What is a Posterior pelvic tilt?
A Posterior Pelvic Tilt is where the pelvis is rotated backwards from the ideal neutral position.
(This pelvis position can be described as having a “tucked tail bone”.)
Additionally – There is a loss of the natural curve in the lower back (Hypolordosis).
In This Blog Post:
- Is It Bad?
- When Do People Experience It?
- Causes
- Muscles Involved
- Tests
- Posterior Pelvic Tilt Exercises
Is A Posterior Pelvic tilt Bad?
No – Having a Posterior Pelvic Tilt is not inherently “bad”.
(There are many people with a Posterior Pelvic Tilt with no symptoms at all!)
However – The potential issues with a Posterior Pelvic Tilt arise when the pelvis habitually gets locked into this position.
The pelvis position can significantly affect the rest of your posture.
As the pelvis tilts backwards, there will be a loss of the natural curve in the Lumbar Spine (Hypolordosis).
Without the natural arch in your lower back, the Lumbar Spine may be predisposed to developing issues such as:
- Disc Bulges
- Sciatic Nerve Issues
- Muscular strains
When do people experience a Posterior pelvic tilt?
A posterior tilt of the pelvis is commonly seen in movements such as:
- Sitting
- Squatting
- Bending Forwards
- Standing
a) Sitting
If you tend to slouch whilst sitting, your pelvis will tend to naturally rotate backwards into a Posterior Pelvic Tilt.
b) Squatting
If your lower back tends to round whilst performing a deep squat, then it is likely the pelvis is rotating backwards.
This is referred to as a “butt wink”.
c) Bending Forwards
Think about the times when you are picking something up from the floor, tying your shoe lace or even putting on your pants.
Are you rounding your lower back?
If so – your pelvis has moved into a Posterior Pelvic Tilt!
d) Standing
If you have a Sway Back Posture or Flat Back Syndrome, then you will likely have a Posterior Pelvic Tilt as well.
What causes Posterior Pelvic Tilt?
If I were to blame just one thing, I would say: Sitting.
You are either sitting too much and/or sitting with bad posture.
(… And if I were to guess, I would say that you are probably doing both!)
Excessive sitting causes certain muscles that control the position of the pelvis to get tight/overactive and/or weak/inhibited. (See below)
As a result – there is a muscular imbalance around the pelvis region causing a net force to tilt backwards.
Muscles involved with Posterior Pelvic Tilt
Tight/Overactive Muscles:
(These muscles will benefit from Releases and Stretches.)
- Hamstring
- Gluteal Muscles
- Abdominal
Weak/Elongated Muscles:
(These muscles will benefit from being Activated and Strengthened.)
- Hip Flexor
- Lumbar Erector Spinae
(These are the muscles that will be specifically addressed in the exercise section.)
How can you tell if you have Posterior pelvic tilt?
Here are simple tests that you can perform to see if you have a Posterior Pelvic Tilt.
a) In Standing:
Instructions:
- Stand up.
- Place one finger on the Anterior Superior Iliac Spine (ASIS)
- This is the pointy bone at the front of your pelvis.
- Place another finger on the Posterior Superior Iliac Spine (PSIS).
- This is the pointy bone at the back of your pelvis.
- Compare the height of these 2 land marks.
If you have a Posterior Pelvic Tilt: The finger at the front of your hip bone will be significantly higher in comparison to the finger on the pointy bone at the back.
(Keep In Mind: Everyone has different shaped and sized “pointy bones”. This can influence the results.)
b) In Bending Forwards, Squatting or Sitting:
Pay attention to the curve of your lower back.
If there is a reduction in the normal arch in the lower back, it is likely that your pelvis is tilting backwards.
Posterior pelvic tilt Exercises
Follow these steps to fix your Posterior Pelvic Tilt:
- Releases
- Stretches
- Joint Mobilizations
- Improve Hip Rotation
- Activate the Inhibited Muscles
- Pelvic Tilts
- Maintain Neutral Pelvis
- Daily Activities
- Other Things To Address
- Tips
1. Releases
It is important to release the tight muscles that are involved with holding the pelvis in a position of a posterior tilt.
These muscles include:
- Gluteal muscles
- Hamstring
- Abdominals
a) Hamstring
Instructions:
- Sit down on the floor with your leg straight in front of you.
- Place your Hamstring muscles on top of a foam roller.
- Use your body weight to apply an appropriate amount of pressure into your Hamstrings.
- Roll your Hamstring muscles over the foam roller.
- Make sure to cover the entire area between the back of the knee and back of the hip.
- Do this for 1-2 minutes.
- Alternate sides.
b) Gluteal Muscles
Instructions:
- Place the back of your hip on top of a massage ball.
- Use your body weight to apply an appropriate amount pressure.
- Make sure to cover the entire back of the hip.
- Do this for 1-2 minutes.
- Alternate sides.
c) Abdominal (Lower)
Instructions:
- Lie down on your stomach.
- Place a massage ball under the lower abdominal region
- Gently circulate your body weight on top of the ball.
- Be careful not to apply too much pressure.
- (Do not squash your organs!)
- Use deep breaths to help relax your muscles.
- Continue for 1-2 minutes.
2. Stretches
The next step is to stretch the tight muscles!
a) Hamstring
Instructions:
- Stretch the Upper and Lower region of the Hamstrings:
- Upper: Whilst standing, place a slightly bent knee in front of you.
- Lower: Whilst standing, place a straight knee in front of you.
- Lean forward by hinging at the hips.
- Keep your lower back completely straight.
- Aim to feel a stretch in the respective region of your Hamstrings.
- Hold for 60 seconds.
- Alternate legs.
(For more stretches, check out this blog post: Hamstring Stretches.)
b) Gluteal Muscles
Instructions:
- Sit down on a chair.
- Sit up right and keep your lower back arched throughout this stretch.
- Place your ankle on top of the other knee.
- Place your hands on the outer side of the knee.
- Pull this knee towards the opposite shoulder.
- Lean your torso slightly forwards.
- Aim to feel a stretch in the back of the hip.
- Hold for 60 seconds.
- Alternate sides.
c) Abdominal
Instructions:
- Lie down on your stomach.
- Place hands on floor directly under shoulders.
- Straighten your elbows.
- Keep your leg completely relaxed.
- Arch backwards.
- Be careful if you have lower back issues.
- Aim to feel a stretch across your lower abdominal region.
- Breathe and expand your stomach as you stretch.
- Hold for 60 seconds.
(If you would like to see more stretches to the stomach region, check out this post: Abdominal Stretches.)
d) Posterior Capsule
Instructions:
- Assume the position as seen above.
- Make sure your knee is directly underneath your hip joint.
- Maintain the lower back arch throughout movement.
- Push your hips backwards.
- Feel a deep stretch in the back of your hip.
- Hold for 60 seconds.
3. Joint mobilization
Tight hip joints can make it very difficult to maintain a neutral pelvic alignment.
Here are a few ways you can reduce stiffness in the hip joints.
a) Hip Traction (Leg Straight)
(You will need a helper with this technique.)
Instructions:
- Lie down on the floor.
- Instruct a helper to firmly grasp your ankle. (See above)
- Relax your leg as your helper pulls your foot away from you.
- Aim to feel a pulling sensation in the hip.
- Hold for 30 seconds.
b) Hip Traction (Leg Bent)
Instructions:
- Lie on the floor in the position as shown.
- Anchor a thick resistance band to a stationary object.
- Flex your hip to 90 degrees.
- Wrap the resistance band as high up into the hip crease as possible.
- Move your whole body further away from the anchor point.
- This to create tension on the band.
- Hold onto your knee with your hands.
- Keep the hip completely relaxed.
- Hold for 1-2 minutes.
- Alternate sides.
4. Improve Hip External Rotation
Hip External Rotation is the movement where the upper leg bone (Femur) rotates outwards within the hip socket.
If you do not have an adequate amount of external rotation in the hip, it may limit one’s ability to get the pelvis into a more neutral position.
Check out this blog post for a full guide on how to increase external rotation: How To Increase Hip External Rotation.
To get you started, perform the following 3 exercises:
a) Butterfly Stretch (Lying Down)
Instructions:
- Lie down on your back.
- Place the bottom of your feet together.
- Bring both feet closer to your body.
- Allow your knees to lower towards the floor.
- Relax your legs completely.
- Aim to feel a stretch in the groin muscles.
- Hold for 30 seconds.
b) Supine Hip External Rotation
Instructions:
- Lie down on your back.
- Pivot your leg outwards.
- Keep your pelvis completely still as you move your leg.
- Aim to feel a muscular contraction in the back of the hip.
- Hold for 2-3 seconds.
- Perform 20 repetitions.
c) Prone Hip External Rotation
Instructions:
- Attach a resistance band around the ankle and anchor the other end to an immovable object.
- Lie down on your stomach.
- Bend your knee to 90 degrees.
- Move your body away from the anchor point to create a suitable amount of tension on the resistance band.
- Pivot your leg inwards.
- Do not move your pelvis.
- Aim to feel a muscular contraction in the back of the hip.
- Hold for 2-3 seconds.
- Perform 20 repetitions.
5. Activate the inhibited muscles
The muscles that are responsible for reversing the Posterior Pelvic Tilt need to be activated.. Wake up your sleeping muscles!
a) Hip Flexor Activation
Instructions:
- Lie down on your back.
- Tilt your pelvis forwards.
- Maintain the arch in your lower back throughout this exercise.
- Lift your knee up.
- Do not let your pelvis rotate backwards.
- Place your hands on top of the knee.
- Push your knees against your hands.
- Hold for 5 seconds.
- Alternate for 10 repetitions each.
b) Lower Back Activation
Instructions:
- Lie on your stomach.
- Stretch out your arms in front of you.
- Lift your upper body and legs high off the floor.
- Aim to feel a contraction of the muscles in your lower back.
- Hold for 5-10 seconds.
- Repeat 10 times.
6. Pelvic Tilts
The next step is to learn how to tilt your pelvis forwards.
a) Pelvic Tilt (In 4 Point Kneel)
Instructions:
- Assume 4 point kneel position.
- Arch your lower back as you tilt your pelvis forwards.
- Aim to feel a contraction in the muscles of the lower back.
- Hold for 5 seconds.
- Return to neutral spine.
- Repeat 30 times.
b) Pelvic Tilts (In Sitting)
Instructions:
- Sit on the edge of a chair.
- Sit upright. Think long and tall throughout the spine.
- Proceed to tilt the pelvis forward.
- Aim to feel a contraction in the muscles of the lower back.
- Hold for 5 seconds.
- Repeat 30 times.
c) Standing Pelvic Tilts
Instructions:
- Stand up right.
- Tilt your pelvis forwards.
- Try not to move your torso or legs as you are moving your pelvis.
- Repeat 20 times.
7. Maintain Neutral Pelvis
In this section – The aim is to keep a neutral pelvis whilst performing the following movements.
a) Hip Flexion with Neutral Pelvis
Instructions:
- Assume the position as seen above.
- Make sure that your pelvis is in a neutral position.
- Engage your core muscles.
- Think about drawing your belly button in and gently tensing your abdominal muscles.
- Lift your knee forwards whilst maintaining a slight arch in your lower back.
- Hold for 5 seconds.
- Repeat 20 times.
- Alternate legs.
b) Hip Bridge
Instructions:
- Rest your back on the edge of a chair.
- Maintain the arch in your lower back throughout this exercise.
- Drive your hips upwards.
- Hold for 2 seconds.
- Perform 20 repetitions.
c) Sitting Knee Lift
Instructions:
- Sit up right on the edge of a chair.
- Maintain the arch in your lower back throughout this exercise.
- Lift your knee as high as possible without rounding your lower back.
- Do not lean backwards.
- Repeat 20 times.
d) Knee Lift (Standing)
Instructions:
- Stand upright.
- Place your foot onto a block at knee height.
- Maintain the arch in your lower back throughout this exercise.
- Lift your knee as high as possible without rounding your lower back.
- Do not lean backwards as you lift your knee up.
- Repeat 20 times.
