Does Anterior Pelvic Tilt Cause Back Pain

Before we answer the question of the article let me first explain the components of the pelvis, or pelvic girdle.


The pelvic girdle is made up of the sacrum, coccyx and the hip bones which are in turn made of the ilium, ischium and pubis. The functions of these structures are the transfer weight from the upper body to the lower body, to provide an enormous amount of attachment sites for various tendons and ligaments and to protect the pelvic viscera. So, as we can hopefully see, the pelvic girdle is a very important part of our anatomy and maintaining its proper function and health is crucial to our overall health.

In a normal functioning pelvic girdle there is a slight tilt forward, from back to front, which is called anterior pelvic tilt (APT). If you can imagine the pelvic girdle as an inverted triangle, the front of the triangle would tilt slightly forward.

For those without the gift of an imagination please refer to the image below.

There is no absolutely defined angle of APT that is deemed most healthy. Because of interpersonal differences in anatomical structure some people will have more APT than others and some will have less, without any impact on their lower body or back health. The generally accepted APT is between 6-13°, which as you can see is quite a variance.

APT that falls outside of those values is usually greater than 13°  – with only around 25% of the population likely to have a neutral or posteriorly tilted pelvis, meaning a pelvis that is either flat or tilted backwards.

The causes of APT are usually combination of muscles that are either shortened and facilitated with muscles that are lengthened and inhibited. The muscles that are shortened in APT are predominantly the hip flexors and spinal erectors. The weakened muscles are usually going to be the abdominal muscles, gluteus maximus and hamstrings.

So Does Anterior Pelvic Tilt Cause Back Pain?

Now, we move on to the question of the article. I believe this to be an important question because in the area of exercise science and exercise physiology there has been a fairly solid belief that excessive APT can be responsible for back pain. The premise makes sense on face value; if the pelvic girdle is held in excessive APT than the lumbar region of the spine will move into excessive lordosis (curvature) and will place stress on the spinal structures and sacroiliac joint, causing pain. However, the literature suggests that this isn’t the case.

The problem with excessive APT is actually more likely to be related to structures that are situated away from the pelvis. When the pelvic girdle is held in excessive APT the femur will begin to rotate internally which will in turn cause the knee to move inward, into what is called a knee valgus position.

The flow on effect from here is that the lower leg bones – tibia and fibula – will begin to rotate internally as well; they have to. This has consequences on the ankle joint as this lower body positioning forces the ankle joint to turn inwards excessively and therefore place a large amount of stress on the arch and structures of the ankle joint.

So, in my opinion, excessive APT is actually more likely to cause feet, ankle and knee problems as opposed to back problems.

How do we fix excessive APT?

We first need to work on strengthening the weak structures surrounding the pelvis. These muscles are the glutes, hamstrings and abdominals. There are numerous exercises that target these areas but my preferred exercises are always isolated movements that target these muscles such as:

  • single leg bridges
  • lateral band walks
  • 4-point kneeling
  • plank variations

These exercises focus on both the deep core and glute muscles working in harmony

We then need to work on lengthening the shortened muscles; the hip flexors and spinal erectors for the most part. The hip flexors are notoriously hard to target with self-myofascial release (SMFR), so a concerted stretching program is the most practical, combined with manual therapy from an experienced manual therapist.

The spinal erectors can be targeted fairly effectively with a foam roller for SMFR, though this type of muscular release is performed poorly unless instructed, so if you believe that this is an area of concern it is in your best interests to seek an Accredited Exercise Physiologist to guide you.

The final, and simplest, method for reducing excessive APT is to be mindful of your posture and bring your pelvis back into a more neutral position. This can be practiced when lying on your back, rotating your pelvis forwards and backwards. This pelvic manoeuvre will always be easier when performed on your back and once this subtle movement is mastered you will be able to perform it with more success when standing.