What is anterior pelvic tilt?
Superficially, anterior pelvic tilt (APT) is a rotation of the pelvis that causes the butt and tummy to stick out. Posterior pelvic tilt is the opposite rotation, causing the butt and tummy to be sucked in. Because every part of the body is connected, this condition has repercussions on the rest of the body as a system. The body is constantly trying to balance itself, so when one part is misaligned, stretched, shortened, or otherwise out-of-balance, other parts of the body will adjust to compensate. You can view it as a cascade moving from the source of imbalance out.
The muscles directly affected by anterior pelvic tilt
The muscles directly affected by anterior pelvic tilt are those that attached to the rotated hip bones. They are either pulled into a chronic stretch or chronically shortened:
- Gluteal group/hip extensors (stretched) – gluteus maximus, gluteus medius, gluteus minimus, and tensor fasciae latae
- Iliopsoas group/hip flexors (shortened) – iliacus and psoas major
- Quadriceps Femoris/knee extensors (shortened) – rectus femoris, vastus intermedius, vastus lateralus
- Hamstrings/knee flexors (stretched) – Semitendinosus, semimembranosus, and biceps femoris
- Adductor group (some stretched, some shortened) – adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis
- Abbductors (some stretched, some shortened) – gluteus medius, gluteus minimus, sartorius, tensor fasciae latae
- Lateral rotators (some stretched, some shortened) – the externus and internus obturators, the piriformis, the superior and inferior gemelli, and the quadratus femoris, gluteal group, illiopsoas group, sartorius
- Medial rotators (some stretched, some shortened) – gluteus medius, gluteus minimus, tensor fasciae latae, pectineus, adductors
- Abdominal wall (stretched)– rectus abdominis, external oblique
- Back muscles (shortened) – latissimus dorsi, iliocostalis, longissimus, multifidus, rotatores, and the minor deep intrinsic muscles
Movement in orthogonal planes
If you noticed in the list above, the rotator, adductor, and abductor groups are affected in both ways (stretched and strengthened) by APT, depending on the individual muscle. This is because APT is a rotation along one plane of the body and the rotation, abduction, and adduction of the hip occur along different (orthogonal) planes. So the muscles involved in each of these actions don’t fall into uniform categories of extension or flexion along the plane of the anterior pelvic tilt.
The Body is Complicated
There are several subtle points to keep in mind when examining your own APT. For one, the root cause can vary from person to person. Sometimes, it’s due to tight hip flexors. Other times, it’s due to a hyper flexible back, weak or stretched abdominal muscles, or even thoracic kyphosis. In order to best treat your APT, learn the root causes and the ways your body has adapted to compensate for those root imbalances. In this post, I’m going to address my particular pattern of anterior pelvic tilt. If something doesn’t seem to apply to you, it may not!
The Thomas Test – A Clue to Your APT
In order to better understand your own APT, you can perform the Thomas test. A video will do a better job of explaining this test than me, so I’ll link to one here. The Thomas test can tell you the following information:
- Whether or not your rectus femoris is short
- Whether or not your psoas are short
- Whether or not your tensor fascia latae is short (which means you might also have a tight iliotibial band)
In my case, I found that my psoas and rectus femoris both have a good range of motion, but I had to work to keep my legs from moving out when I performed the test, indicated my tensor fascia latae is short and/or more comfortable in a posterior alignment. The tensor fascia latae and iliotibial band (collectively known as the iliotibial tract) run alongside the side of the leg, with some fibers anterior and some posterior to the middle of the side. Tightening of the posterior iliotibial (IT) tract works to laterally rotate the leg and flex the knee.
Figuring out my IT tract may be tight was like a missing puzzle piece. My legs tend to laterally rotate when I lay on my back and I can never fully straighten my legs, despite having good flexibility in general. Both of these clues to my anatomy fit with a tight IT tract.
If the Thomas test revealed a normal range of motion in all of the muscles tested, your APT stems from something else – a hyper-flexible low back or weak abdominals are other common causes.
Muscles indirectly affected by anterior pelvic tilt
This is where things deviate from person to person as individual bodies find different patterns of strain to balance APT. Generally, when the pelvic region tilts forward, the low back is put into an arch. This shortens the muscles along the low back.
