Does Anterior Pelvic Tilt Cause Back Pain

Does your back hurt? You’re not along. It is estimated that 70–90% of people will suffer from lower back pain in some form at some point in their lives. There’s lots of different things that can cause back pain, with anterior pelvic tilt often blamed… But does it actually cause back pain?

Before I answer that question, 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 (ilium, ischium and pubis). The functions of these structures are the transfer weight from the upper body to the lower body. They also provide an enormous number of attachment sites for various tendons and ligaments and to protect the pelvic viscera. It’s a very important part of our anatomy and maintaining its proper function is crucial to our overall health.

What is Anterior Pelvic Tilt

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.

Image courtesy of BodyGuide

There’s 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 it doesn’t necessarily impact 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°. Only around 25% of the population have a neutral or posteriorly tilted pelvis, meaning a pelvis that is either flat or tilted backwards.

APT is usually caused by a combination of muscles that are shortened and other 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, then the lumbar region of the spine will move into excessive lordosis (curvature). This places place stress on the spinal structures and sacroiliac joint, causing pain. However, the literature suggests that this isn’t necessarily 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. This 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?

Step 1. Strengthen

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.

Step 2. Lengthen

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

The spinal erectors can be targeted fairly effectively with a foam roller for SMFR. This type of muscular release is generally performed poorly unless instructed, so get advice from an Accredited Exercise Physiologist to get started.

Step 3. Movement

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. Try lying on your back and rotating your pelvis forwards and backwards. Once you’ve mastered this subtle movement on the ground, try doing it standing up.

Got back pain?

If you’re living with back pain and need some advice on exercising safely, chat to your local Accredited Exercise Physiologist. They will help assess your function and give you an exercise program specifically tailored to your needs.

To find an exercise physiologist near you, click here.