8. Daily Activities
You can perform all the above exercises, BUT… if you do not apply it to the positions you adopt throughout most of the day, then your Posterior Pelvic Tilt will continue to exist.
Since your pelvis has been in this position for some time now, your body is going to try and go back to it as a default setting. You need to resist this!
Be aware of your pelvis position.
Maintain a neutral pelvis throughout the following positions:
a) Sitting
“Sit on your sit bones”
Instructions:
- Sit down on a chair.
- Place your hands underneath each buttock cheek.
- Tilt your pelvis forwards and backwards.
- Feel for a pointy bone prominence under your hips.
- These are referred to as your “Sit Bones”.
To position your pelvis properly: Sit directly on top (or even slightly in front) of the pointiest part of the Sit Bone.
(Most people will tend to let their tail bone tuck underneath and sit behind the sit bones.)
b) Hip Hinge (aka bending forward)
Instructions:
- From a standing position, hinge forward from the hips.
- Make sure to maintain the arch in your lower back.
- Only bend forward as far as you can maintain neutral pelvis.
- Tightness in the hamstring region should be the limiting factor to your movement.
- Repeat 20 times.
- To progress: Hold onto a weight.
(For more exercises, check out this blog post: Hinge Exercises.)
c) Squatting
Instructions:
- Stand sideways to a mirror so that you can monitor the curvature of your spine.
- Practice squatting as deep as you can go.
- Only squat to a depth without letting your lower back round forwards.
- Maintain a neutral pelvis.
- Repeat 20 times.
d) Walking
When walking – be mindful of the position of your pelvis.
If it is comfortable, try to maintain a more neutral pelvis. (… but don’t force it!)
9. Other things to address
If you have tried all of the above exercises and you still have a Posterior Pelvic Tilt, you may need to consider specifically address the following postural issues:
a) Sway Back Posture
The Sway Back Posture is where the pelvis is pushed in front of the vertical line of the ankle.
As a result – the pelvis will tuck under and the torso will “sway back” in the attempt to compensate for the forward shift of the pelvis.
For a detailed guide on how to address this issue:
See Post: Sway Back Posture
b) Flat Back Posture
This is where there is a decrease in the normal curvature of the spine.
For a detailed guide on how to address this issue:
See Post: Flat Back Posture
10. tips
Here are some quick tips to help you maintain a more neutral pelvis position whilst Sitting, Standing, Sleeping and More.
Sitting:
a) Use a lumbar support in sitting
Using a lumbar support on a chair will maintain the natural lumbar curve and discourage the pelvis from tipping backwards.
b) Keep hips higher than knees
When sitting – Aim to have the level of your knees slightly lower than your hips.
This will encourage a more neutral pelvis position.
To keep your hips in a relatively higher position:
- Increase the height of the chair
- Use a kneeling chair
- Use a seat wedge cushion
c) Large Belly Size
If you tend to have a large stomach, this will create a physical block between your pelvis and thighs.
This can make it difficult for the pelvis to attain the ideal position whilst sitting.
If you fall into this category, I suggest that you sit from a slightly higher chair so that there is adequate space at the front of the pelvis.
d) Avoid Sitting on Soft Couches
Couches are usually too soft, too low and too deep to provide adequate support for your pelvis.
e) Driving
Adjust your car seat appropriately to ensure you sit with good posture.
Standing
a) Do NOT butt/abdominal grip
This basically means to avoid over tensing your glutes and/or abdominal muscles whilst you are standing. Relax!
b) Do not push your hips forwards
Avoid resting your hips in the forwards position.
This will encourage the pelvis to tilt backwards.
Sleeping Position:
a) How should I sleep to correct Posterior Pelvic Tilt?
If you sleep on your back, place a small rolled up towel underneath the arch of your lower back.
This will help maintain the arch required to keep the pelvis in a more neutral position.
a) Do not sleep on a soft mattress
A soft mattress offers no support to the pelvis and lower back region.
As a result – the pelvis may sink into the bed and place the pelvis in a posterior tilt.
Aim for a firm (but comfortable) mattress.
Other:
a) Bend your knees when lifting objects from the floor
This will help keep your back and pelvis in a more neutral position.
b) Avoid overdoing reverse curls
Abdominal reverse crunches will tend to encourage a posterior tilt of the pelvis.
Conclusion
Posterior Pelvic Tilt is where the pelvis is rotated backwards.
It can predispose you to issues such as Disc Bulges, Sciatica and Muscle strains.
The main cause is likely related to prolonged sitting with poor posture.
To correct the position of the pelvis – you will need perform the recommended exercises to address the muscular imbalances.
Throughout the day, be aware of the position of your pelvis. Correct it as appropriate.
What to do next
1. Any questions?… (Leave me a comment down below.)
2. Come join me on the Facebook page. Let’s keep in touch!
3. Start doing the exercises!
Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content provided on this blog post is at your sole risk. Consult a healthcare professional before starting any exercise. For more information: Medical disclaimer.
You have great advice on this website. I have a posterior pelvic tilt and years ago I worked with a great physical therapist.
Unfortunately I got away from her exercises and good advice. I do have two questions I wanted to ask you on using a seated wedge cushion. Both my physical therapist and you recommend this. I have two of these at home, but it’s been so long since I used them, I forgot in the proper way to use them. Here are my two questions:
1. When I position the wedge pillow on a chair, does the higher-end go toward the back of the chair and the lower end go toward the front of the chair?
Then I recall that I sat somewhere near the middle of the cushion.
2. I never asked my therapist this question. Can I use the wedge cushion when I’m driving in my car? If not, how would you recommend that I position the car seat?
Thank you for making your great advice available.
Hi Catherine,
Thanks for your questions.
1. The higher end goes towards the back of the chair. This is to encourage the hips to be higher than the knees which can help promote a better pelvis sitting position.
2. Yes – you can use a wedge pillow for the car. However – you might need to get one that has been specifically designed to fit in cars. Just make sure that it is not impeding your ability to drive safely.
Mark
Thank you. Do you know where I would find a wedge cushion that is specifically for use in cars?
Hey Catherine,
Amazon has quite a few. That would be a good place to start.
Mark
Hi Mark,
Thanks for sharing the knowledge on the posterior pelvic tilt, from my personal experience I want to highlight on the issue of muscle imbalance between hip abductors and adductor muscles. I think these muscle groups aren’t covered in this topic.
In case of PPT, the adductor muscles becomes super weak and abductor muscles becomes tight & shortened.
For a month, I tried doing abductor muscles group strengthening exercises like clamshell, and side lying leg raise along with adductor muscles stretch (groin stretch). I can bet that mostly people with PPT experience groin pain and they start doing adductor stretch, this is completely wrong. The pain in adductor muscles is due to weakness.
After noticing not much improvement in my PPT condition, I started begin doing adductor strengthening followed by gluteal muscles stretch. I noticed sudden improvement in my PPT condition, have been able to maintain neutral spine most of the time.
Adductor muscles strengthening plays a vital role in reversing the PPT because in case of APT, this same adductor muscles become tight.
Please let me know what’s your take on this.
Hi Mark,
Thanks for taking the time to write this article it is incredibly informative, there really is such limited information online about Posterior Pelvic Tilt, let alone exercises people should do. After reading through your whole article I am 100% certain I suffer from this.
You listed quite a lot of exercises. Do you have any that you recommend I should start off with and maybe do daily? I am 170cm, 66kg if that is any help.
Thanks again,
Craig
Hi Craig,
If you have tightness in the hamstring and lower abdominal muscles, you might benefit from the Releases and Stretches to these particular muscles to start off with.
As they release and you reclaim some flexibility, you can start to address the strengthening exercises.
Mark
Hi mark, my problem is that when I train my quads in the gym and run my quads fatigue really quickly and I think it’s due to maybe and imbalance? And when doing the leg extensions on the machine I get pain in my lower back as well as quickly fatiguing quads
Hey Jess,
It could just mean that you have weak quadriceps and need some time to build them up. (This is likely true especially if you have just targeting this muscle group.)
In regards the lower back pain when doing the seated leg extensions: Make sure that you maintain a neutral lower back. There should be maintenance of a natural arch as you full extend your knee.
Another issue is that it may be due to a bit of neural tension in the sciatic nerve. If this is the case, performing some nerve glides/stretches might help with that: Sciatic nerve stretches.
Mark
Hello Mark,
I am definetely sure that I have posterior pelvis tilt but only one side. Is this possible to have one sided posterior pelvis tilt? Also, that side’s hip flexor muscle is very weak.
The thing I discovered lately is my Rectus Femoris on the same side take over Psoas muscle. So I have 2 questions;
1_ What can I do to neutralize posterir pelvic tilt only for one side?
2_ How can I isolate Psoas or minimize the recruitment of other muscles instead of Psoas?
– I learned a movement which you tie your ankle and hip al together (like bending knee) and do hip flexion when lying down. Does this eliminate rectus femoris since it elongates the muscle?
Mark, you don’t know how much impact you’ve made on me. I’ve sat all my life. Although I exercise often, when I sit down and work, I’ve never been able to maintain steady focus for long periods because I get uncomfortable sitting. Before, I would go home and just crash because of headaches, tight and overactive back and neck muscles. Now, much less. Since learning sitting posture I feel so much better. Energy levels have gone way up. It’s amazing how bad posture has robbed me of my energy. When I go home, I still have plenty of energy to be productive.
Thanks a million!
Whoa! What an awesome comment you left here, Kevin.
Great to hear that you have more energy after fixing your sitting posture. Hope the exercises continue to help you out!
Thanks for letting me know!
Mark
Mark, hi great website! I have had sciatica pain for the past two months. An X-ray done showed I have a pelvis tilt, my right side hip is higher than the left. I went to an acupuncturist twice. The pain I have is when attempting to get comfortable falling asleep or staying asleep for the full night. The nerve feels like a severe cramp and does not let me sleep whether I’m lying on my good or bad side nor on my back. What exercises/stretches do you recommend and what to do to get a full nights rest. Thank you for your time.
Hey Isaiah,
Do you have a disc bulge that may be irritating the sciatic nerve?
You will need to get a CT or MRI scan to determine this.
If you do, I have some simple exercises that might help you out on this blog post:
Bulged Disc Exercises.
(If you are in a lot of pain, you might need to do just stick with 1 or 2 of the basic exercises and slowly progress as tolerated)
Mark
Hi Mark! One struggling to improve hip flexion due to tfl. I also have very limited knee extension.
Would lying knee extension exercise while hip flexed improve hip flexion due to rectus femoris being a biarticular muscle?I’ve tried for some weeks and seams so but I would like to know if my thought is right. Thanks!
Hi Charles,
Do you mean you are have limited hip flexion range?
If you experiencing a pinch at the front, it could be due to hip impingement.
See post: Hip Impingement.
Limited knee extension is usually due to some sort of hamstring/popliteus/calf tightness and/or a knee joint problem.
Mark
Thanks a lot Mark for answering my other question. Just one follow up. You mention using a kneeling chair. I don’t have a kneeling chair, but I can get my office chair pretty high. My question is if I should sit with my legs like on a kneeling chair? Basically with the feet under my butt (instead of in front of me) and feet alsmost vertical? When I sit I often get tightness/pain in the front of my knees and I wonder if it could be the sitting position.
Hey Thomas,
If you tuck your feet underneath you whilst sitting on a chair, this places your knee in more flexion which can compress (or pull on) some structures at the front of the knee. This might be the reason why you get a bit of tightness at the front.
The kneeling chair will place more pressure on your knees so it is probably not recommended if you have existing knee issues.
Mark
Thanks a lot for all the instructions! One thing I’ve been wondering. Can tight hamstrings and glute come as a result of forcing the lower back and pelvis into a posterior pelvic tilt? So more like the other way around than what is usually said with tight hamstrings and glutes causing a posterior pelvic tilt.
Hi Thomas,
Yes – as hamstrings are used to posteriorly tilt the pelvis, prolonged periods of this pelvis position can result in hamstring tightness.
It works both ways.
