever symptoms you are experiencing.
Apart from following other routes of advice given by your physician, it is important to exercise and otherwise stretch any affected areas that are causing the anterior tilt of the pelvis.
While this is most frequently the muscles of the posterior chain or the hip flexors themselves, certain concurrent injuries can also present an anterior pelvic tilt as a symptom, and as such targeting these areas with exercise and stretching drills is essential as well.
Prior to physically rehabilitating anterior pelvic tilt with stretches, it is important to understand the distinction between stretching and exercise, as they are two types of movements meant for different stages of the rehabilitation timeline.
Stretching is considered to be lower impact and may be performed earlier in physical rehabilitation than with resistance exercise, and it is generally advised that the patient cease stretching if any sort of pain or fatigue is encountered during stretching performance.
The kneeling hip flexor stretch is a dynamic stretch with a relatively short range of motion, making it excellent for individuals with concurrent injuries or otherwise poor hip flexor mobility.
It is performed without any sort of equipment, and will generally only recruit or otherwise target the tissue surrounding the hips.
The kneeling hip flexor stretch primarily targets the hip flexors, but can also target the glutes depending on the distance between the legs of the patient.
To perform the kneeling hip flexor stretch, the patient will enter a lunge position with one knee against the ground and the other extended before them with the heel of said leg in contact with the floor, as if taking a knee.
Tightening the core and glutes, the patient will then tilt their pelvis forward somewhat, leaning with the forward leg. If done correctly, a stretching sensation will be felt along the hip flexor of the same side.
Holding this position for several counts, the patient will then switch sides, repeating the movement on the opposite leg.
This completes the kneeling hip flexor stretch.
The bridge stretch is a dynamic lower-body stretch that is visually similar to the glute bridge exercise, but is otherwise performed for the purpose of improving mobility in the hips, lower back and glutes.
It requires no equipment other than a suitably comfortable exercise mat, and is otherwise safe to perform if the patient’s sole condition is a minor to moderate case of anterior pelvic tilt.
The bridge stretch primarily targets the hips, posterior chain and lower back, but can also stretch the distal end of the quadriceps femoris muscle as well.
To perform the bridge stretch, the patient will lie on the floor with their chest facing upwards and the heels set on the ground, keeping the knees a natural distance apart.
Keeping the head and upper back in contact with the floor, the patient will then press through their heels, pushing their pelvis upwards until an angled line is formed from the knees to the chest.
They will hold this position for several seconds before slowly returning to their original lying position, thereby completing the stretch.
The pelvic tilt stretch is quite similar to the bridge stretch, simply with a lower intensity and a smaller area of action so as to reduce any risk of injury that may occur.
This particular stretch is most suitable for individuals who wish to minimize the number of other muscle groups affected by the movement, such as would be the case in concurrent injuries or isolated muscular weakness of the hip flexors.
Pelvic tilts aid in developing the abs, lower back and the hip flexors.
To perform the pelvic tilt stretch, the patient will lie chest-up on the floor with their heels pressed on the ground and the head supported by their arms or a pillow.
Then, contracting their abdominal muscles, they will “pull” their stomach towards their spine, bending the hips upward as they do so. This should have the effect of the glutes contracting to support the movement.
They will hold this position for several counts before relaxing their core and gluteal muscles, thereby completing the pelvic tilt stretch.
While stretches for anterior pelvic tilt are meant to restore basic muscular strength and mobility to the responsible areas, exercises are meant to directly stimulate hypertrophy or otherwise result in stronger musculature relating to the pelvis itself.
This is achieved by inducing tension and resistance along any affected or weakened musculature causing the pelvic tilt.
Whether with the use of additional weight or simply with the patient’s own body alone, squats are an excellent method of correcting anterior pelvic tilt as they target the entirety of the lower body and core to a significant extent.
Of course, this intensity also means that individuals with concurrent injuries or those who have not been cleared for strenuous exercise should avoid performing squats without consulting their physician first.
Squats work the entirety of the lower body, though they are most effective as an APT rehabilitation movement when used to target the gluteal muscles or hip flexors, making squats somewhat less suitable for individuals with anterior pelvic tilt as a symptom of weakness in the lower back.
To perform a repetition of the squat exercise, the patient will dig their heels into the floor at approximately shoulder-width distance apart, pointing their toes slightly outwards in-line with the hips.
