This blog post covers the exercises and stretches to help fix an Anterior Pelvic Tilt.

What is Anterior Pelvic Tilt?

The Anterior Pelvic Tilt (APT) is where the pelvis is in a forward rotated position.

(It is also referred to as “Donald Duck Syndrome”.)

Table Of Contents

• Characteristics
• Is It Bad?
• Causes
• Test For Anterior Pelvic Tilt
• Exercises To Fix Anterior Pelvic Tilt
• Common Questions

Characteristics

The main characteristics of Anterior Pelvic Tilt tend to include:

Is It bad?

Having an anterior tilt of the pelvis is not inherently dangerous, however, it could be one factor that may have some influence on issues that you are experiencing.

As the pelvis is the foundation of your spine, it is common for a poorly positioned pelvis to drastically affect your whole posture.

If the pelvis is in a sub-optimal position, your whole posture may be “out of position” as well.

Potential Issues

• Lower Back Pain
• Lumbar Foraminal Stenosis
• Degenerative Disc Disease
• Snapping Hip Syndrome
• Tight Erector Spinae muscles
• Lumbar Hyperlordosis
• Hip Impingement
• Disc Bulge/Herniation
• Sciatica

Causes

In my opinion: One of the main causes is excessive SITTING.

Excessive sitting may lead to certain muscles that control the position of the pelvis to get tight, overactive, weak and/or inhibited. (See list of muscles below)

As a result – there is a muscle imbalance around the pelvis causing a net force to tilt forwards.

Muscles Involved With Anterior Pelvic Tilt

Tight/Overactive Muscles:

(These muscles will need to be Released and Stretched.)

(These muscles will need to be Activated and Strengthened.)

Weak/Inhibited Muscles:

Test for Anterior pelvic tilt

Try this simple test to determine if you have this postural issue.

How To Determine If You Have An Anterior Pelvic Tilt

Instructions:

• Stand up.
• Locate the following land marks:
  • (See above image for the points.)
  • Anterior Superior Iliac Spine (ASIS) = Pointy bone at the front.
  • Posterior Superior Iliac Spine (PSIS) = Pointy bone at the back.
• Compare the relative heights.

How Much Pelvic Tilt Is Normal?

It is normal for the pelvis to have a slight forward tilt of about ~5-10 degrees.

(This is what I refer to as a “neutral pelvis”.)

Exercises for Anterior pelvic tilt

STEP 1: Pelvis Tucking
STEP 2: Releases
STEP 3: Stretches
STEP 4: Hip Internal Rotation
STEP 5: Activation Exercises
STEP 6: Core Exercises
STEP 7: Neutral Pelvis
STEP 8: Strengthening Exercises
STEP 9: Hip Flexor Strengthening
STEP 10: Daily Activation
STEP 11: Breathing
STEP 12: Other Areas To Consider
STEP 13: Helpful Tips

Note: As you become familiar with the exercises and the effect they have on your pelvis, focus on the exercises that give you the best results.

1. Can you tuck your pelvis?

Perform the following pelvis movement to determine what exercises you need to focus on.

Pelvis Tuck

Instructions:

• Stand up right.
• Have your feet shoulder-width apart.
• Lock your knees straight throughout this movement.
• Tilt your pelvis backwards.
• You can also think of this movement as “Tucking your tail bone underneath you”.
• … Can you do it?

If you CAN NOT tilt your pelvis backwards:

Focus more time on performing the Release and Stretch exercises.

If you CAN tilt your pelvis backwards:

Focus more time on performing the Strengthening and Control exercises.

If you are not sure:

Perform all of the suggested exercises in this blog post.

2. Releases

The tight muscles which are holding the pelvis in an anterior tilt will need to be released.

Lower Back

(Target muscles: Erector Spinae, Quadratus Lumborum)

Instructions:

• Place a massage ball underneath the muscles on the side of the spine in the lower back.
• Apply the appropriate amount of body weight over the ball.
• Do not place the ball directly over the middle of the spine.
• Duration: Continue for 3 minutes on each side.

Note: A small amount of bruising can be normal after the first few times performing these self releases. Go gentle!

Latissimus Dorsi

Instructions:

• Locate the Latissimus Dorsi muscle.
• Place a foam roller directly under these muscles.
• Apply an appropriate amount of body weight onto the foam roller.
• Roll your body in an up/down motion over the foam roller.
• Do NOT hold your breath.
  • (Ease off the pressure if you are tensing up.)
• Make sure you cover the entire length of the muscle.
• Duration: Continue for 2 minutes on each side.