Mark
Hi Mark! thanks for the site it’s incredibly useful. I have a diagnosed Posterior PT but I’m having a very hard time activating my hip flexors. Everytime I try to do any hip flexors exercise my TFL takes all the work. Besides I would very much like to know how to activate my psoas but after trying everything I can’t even feel it.
Thanks!
Hello Manu,
It is quite common to get the TFL to take over during hip flexion.
My suggestion: Make the exercises easier. eg. instead of lifting your knee up whilst sitting, you can do this same exercise whilst lying on your back with feet supported on wall.
Mark
Hi Mark, if someone have posterior pelvic tilt, how should he work on adductors?
Thanks
Hey Pippo,
If there is any tightness in the adductors, it would most likely be the posterior section of the adductors. (right next to the medial hamstrings)
You can release/stretch this area similarly as you would with the hamstrings.
Mark
What a comprehensive website. Thanks for all your advice.
Thanks Rachael! Hope it helps.
Mark
Hi Mark–
Thanks for these blog posts! I have really bad posterior pelvic tilt (cannot hinge forward in pancake at all, even when raised on blocks, and struggle in pike pose too). However, when running I was told that I have flat/heavy feet and my knees collapse inwards. Is this a case of muscle weakness or tightness, and which exercises would you most recommend?
Thanks,
Jess
Hi Jessica,
It sounds like you may have a few postural issues: (not all might be a major issue though!)
– Exercises for flat feet.
– Knees that collapse inwards.
If you struggle with pike pose and hinging forwards, this may suggest tight hamstrings and/or possibly even tight posterior hip. (stretches to these areas will help!)
Mark
No I actually have a slight swayback posture, that’s why I’m trying to understand why my perineum pain disappear when I do a posterior pelvic tilt and wish you could help
Thanks
Hi Louis,
Due to the many factors that will contribute to your symptoms, it is probably best to get an in-person assessment by a pelvic floor specialist or perhaps someone well-versed in PRI.
If a posterior tilt helps, then it is probably be due to its effect on the musculature that make up that area of the body. The pelvis position can influence the ability of certain pelvic floor muscles to engage or relax.
Mark
Hey Mark,
First thanks for all your help,
I feel a tightness in my perineum when I’m standing, and I noticed that when I put my pelvis in a posterior tilt position on purpose, it relieves the pain, could you help me indentifying the problem?
Hi Louis,
Are you standing with an Anterior pelvic tilt naturally?
The pelvis position can affect the function of the pelvic floor muscles.
Mark
Hi, Mark!
Mu pubic bone is more anterior than my ASIS. When you look at me at the side, my pubis is more anterior than my legs. I really have an insecurity about this because I can’t wear skinny jeans or leggings because my pubis is bulging. I always wear long clothes to hide it. I believe that this is caused by my posterior pelvic tilt. I also have mild scoliosis and my back aches a lot. I have researched about this a lot but I still don’t know what really caused this.
Also, what is the best sleeping position when you have a posterior pelvic tilt? I saw in one of the videos while researching about my condition that sleeping on your stomach is also one of the reasons. I always slept on my stomach since I was a kid.
Hey Anne,
It sounds like you have Sway back posture. Check out this blog post for all the exercises that you need to know for that.
This would explain that Pubic bone in front of the ASIS and legs.
A major cause of this type of posture is sleeping on your stomach.
If you sleep on your stomach, I would also feel you may have thoracic hyperkyphosis.
Mark
Hi the my left hip sit higher than my right. It seem left hip has posterior pelvic tilt, right hip may have a little anterior pelvic tilt. Tight hamstrings on leg side, right ql on right sid and weakness in external abductors. So I don’t believe it’s a lateral pelvic tilt. Is it possible for a posterior pelvic tilt to make it appear that I have a lateral pelvic tilt: left hip hike? And what can I do to fix this? Thank you!
Hi Audrey,
If one side is in posterior tilt and the other is in an anterior tilt, you likely have a degree of rotation.
It is possible for a rotation of the pelvis to cause one hip to be higher than the other. (It would be a very slight difference though.)
If this is the case with you – I would focus on addressing the rotation rather than the tilt.
Mark
Hi Mark,
I’ve revisited this post several times as it’s very detailed. I’ve suffered with lower back pain off and on for years. I will experience very sharp pain in my lumbar region only when I overflex my spine. For example, when performing a hip hinge pattern or doing a stretch such as the toe touch or forward fold. Mind you, my range of my motion is very poor. For the longest time, I thought the culprit might be tight hamstrings so I worked on lengthening them. And then I thought I might have a “posterior pelvic tilt”. But when I measure my pelvic tilt, it’s pretty level and when I do the Thomas test, my lower leg stays completely flat. Having said that, it’s very uncomfortable for me to sit with my legs straight or crossed and sit upright. Actually, I’m a personal trainer and I’ve been trying to figure out the cause for years without much success. Any insight on why my lower back seems so tight or preventing me from touching my toes without risking throwing out my back?
Hey Simon!
Sounds like your lower back in SENSITIVE to lumbar flexion. (This generally happens when you posterior tilt your pelvis)
From what you have said, it sounds like you may have:
– tight hamstrings (make sure you stretch UPPER hamstrings as well). Check out this post: Hamstring stretches.
– possible lack of true hip flexion stopping you from keeping your pelvis neutral when the hips are flexed (sitting, bending forwards).
For more info: Hip impingement.
– very tight lower back. (possibly with an excessive arch?
Check out this post: Hyperlordosis
– Difficulty with crossed leg sitting may indicate issues with your external rotation mobility in your hip. There are some exercises you can do in this post. I would also encourage you to work on internal rotation if you are lacking as well.
Another thing you can check is for a posterior disc bulge in the lumbar spine. These can sometimes cause pain when bending forwards.
Mark
Hi Mark,
Have you come across a posterior pelvic tilt that’s predominantly on one side? That’s what I seem to contend with. It’s on the right side. The pelvis seems to twist to the right. Standing, my right foot is usually a few inches behind the left and turned out; lying supine, the right foot will also flop outward. Is there anything you recommend to correct an asymmetry with a posterior tilt?
Thanks, Jon
Hey Jon,
Check out this blog post: How to fix a Rotated Pelvis.
I think you will find it very helpful for your situation.
If your right foot is pointing outwards along side a pelvis that is rotated to the right, I feel that you might need to work more so on the LEFT hip.
Mark
hello
i see that you have added a lot of exercises but not for erectors.do you know how to stregthen erector spinaes? especially lumbar erectors
Hey Marco,
If you scroll to 4. Activate The Inhibited Muscles, b) Superman, this is how I would strengthen the erector spinae group.
Keep in mind – the pelvic tilts will also engage the Lower back muscles as well.
Mark
Great article man! On of if not the best on the internet. Helped a lot, thx. Not sure about exercise 5d though (hip flexion knee to chest with neutral pelvis from the quadraped position). I feel like this is anatomically impossible. Got a video?
Hey Adam,
Thanks for your comment!
Make sure you are not completely taking your pelvis into a full anterior pelvic tilt as you do the Hip flexion in the 4 point kneel position.
This will place your hip in end range flexion and will run out of space to left your knee.
Mark
My daughter had back surgery several years ago. She also had a total hip replacement twenty years ago. Recent xrays showed a tilted pelvis. Hip and back are both fine. She does not help with anything and will not lean over to clean her cat box. She sits in her job and at home. Should she be doing these exercises with her history? Should she be moving more and helping with housework? I am 78 and she is 58. I do the lawn and all housework. Look forward to hearing from you.
Hey Mark!
Amazing information as usual. I’ve been working on my standing anterior pelvic tilt and other ailments every single day the last 3 months and its finally dramatically better, I’m starting to naturally pass the wall test. My question is when I sit or bend over my pelvis wants to go into a posterior tilt, I hardly ever have to sit, I’m standing all day long, but when I “sit properly” my lower back tires out extremely quick. Would it be wise to add some of these stretches/exercises to my routine or would that hinder the progress I’ve made with my standing APT? Also, I’m way more flexible everywhere except my groin and hip flexor areas, butterflys are the only real stretch I’m making little progress in, any suggestions?
Thank you very much,
Ryan
Hey Ryan,
If your lower back tires after sitting for a long period of time, you might want to ease off 20-30% of your correction.
Remember- we are not trying to jam our back stiff to keep good posture.
If you are still having issues, consider doing some lower back endurance training (eg. superman holds)
In regards to your stretches, try holding them for longer as opposed to doing many 3-4 sets of 30 seconds.
Mark
Hello, Mark and thanks for your good work. I have been diagnosed with hypolordosis, probably related to aging of my spine, arthritis, stenosis, etc. etc. etc. (!!). I know that your flatback exercises are primarily for those with postural rather than structural problems such as mine. Nonetheless, I am desperate to avoid surgery. I workout every day and since my hypolordosis symptoms have worsened, I am trying hard to integrate specific movements to address the flatback problem with the hope that even though it can’t change structural, perhaps dealing with the muscular problems will help, even slightly. I also feel being proactive in this way — even if not guaranteeing improvement — will be psychologically helpful to me. I would be hugely grateful is you could suggest which of the many exercises you discuss for hypolordosis are the most important for beginning. Not a single practitioner I have seen (including physical therapists, orthopedic docs and (ugh) spinal surgeons have addressed my hypolordosis in any meaningful way. Thank you for being someone who gets it. I feel lucky to have found you.
Hello Anita,
The exercises specifically I recommend for a flat back are in this blog post: How to Fix Flat back posture.
I would strongly encourage you to get very good at the “segmental cat/cow exercise” (have a quick search on youtube for this)
In the event your back is fused, you will need focus your attention on all of your other joints in your body that you do have control over and get them stronger as much as you can.
Mark
hello i have Posterior pelvic tilt whilst sitting and bending and squatting and i have Anterior Pelvic Tilt and Swayback whilst standing With upper cross syndrome In the upper body What is the strategy to correct all of these poor posture
Hey Mark. I was told my my other doctor that I know pain at the top of my knee cap due to PPT. I just started the excersize as described and already feeling better but the pain comes and goes. How long would u say it will take for the pin to be gone after I retrain my spring curvature?
I cant do the posterior capsule stretch on my right side because it puts a massive stretch on the front right side of my hip region where the tfl muscle is and because of that i cant even get in the proper position to do the stretch. On the left side it is not tight. I also feel the Pelvic tilt (in 4 pt kneel)
Only on the right side of my back. Any idea wat the problem could be?
Hi Erik,
It might be due to a lack of external rotation in your hip.
If you don’t have hip external rotation, it will be difficult to get into the said stretch.
Mark
Hi mark,
Do you only have to do the posterior capsule stretch on one side? Cause i only really feel it on my right side.
Hey Erik,
Yes – I would.
However, it is possible to have one side tighter than the other. If this is the case: you may also have a degree of pelvic rotation.
Mark
Hi mark,
It turns out you are 100% right. I have a right rotated pelvis, but wich exercises from this blog (PPT) would you recommend me to keep doing? Hopefully not all of them anymore ??. Thank you for all the help btw, it is very much appreciated.
Hey Erik,
I usually recommend to do all of them in the initial stages.
Reason behind this is that you can see/feel which exercises your body responds to the most. From here- you can focus on the select few.
Mark
Hi Mark,
Some advice in this page and your swayback posture page seem to be at odds with each other (e.g. “avoid tensing glutes unnecessarily” on this page and “Strengthen gluteal group” on swayback page).
Is there a big difference between PPT and Swayback?
How can I tell which one I have? Or is both likely?
Hey Ross,
Sway back posture refers to the pelvis being IN FRONT of the ankles and encompasses a range of postural deviations. It will occur with a posterior pelvic tilt.
You can strengthen your glutes. This is different to overly tensing them when they should be relatively relaxed.
Mark
Hi,
I’m having trouble understanding how to tilt your pelvis forward, such as the pelvic tilt in sitting. It feels like I’m just pushing my lower spine forward.
Thanks. I’ll take a look at that.
Also, when I try to do the hinging and hamstring stretch, it feels like I’m just bending from the middle of my back and lower back remained curved.
