Should I be worried about my Anterior Pelvic Tilt?

If you’re here and you don’t know what an “anterior pelvic tilt” is, I am so thrilled for you. This means you likely haven’t been victimized by some well-meaning clinician or coach. You can just skip this blog, this isn’t for you.

But if you have heard of pelvic tilt, been told you have it, been told it’s bad or that it is holding you back in some way, this blog is for you.

TLDR: As a sports chiropractor who specializes in working with athletes and pregnant people with low back pain: I am not worried about your anterior pelvic tilt.

What is Anterior Pelvic Tilt?

Pelvic Tilt refers to the relative position of your pelvis to your Lumbar spine above and your legs below. Anterior Pelvic Tilt is identified as the position of your pelvis when it is tilted forward relative to neutral position. In anatomical terms, an anterior pelvic tilt is when the front of front of the pelvis drops down (like the ASIS or pubic symphysis). Or, if your point of reference is on the back, then it is when the back of your pelvis lifts up (like the PSIS, tailbone or coccyx, or ischial tuberosities).

What is anterior pelvic tilt?

Why are people worried about Anterior Pelvic Tilt?

Anterior Pelvic Tilt is thought to be problematic because in the 1970s a medical doctor and researcher, Vladimir Janda, made some observations in his patients and coined the term: lower cross syndrome and definite it as a postural abnormality. Janda theorized that this “postural imbalance” of the pelvis characterized by specific patterns of ‘tight’ and over-active muscles relative to some ‘weak’ and under-active muscles. He  thought prolonged sitting was a major cause of these imbalances and that Anterior Pelvic Tilt was a cause of low back pain.

What does the research say about Anterior Pelvic Tilt?

The trouble is… there has been a lot of research done in related to posture, anterior pelvic tilt specifically and muscle imbalances and relentlessly, the data shows that anterior pelvic tilt, and what Janda called lower crossed syndrome does not CAUSE low back pain.

Here a study by Herrington in 2011, observed that in 120 healthy subjects with no lower back pain, 85% of the males presented with anterior pelvic tilt, and 75% of the females presented with anterior pelvic tilt… and again had no pain at all. https://pubmed.ncbi.nlm.nih.gov/21658988/

A systematic review from Laird et al in 2012 concluded that studies that looked at the relationship between posture and low back pain, fail to show any relationship between posture modification improving pain or activity limitation. https://pubmed.ncbi.nlm.nih.gov/22958597/

Another study from Murrie et all, showed no correlation between people with Anterior Pelvic Tilt and pain and people without APT. http://www.ncbi.nlm.nih.gov/pubmed/12589669

What about the supposed ‘muscle imbalances’ that Janda hypothesized being the cause of Anterior Pelvic Tilt? Well it turns out Anterior pelvic tilt is NOT associated with tight hip flexors, statically or dynamically, as evidenced by Heino et al in 1990 and Schache et al in 2000. On top of that, a study by Koumantakis et al in 2021 discovered that the number of sitting hours per day was not related to lumbopelvic posture.

Even better news is that it is nearly physically impossible to sit enough to cause this classic imbalance as Janda describes it. As Williams et al demonstrated that “normal day to day motion prevents much of the “damage” from sitting”. Thankfully, getting up, shifting in your chair, changing position at all seems to be all it takes.  https://pubmed.ncbi.nlm.nih.gov/2344211/

Also if anterior pelvic tilt doesn’t seem to be a problem, then what about other problems with posture like: flat feet or knocked knees? Turns out these aren’t associated with increased injury either.

https://pubmed.ncbi.nlm.nih.gov/27312709/

Where does that leave us?

…Anterior pelvic tilt is common in people without pain, those who have pain don’t necessarily have anterior pelvic tilt, muscle imbalances don’t seem to be causing anterior pelvic tilt, and if you do get stiff from sitting you can just move around a bit to reduce that.

Does this mean anterior pelvic tilt doesn’t matter?

It means that in humans, the existence of anterior pelvic tilt is not a risk factor for pain or dysfunction. If you have anterior pelvic tilt, and you don’t have pain, you can go on about your life with zero fear or worry.

But, what if I do have pain with Anterior Pelvic Tilt?

The position you are in does not matter… until it does. For example, If you find that you have pain and moving into a position with anterior pelvic tilt is painful, or moving away from anterior pelvic tilt is less painful, then your position could matter for you.

If you have a job or favorite activity where it benefits you to access an anterior pelvic tilt but you can’t because of pain then it could matter for you. Some of these things include cross fit, olympic lifting, sprinting, doing yoga, bearing children, or just want to be able to access that range of motion.

What if doing anterior pelvic tilt exercises have helped you? Fantastic. However, realize that if they helped there’s a litany of reasons for this that have nothing to do with your pelvis position. Maybe with the addition of pelvic tilt exercises, you are more active now. Exercise in general has great impact on our sleep, energy levels, sense of purpose which is all related to pain. Or maybe the exercises have added more variability to the movements you were already doing. Maybe you learned the exercises from a trusted source, who validated your fears and beliefs, and met your expectations. These are all valid things to address as it relates to back pain, that have nothing to do with the anterior pelvic tilt itself.

What can I do about back pain?

If you do have pain, an important thing to know is that without a doubt, your musculoskeletal system is adaptable. If you give it a challenging exercise, in a dose that you can tolerate well without spiking pain, but is still hard, then you will adapt. So if you want to get stronger you can. If you want better endurance you can do that. If you want to increase or decrease tension, increase or decrease stiffness, or target coordination or balance, and you want to do it with an anterior pelvic tilt you can do that too. As I mentioned above, staying active and involved in hobbies, recreational activities and physical activity that makes you happy, varrying the types of activity you do as well as varrying intensity, range of motion, volume, frequency etc. Focusing on sleep, diet, valued friendships and community are all evidenced based ways to tackle back pain.

If you have more questions about your anterior pelvic tilt or back pain contact us at Back Bay Health for a free 20 min discovery call to learn about how we can help you reach your goals today.

(Psst… all of this goes for posterior pelvic tilt as well. )