Our pelvic bone is perfectly balanced over the hip joint. It is due to perfect coordination between the muscles around the lumbar. When there is an imbalance in muscle pull, the pelvic bone can either tilt anteriorly or posteriorly.
So, what are the differences between anterior vs posterior pelvic tilt? What causes them? Let’s try to find out in this article.
Normal pelvic alignment
We can measure the pelvic tilt by a straight line bifurcating the ASIS and PSIS. When pelvic bone is aligned normally over the hip joint, the ASIS and PSIS are in level1.
Normal pelvic alignment is important for normal curvature of the spine, which puts the least stress on the anatomical structures around the spine2. In normal conditions, the spine forms a curve at lumbar region called lumbar lordosis and cervical lordosis in cervical region.
But, when pelvic alignment is disturbed, it also affects the alignment of the spine. This causes stress on the intervertebral disc, paraspinal muscle and, ligaments, facets joint. Over time, this can contribute to chronic low back pain.
Pelvic tilt imbalance is one of the major causes of non-specific low back pain, and in a study, it is most common cause of non-specific low back pain in office workers3.
So, when do we say the pelvis is anteriorly tilted.
In anterior or posterior pelvic tilt, the position or motion of the pelvis is studied in the sagittal plane and horizontal frontal axis
Anterior pelvic tilt
In anterior pelvic tilt, the pelvic bone rotates anteriorly. This causes the ASIS to be lower than the PSIS1. This rotation causes a crossed curve of the lumbar lordosis.
So, what is the cause of anterior pelvic tilt?
The cause of pelvic tilt can be explained by lower crossed syndrome. In lower crossed syndrome, there is tightness in the hip flexors and lumbar extensors. Conversely, there is weakness of the abdominal muscles and hip extensors.
In one of my posts, I have discussed in detail the “anterior pelvic tilt correction exercises”, I highly recommend you go through it.
Posterior pelvic tilt
Opposite of anterior pelvic tilt, the pelvic rotation is in the posterior direction in posterior pelvic tilt. This causes the ASIS to sit higher than the PSIS. Because of this, the normal curve of the lumbar spine reduces. There is loss of lumbar lordosis, and the low back often looks flat. This change can also encourage a more rounded upper back (increased kyphotic posture).
Someone with a clear posterior pelvic tilt may appear to stand with the hips pushed forward and the tailbone tucked under. The abdomen can look flattened rather than protruding.
So, what is the cause of posterior pelvic tilt?
The muscle pattern is roughly the reverse of lower crossed syndrome. There is often tightness in the hamstrings, gluteal muscles, and abdominals. Conversely, there is weakness or underactivity of the hip flexors and lumbar extensors.
Common contributors include prolonged slumped sitting (a “C” shaped posture), habitually tucking the tailbone, over-emphasising “core bracing” or posterior pelvic tilt cues in exercise, and reduced activity of the muscles that keep a natural lumbar curve. Simple posture correction exercises can help address the upper-back rounding that often accompanies this pattern.
Posterior pelvic tilt is less common than anterior pelvic tilt in the general population, but it still matters. Flattening the lumbar curve can stretch the posterior structures of the low back and change how load is shared through the spine and hips. Targeted lower back stretches may ease related stiffness when used carefully.
Correction focuses on the opposite strategy to anterior tilt: gently restoring a more neutral lumbar curve, improving hip flexor and lumbar extensor control, and reducing excessive tightness in the hamstrings and overactive “tuck” pattern—always within a comfortable, symptom-free range.
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The author is a physiotherapist who has been practising for the last 17 years. He holds a Bachelor's in Physiotherapy (BPT) from SVNIRTAR (Swami Vivekananda National Institute of Rehabilitation and Research), one of the prestigious physiotherapy schools in India.
Whatever he learns dealing with his patient, he shares it with the world through blogs and e-books. He also owns a YouTube channel, "Sunit Physiotherapist" with over 8 lakh active subscribers. Here, he shares everything he gets to learn serving the patient.