Hi Jon Yee,
You might have a super tight upper hamstring. This will make it hard to maintain a neutral lower back arch when hinging.
If this is the case – I would release and stretch out that upper hamstring until it becomes easier.
Mark
Do you have any recommendations of stretches for upper hamstring? I was thinking of sitting on a tennis or lacrosse ball on a hard surface to roll it out.
Hey Jon,
I have some suggestions for that in this blog post:
Hamstring stretches
With your stretches, it’s all about the angle!
Mark
Hi Mark. This may seem like an odd question but I have hyperpronated feet and valgus knees, but then I have a posterior pelvic tilt, not anterior (consequently I have a flat low back that has caused me problems). How is it possible that having hyperpronated feet I have a posterior pelvic tilt and not anterior?
Thanks!
Hi Carlos,
You can still have pronated feet/knee valgus with posterior pelvic tilt.
In this case – your hips may have very tight hip internal rotators (groin area) but hard to say without an assessment.
I would advise the exercises for knee valgus and flat feet.
Do you have a pure posterior pelvic tilt or sway back posture?
Mark
I think I might have sway back posture because I sway a little forward when I stand up, hyperextending the knees. I also have very tight harmstrings and low flat back
Is it possible that we could do an assessment?
Hi Mark
Thanks so much for the info. Please make my day now.. is this fixable for good? (please say yes)
And another thing, how often should I do these stretches/ exercises?
Thanks again
Cheers
Hi Adanarias,
Yes!
And you can start the exercises every 3 days or so, then see how your body responds, then either increase/decrease frequency depending what is necessary.
Mark
Hey Mark, first of all, great post thank you for this!
I have problems with the exercise where im in a 4 point stand and should bring my knees to my chest while keeping a neutral pelvis. Same thing when i sit with a netral pelvis and should lift my knees up. i can basically bring them up 1 or 2 inches while keeping my pelvis neutral, because my hip flexors wont let me do more, i feel them hard during those exercises. is it normal? what can i do?
Hello Mark, excellent post regarding posterior pelvic tilt, thank you for these information.
I am not sure if I have posterior pelvic tilt, however some of the symptoms you mentioned match mine.
I have very weak gluteal muscles, quadriceps and gastrocnemius. As a result, when I walk I put all my body weight on my hamstrings. This has caused my hamstrings to become way too big and tight. I try to do strengthening exercises for my gluteal muscles and quadriceps but the hamstrings take over most of the work. However, when I go to the gym to workout my hamstrings I realise that they are too weak as they can’t handle even 5kg resistance.
How is it possible to be so big and tight and at the same time weak?
Hi Andrew,
It is actually pretty common to have a weak muscles that is very tight.
Have you had a look at this post before?
Sway back posture
It might relate to you.
Mark
Wow, your posts are amazing! Thank you for your time and work on these. I apokogize ahead of time for the long post. Please forgive. I have anterior pelvic tilt with severe bad posture due to congenital factors, and I now have almost deteriated L4. Whats the best way to heal it without surgery? And can it be? I myself decided to just live with it a long time ago, but now my 5year old daughter is struck with the same tilt and posture, however, she is not diagnosed with any disorders at this time. When she sits, her lumbar is completed reversed, and is C-shaped, standing and its not so bad. Thank you again for your insight and amazi g work!
Hey Joshua,
I would recommend this post: How to fix Anterior pelvic tilt.
Or perhaps even this one: Hyperlordosis (Arched lower back)
These postures tend to place more stress on the L4 region.
Mark
Hi Mark.
It is so kind of you to provide these posture fixing exercise programs. They are very detailed and look easy to follow.
I have been diagnosed with a left anterior/right posterior pelvic tilt. I’ve looked at your exercises for anterior pelvic tilt and posterior pelvic tilt but it seems a little overwhelming to do both programs or to try and figure out which ones from each program to do. Can you suggest a few exercises to start with that would address my problem specifically?
Thank you so much.
Hi Chris,
I would actually recommend doing the exercises on this blog post instead:
How to fix a Rotated Pelvis.
Best of luck.
Mark
If the person had the rotated pelvis but also a hip hike on the left side, would you attack the hip hike first or rotated pelvis?
Hey Max,
You can start with either.
Sometimes you may find correcting one, might help correct the other.
Mark
Hey
Love this article. I agree with most of it, and have done a lot of these exercises which have improved living massively. But, having been in a situation where this caused a shit ton of pain, I recommend two things:
1) the abdominal stretch should be done in a chair and with arching the back instead of lying on the stomach. One of the faults with the prone abdominal stretch is that it is putting a massive stretch on the hip flexors which are already long and in my case spastic from being overstretched all day while standing in extension.
2) the adductors I don’t think should be stretched. In PPT I believe (I may be mistaken) that the attachment and insertion points of the adductor group are much further away than neutral given the pubic bone being higher/more forward than it should be as well as the very common hip extension combination causing the muscular attachments on the femur to also elongate the adductor group.
One more thing after those two is I’ve found massive success by imagining pushing my pelvis backward. This cue tends to stack up my alignment well from the side, as well as push my PPT into a neutral, and of course since the pelvis is no longer extended in front of my body, fix my internally rotated femurs (noting this based on the greater trochanter in relation to the pelvis). Also, it tends to make my spinal erectors turn THE HELL ON. Like, dramatically. Bascally when standing or sitting I imagine pushing my butt back like I’m stopping a door from closing and it seems to fix everything.
Why is it important to bend your knees when performing a posterior pelvic tilt? What is wrong with extending the legs in supine?
Hi Steven,
Both is fine to do.
Mark
Hi Mark,
I am confused about my situation of pelvis it seems to be tilt or drop but can’t decide and my hamstrings are excessively tight, and seems to have posterior pelvic tilt also. Can I talk to you personally through email or something? Please I am suffering from back pain also.
Hi Hitesh,
Do you have a sway back posture? This is commonly due to tight hamstrings and can be related to lower back pain.
Mark
Hi! My physical therapist said to “pull” my abs upwards so my lower back doesn’t arch and to learn to walk this way to retrain myself. She said my lower abs are weak which causes the pelvic tilt. She also has me doing an exercises which I see both you advise against. What should I do?
Hi Noel,
It sounds like you have an anterior pelvic tilt and not a Posterior pelvic tilt (this page).
Check out this post: Anterior pelvic tilt.
Mark
Hi Mark,
As @Delroy has asked, my question is same.
I have apt while standing but ppt when sitting with legs extended.
As per you suggested ‘rectify whichever is causing the problem’.
But the problem is, at home I do floor sitting with legs extended where I will in ppt ( I can sit cross-legged without ppt and more in neutral pelvis) and at the outdoors while playing , I will be in apt. So, whichever is more sitting or standing, will cause the pain.
Can you please explain how muscles act differently while standing and sitting. So, that I can be comfortable in both the cases.
Thanks.
Hi Ankur,
Do you know which structure might be causing your issues? (Muscle, joint, disc etc) Or have you had any scans.
Mark
Hi Mark,
The MRI scans were clean as were the Xray.
I have pain while standing in the iliocostalis lumborum just between the spine and the hip crest, if I squeeze my lower back but surprisingly no pain in the left side.
If I make a posterior tilt and then squeeze there is no pain in the iliocostalis lumborum on the right side as well.
But when I sit with legs straight , I don’t have a straight spine. And after sometime , I start getting pain in the lower back in middle and surrounding areas.
On a side note:_
But I feel my left side of pelvis is shifted forward and right side of the pelvis is shifted backwards.
There is a substantial imbalance in the right and the left iliocostalis lumborum, right being very tight. And there is a hike in the right pelvis.
I am already doing the exercises suggested by you for the twisted pelvis. It has been really helpful but the imbalance of the said muscle is still not rectified.
Hello Mark! Thank you so much for your posts! I have always been told that I have a tilted pelvis, but no follow-up information to correct it or even what kind of tilt. By your diagrams and information, I believe that I have a posterior tilt. In June of 2017 I was diagnosed with rectal cancer and chose to walk away from the poison of chemo, radiation and the mutilation of surgery and give my body the environment it needed to heal, by way of re-hydration, nutrition, de-stressing and trust in God to direct me in every way. Finding your page is no accident! I do believe at this time that the cancer mass that was the size of a baby’s head has significantly been consumed and now I have a prolapsed rectum!! I do have a weak pelvic floor and have learned what exercises would be beneficial but clearly understand that my tilted pelvis could very well prevent any progress! Thank you once again! Would love to know of any advice and thoughts that you may have.
Hi Ronda,
A neutral pelvis will help you recruit your pelvic floor muscles.
I would also consider working on your breathing and getting the diaphragm to function effectively. This will also affect pelvic function.
Mark
Hi Mark
Great website you got going here!
One question my pubic bone tends out to stick out a little. Is that normal for a posterior pelvic tilt and is there anything else I could do. And my posterior pelvic tilt is very bad. Is there anyone I could see for this?
Hey Tiffany,
It may be due to the pelvis position, or more commonly, could be due to the natural size/shape of the pubic bone area.
Mark
Also have a look at this post: Sway back posture.
Hi Mark,
I love your site, I swear every page is so helpful! I’m two years postpartum and have the typical “mom posture.” Tucked butt, rolled shoulders and sway back. I’ve also had chronic pain in the si joints. sit bone and groin, a super tight piriformis, and an overly tight pelvic floor. I also have trouble activating the glutes. I didn’t realize I had such bad posture and had such a posterior tilt until I took a picture and noticed how far behind my butt my shoulders were. Could this be factor contributing to all the pain I’ve had? Any other tips you have for those postpartum? Thanks!
Hey Sarah,
Make sure you check this post too: How to fix Sway back posture.
Especially after pregnancy, it is quite common to have laxity in the SIJ ligaments. This predominantly due to the hormones to help stretch the body.
The main muscle to help stabilise this area are the GLUTES. (although there are many that actually work together to help as well).
Have a look at the blog post I mentioned above. That should help!
Mark
Great article!
I have a question.. I tend to end up in the PPT seating position demonstrated but when I stand I feel I’m more ATP.. What would you do differently to correct that?
Hi Delroy,
This is actually very common!
What you focus on is dependent on which position you have issues with: sitting vs standing.
Mark
Hi Mark, thanks for the article.
The funny thing is most of pts/ trainer say excessive sitting is the reason for APT.
So would you say, sitting can cause APT in one and PPT in the other person?
thanks
Hey Phill,
Sitting can cause both.
It really depends how your body responds/compensates.
Mark
thanks, thought the same
Hi Mark,
great post as always. I had a question for you regarding glute workouts for someone who has a swayback and PPT (which is me unfortunately). Do you recommend strengthening the gluteal complex with basic exercises like bridges, clam shells etc?
I find my butt is always in a clenching pattern so not sure what to do. When I do any glute workouts it makes them more tight. However, I know my glutes need work as well. Please let me know when you get a chance.
Thanks,
Alec
Hey Alec,
Strengthening the glutes is still very important regardless of what pelvic posture you have.
But if your goal is achieving a neutral pelvis- you will want to prioritise glute strengthening from the neutral pelvis. (and not to only strengthen it from a ppt starting point)
In PPT, the extension fibres of your butt muscle will essentially be in a shortened position and is not the best way to engage them.
Mark
hi mark, i have terminal knee extension problem, how can fix this. My orthopedist says put weight on knees, is there diffrent solution? and leg extension machien is good for this. Thank you
Hi sercan,
It really depends on what is causing it in the first place.
Was there an injury associated to this issue?
Mark
no, there is no injury, i have always this problem until childhood, by the way 26 age.
i have posterior tilt and my hamstrings and calf so tight. when I bend, I feel hamstrigs tightness of hamstring muscles
maybe posterior tilt associated with terminal knee extension
Hi Mark,
I stretch at least twice a day, either in yoga classes or at home, doing many of the exercises you have recommended above. However, I feel as though my posterior pelvic tilt has not improved much at all, as I still cannot sit in a seated straddle position without an extremely curved back. I often have pain throughout my whole back on a daily basis.
