Anterior Pelvic Tilt

Picture of APT on the left by Oliver Ludwig

I had a patient come in this week saying he was told by another physiotherapist that he had an anterior pelvic tilt (APT) that was causing his low back pain. 

He was told that his poor posture while sitting for long hours caused it. Sitting for long hours is often thought to shorten the hip flexors while also weakening the core. There is no evidence that prolonged sitting causes APT. Some correlations were reported but lack consistency between left and right sides (Elliot et al, 2021).

However, even after being 'corrected' for his APT, his low back pain did not go away.

Many people will present in our clinic with a pelvic tilt. An article from Manual Therapy found that 85 percent of males and 75 percent of females (from 120 subjects) presented with an APT without any pain or disability. 6 percent of males and 7 percent of females presented with a posterior pelvic tilt without pain or disability too. So is APT really a dysfunction or is it normal?

There are also no agreement or guidelines as to what is too much or too little pelvic tilt. Moreover there is also no reliability between health professionals in clinical testing while assessing if a patient has APT (Preece et al, 2008). One health professional will assess you and say you have an APT while another may say otherwise.

APT is also not related to low back pain. Have a look at this systematic review by Chun et al (2017). In fact, patients that have low back pain had more 'neutral' pelvic (or hip) positions.

For those of you who have been told, APT is also not related to hip flexor tightness (Elliot et al, 2017) or a weak core (Walker et al, 1987). Neither does your hamstrings length or flexibility affect APT (Li et al, 1996).

So do not worry if someone or a health professional tells you that you have an anterior or posterior pelvic tilt for that matter. It may be changeable and may help reduce pain and/ or symptoms. It is not something that you need to be overly focused on. Treating the cause of the problem is much better than just treating the symptoms.

References

Boukabache A, Preece SJ, Brookes N et al (2021). Prolonged Sitting And Physical Inactivity Are Associated With Limited Hip Extension: A Cross-sectional Study. Musculosk Sci Pract. 51: 102282. DOI: 10.1016/j.musksp.2020.102282

Preece SJ, Willan P, Nester CJ et al (2008). Variation In Pelvic Morphology May Prevent The Identification Of Anterior Pelvic Tilt. J Manual Manip Therapy. 16(2): 113-117. DOI: 10.1179/106698108790818459.