Hip Flexors

(Target muscles: Rectus Femoris, Tensor Fasciae Latae, Anterior Adductors, Sartorius, Pectineus, Anterior Gluteus Medius)

Instructions:

• Place a foam roller underneath the front of the thigh.
• Apply the appropriate amount of body weight over the foam roller.
• Duration: Continue for 3 minutes on each side.

3. Stretches

Before you can start to activate/strengthen any of the weak muscles, you will need to stretch the tight muscles which may be locking your pelvis in the anterior tilt position.

Hip Flexor Stretch

(Target muscle: Iliopsoas)

Instructions:

• Assume the lunge position as above.
• Perform a Posterior Pelvic Tilt:
  • “Tuck your tail bone underneath you”.
  • Keep your glutes contracted.
• Lean your torso away from the side you are stretching.
• Aim to feel a pulling sensation at the front of the hip.
• Hold for 30 seconds.
• Perform on the other side.

Rectus Femoris

Instructions:

• Stand up right.
• Pull your ankle behind you as to bend your knee.
• Stay up right and keep your knees in line with each other.
• Tuck your tailbone underneath you.
• Drive your hips slightly forward.
• Aim to feel a stretch at the front of your thigh.
• Hold for 30 seconds.
• Perform stretch on the other side.

For more stretches: Rectus Femoris Stretches

Tensor Fasciae Latae (TFL)

Instructions:

• Assume the kneeling lunge position. (see above)
• Keep your feet in line with each other.
• Proceed to lunge forward.
• Tuck your tail bone underneath you.
• Lean your hips to the side whilst using your arm on a support to keep your balance.
• Aim to feel a stretch in the front/outer side of your hip.
• Hold for 30 seconds.
• Repeat on other side.

For more stretches: Tensor Fasciae Latae Stretches

Groin Stretch

Instructions:

• Sit on the floor with your back against a wall.
• Assume the position as shown above.
• Sit up at tall as possible.
  • Try to create an arch in your lower back.
• Slowly push your knees down towards the ground.
• Aim to feel a stretch in the groin.
• Hold for 30 seconds.

Lower Back Stretch

Instructions:

• Sit down on a chair.
• Push your knees out to the side.
• Lean all the way forward.
• Aim to feel a stretch in the lower back.
• Hold for 30 seconds.

For more stretches: Erector Spinae Stretches

Latissimus Dorsi

Instructions:

• Assume the position above.
• Hold onto a door frame with your hand.
• Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
• Use your body weight to sink into the stretch
• Twist your pelvis away.
• Aim to feel a stretch on the side of your torso.
• Hold for 30 seconds.
• Alternate sides.

For more stretches: Latissimus Dorsi Stretches

Quadratus Lumborum

Instructions:

• Lie on your side on an exercise ball.
• Support your feet on a wall to maintain balance.
• Reach over with the arm on the upper side.
• Aim to feel a stretch on the upper side.
• Hold for 30 seconds.
• Alternate sides.

For more stretches: Quadratus Lumborum Stretches

4. Hip internal Rotation

Hip internal rotation is where the thigh bone twists inwards within the hip joint.

If you lack internal rotation in your hip joint (or if your hip is locked into external rotation), this may prevent your pelvis from achieving a more neutral position.

How Much Internal Rotation Do You Have?

Depending on the shape of your hip joint, you should have approximately 30-45 degrees of internal rotation. (See above image)

For a detailed blog post on how to increase Internal Rotation in the Hip

See Post: Hip Internal Rotation Exercises

To get your started: Here are some exercises to help improve INTERNAL rotation in the hip:

Posterior Hip Release

Instructions:

• Place your gluteal region on a massage ball.
• Apply an appropriate amount of body weight.
• Perform circular motions.
• Make sure to cover the whole area.
• Duration: 2 minutes each side.

Posterior Hip Stretch

Instructions:

• Sit down on the edge of a chair.
• Place your ankle on the top of the knee of the other leg.
• Sit as tall as possible as to create an arch in your lower back.
• Whilst maintaining this arch, pull your knee in the direction of the opposite shoulder.
• Hold for 60 seconds.
• Repeat on other side.

Internal Rotation Over Pressure

Instructions:

• Lie down on the floor facing upwards.
• Slightly bend your knee.
• Allow the knee to fall towards the mid line.
• Place the other foot on the outside of the knee and push the knee down towards the ground.
• Hold for 60 seconds.
• Repeat on other side.