I recently saw my Primary Care Physician and told her about this and all she did was send me home with a print-out of stretches to do that I already do on a daily basis. :(
I was wondering if there’s a certain type of Specialist you recommend I see? My regular doctor was no help, and I already try very hard on my own to stretch as best as possible.
Thank you,
Kate
Hi Mark, firstly thank you for your insight. I was diagnosed with epilepsy 3 years ago, however no investigation was done into possible causes. I discovered myself that I had a posterior pelvis tilt and began training this in December of last year and have since had no seizures whatsoever. Once I can across your site I found it so informative and easy to follow, though I must ask would you advise to follow this routine step by step? Also how often would you advise to carry it out?
Again thank you for sharing your knowledge and insight.
Rob
Hey Rob,
You do not have to follow this routine step-by-step…. although I do recommend to at the start just so you can get the feel for the exercises.
From there, you can choose which ones you feel provide the most benefit and stick with those.
1-2/week is a good place to start. (More the merrier though)
Mark
Hi Mark – would there be any way to make a video of some of the postures so it’s easy to follow? :)
Hey Jen,
That’s a great idea.
It’s definitely on the to-do list.
Mark
Hi Mark,
I have been trying to find a solution to my problem for 4 years now, i also have an anterior tilt on the left side and a posterior tilt on the right side, my psoas muscle on the left is over stretched and painful and my right psoas is tight and short and giving me a tight piriformis a pretty much tightness through the entire right side of my body, along with a rounded shoulder that side too. I too am struggling to find a solution for this and becoming quite desperate :( Im 29 and have lived with this for 4 years and see no light at the end of the tunnel. It has stopped me from all activity, and it all started when i was an audio typist, placing my hips in a twisted position with one further forward than the other, whilst using the foot pedal with my right foot. I’m not on facebook so would greatly appreciate any help you have on this!
Thank you
Tamara :)
Hey Tamara,
Sounds like you are stuck in Right pelvis rotation.
I have a blog post coming out on Pelvis rotation (which I will get back to editing once I reply to all of the comments).
If your pelvis is twisted (which is commonly caused by the way that you like to sit), it will cause a chain of compensatory adjustments throughout your whole posture.
Keep an eye out for the new blog post! That would be a great place to start.
Mark
FYI- there should be a keyboard function key prompt in place of foot pedal. I had a client with this issue & discovered her transcription leg was part of the issue from ankle to hip! Myofascial release techniques to release pattern of 20-30 yrs of 1-legged pedalling also referred to hip flexor & scar tissue in hip from another structural issue!
Hi Mark,
I found your website really good and informative. Congrats!
My condition: spine issues for over ten years now, bulging L4/L5 disc, recent (Dec 2017) lumbar microdiscectomy L5/S1 operation due to a herniated disc, plus flat back (loss of lumbar lordosis). Although I’ve attended a chiropractor for a one-week preventive treatment once a half year/year and tried to stay active (regular brisk walking almost every day and swimming once a week), it seems that sedentary office work for approx. 8 hours a day, disc problems & bad posture has led to gradual deterioration.
In view of the above, I’ve got a couple of questions. Apart from doing exercises, would you recommend the following:
1) When back at work, standing position at a standing desk or a sitting position or a combination of both? For a year or so I’ve got a Spinalis chair with a movable seat like on an exercise ball with a lumbar support/roll.
2) Using McKenzie Night Roll Lumbar Support when sleeping
3) TRX suspension
4) Anything else?
Thanks a lot in advance for your reply
Hi Tomasz,
1) At work, try to shift positions every 30 minutes. Move, move, and move!
(Even if it means just standing up for 10 seconds to stretch !)
Any prolonged position can place extra stress onto your lumbar spine.
2) MCkenzie roll is fine to do as well.
3. TRX suspension exercises are generally great. I would encourage activating the deep core muscles as much as you can in as many different positions.
4. If you sit with a posterior pelvic tilt, consider getting a kneeling chair :)
Mark
Hi Mark my self Shameer.I have severe pain in my neck & back& knee. When I observe the picture i’ve been have flat glutes with posture tilt .How can I solve this problem.Iam mentally depressed by this .
Hi Shameer,
What exercise you do is dependent on what exactly is wrong with your neck/back/knee.
You may need to consider getting these areas assessed even before fixing your posture.
Mark
I didn’t fix my posture .considering by your images I came to know recently .I have posterior pelvic tilt.but IAM suffering this from last 3 years. I tried different exercise which you guide by image but I can’t fix my posture how can I fix it…
2)I think my wrong leg exercise in gym leads to posture
Hi Mark
I think my leg work out goes wrong and it leads to posterior pelvic tilt.ane IAM suffering this from last 3 years .due to this I think my knee & neck ,backpain occur.I followed your exercises it giving some posture become normal and again it will tilted .How can I fix this .
2)i didn’t go to any doctor .can I fix fix my self by your guide exercise (or) compulsory I have to meet to the physiotherapist
3) another thing when I walking my left side knee is hurting very much
Hi Mark,
Really appreciate the article. I’ve been suffering from low back pain, mainly in the SI area, for several months. Like others, I sit all day, and have had notoriously poor posture, including kicking my feet out straight at my desk and slouching. At first, my doctors and PT thought the SI joint was the culperate of the pain, but I’m beginning to think it’s more muscular. Some of the stretches you provide here actually brother the area, including anything where I’m sitting straight against a wall. I’ve even notice some stretching of my upper back (recommended by you for rounded shoulders) get a reaction from my SI area. I’m guessing this means my entire back area is tight, and stretching one muscle groups pulls all the way down the chain?
I’m relieved that this seems to be due to muscular trouble other than a disc or joint issue. But should I be focusing on my posterior tilted pelvis or rounded shoulders more? Or both?
Hey Tom,
If it’s a muscular issue, this is a much easier fix then joint damage!
However- determining which area might be the leading CAUSE of your pelvis pain is the hard part.
Please feel free to private message me on the facebook page and I’ll see if I can give you more specific suggestions.
Mark
Your website is awesome. Lots of incredible advice. I have had bad posture since I can remember. I’ve always slouched and stand in a sway back posture. Some years ago I started running and now I’m realizing how much my bad posture has affected my body. I’m trying to improve my performance but the imbalances in my muscles make my gait a perfect example of terrible running form. I have very weak hip flexors (even suffered from psoas tendonitis), my hamstrings are extremely tight although I stretch them regularly and I’m all hunched up. I have made a purpose to fix my posture (or at least improve it). I started doing your exercises about a month ago but I slouch unconsciously very often and when I do my pelvis also tilts. My back also hurts all the time, not a bad kind of pain, but muscular pain like you get after heavy exercise. I’m 38 and have had bad posture since I was a small child, so swaying back and slouching is my “normal”. Will it take too long for my back muscles to stop aching? Does sleeping posture have any influence in my problems? I sleep very tightly curled up on my side, my knees almost touching my chest. By doing these exercises, will my posture eventually improve by itself or I have to keep reminding myself to stand correctly?
Hi Priscila,
It sounds like you may have a sway back posture? Check out this post if you are not sure.
If posture is the cause of your pains: these exercises will help improve your posture, which is turn will help make your muscles work better, which in turn will make them stop hurting.
Sleeping can cause postural issues. It sounds like you have described your sleeping posture as the “fetal position” which when you think about it, is what I refer to as ‘Horizontal slouching’.
Mark
Hey, Mark!
This is a page I come back to time and time again to help with my posteriorly rotated pelvis (left SI joint area only) as well as a cranky sacrum that likes to shift to the right. I’m a competitive powerlifter (taking time off to correct, strengthen, and rebuild) so of course the meat and potatoes of my training is squat, bench, and deadlift. Is there anything else, in addition to this post, you’d recommend as far as mobilization or rehab exercises to help alleviate this issue? I do see a chiropractor and also have a friend who is a PT, but I love to get opinions and options from all outlets. Thanks so much for your time!
This page is such a life saver!
Esp because you go through details, like sitting properly. Thanks!
So I’ve been going to a physio for sciatica and hamstring pain, getting better but the exercises make my upper back muscles go tense instead. Any suggestions for shoulder blade/shoulder/neck stretches? Should I avoid doing things like push-ups, crunches or plank until the rest of my body gets stronger?
Hey Nat,
These posts should help you out:
Shoulder blade pain
Rounded shoulders
Neck stretches
Mark
Hi Mark, I’m 20 year old guy with suspected ppt and shoulders. I have very tight shoulders which affects my dips at the gym which causes sternum pain and my bench seems to have difficulties especially with increasing weight. I’ve decided to do neither since I’ve discovered I’ve had these problems but recently what’s been bothering me the most is my bulging dic where my tail bone is located. It’s been acting up with a tingly sensation that sometimes spread to my legs. It’s been triggered when I sleep wrong or if I arch my lower back for support during a set of bench press. I do alot of heavy lifting from construction job too and it’s been difficult for me to work under the tingles which sometimes causes me to limp and have difficulty bending down. I’ve been trying to deal with it but it’s beginning to be a big hindrance.
Hey Rai,
Based on the tingling sensations in your legs, it sounds like your nerve in your lumbar spine is being pinched! (This bulging disc can increase the likelihood of this occurring)
I would suggest avoiding any positions or activities that reproduce your leg symptoms. You really don’t want to play around with nerves.
Have you tried doing McKenzie lower back extensions? Have a quick google of it to see what it is. I find it very helpful for disc issues.
In regards to your shoulders, check out this post to see if you fall into this category.
Mark
Thanks Mark, I’ll give it a try
What’s the difference between sway back and posterior pelvic tilt? To me sway back looks like a worse version where the hip flexors have became even weaker.
Hey Oskar,
The main difference is that the hips are shifted way forwards relative to your base of support (your feet) in a sway back posture.
Mark
Hello,
is it possible to have a posterior Pelvic Tilt on one side?
Thix is a Xray of my pelvic. Seems like my right side turns backwards or?
I am 27 years old and have so much pain and trying to search the solution of my pain :(
Hi Zacherl,
A posterior pelvic tilt on one side and an anterior pelvic tilt is essentially a rotated pelvis.
This could to uneven loads throughout your body!
What kind of issues are you experiencing?
Mark
Mark,
I have had si issues since I was a teenager. My pt when I was young gave me a heel lift and I wore a wrapping brace when plain basketball. I just realized that I have a fairly severe posterior tilt. Like you said too many hours working from home on a sofa has made it worse.
Question is that when I do a lot of these excersizes they inflame my si a bit…is that okay? Will the si fix if I just keep doing this stuff and work on fixing the tilt?
Hey Kevin,
You will need to modify the exercises that are causing the SI to inflame.
Which ones in particular?
Mark
is it unusual to have much more pain in one leg/ side of hip than the other if you have posterior pelvic tilt?
Hi Fish,
If you are uneven between your hips or favour on side more when you move, then it may stress one side more than the other.
It sound like you may be a posterior tilt mixed with other postural asymmetries. (eg. pelvis hitched, rotated pelvis, leaning on one side more etc)
Mark
I’ve had pain on that leg/hip for very long, before I had noticeable back pain, or in other parts. I’m beginning to think posterior pelvic tilt may just be symptom to another problem, rather than a combination of postural asymmetries but it’s also possible as well.
thanks for the reply mark
We will have a responsibility. Will we have a permanent result if we will do these exercises continuously?
Hey Mert,
I would say so!
Mark
Hello Mark. I started working out about a year ago and ive been experiencing coming and going pain in alot of different areas and my google searches 90% of the time has led to the conclusion of some kind of pelvic tilt. A big reason to this conclusion is the fact that ive been a gamer for about 7 years and didnt start thinking about my posture at all until the recent 2 years.
I have a hard time checking the pelvic angle myself as i dont really understand where the points are. My back isnt completely flat, it has some curve to it but your pictures of sitting, squattin, bending, and standing look alot like me. I also tried your sitting against wall thing and failed to do that, and my posture looks somewhat like the swayed back you mentioned here.
Went to a physiotherapist recently for my different pains and told him i suspected tilted pelvic of some kind, he said nothing about it and proceeded with the exam. After the exam he told me i had tight glutes, weak spinal erectors and that my hip flexors were fixated in place. Gave me 2 mobility exercises and told me to stretch my glutes once a day and sent me on my way.
