How Pelvic Tilt Affects Your Back Pain (and How to Fix It)

If you’ve ever struggled with back pain, you may have heard about anterior or posterior pelvic tilt—but how does it actually affect your body? The way your pelvis is positioned, either forward (anterior pelvic tilt) or backward (posterior pelvic tilt) plays a major role in posture, core muscle engagement, and spinal alignment. Identifying your own pelvic alignment and making small adjustments can help you reduce strain and tension, enhance core stability, support a healthier back, and help you move with greater ease.

Let’s explore how to figure out which pelvic alignment you have, whether anterior or posterior, what causes pelvic tilt, and what you can do to fix it and find better balance.

What is Pelvic Tilt?

The pelvis is a central structure in the body that supports the spine and helps maintain proper posture. Pelvic tilt refers to the way the pelvis is positioned in relation to the rest of the body. 

There are two main types:

1. Anterior Pelvic Tilt: This happens when the front of the pelvis tilts forward and downward, exaggerating the natural arch in the lower back. It is often linked to tight hip flexors and weakened abdominal and glute muscles, creating a noticeable lower back sway.
2. Posterior Pelvic Tilt: In contrast, excessive posterior pelvic tilt occurs when the pelvis tilts backward, causing the lower back to flatten out instead of maintaining its natural curve. This "flat back" posture reduces the normal inward curve of the lumbar spine, leading to a more rigid and straightened appearance.  

Impact of Pelvic Tilt on Back Pain

Understanding how pelvic tilt affects back pain hinges on its influence on spinal alignment and muscle balance.

Commonly observed in individuals who sit for prolonged periods, anterior pelvic tilt can lead to excessive lumbar lordosis (arched lower back), which may compress spinal discs and nerves. This compression can manifest as sciatica or radiating pain down the legs due to impinged nerves. A condition known as stenosis involves a slight compression where the back of the vertebrae narrows, causing them to potentially touch each other. This situation can lead to significant issues because nerves and blood vessels exit the spine and spinal cord into the legs, necessitating adequate space in this area.

The primary problem associated with anterior pelvic tilt is that it reduces the space required for these nerves and blood vessels to exit properly. If you experience nerve symptoms in your legs, this could be a contributing factor. When you've maintained a particular position for an extended period, the vertebrae can gradually deteriorate due to repetitive trauma, leading to them sliding forward, a condition known as spondylolisthesis, where vertebrae slip forward over each other. 

Posterior pelvic tilt tends to promote a more neutral spinal alignment, which can alleviate pressure on the lumbar spine. By opening up the back of the vertebrae, posterior pelvic tilt can reduce strain on spinal discs and nerves, which can ease discomfort associated with conditions like spinal stenosis.

Assessing Your Pelvic Tilt

Figuring out if you have an anterior or posterior pelvic tilt can be accomplished with the simple self-assessment below:

• Anterior Pelvic Tilt: Lie flat on your back with legs straight. If your lower back arches significantly away from the floor and feels tense, it's likely you have an anterior pelvic tilt. If you feel significant tension in your lower back, almost as if it's trying to lift off the floor, this may indicate tightness in your hip flexors, which can pull on your spine. If this sensation is uncomfortable, it further suggests that your pelvis is likely tilted anteriorly.
• Posterior Pelvic Tilt: When lying flat, if your lower back feels flattened against the floor without a slight curvature of the spine, you may have a posterior pelvic tilt.

Identifying your pelvic tilt type provides valuable insight into potential contributing factors to your back pain and informs the approach to corrective exercises.

Corrective Strategies: Moving Towards Neutral

While achieving a perfectly neutral pelvic position may be the ultimate goal, particularly for optimal spinal health, many individuals benefit from transitioning towards a posterior pelvic tilt to alleviate discomfort. Here’s how you can start:

1. Core Balance Training Approach: Developed to address muscle imbalances commonly associated with pelvic tilt, the Core Balance Training program emphasizes reactivating key muscles to support a neutral or more congruent posterior pelvic tilt if your body is naturally biased towards anterior pelvic tilt. This includes strengthening the abdominals and gluteal muscles while releasing tight hip flexors.
2. The Anchor Triad: Central to the program is the concept of the Anchor Triad, consisting of three key muscle engagement points—Lower Front anchor (pubic bone), Upper Front Anchor (bottom of the rib cage in the front), and the Back Anchor (bottom of the rib cage in the back). These are the foundations of the program. These three anchors serve as a reliable system to support the spine, allowing you to lean on them and naturally bring both the spine and pelvis into a neutral position, regardless of whether you tend toward anterior or posterior tilt. By connecting with these anchors and establishing this foundational support, you're achieving what I refer to as core balance. You can depend on this. It functions like a brace, effectively maintaining your spine in a neutral position.
3. Progressive Exercises: Starting with foundational exercises like the back anchor awareness, the front anchor awareness, and the bridge (done the correct way), which encourages a more congruent posterior pelvic tilt, and gradually incorporating techniques to engage the anchor triad, the Core Balance Training program aims to help you reconnect with and strengthen core muscles essential for spinal support. We initially use the floor as a cue because that’s how we first learned to develop our core as infants. We emulate this foundational experience to reset our movement patterns and reconnect with the deep spinal support muscles.

Benefits of Core Balance Training

The glutes and abdominals collaborate to create posterior pelvic tilt.

These two muscle groups often become inhibited or weak and lengthened due to the predictable patterns of muscle imbalances prevalent in our society, largely stemming from prolonged sitting. This phenomenon explains our tendency toward anterior pelvic tilt, as there isn’t sufficient tension in these muscles; they aren’t active enough. This pattern is the most common and predictable.

I would estimate that around 80% of individuals experiencing chronic lower back pain are dealing with an anterior pelvic tilt. To address this issue, we need to reactivate the muscles that facilitate a posterior pelvic tilt. However, we don’t want to fully shift into a complete posterior tilt, as that would be compensatory and not a true solution. Such a position can lead to problems, as a full posterior tilt can stretch the discs slightly, potentially exacerbating soreness, tenderness, and pain, especially for those with disc injuries.

There is no definitive answer regarding whether anterior pelvic tilt or posterior pelvic tilt is better. The reality is that the optimal position for the spine is neutral. Our goal should be to move toward this neutral position by working on achieving a posterior pelvic tilt, as this essentially restores pelvic balance when anterior pelvic tilt is present.

The Core Balance Training program is adaptable and can address both excessive anterior and posterior pelvic tilt, guiding individuals to a more balanced and neutral pelvic position. The program focuses on muscle activation and spinal alignment to remove any discomfort an individual is feeling, but it also can help prevent future issues that may arise that are relevant to muscle imbalances or bad posture, coexisting with anterior/posterior pelvic tilts.

Conclusion: Taking Charge of Your Spinal Health

If you’re currently experiencing back pain, identifying and assessing an anterior or posterior pelvic tilt through specific exercises and muscle reactivation can significantly improve your way of life. 

Core Balance Training can give you the tools to align your spine and reduce your chronic lower back pain, leading you to a more balanced life.

Have you ever noticed how your pelvic alignment affects your posture or back pain? Have you tried any of these strategies? Share your experience in the comments!