Straight Leg Rolls

Instructions:

• Sit on the floor.
• Have your legs straight in front of you.
• Rotate your leg inwards.
• Aim to feel a muscular contraction in the groin region.
• Perform 30 repetitions.
• Repeat on other side.

5. Activation exercises

Now that your tight muscles have been stretched and released, the next step is to address the muscle weakness associated with an Anterior Pelvic Tilt.

Target these muscles:

• Gluteals
• Hamstring
• Lower Abdominal

Gluteus Activation

Instructions:

• Lie on your back with knees bent and feet on the floor.
• Engage your glutes to tilt your pelvis backwards into a neutral position.
  • This should flatten your lower back onto the ground.
• Press your heels into the floor.
• Drive your hips upwards.
  • Aim to feel the contraction of your glutes AND hamstrings.
• Lift your hips as high as possible whilst keeping a neutral spine.
  • Do not over arch your lower back.
• Hold the end position for at least 30 seconds.

For more exercises for the glutes:

See Post: Gluteal Strengthening Exercises

Hamstring Activation

Instructions:

• Lie on the floor.
• Place your feet on the wall with your hips and knees bent at 90 degrees.
• Dig your feels into the wall and lift your tail bone off the floor.
• Tilt your pelvis backwards.
  • This is to flatten your lower back onto the ground.
• Feel the tension in your hamstring muscles.
• Hold for 30 seconds.
• Repeat 3 times.
• Progression:
  • Alternate lifting your feet off the wall without compromising the pelvis position.

For more Hamstring exercises:

See Post: Hamstring Strengthening Exercises

Lower Abdominal Activation

Instructions:

• Assume the 4 point kneel position.
• Tuck in your tail bone to rotate your pelvis backwards.
  • Engage your core muscles by drawing your belly button in.
• Exhale all the air in the lungs as you form this position.
• Hold this for 5 seconds.
• Repeat 10 times.

6. Core Activation

The core is a group of muscles that are responsible for keeping the pelvis aligned with the spine.

Having a strong core can help maintain a more neutral position of the pelvis.

How To Activate The Core

Instructions:

• Lie down on the floor.
• Have your knees bent and feet on the floor.
• Take a breath in through your nose.
• Slowly exhale all the air out of your lungs through your mouth.
• As you completely empty out the air in your lungs, draw your lower stomach region inwards.
• Gently tense your abdominal muscles.

(Think of this core activation like a wide belt that is completely wrapped around your mid section and it’s firmly hugging you from all directions.)

Core Strengthening Exercise

Now that you know how to activate the core muscles, let’s challenge it with the following exercise:

Dead Bug Exercise

Instructions:

• Lie on your back with both of your knees bent in the air.
• Engage your core and abdominal group by gently drawing in your belly button.
• Rotate your pelvis backwards.
  • Tuck your tailbone underneath you.
• Keep your lower back flat against the floor throughout this exercise.
• Slowly lower the opposite arm/leg.
  • Lower the better! (… but only if you can keep the lower back FLAT!)
• Make sure that you do not feel your lower back muscles overly engage as you lower your legs/arms.
• Perform 5-10 repetitions.

If you would like more information on how to strengthen the core, feel free to have a look at this blog post:

See Post: Core Exercises

7. Finding neutral pelvis

The main aim with the following exercises is to:

• Achieve a neutral pelvis in various positions and
• Gain an understanding of what neutral pelvis FEELS like.

4 Point Kneel

Instructions:

• Assume the 4 point kneel position.
  • Hands under shoulders.
  • Knees under hips.
• Find the end range of pelvis movement:
  • Tilt your pelvis all the way forwards.
  • Tilt your pelvis all the way backwards.
• The neutral pelvis will generally be the midpoint of these two positions.

Sitting

Instructions:

• To position your pelvis in neutral while sitting, you will need to “Sit on your SITS bones”.
• To find your sit bones, place your hands (with palms up) underneath your buttocks whilst sitting on a chair.
• Feel for a pointy bony prominence.
  • (This is your Sits bone!)
• Think of these bones as upside down TRIANGLES.
  • The goal is to distribute your body weight between the tip (aka the pointiest part) of the triangle (as opposed to the side) and your anterior pelvic floor muscles.
• This will place your pelvis is a more NEUTRAL position.