When he saw my forward back curve while doing a stretch all he commented it, but when i asked about it he said “thats just the way you look” which really didnt feel great as i was hoping to fix it, or atleast improve it. He said the same thing about one of my hips being a tiny bit higher than the other which i was told some years ago by a school doctor.
So what do you make of this? Do you think i have PPT? Im just so confused because i expected him to tell me if i did. Also, can the hip height difference be lateral pelvic tilt or is it more likely to be a disfiguration? Is there any way to find out other than a mri?
Sorry for the huge wall of text, just wanted to clarify my situation completely.
Huge thanks in advance, Dennis.
Hi Dennis,
I would need to see a picture of you to determine what kind of pelvic tilt you have.
But it sounds like you have a sway back posture.
Different hip height is usually caused by a) lateral pelvic tilt, b) Leaning on one leg more, c) leg length discrepancy. This should be easily assessed by your Physio. (I am preparing a blog post on lateral pelvic tilt, however, it won’t be out for another few weeks.)
Mark
I have an posterior problem due to this iam suffered a lot of back and. Neck pain .when iam sitting. sit bone is so pain full.how to correct my pelvic tilt and iam suffered this by last four years
I need to ask one question. When I squat down I get that rounded back in the picture. I also get a strain and pinching hurting feeling i my groin and quad attachment in the hip while doing it.
It feels extremely tight and stretching is not helpful. Is it possible that I suffer from this condition and have too elgonated quads/hip flexors that it feels like its tight?
I stretch a lot in the squat position but im not making any progress at all. I can sit with my back against a wall with straight legs and no curved back. Im not sure whats wrong with my body.
Thanks!
Hi Patrick,
Thanks for the question.
You may have elongated hip flexors, but that really shouldn’t cause you any issue if you are squatting.
Have you heard of Hip impingement?
That may be what is causing your issues.
Mark
Thanks for answering. Yeah ive heard about it and it might be the cause. I just really dont want to accept it. Maybe muscle imbalance is causing my joint to move bad causing pain.
I need to get an xray anyway:(
Thank you! Clear & logical explanations. I was beginning to think my problems were caused by a posterior pelvic tilt & I think that you have confirmed it. I have had both hips replaced at an early age ( I have had a very active life & am hypermobile) & since then have had a knee problem ( fibula head irritation-not arthritis.) Horse riding helps my knee but I think it is because I sit with good posture when riding & need to adopt good posture all the time. I do some of these exercises anyway but not often enough. Thanks again.
Hi Trudi,
Thanks for taking the time to write me a comment.
I hope the exercises will be beneficial for you :)
Mark
HI Mark, thank you very much, very clear concise instructions. Should i do all of these exercises and how often, everyday?
Thanks
Calum
Hey Calum,
Start with doing all of them. You can remove exercises if you do not have any benefit from it.
Do these exercises 1/day.
Mark
Ok thanks! :)
Very helpful. Thanks
Thanks for the comment, Richard.
Hi there,
What advice do you have if one hip feels tighter than the other? For example, my right hip is very tight after jogging or squats. Only the right one. Stretches help for immediate relief but I’m curious if there is something I should be doing in the long term.
Thanks!
Hi Mark, thank you for your great article. I have a question. When I stand up, my feet are not lineup, one is about One and a half inchs ahead. What do you think would cause this?
Li
Hi Li,
This may be due to a rotated pelvis. (… which could be due to many reasons!)
Eg. If your pelvis is rotated to the Right (think about your zipper facing towards the right side), it is likely that your left leg will be in front.
Whilst standing, if you place your hands on your bony bits at the front of your pelvis (ASIS), is one more forward than the other?
Mark
Thanks, I saw a case earlier like this. I thought it maybe the reason. I tried the two methods you suggested, I could not tell. (I rarely wear zip pants, but I got one and tried on, it faced middle. I also put my hands on my pelvis, I could not tell if one is in front of the other) . I will still do that two exercises you advised others to do earlier. I will let you know if improving. Thanks again.
Li
This is a very complete and great analysis of posterior pelvic tilt, thank you Mark!
Thanks for dropping by, Von !
hi I suffered from mild diffused bulging disc in my l4 l5 l5 s1 discs. ..I have been trying some hamstring exercises told by my PT……Though there is constant pain in my lower back…..I can’t stand for 10 mins….it starts hurting….nor can I walk on uneven surfaces…..my lower back hurts…..Any suggestions……regards.
Hey Ravi,
If your pain is acute, I would recommend just doing pain-free movements of your lumbar spine.
If it doesn’t hurt, try this:
Once your pain resolves, you can start to focus on more intense exercises.
Mark
Hi Mark,
As one of your bonus tips you mention “Do NOT butt/abdominal gripping”. As someone that has posterior pelvic tilt and is looking to make strength gains with squats and deadlifts I’m a bit conflicted. I’ve read from multiple sources (and have personal success with) how the glute squeeze before descent in a squat as well as at the top of the deadlift are optimal, not to mention both exercises requiring tight abs for spinal rigidity. Please advise what you mean by this tip and how both queues might be detrimental to one’s posture with PPT. Thanks.
Hey Tom,
It is fine to engage your glutes whilst lifting. (In fact – I would definitely encourage it!)
The problem is – if you are already in PPT and you engage your glutes AND cause more PPT, this is what you want to avoid.
If you are engaging your glutes, but not causing more PPT, that is completely fine.
It is exactly the same for abdominals. You definitely want to brace WITHOUT causing more posterior tilt in the pelvis.
Hope this makes things clearer.
Mark
Dear Mark –
Thanks a MILLION for this post. All other websites talk only about loosening tight hamstrings to fix PPT and that’s it. This is super comprehensive and makes total sense.
Two questions: 1. Can we “make it till we fake it?” – i.e., in addition to doing the exercises/taking the measures here, can I also walk around by exaggerating my lumbar lordosis a bit to eliminate the PPT (I can look in the mirror and see how much to sway my hips to do this) and over time my body catches up to it OR would that strain my spine/pinch a nerve? I was thinking maybe doing so retrains the muscles/nerves etc (just like sitting on my sits bones is unnatural to me at the moment but I am supposed to do that as part of the recovery you explain).
2. I have done some squats and deadlifts in an effort to strengthen my back etc. and have a slightly pinched nerve in the lower back at the moment as a result. I am too scared to go back to the DL and S going forward. Are there other weight bearing exercises you recommend to substitute for those two that is gentler on the back and can be done while battling with the PPT?
THANK YOU :)))
Hi Asli –
Thanks for your questions.
1. You can do that… to an extent. However – forcing your posture may cause other issues later on. Over time, we ideally would like good posture to become more natural for you.
2. You can try dead lifts and squats without any weight.
Alternatively – you can practise stepping up/down/sideways with neutral pelvis.
Mark
Thanks for the reply.
As someone with PPT and swayback posture I feel like I’ve been making this mistake for several months (I was squatting 3x a week, usually between 200-300 lbs.) While squeezing/tensing glutes before squat descent has helped make the weight feel more secure on my back, helped me ‘brace’ easier, and overall made the reps feel easier, I discovered that a) my starting position for squats while squeezing glutes shifted my pelvis in front of the center of gravity, and b) I was ever so slightly posteriorly tilting my pelvis to achieve this starting position
I think I’m now beginning to understand your words of advice and am hoping by squatting while paying more attention to my pelvic positioning (along with all the great exercises/info you list on this site) I can finally finish progress on fixing my PPT (Have been trying to fix it about two years now and am about an inch away from a neutral pelvis.) Thanks again.
Hey Tom,
Definitely bracing the glutes is the way to go when squatting, but be careful with the forward movement of the pelvis when you over grip your butt!
Mark
About 18 years ago I was in an accident that resulted in a anterior tilt to my pelvis on the left side and a posterior tilt on the right side, do you have recommendations for me as a means to balance them better? The fact that they are literally opposites, poses many challenges and makes me feel achy and tired a majority of the time.
Hi Geneva,
This is what I refer to as a rotated pelvis.
If your left pelvis is forward, and you right pelvis is backwards, your pelvis would generally be oriented towards the right side. (Think about where your zipper in front of your pants is facing)
There’s quite a few exercises you can do for this and will be releasing a blog post on this soon :)
These tight areas can cause a rotated pelvis.
Mark
Mark
Hi Mark,
Thank you so much for this page, it is very helpful! I have a rotated pelvis as well. Have you posted the blog concerning this yet?
Thanks,
Lynnlee
Hi Lynnlee,
It is still on the To do list.
Best way to know when it is uploaded will be via the facebook page.
Mark
I do have the exactly same problem. Did you posted the blog entry already?
Thank you so much for your work!
Not yet Zacherl!
But feel free to message me directly on Facebook and I can try to help you out there for your specific problem.
Mark
I get this tilt when squatting or deadlifting at the gym. Will this help me to be able to go deeper without bending my back?
Ive also heard not to stretch hip flexors? Is it true?
I stretched them because I thought it could help my squat but instead I got so much pain after doing it.
Hi Matt,
Sounds like you are referring to the butt wink which is seen at the bottom of a squat.
If you have tight hip flexors that is limiting hip mobility, then you can stretch them. If they are not tight, then you do not necessarily have to stretch them.
To fix butt wink, I would focus on:
– Upper hamstring stretches
– Hip joint mobility
– Strengthening the position where you just start to butt wink with an isometric hold. You can do this by pressing up into a heavily weighted bar at the depth you butt wink.
Mark
Thanks for the reply! I tried thomas test on myself and I dont think ive got tight hip flexors. They do feel weak though.
Im going to try out your tips and see if my squats will get better. What worries me is my hip flexor pain. Maybe its normal after beginning to squat and bend the hips after many years of never doing it.
Hi Matt,
Most people I see have very weak hip flexors (whether they are tight or not).
With your hip pain, just make sure that you do not have femoral acetabular impingement. Have a quick search on google and you’ll find heaps of info on it!
Mark
Hi, would this article apply to a single posterior hip tilt?
Thanks,
Sia
I came across your article after 16 months of painful sciatica that started in my left leg and has now transitioned to both legs. I was a very active happy go-lucky person and the past year has totally rocked my world. I kept getting brushed off by doctors because they said the herniation I have is so small it shouldn’t be a big deal, except I experience pain pretty much 24/7, I cant get my body in a position that gives my nerve a break. My new PT has discovered that I have a pretty bad posterior tilt and she believes that I am always in pain because of my hips rotation. It was hard for me at first to pull out of the posterior pelvic tilt during the day and even when doing my exercises. It is like my muscles have a death grip on my hips. Today I was able to pull out a little more and notice my lower back is very achy, but Id rather that ache then the sciatica in my legs. This is new since nothing was helping relieve the pain. I know I have some more work to do to fix all my weak muscles, but I am wondering if you have ever heard of a case like mine where someone fixed their issue through posture and muscle balance and how long it takes to fix posterior pelvic tilt. I know it is different for everyone, but I am really just looking for an educated guess on that timeline.
I hope you get an answer. I am literally in the exact same boat, for the exact same amount of time. I also had my doctor say the say thing about a small disc bulge, I have the sciatica in both legs… It’s beyond annoying.
I feel like symptoms of multiple posture issues that makes me stiff throughout and have back pain. I do have a lot of the posterior pelvic issues and some anterior pelvic issues and also rounded forward shoulders with my head always looking down. I cant touch my back against the while sitting down in a L position on the floor against the wall, it actually creates back pain trying to do this. Although I also have a donald duck butt. I have very tight glutes and hamstrings quads, groin muscles and also inactive psoas muscle and I have impossible time tilt my hips forward or back. I have a hard time activating my glutes when doing RDL or Good morning I have to use a belt and put extreme pressure through my abs to feel my glutes and hams work. Also I cant transfer any power from my lower extermity to my upper extremity. I can push press almost the same I can strict press which is my bodyweight.
