Tilted Pelvis: Symptoms, Treatments, Causes, and Distinctions

Back pain in men.
Back pain can have many causes. kozzi2

A pain in your back may come about for any number of reasons, such as trauma, arthritis, stenosis, or unknown causes. When your healthcare provider can’t give you the cause of your pain, it’s generally labeled as non-specific low back pain (NSLBP).

In many cases, posture problems underlie non-specific low back pain. This is because posture misalignment can signal nerves in the area to fire off pain signals.

With posture-related back pain, especially in your low back, some degree of abnormal pelvic tilt can be involved. In fact, ​a chronically misaligned position of the pelvis is often the cornerstone of a variety of posture problems, including those that affect not only the low back but other areas of the spine, as well.

Tilted Pelvis and Back Pain

The pelvis is a centrally located bone to which your spine, as well as your hips, are connected. It has a certain position that’s considered well-aligned or “neutral” (and thus healthy).

The pelvis can also tilt forward and back, it can rotate forward or back, and it can hike up or down on one side. And, it can do a combination of two or more of these movements at the same time.

Such pelvic moves may seem subtle or even non-existent when you experience them, but as they turn into habits, or become stuck, as is often the case after an injury, they can produce a cascade of issues or problems in nearby areas. One of these areas is, of course, the low back.

Forward and Backward Pelvic Tilts

A skeleton of the pelvis, sacrum, lumbar spine, hip joints and femur bones.
A skeleton of the pelvis, sacrum, lumbar spine, hip joints and femur bones. sciencepics

When the pelvis tilts forward or back, the entire bone (which is made of several bones that are "seamed" together at their joints) moves into just one direction. Each tilt direction affects the low back differently. Either scenario—anterior or posterior pelvic tilt—may cause pain, but not necessarily.

Forward Pelvic Tilt

A forward tilt, called anterior pelvic tilt, may tighten up your low back muscles because it accentuates the small amount of naturally occurring curve that’s present in a healthy spine. Posture problems related to a forward pelvic tilt are much more common than those related to a posterior tilt. Forward pelvic tilt can be caused by extra belly weight (including pregnancy weight) as well as other things.

Backward Pelvic Tilt

A backward tilt, called posterior pelvic tilt, does just the opposite. It reduces the amount of normal low back curve you have, which in turn, elongates the back muscles past their normal tolerance for stretch.


Most of the time, chronic posture problems that are due to a forward or backward tilt respond well to exercise programs specifically designed to address the “deviation” from neutral. (Neutral pelvic positioning is considered well-aligned and is tilted neither too far forward nor too far back.)

Such programs generally involve both stretching and strengthening. Areas targeted include hips, back, and core. Seeing a qualified physical therapist or personal trainer for guidance and a program will likely be your best bet for returning your posture to a well-aligned position.

Pelvic Obliquity

A woman challenges her balance and strenghens her outer hip muscles by standing on one leg.
Increase back muscles and balance with one legged standing. undrey

Things get interesting with forward or back pelvic rotation and/or one-sided hip hiking. This is a phenomenon called “pelvic obliquity” or side-to-side pelvic imbalance. Most of the time, pelvic obliquity—where one hip is higher than the other—is related to a leg length difference and/or scoliosis.

Leg length difference as a condition comes in two types—the functional type and the anatomical type. Generally, functional leg length difference can be traced back to pelvic obliquity; it’s assessed in terms of pelvic obliquity.

People with a functional leg length difference may also have scoliosis. The research is mixed as to whether the leg length difference actually causes scoliosis, but at any rate, this type of scoliosis is considered functional, not anatomical. Scoliosis, in this case, starts with the pelvic obliquity, which in turn moves the spine away from ideal alignment.

A functional leg length difference is not always accompanied by scoliosis. Some reports state that up to 87% of people with leg length differences also have scoliosis.

Functional leg length differences, and especially the pelvic obliquity that drives them, usually come from the day in and day out way you perform common activities (sitting, standing, walking, housework, playing sports, etc.).

Anatomical Leg Length Difference

Physician examines a patient with low back pain.
Physician examines a patient with low back pain. mangostock

Anatomical leg length difference is the real deal. This is where one of your legs is actually and measurably longer than the other, and your hip bones in back line up horizontally. It can be very painful and is often disruptive to daily activities, social activities, and sports.

Generally, anatomical leg length inequality is treated by putting an insert in the shoe of the shorter leg to help even things out. Getting a core strengthening program that also works the hips will likely help you reduce pain and increase your physical functioning by addressing the muscle imbalances in the pelvis.

As with all types of pelvic positioning problems, it’s probably best to see a licensed physical therapist for the program, as this is a medical condition.

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