Standing

Instructions:

• Whilst standing, place your fingers on the ASIS and PSIS.
  • They are the “pointy bones” that stick out the most at the front and back of the pelvis, respectively.
• To position your pelvis in neutral, you will need to tilt your pelvis in a backwards directions until the ASIS and PSIS are approximately in line with each other.
  • (Keep in mind – it is normal to have a slight anterior tilt of 5-10 degrees.)
• To help you maintain this pelvis position, you can try shifting your bodyweight on to the mid section of your foot to be less heavy on the heels.

8. Strengthening Exercise (with Neutral pelvis)

The following exercises involve maintaining the pelvis in a neutral position.

Hip Extension

Instructions:

• Assume the 4 point kneel position
• Place your pelvis in a neutral position.
  • Engage your core and glute muscles to lock the pelvis in place.
• Whilst maintaining this alignment, lift your leg as high as possible.
• Do not let your lower back sink in.
  • You should not feel the lower back contract significantly.
• Aim to feel the contraction in your glutes.
• Alternate between sides.
• Repeat 10 times.

Over Head Reaches

Instructions:

• Stand up right.
• Place your pelvis in a neutral position.
  • Activate your core and glute muscles to achieve this.
• Whilst maintaining your pelvis alignment, raise your hands over your head as far as possible.
• Do NOT let your ribs to flare outwards.
  • “Keep the ribs down”
  • The lower back should not arch.
• Repeat 10 times.
• Progression:
  • Perform shoulder presses (with weight) in the standing position.

Pull Downs

Instructions:

• Whilst standing with a slight forward lean, pull the resistance band downwards.
• Lock your pelvis in a neutral position.
  • Activate your core muscles.
• Slowly let your arms recoil to the over head position.
• Your torso and pelvis should not move during this exercise.
  • Do not let your lower back arch backwards!
• Pull the resistance band back to starting position.
• Repeat 10 times.

Plank

Instructions:

• Get into the plank position. (see above)
• Position your pelvis in a neutral position.
  • Engage the core and glutes to stabilize the pelvis.
• Make sure your lower back does NOT sink in.
• Hold for 30 seconds.

Hinge Pattern

Instructions:

• Whilst standing with a neutral pelvis.
• Keep your lower back neutral throughout this exercise.
• Make sure to have your core muscles engaged.
• Slowly lower the weight by hinging at the hips.
  • Aim to feel a pulling sensation in the upper hamstring region before returning to the starting position.
  • Keep the weight close to your body.
  • The knees should bend slightly.
  • This lowering phase should take 3-5 seconds.
• Perform 10 repetitions.
• Note: The pelvis should stay neutral relative to the spine throughout the movement.
• Progression:
  • Hold onto an appropriate amount of weight in your hands.

9. Strengthen Hip Flexors

Wait a minute… Why would you want to strengthen the hip flexors? Won’t strengthening exercises make them tighter?

In my experience, I find that most people are very weak in these muscles.

(In fact – The hip flexors may be tight as a compensation for being WEAK!)

Concentric Contraction

Instructions:

• Whilst sitting with your pelvis in a neutral position, raise your knee as high as you can go.
  • Do not lean backwards.
• Aim to feel a contraction in the front of your hip.
• Hold this position for 5 seconds.
• Repeat 10 times on each leg.

Eccentric Contraction

Instructions:

• Apply leg weights to your ankles.
• Lie down at the end of a bed with your legs dangling.
• Hug one of your knees towards your chest.
• Allow the other leg to drop off the edge of a bed.
• Keep your lower back completely flat throughout the whole exercise.
• Keep your other leg straight.
• Slowly lower and raise this leg.
  • Allow the leg to drop towards the floor as far as you can go.
• Aim to feel a stretch and contraction at the front of your hip.
• Repeat 10 times.

10. Maintaining neutral pelvis

The next step (… and in my opinion the most important) is being aware of your pelvis position throughout the day.

Make an effort to maintain a neutral pelvis in your daily activities such as standing, walking, sitting and hinging.

Eventually – The end goal is to maintain your neutral pelvis as effortlessly as possibly.

Note: Do not overly force your pelvis into the correct position!

11. breathing

Inefficient breathing patterns (such as breathing with Flared Ribs) can result in the anterior tilt of the pelvis.

Breathing Exercise

(This exercise will help to engage the Diaphragm muscle in a more efficient position.)