Then my upper body my shoulders are always slumped forward abs especially in loaded position caves in. My shoulders, pecs, and upper back are always tight. I just feel my whole body is just screwed up and tight. I want to be able pick a exercise routine that can correct my issues but I dont want to have to spend 1.5hours to do all the exercises that is needed before I can even workout. I always relative strong and active person, but I just getting stiffer as I get older and want to correct it. Also I have a burning sensation in my upper back for about 12 years after lifting session that I pulled an upper back muscle.
Any suggestions for an exercise routine to correct my posture would be helpful.
Thank you,
Chris
Oh my god. This is exactly what I’m looking for. I’m Korean man and I’ve been looking for information to correct posterior pelvic tilt in Korean websites, but most of what I found were just commercials and advertisements for hospitals and so on without any substantial useful information to correct it. But this is perfect. I cannot thank you enough for this.
Hey mate,
No worries!
Hope it helps you out.
Mark
Hello,
My name is Morgan and I have developed a PPT with Kyphosis and Forward Head Posture. 10 Months ago I was rear ended by a car going 70 mph, and my back suffered a bunch of disc bulges and one disc herniation at L5/S1. I became incredibly sedentary during this time and rested my back / got Injections / slouched on the couch. Recent MRI reveals only three slight disc bulges from T4-T7 and slight stenosis at C5. Now I am 10 months post accident and I want to get back in shape to return to construction labor. I originally went back to the gym approx 3 months ago and did the same lifting routine I used to do while working construction, and although I didn’t suffer any injuries it felt like I was making my posture imbalances even worse. I have about 5 weeks left to correct my PPT and to get my T Spine to rest in proper alignment. I tried to do some back Extension before reading this but it felt like my hamstrings were already super tight and was feeding the problem. Tonight I will do this regiment and continue it religiously as well as run for an hour a day and try to be on my feet as much as possible. Would swimming help my upper back?
Hi Morgan,
Any movement of the body that does not hurt you is only going to benefit you. Swimming is great as it is gentle.
Let me know if you need any help with the exercises.
Mark
I have,bilateral facet arthropathy
Posterior annular tear L3/L4,
Posterior central disc bulging L4/L5,
Circumferential disc bulging with bilateral recess encroachment in L5/S1
I have struggled with my back for many years and don’t have great posture. I recently had another chiropractor have a look and she did a 4D alignment scan and said I have PPT, and also my right leg is short,she also said my glutes were not switching on. On top of this issue i
have quite exaggerated femoracetabular impingements in my hips which limits motion of my hips and the right one is very worn. I struggled with the glute exercises because of my hips and wouldn’t have the energy to do this every day as I also get run down a lot. Any tips would be appreciated. Cheers
Hey Neil,
With that many posterior disc issues, it sounds like you sit (or have sat) for long hours at a time? Prolonged sitting can cause PPT as the pelvis tilts backwards when sitting with bad posture.
With PPT – it is very difficult to engage your glutes. Re-positioning of your pelvis should precede strengthening glute exercises. Without good glute function, it can lead to hip issues like your impingement.
However, If you are in a lot of pain at present, it is best to try to settle that down first.
If you have pain in your back that is due to your posterior disc bulges, try this exercise to help re -align some of the protruding disc.
Aim to feel tension in you back. Do not push into pain. Hold for 1 minute, relax back down, then repeat 5 times.
Also – did the chiropractor say you have PPT in sitting AND standing?
Mark
Hi Mark,
I have been suffering from back pain, upper back pain et neck pain from the last 2 years. I had a really big issues with it. I spent alot of money in healthcare service and saw many health professionnals. After two years, I realised I had a flat back and a forward head posture, I searched for some help on the internet and found your article… I must say a big THANKS YOU, you don’t know how much only after a week of doing exactly what you said in this article actualy helped me so much. It’s weird now I feel like I can breath correctly, I can sit for more than 1 hours straight without having all my muscles spasming and alot of pain. I couldnt stand still more than 10 seconds without having big problems too. My breathing was awful and felt alot of tension in my harmstring and my high abdominal muscles. SO really thanks you very much for this, I’m from Québec and I speak french so i’m sorry for my grammars. Btw, im feeling 10 times better just after 1 week of doing those exercices!!
Hi Alex,
That’s amazing to hear!
Breathing better is a good sign that your posture is heading in the right direction.
Keep up the good work, mate.
Mark
Hi, Mark! I was hoping to get your input on an issue of mine: recently I’ve been experiencing pins and needles in my arms and legs, along with some very mild and occasional muscle spasms. The pins and needles sensation is not constant but comes in “bursts” or episodes throughout the day. Is this something that, in your opinion, can be caused by bad posture and/or a compressed nerve? I do have a pretty bad posture (anterior pelvic tilt, rounded shoulders, forward-head posture, etc). In the past few months, I’ve had some muscular issues causing headaches and a stabbing pain in my chest, for which I’m being treated for by a local physiotherapist — unfortunately I’ve been unable to discuss this issue with them and won’t be able to do so for another month. Sorry if this is off-topic or asking too much, but it’s been a stressful year for me and this is yet another thing that’s causing me to worry. Thanks for your time.
Hey Thomas B,
Pins and needles in the arms/legs can be caused by many things. Chemical/hormonal imbalances, stress, diabetes, certain foods etc etc.
However – I would advise getting further investigations such as a blood test to rule out other factors.
Your bad posture may be a contributing factor, but it is odd how your symptoms come in bursts? Unless these bursts occur right after you do something physically?
Mark
Are you supposed to do all of these everyday? What is the timeline on this?
Hey Emma,
I would recommend at least 1/day. But it really depends on how severe your Posterior pelvic tilt.
Mark
Hi mark
It started with QL pain on one side before 2 years and gradually it started spreading the whole side(left side)..consulted orthopedic, physiotherapist, chiropractors…But unfortunately no use.Took MRI,Xrays,blood tests for auto immune disease etc .Everything came normal…Many doctors said as fibromyalgia..It’s been 2 years now morning getting up with severe neck tightness and pain..whole back as well,one side lower back tightness and pain.trapezius as well but everything only on left side..Please do help me out if possible.Thanks
Hi Asif,
What does your posture look like?
And.
What are you doing most of the day?
Mark
I was training intensely before this problem..when the pain started i stopped everything..Now i have put on 15kgs extra weight..My posture looks like having hunched behind the neck.Also when i do shoulder press am not feeling anything in left side shoulder instead i feel pressure in lats.As of now mostly sitting job am doing…
what was your mri and x-ray taken of?
I have levator any syndrome and not getting relief from standard treatment for it. Have you seen symptoms of levator ani syndrome in patients with posterior pelvic tilt?
Hey Brad,
If you are referring to incontinence, it is actually more common than you think. (and can happen with posterior pelvic tilt)
Has anyone checked out your breathing ?
Mark
Hey Mark. I have a bulging disc in my lower spine from posterior pelvic tilt.
im trying to do those exercises but it seems to pinch my sciatic nerve so I can’t fully do these exercises without intense pain. Do you have any suggestions to how I can implement these exercises? Thanks a lot
Hi Chris,
Which exercise are you having difficulty with?
Be careful if your lower back has inflammation of the bulging disc as this will make pretty much all movements painful.
Mark
I am having difficulty with hamstring stretches as well as gluteal stretches. Do you know any way I can somehow suck my bulging disc back inside?
Hi Chris,
What kind of difficulty are you experiencing with the stretches?
Also – once a disc bulge is out, it is unlikely that it will go back in again unfortunately.
However, this exercise below will help push it back to some degree.
“McKenzie Extension for lower back” (use youtube)
Mark
Difficulty as in it feels like my sciatic nerve is being pinched by the bulging disc and theres an intense pain if I go to a certain extent with these stretches.
Ive had the pain on my right leg a few years back but i think that one got pushed back in because I have no pain anymore but now its on my left side.
thanks again
Hi Chris,
Try to maintain a neutral spine by tilting your pelvis slightly forward whilst performing these stretches.
This should help with the bulging disc pain.
Mark
Dear Mark
Thank you for your informative note. I was diagnosed with l4-l5 protrusion some month ago which made me crippled for two weeks. I did several treatments and am back to my normal life. However, I still have serious problems with SLR. when my leg is raised over 45 degrees I have to bend my knees. I also have serious difficulty sitting with my legs straight in front of me. My knees will bend and I cant straighten them; they do not stick to the floor. If I push myself to straighten my knees, my back would go backward. My MRI also shows that my lumbar lordosis is highly decreased. What should I do to get rid of my problems?
Hi Mohsen,
Have you tried to do nerve glides?
Sometimes after a disc protrusion, your nerve can become tight and limit your SLR. Try out the above 2 exercises and see how you go.
Just make sure that you do not push yourself too far that you reproduce any symptoms like tingling/numbness/shooting pain in your leg. You are aiming for a firm stretch.
Mark
Hi Mark- thanks for your post it was very helpful i am truely thanful to you. Unfortunately two years ago a chiropractor messed up my back and it was stuck of locked in a position and i he wasnt able to correct it and i went too see various other physio and chiro to see if anyone could “fix” my back but they only made it worse. After almost 8 months of dealing with the worst pain i finally met a good chiro who said i was locked ij a posterior pelvis tilt. He correct it and i immeidately felt a releif but all my muscles became so weak by then. To this day i am working to improve my muslce strengthing and all but i still feel alot of soarness and discomfort sometimes and just stiffness.
Can u give some tips and motivational advice on how to keep improving and overcoming this as i am in mu mid 20s and i dont want to have issues with pregnancy in the future years.
Thanks!
Hi Aisha,
As long as you have a specific plan on how to get stronger, you will get stronger.
… And as you get stronger, your body will get better.
Especially if you are planning on getting pregnant, you will need to make sure your body is strong and stable enough to handle the increased load on your back.
What exact exercises are you doing to get stronger? I am happy to review them if you like.
Mark
Hi Mark,
I was doing alot of streches for hip flexors, childs pose, streching tight hamstrings.
Excercises i am doing is lunges, squats with light weights, dead lifts with light weights. Also doing cardio and hanging from a bar. I havent been able to do it lately becus of busy schedule but im getting back to it!
What esle can i do when i feel “stiff” and soarness around lowback region? What other excercises can i do strengthen low back and core to reverse the tilt posture my body keeps reverting to since it was locked in that posture for several months?
Deadlifting and lower back strenghthening is the key.
Hi!
About the strechings – how many times shall we repeat them, and how many times per day? I definately have “no ass syndrome” and it’s been years (since i developed as a teen) since i was asking myself what is wrong, why i have no ass. Now i understood. I am 30yrs old now, I do waiter job and I am definitely not sitting all day. In my teen years I grew up fast and I was feeling bad being taller than everyone, so I subconsiously (or no, don’t remember) was having this position while standing next to other people.
I started going to the gym and I am wondering what strenght exersises should I perform? Are heavy squats recomendable? Leg press machine? Kick backs with weight?
Thanks very much for the useful information!
Hi Diana,
Try to do these exercises at least 1/day. (but recommended 2/day if you can)
You want to train your glute muscles in a neutral pelvis position.
Squats, Deep lunges, standing kick back, bridges etc. They are all really good!
Have a look at this post for a full list of glute exercises that you can do.
Mark
Hi, can i have Anterior Pelvic Tilt while standing and an Posterior Pelvic Tilt while sitting?
Hi Will,
Yes you can.
In fact – this is what happens with the majority of people.
Muscles work differently when comparing in standing and sitting.
Mark
ADDIT: I would just be careful over stretching the hamstrings and strengthening the lower back muscles.
57 yo male, with posterior pelvic tilt (PPT). Tall, skinny, athletic years ago, but seriously lethargic, and sitting poorly for last 20 years . Currently carrying 20 extra lbs around waist (6’2″ 195lbs). Am working on getting rid of the tilt, and adding “core” strength heading into older age. 20 years is a lot to reverse.
Q. when I decide to rest, is it best to sit in recliner, or flat (in a bed)?
Q. What is the best sleeping position?
Q. I still work at a computer all day. Is it best to create a taller “standing desk”, sit on a rubber ball (if so, what size, inflation?), or use a knee chair (if so, what dimensions?)? I may use two desks, one to stand at as long as possible, then a sitting desk after I get tired. Your thoughts?