In addition to the shortening of the low back, the muscles and skeletal system will make many adjustments to balance the body in a standing and sitting posture. In my case, with the pelvis and low back rotated anteriorly, the upper body angles in the opposite direction to achieve balance. This causes the chest to protrude as the entire spine arches. Gravity then causes the shoulders to retract and the scapula to slide towards each other. This particular pattern of secondary strain is common. These muscles are either stretched or shortened:
- Posterior shoulder and rotator cuff muscles (shortened) – rhomboids, trapezius, teres minor, infraspinatous
- Anterior shoulder and rotator cuff muscles (stretched) – pectoralis minor, subscapularis
- Shoulder medial rotators (stretched) – subscapularis, teres major, latissimus dorsi, deltoid, pectoralis major
- Thoracic back muscles (shortened) – spinalis, semispinalis
Now let’s consider the region below the hip. The femur (the primary bone running along the thigh) has a large range of motion inside of the hip socket and isn’t forced into a new alignment with the rotation of the pelvis. Often, APT causes the legs to assume a locked knee position instead of bent knees. This is true for me, except my locked knees are never fully straight. I mentioned that a tight and/or posterior dominant IT tract was part of my anterior pelvic tilt system. Since posterior IT tract is involved in flex the knee, this could be partially to blame for the perpetual bend in the knee that never goes away despite stretching the legs. This bend slightly reduces the stretch in the flexors and the contraction of the extensors mentioned above. With the slightly knee bent, the foot is in slight dorsiflexion so muscles involved with plantar and dorsiflexion are also affected:
- Iliotibial Tract (shortened) tensor fascia latate and iliotibial band
- Ankle Dorsiflexors (shortened) – tibialis anterior, extensor digitorium longus, extensor hallucis longus, peroneus tertius
- Ankle Plantarflexors (stretched) – soleus, plantaris, peroneus longus, gastrocnemius, flexor hallucis longus, flexor digitorum longus, tibilias posterior, peroneus brevis
How Anterior Pelvic Tilt Affects Your Dancing
APT affects the mechanics of your dancing and the appearance of your lines. If you have a tight posterior iliotibial tract, the leg will never achieve a straight long line. With the hip flexor anteriorly rotated, your butt sticks out. With the posterior shoulder muscles contracted, your shoulders don’t stay in front of your body. All of these imbalances compromise your dancer’s frame. With the abdominals chronically stretched and weak, it’s difficult to engage them as you lean your upper body back for the ideal ballroom shaping. Whether smooth or rhythm, ballroom dancing is about moving from your core and APT prevents your core from engaging the way it should.
How to combat anterior pelvic tilt
When a muscle is engaged, it is actively contracting. However, a passive contraction occurs when a muscle is shortened due to an alignment of the skeletal system that reduces the space between to muscle’s insertion points. When the hip is anteriorly rotated, some of these muscles are chronically stretched while others are chronically shortened, but none of the affected muscles are necessarily strong. Therefore, you should neither avoid nor focus on strengthening the already shortened muscles unless you have specifically identified an imbalance of strength.
Rather, to correct the alignment of the pelvis, we should focus on strengthening the chronically stretched muscles. Simultaneously, we should focus on stretching the chronically shortened muscles. Both of these foci will help move the hip into a more balanced alignment.
Exercises and Stretches to Combat Anterior Pelvic Tilt
To reiterate, these exercises and stretches are designed with my particular brand of APT in mind. Please make adjustments if you understand your body to have a different pattern of APT. I also have a workout checklist that includes everything from this post and my Daily Workout of a Ballroom Dance Yogi post in an abbreviated (but complete) checklist format.
Iliopsoas group/hip flexor and quadriceps Femoris/knee extensor stretches
- Lunge stretch keeping hips forward. Can also lift arm above the head and bend upper body to enhance the stretch in the hip flexor.
- Cobra pose – keep the abs engaged to avoid overarching the low back. Also work the hamstrings and calves.
- Upward facing dog pose
- Bridge pose (or full wheel pose) – keep the abdominals engaged during this pose to avoid overarching the low back or overstretching the abdominals. Try to keep the stretch in the hip flexors.
- Pigeon – Adjust this pose so that you feel it predominantly in the quad of the back leg, then re-adjust so you feel it predominantly in the hip flexors of the front leg. Make sure both get stretched.
Back muscle, posterior shoulder, and rotator cuff muscle stretches
Even though I’m focusing on stretching the back muscles for APT, if you spend a lot of time at a desk with a slouched back, it’s important to strengthen these muscles as well.
- Child’s pose
- Shoulder stand – not only does this stretch the all of the back muscles, it also works pectoralis minor and the hamstrings work to keep the legs together. Make sure to keep the pelvis posteriorly rotated.
- Plow pose – Can extend the stretch in the back by taking shoulder stand into plow pose.
Iliotibial Tract Stretches
- Use a foam roller to really target the IT band
- Butterfly pose – play with this pose until you feel the IT tract being stretched primarly.