Set up position:

• Lie down on your back with your legs in a bent position. (see picture)
• Ensure that your lower back is completely FLAT on the floor.
• Your lower ribs should not be flared.
• Keep your neck and shoulders COMPLETELY RELAXED throughout the whole exercise. (use a pillow if required)

Inhalation phase:

• Take a deep breath of air through your nose.
• FEEL your lungs and ribs expand in all areas of your rib cage.
• Your lower back should not arch up as you breathe in.
• Do not flare out your ribs.
• Keep your neck and shoulders completely relaxed.

Exhalation phase:

• After you reach maximum inhalation, start to slowly EXHALE through slightly pursed lips.
• Continue to exhale until your lungs are COMPLETELY empty.
  • Your lower ribs shoulder flatten towards the floor.
  • The core muscles should start to engage as you do this.
• Maintain the rib cage position as you take a breath in again. (Inhalation phase)
• Alternate between inhalation and exhalation phase for 3-5 cycles.

12. Other areas to consider

Have you persisted with these Anterior Pelvic Tilt exercises… and still can’t seem to improve the position of the pelvis?

You may need to address other areas of your posture:

Thoracic Kyphosis (Hunchback)

If you have a hunched upper back, this will tend to bring the torso and head in a forwards position.

The can cause the pelvis to compensate by moving into an anterior tilt of the pelvis.

This is your body’s attempt to keep your head and torso in a more up right position.

For more information: How to Fix a HunchBack Posture

Lumbar Hyperlordosis

If your lower back has an excessive arch (Hyperlordosis), it may be locking your pelvis in an anterior tilt.

For more information: How to Fix Hyperlordosis

Flat Feet

If you have flat feet, it can cause a domino effect through the legs which can end in the pelvis tilting forwards.

For a complete blog post on how to fix this issue:

See Post: How to Fix Flat Feet

To get you started, try out this exercise:

Short Foot Exercise

Instructions:

• Sit down on a chair with your feet on the ground.
• Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
• Keep the base of the big toe on the floor throughout this exercise.
• If performed correctly, you should be able to feel the muscles under your foot tense up.
• Hold this for 10 seconds.
• Repeat 30 times.
• Progress this exercise to a standing position.

13. Other tips

Here are some simple tips to help you maintain a more neutral pelvis.

Reduce Abdominal Size

Any extra weight in the region of the belly will pull the pelvis into a forward tilted position.

This usually effects:

• Pregnant women
• People who are obese
• Bloating issues in the gut

Reclaim Full Hip Extension

If you have limited extension in your hip during walking, this may cause the pelvis to tilt forwards as a compensation.

It is important to have full hip extension without having the need to arch the lower back.

When walking – Make sure that you can feel your glutes contract as the leg extends behind you.

I recommend allowing more time for your leg to glide further behind you before lifting it up for the next step.

For a full guide on improving hip extension:

See Post: Exercises To Increase Hip Extension

How to Fix Anterior Pelvic Tilt While Sitting

When sitting – make sure that your hips are slightly higher than your knees.

This will reduce the amount of hip flexion whilst in the seated position.

The aim of this is to minimize the likelihood of the hip flexor muscles from getting tight.

14. Common Questions

If you have any other questions that you would like to ask me, feel free to leave me a comment.

How Long Does It Take To Fix?

This is a very difficulty question to answer as there are many variables to consider!

Generally speaking – I would persist with the exercises for at least 6 months to see if the exercises are helping.

Are There Any Exercises To Avoid?

You don’t need to strictly avoid any exercise, however, care should be taken with any exercise which encourages the hyper extension of the lower back and forward tilt of the pelvis.

A combination of these 2 movements tends to encourage the anterior pelvic tilt.

This might include exercises such as:

• Superman extensions
• Over extending whilst deadlifting/kettle bell swinging
• Lumbar spine hyper extensions
• Over head exercises such as shoulder press
• Planking without core activation
• Squatting with hyper extended lower back

(Note: You can still perform these exercises as part of a general exercise program, however, make sure that you include the exercises for your posture as well.)

How Should You Sleep?

If you sleep on your back: Place a thick pillow underneath your knees as this will tilt your pelvis backwards into a more neutral position.

It will also help reduce the amount of excessive curve in your Lumbar Spine.

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Conclusion

Anterior Pelvic Tilt is where the pelvis is in a rotated forwards position.

Follow the steps mentioned in this blog post to help address your Anterior Pelvic Tilt.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.