Q. Is there a proper position that I can use in a reclining chair with laptop in my lap that will help (PPT)?
Q. I’m trying to get ideas on how to apply correct posture to all parts of my life, not just gym time. I have room in my office to excercise during work hours. Am playing racquetball, tennis, ping pong, and golf, but sitting otherwise. I’m thinking a couple of hours at the gym every other day won’t do it.
Your thought, please.
Hi Wallace,
Thanks for your questions.
Q. when I decide to rest, is it best to sit in recliner, or flat (in a bed)?
It doesn’t really matter which one you rest in. However – if you want to avoid tilting your pelvis, then I would say lie flat on your bed. Please note that PPT is not necessarily a bad thing unless it is excessive and stuck in that position for a long period of time.
Q. What is the best sleeping position?
I have written a post on this which can find right here.
Q. I still work at a computer all day. Is it best to create a taller “standing desk”, sit on a rubber ball (if so, what size, inflation?), or use a knee chair (if so, what dimensions?)? I may use two desks, one to stand at as long as possible, then a sitting desk after I get tired. Your thoughts?
The best option is to change positions
as many times as you can
. Being stuck in any position (including standing) places too much stress to the body. I use 3 different chairs at home myself.
Q. Is there a proper position that I can use in a reclining chair with laptop in my lap that will help (PPT)?
Not that I can think of, unless you have a reclining chair specifically made for laptop use where there is a docking station.
Q. I’m trying to get ideas on how to apply correct posture to all parts of my life, not just gym time. I have room in my office to excercise during work hours. Am playing racquetball, tennis, ping pong, and golf, but sitting otherwise. I’m thinking a couple of hours at the gym every other day won’t do it.
In the ideal world, it is better to have as many hours (or more) being active then you are sitting down. If you can focus on postural exercises several times throughout the day whilst you are working, that would be a more practical goal.
Greetings,
i like to workout alot on a serious level. (Bodybuilding) but it seems like i cant even do some of these stretches. For example i cant set my arms straight understand my shoulders for the abdominal stretch. any alternative for this one?
also. How often should this routine be done, daily?
after or before a leg or upper workout, cold of warmed up before?
Thanks.
Hi,
You can do the same exercise with your forearms on the ground and elbows bent position. You should still be able to get a decent abdominal stretch if you position your self properly.
You can perform these exercises everyday if your body can tolerate it. If not – every 2 to 3 days is fine too.
Mark
I had 6 pack abs but after having ppt it is seeming that i have become fat (only for my stomach).I have to now take my stomach in to make my abs come up.Is it possible for fit people to have ppt? I dont know how worse is my ppt so can i send the photo
Hey Jake,
Feel free to send me a photo.
I’ll have a look for you.
Mark
Mark,
Thank you so much for your information as I feel my posture improving so so much. Just a question, do you feel that PPT can be related to love handles? To where poor posture “redirects” fat to be stored in lower back as to the butt?
Hi Danny,
Thanks for commenting :)
Posterior Pelvic tilt can give the illusion that there is excess fat around the waist line.
Usually you can see fat roll imprints on the stomach region after sitting in bad posture for a long period of time.
But ultimately, you would want to try and lower total body fat% to get rid of those love handles.
Mark
Hello, Mark. First of all, thank you so much for the wonderful blog about fixing posture. I have been practicing the stretches you posted about and it has helped me immensely. I have one question though, is there a way to correct bow legs? Some say it can be fixed by exercise but some say it can only be fixed by surgery. I’ve been self-conscious about my bowlegs for many years now and tried to find a cure for it. I know there’s a lot of info on the internet, but most of them are scam. I am asking you because you seem most reliable when it comes to this subject. Thank you and have a happy new year.
Hi Orange Jello,
If your bow legs are STRUCTURAL… meaning if your bones are shaped this way, then it can not be fixed.
However, if it is due to positioning of your pelvis/hips/knee/ankle, then it can definitely be improved.
Were you born with it?
Mark
I don’t know for sure. I do believe I was born with it. I heard that many infants were born with bowlegs, which is normal, but their legs straighten as they grow up?? But I guess my legs didn’t straighten for some reason. I know that it isn’t rickets. Do you think the exercises can improve my legs to appear less bow-leggy even if it’s structural? I’m still going to do the exercises to fix my posterior pelvic tilt.
If your bones are shaped like that, there is not too much we can do besides strengthening your muscles in that position.
How’s your foot posture? Do you have high arches?
Mark
I think my feet are a little bit to the high arch side. My shoes tend to wear on the heels. I never had foot problems though.
Hi, I am 63 yo. I have a posterior pelvic tilt and my left leg I
can’t lift it straight more than 45 degrees. You think these exercises
will work on me. I would appreciate any suggestions. What could
I do for the leg. Thanks, Lovelace Boudreaux
Thank you so much for sharing your knowledge with us, this helps immensly. I`m a 25 year old man, in good shape, but i obviously have PPT. I go to the gym regularly, and my question is, should i stop squatting? Also, my glutes are very tight, but also very weak, does that make sense? I`m also having trouble with my hip flexors, they often pop/hurt when squatting and even when im just straightening my leg from a lying position.
Once again, thank you for the article, hope you reply!
Hey Marko,
If you stand with a Posterior Pelvic Tilt, then it is likely your hip flexors are constantly being stretched. This can make them very weak and may explain why you have difficulty with lifting up a straight leg from a lying down position.
Focus on restoring normal neutral pelvis, and strengthening your hip flexors.
I am a big fan of squats, and I prescribe them to many of my patients. However- if you squat with the incorrect technique, then this is where you might want to reconsider doing squats until you address your underlying issues.
You might need to have someone have a look at your squat technique and go from there.
Hope this helps!
Mark
Hi, I am 63 yo. I have a posterior pelvic tilt. I can’t lift my left
leg straight more than 45 degrees. You think the exercises will
help. This is very painful. This is from bad posture, I hope it’s
not to late for me. Any help will be appreciated. Thanks,
Lovelace
Hi Lovelace,
There are quite a few reasons as to why your Left SLR is limited.
Disc pathology
Tight hamstring
Overly stretched hamstring
Nerve tension
Myofascial tightness
Incorrect pelvis position
… just to name a few
For your particular situation… what exactly is painful? Where does it hurt, What does it feel like? How does it compare with the Right side?
But yes, having a posterior pelvic tilt can lead to all of the above mentioned. So working on that will definitely help.
Looking forward to your reply.
Mark
Hi, Mark,
These instructions are very helpful, thank you so much. Some of them are very painful; would you recommend investing in chiropractics, physical therapy, massage therapy, or a combination to treat advanced PPT?
Thank you.
Hey there Mary,
Thanks for visiting the blog.
Which exercises in particular are painful? We might need to change the way that you are performing them so that it is not flaring up any symptoms.
To be honest, all those health practitioners that you mentioned are great at addressing your PPT.
You just need to make sure that you find the right practitioner who is familiar with dealing with this type of issue.
Mark
Thank you for creating the blog, and your quick response! To be frank, even holding my pelvis in a neural position is somewhat painful – as all of my afflicted muscle groups are so weak/tight – so almost all of the stretches are difficult to maintain in the correct position. I think the fascia is very dense and I don’t have a massage ball for the releases – is there a substitute you suggest?
The reason I asked about specialists is I feel I would benefit from having a professional coach me and ensure I am keeping correct posture throughout treatment and recovery.
I have suffered from this malady since an injury to my sacrum at the age of 12 from an ATV accident, and was only recently diagnosed at 26; it is so truly amazing to know that it is possible to treat this anatomical issue which has been digressing steadily throughout my life without treatment.
One last, hopefully quick question (and thank you so much for your time and professional advice) – if I were to take an over the counter pain medication to combat the constant soreness, would you be more inclined to recommend ibuprofen, advil, or tylenol while attempting this physical therapy at least 2x/day?
Thank you so much! I really appreciate it.
Mary
Hey Mark,
Ive been working on your poked neck and rounded shoulder routine for the past couple of weeks and its been great so far. I have an impinged shoulder and im definitely experiencing less pain in general. I notice that I definitely have a posterior pelvic tilt as well, especially when sitting which I read can affect my upper back and shoulder pain. While getting the impingement fixed is first priority, how would you rank what the most important fix between the neck shoulders and pelvis? Im trying to do it all every day, its just tough, especially if I throw in the workout for the PPT.
Thanks for sharing everything on your site, much appreciated.
Hi Brent,
It’s all connected!
If you want specific exercises for your shoulder impingement, check out this post!
In terms of what takes priority, it really depends!. But if you want a general order of priority, I would focus on fixing the pelvis first.
Why? It is your foundation. (Think of a stack of bricks… If the bottom piece is not placed properly, everything on top (even if stacked nicely) will be off balance.
However – if you experience pain in the neck/shoulders, it is a good idea to address these areas first with the neck/shoulder specific exercises to reduce your symptoms.
There are definitely a lot of exercises to do, but as you get better, you can start to omit some of them. It’s all about building momentum in the initial stages.
Hope this helps!
Mark
Oh Mark,
P.S.- his adductor mms are overactive and abductors inhibited/weak. ?
Hi Mark!
Thank you for this article. It is a great help. My question is: I have a patient who sits all day due to MS. His PPT is extremely advanced. What advice would toy give to begin to see significant improvements in his lordosis so that he can begin to maintain better posture.
Thanks!
Hey Bonita,
Cheers for your questions!
Here are a few additional ideas from the top of my head:
– Make sure that the chair is appropriately adjusted to your patient’s measurements.
– Use a lumbar support for the lower back to increase lumbar lordosis.
– Ensure that your patient sits all the back into the chair.
– Use a seat wedge or slightly tilt the chair backwards to help open up the hip angle.
Is he able to do any of the above exercises?
Mark
–
Thank you for these exercises! My back is very flat – years sitting working at a desk, I think. How often and for how long (ie years?) will I need to do these before my lower curve returns? :)
Hey Alison,
It’s different for everyone.
But you should see small improvements regularly with consistency with the exercises.
Mark
Is it possible to have weak and tight hip flexors with a posterior pelvic tilt? My abdominals are so tense and they cannot relax…
Hey Chris,
Most definitely!
Tight muscles can actually be weak muscles. You may want to strengthen then, but do so with a) your pelvis in neutral and b) in balance with all the other surrounding muscles.
The tightness you feel in your hip flexors is what we refer as the muscles being Eccentrically Loaded.
Think about a rubber band. If you stretch it out, there is now a lot of TENSION in the band. Similarly like your hip flexors, Although it is stretched out (not tight), you can still feel the sensation of the muscles feeling tight.
Hope this answers your question.
Mark
Hi Mark,
Thank you for taking the time to answer our questions! My question is this: I have a PPT and tight hips. My glute muscles are also pretty nonexistent. I want to start working out: my two goals are to work on cardio endurance, and to build muscle in my lower body. I’m finding glute exercises tricky because of my tight hips. Would you advise doing these exercises to correct PPT for awhile before trying to build gluteal muscles, or can do I both at the same time? I’m planning on doing the routine you have here every day if I can. Thanks!
Hey Josie,
When you say tight hips, which muscle do you feel is tight?
Also – you can continue doing glute exercises provided that you are not performing them with your pelvis in a posteriorly rotated position.
Mark
Mark, I just wanted to thank you for your incredibly valuable advice. I have just started the exercises and it has already alleviated much of my pain and stiffness. I am so grateful to you for your efforts. Thank you, Ryan W
My absolute please, Ryan!
I am very happy that you have found that the exercises have helped with your pain!
Mark
your post is very much appreciated, im always suffrering in tension headache due to bad posture.. your post is very informative, can u give me an advice.. i want to improve my butt im 46 yrs.old i want to focus on squats and lunges, would it cause posterior or anterior pelvic tilt..thanks
You can do lunges and squats.
The main focus will be to keep the pelvis Neutral. If you perform these exercises properly, it will not lead to a posterior or anterior pelvic tilt.
Mark