Posterior Pelvic Tilt: Causes and Treatments

Posterior pelvic tilt is a condition characterized by the pelvis being pulled downward in back, causing the lumbar arch to decrease. This condition can cause back, hip and leg pain.

Causes

Posterior pelvic tilt is caused by muscle imbalances in the core and legs. Muscle imbalances in the lower body can pull the pelvis down and under, flattening out the lumbar lordosis from the bottom. The typical muscle imbalance scenario that causes posterior pelvic tilt involves tight hamstrings, glutes and lower abdominal muscles coupled with weak quadriceps, psoas and lower back muscles. Tight muscles exert a pull on body structures that is not counterbalanced by the pull of weak muscles. The pelvis is pulled downward by the glutes and hamstrings and under by the lower abdominals.

Posterior pelvic tilt is not as common as anterior pelvic tilt, or the titling of the pelvis downward in front, which is caused by the opposite muscle imbalance. In the general population, hamstrings are weaker than quads and the psoas are tight, whether you’re a runner or an office worker. Those at risk for posterior pelvic tilt are mainly gym-goers who over-focus on their glutes, hamstrings and abdominal muscles. Straight leg dead lifts and leg presses are two gym exercises that may cause the glutes and hamstrings to become tighter than the psoas and quads. Any exercise that isolates the abdominal muscles will likely cause an imbalance between the abdomen and back.

Symptoms

The most obvious symptom of posterior pelvic tilt is a loss of curvature in the lumbar spine and a pelvis that is higher in front than in back.

As postural dysfunction advances, the upper body will begin to pitch forward. This is because the spine is a unit and a change in one area will cause change in another area. As the arch flattens in the lower back, the thoracic segment in the upper back and the cervical segment in the neck are pushed forward. People with advanced posterior pelvic tilt may appear stooped over.

Discogenic pain may result from this condition as spinal discs are subjected to uneven pressure. As the anterior sides of the lumbar vertebrae move closer together, the pressure placed on the spinal disc may cause a rupture or bulge on the posterior side. Disc herniation or bulging can irritate the nerves that travel through the lumbar spine to the lower body, causing sciatica pain.

Muscular pain may be present in any of the muscles involved in posterior pelvic tilt. The muscles that are tight are chronically strained and likely have knots called trigger points. The weaker, overstretched muscles are also strained by the stretching they’ve endured; muscles contract as they’re stretched to protect themselves from tearing. The constant contraction of both the weaker and stronger muscles can cause pain, cramping and spasms.

Treatment

The best way to correct pelvic tilt is to balance the muscles affecting the pelvis. Chronically tight muscles require more than stretching to regain their flexibility. Foam rolling, or self-myofascial release (SMR), can restore length to the hamstrings and glutes. If you have trigger points in your abdominal muscles, you’ll likely need to seek out myofascial release from a practitioner as these muscles aren’t in a good location for rolling. See www.myweightlifting.com for information on how SMR is applied to various muscles of the body.

Part of balancing your body is strengthening muscles that are weak. Once your overly-tight muscles have regained flexibility, it’s time to start building your lower back, quads and hip flexors. Lunges help to strengthen the quads and hip flexors while also retraining these muscles to work with the hamstrings and glutes, rather than being dominated by them. The superman pose, which involves lying on your stomach and lifting your arms, head and feet a few inches off the ground, builds your lower back muscles.

Aside from directly correcting muscle imbalances, preventing them in the future will be an essential component of back pain treatment. You will need to redesign your workout regimen to support the development of a balanced body. Focus on exercises that develop multiple muscle groups and ensure that your form is correct.

People with posterior pelvic tilt would benefit from consulting with a physical therapist concerning healthy ways to exercise. Resolve posterior pelvic tilt before it becomes a source of chronic pain.

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