Then, bending at the hips and knees simultaneously, they will lower themselves until the pelvis crease is parallel with the knees.
Holding this for a count, they will then push through the heels, returning to a standing position and thereby completing the repetition.
Planks are a bodyweight exercise that isometrically recruit the muscles of the core and lower back in a zero-impact manner, making them excellent as a tool for rehabilitating anterior pelvic tilt.
Considering the fact that many anterior pelvic tilt cases are caused by weakened core musculature, performing the plank as a rehabilitative measure may be among one of the most effective ways of remedying APT, though this is not the case for APT caused by hip flexor or gluteal weakness.
Planks target the entirety of the core, including those of the lower back and the abdominal muscles.
To perform the planks exercise, the patient will lie in a table position where only their elbows and feet are in contact with the ground.
Flexing their core and squeezing their glutes, they will then make their torso rigid as it forms a straight line.
Holding this position for a predetermined length of time, the patient will then relax their core and allow their knees to once again touch the ground, completing the exercise.
The glute bridge is a compound bodyweight exercise meant to reinforce the posterior chain and hip flexors in a manner that places as little impact as possible on the surrounding connective tissues.
This is achieved by creating tension through the lower back and pelvis in a static position, meaning that the majority of the training stimulus induced is isometric in fashion.
Like other bodyweight exercises, the glute bridge does not require any sort of equipment and is generally suitable for most individuals.
The glute bridge exercise targets the gluteal muscles, the lower back, the hip flexors and the hamstrings - though it can also recruit the abdominal muscles if the pelvis’ range of motion is maximized.
To perform a repetition of the glute bridge exercise, the patient will lie on the ground face-up with their heels pressed against the floor and the knees set approximately hip-width apart.
Contracting the core, the exerciser will then push through their heels into the ground, forming a straight line from their knees to their chest.
Flexing the glutes and core as they hold this position for several seconds, they will then lower themselves back to the floor, thereby completing the repetition.
Most cases of anterior pelvic tilt are caused by excessively tight or otherwise weak hip flexor muscles, though weakness in the gluteal muscles or other core musculature can also be the cause - albeit less frequently.
Apart from following instructions given by a medical professional, the quickest way to remedy a case of anterior pelvic tilt is to perform the appropriate stretches and exercises needed to fix whatever underlying physiological issue is causing the pelvis to tilt in such a way.
Note that varying levels of severity will take longer or shorter periods of time with which to recover from, with certain causes of anterior pelvic tilt even requiring surgery in order to return to full physiological ability.
Generally, outside of the most severe of anterior pelvic tilt cases, most individuals will see some level of improvement within one to two months of regular exercise and stretching of the affected muscles.
Of course, this is not an exact timeline, and factors like age, concurrent injuries or rehabilitation plan adherence will directly affect how long it takes to correct anterior pelvic tilt.
Though the best way to fix anterior pelvic tilt is to strengthen the muscles that are responsible for it, there are certain points in the recovery process that mandate placing as little stress upon the area as possible.
The specifics of this will vary widely, and it is best to ensure that you have the go-ahead from your physician prior to attempting any sort of strenuous movement involving the affected musculature, as placing tension or resistance therein can in fact worsen your APT if timed poorly.
1. Falk Brekke A, Overgaard S, Hróbjartsson A, Holsgaard-Larsen A. Non-surgical interventions for excessive anterior pelvic tilt in symptomatic and non-symptomatic adults: a systematic review. EFORT Open Rev. 2020 Jan 29;5(1):37-45. doi: 10.1302/2058-5241.5.190017. PMID: 32071772; PMCID: PMC7017593.
2. Yoo WG. Effect of Individual Strengthening Exercises for Anterior Pelvic Tilt Muscles on Back Pain, Pelvic Angle, and Lumbar ROMs of a LBP Patient with Flat Back. J Phys Ther Sci. 2013 Oct;25(10):1357-8. doi: 10.1589/jpts.25.1357. Epub 2013 Nov 20. PMID: 24259793; PMCID: PMC3820203.
3. Król A, Polak M, Szczygieł E, Wójcik P, Gleb K. Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. J Back Musculoskelet Rehabil. 2017;30(4):699-705. doi:10.3233/BMR-140177