Ankle dorsiflexor stretches
- Toe extensor stretch – Use your hands or a band to facilitate the stretch
We want to strengthen glutes, hamstrings, abdominal wall, ankle plantar flexors, and anterior muscles of the shoulder. We want to avoid exercises that target the hip flexors specifically.
Abdominal Wall Strength
- Boat pose – do until you feel back arching, which indicates the hip flexors are taking over.
- Crunches (and crunch variations) – keep the legs vertical with the knees bent and parallel to the floor when performing these.
Crunches are preferred to sit-ups with the feet on the floor, which work the hip flexors, in addition to the abdominal wall.
- Avoid focusing on abdominal exercises that involve lifting and lowering the legs, since this is the action of the hip flexors.
- Dumbbell side bends
- Plank – squeezing glutes the entire time. Don’t let back arch. Keep hips in a posterior pelvic tilt position. Keep legs slightly apart and squeeze glutes while performing plank to help the posterior alignment of the pelvis.
- Neutral pelvis palloff press – Works obliques. Feet stay wide and pull cable into body then push and pull cable into body.
Glute and Hamstring Strength
- Lunges (with or without weights) – These work the hamstrings and the quadriceps. If you know your quadriceps are tight, you may want to limit this exercise. Forward lean when in the lunge position to promote more glute activation when coming up to neutral standing.
- Cable back kicks – For this exercise and all exercises that involve bringing the leg behind the body, try to avoid laterally rotating the leg – keeping the hips square – if you want to avoid strengthening an already tight IT band.
- Hip extensions (machine, floor, or flying dog variations) – Keep hips square and avoid rotating the leg laterally to avoid working the IT tract.
- Bridges – Keep the feet pointing forwards, not out, to avoid working the IT tract. Squeeze the glutes and try to keep the pelvis posteriorly rotated as you raise the hips.
- Hip/leg abductions (cable, machine, or floor) – Notice how shifting the angle of the leg as it abducts works different sides of the muscles. If you are trying to strengthen the anterior IT tract to help counteract a tight posterior IT tract, focus on bringing the leg out and slightly in front of the body rather than out and behind the body. Use a foam roller between sets to prevent excess contraction of the IT tract.
- Bulgarian splits squats (driving through heel) – lunges with back foot on a bench. Stay posteriorly tilted and keep knee over foot. Lower yourself down and push through heel and butt to lift up.
- Stiff legged dead lifts – Not only are these great for the hamstrings and glutes, but they work the entire back. Though we are not focusing on strengthening the back muscles, it’s healthy to do a bit of strength training throughout the body.
- Squats (with or without weights) – These also work the quads for balance. If you’re a dancer, strong knee extenders are important for straight legs. If you have a short IT tract like me, resist the urge to do the exercise with your feet turned out and instead take a wider stance (which works the inner thighs more).
- Angled leg presses – depending on where you place your feet, you’ll work the quads or hamstrings more.
- Upward plank pose – A dynamite exercise that also stretches the hip flexors and strethens the abdominals. Don’t let the seat drop or the back arch.
Plantar Flexor Strength
- Leg curls (standing, laying, or seated) – This works the plantor flexor gastrocnemius as well as the hamstrings
- Calf raises (seated, standing, with or without weights)
- One-legged toe raises
- Donkey calf raises
Anterior shoulder and shoulder medial rotator strength
- Incline press
- Bench press
- Push up – If you have trouble doing these without arching the back, put your knees on the floor to keep the pelvis posteriorly rotated.
- Parallel bar dips
- Dumbbell press and flys (including inclined variation)
- Deck flys
- Cable crossover flys – This is one of the few exercises here that target pectoralis minor.
Using a foam roller allows you to lengthen muscles that are difficult to target when other muscles have an imbalance of strength or flexibility that makes them difficult to reach. Some areas to target with the foam roller include:
- Back muscles – Lay on roller and roll along back, keeping core engaged so back doesn’t curve around the roller.
- Tensor fascia latae and IT band
- Hip flexors
Exercises and Stretches to Avoid or Use with Caution
Skip or modify any core exercise that causes you to arch you back in order to perform. For example, there are many core exercises where you lay on your back and lift your legs in various ways. If you can complete these with your back flat on the floor and your core engaged, fine. But if you find your back arching off the floor, that means you are using your hip flexors to complete the exercise. We want to focus on stretching the hip flexors and strengthening the opposing muscles to achieve a balanced posture.
Other Ways to Combat Anterior Pelvic Tilt
Find ways to sit less. Sitting puts your hip in flexion, contributing to APT. When you do sit, try to keep your core engaged. In other words, sit with good posture.
Anatomy Zone – This site is really helpful in viewing anatomy.3