Tilted Pelvis: Symptoms, Treatments, Causes, and Distinctions

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

Back pain can have many causes. These may include:

  • Trauma
  • Arthritis, a degenerative condition of the joints
  • Stenosis, a narrowing of the spinal canal

Back pain may also have unknown causes. When your doctor can’t find the cause of your pain, it’s called non-specific back pain (NSBP).

In many cases, NSBP in the lower back is caused by posture problems. This is because poor posture can trigger nerves to fire off pain signals.

Posture-related back pain, especially in your low back, may involve abnormal pelvic tilt. In fact, a misaligned pelvis is often present in many types of posture problems. This includes problems that affect the low back and other parts of the spine.

This article looks at how a tilted pelvis might cause back pain. It also discusses how this problem can be corrected.

1:33

Click Play to Learn How to Handle a Tilted Pelvis

This video has been medically reviewed by Oluseun Olufade, MD.

Tilted Pelvis and Back Pain

The pelvis is actually a group of bones held together by joints. It is connected to your spine at your lower back.

Your pelvis is considered well aligned or "neutral" when it's tilted neither too far forward or too far back.

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

You normally use this range of motion in your daily activities. Problems happen when you don't return to the neutral position while standing or sitting.

A pelvic tilt may seem subtle or even non-existent when you experience it. As it turns into a habit, though, it can cause problems in nearby areas. One of these is the lower back.

Recap

A tilted pelvis often happens because of poor posture. It can cause problems in the lower back and in other nearby parts of the body.

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

A forward tilt is called an anterior pelvic tilt. A backwards tilt is called a posterior pelvic tilt.

Each tilt direction affects the low back differently. Both may cause pain, but not always.

Forward Pelvic Tilt

A forward tilt may tighten up your low back muscles. This is because it accentuates the small amount of curve in a healthy spine.

Posture problems that have to do with a forward pelvic tilt are the most common. A forward tilt can be caused by a number of things. One common cause is extra belly weight, including pregnancy weight.

Backward Pelvic Tilt

A backward tilt does the opposite. It reduces the amount of normal low back curve you have. This elongates the back muscles past their normal tolerance for stretch.

Correcting Forward and Backward Tilt

Most of the time, posture problems caused by a forward or backward tilt can be corrected. This is true even if the problems are long-term.

Exercise programs can help fix the deviation from the neutral position. These programs usually include both stretching and strengthening exercises. They target the hips, back, and core.

Your best bet for correcting a pelvic tilt is to work with a qualified physical therapist or personal trainer.

Recap

A simple pelvic tilt can be either forward or backward. Most of the time, these types of tilt can be corrected with physical therapy.

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

Pelvic obliquity is more complicated than a simple tilt. It is caused by forward or backward pelvic rotation and/or one-sided hip hiking. Pelvic obliquity is also called side-to-side pelvic imbalance.

In simple terms, pelvic obliquity is where one hip is higher than the other. It can be related to scoliosis. Scoliosis is when the spine has an abnormal curve. Most of the time, though, pelvic obliquity is related to a leg length difference.

There are two types of leg length differences. The functional type stems from how you stand, sit, or otherwise move during normal activities. The anatomical type is when there is a physical difference in the lengths of your legs.

Most of the time, functional leg length difference has to do with pelvic obliquity. It is sometimes also related to scoliosis. The research is mixed as to whether the leg length difference is what causes the scoliosis.

This type of scoliosis is considered functional, not anatomical. Scoliosis, in this case, starts with the pelvic obliquity. The pelvic obliquity moves the spine away from ideal alignment.

Functional leg length differences can usually be treated with physical therapy.

A functional leg length difference doesn't always happen along with scoliosis. It is common, though. Some reports say up to 87% of people with leg length differences also have scoliosis.

Anatomical Leg Length Difference

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

When you have an anatomical difference in leg length, one of your legs is measurably longer than the other. This imabalance can affect your bones and your muscles. The condition can cause a lot of pain. It often gets in the way of daily activities, your social life, and any sports you may play.

This condition is usually treated with a shoe insert. An insert in the shoe of the shorter leg evens the leg length.

Physical therapy can also help. This usually includes core strength exercises that work the hips. This kind of exercise will help reduce pain. Because it helps muscle imbalance in your pelvis, it will also make it easier for you to do day-to-day activities.

Anatomical leg length difference is a medical condition. For this reason, it is best to start this kind of program under the care of a licensed physical therapist.

Recap

Pelvic obliquity is when one hip is higher than the other. It is usually caused by a difference in the lengths of the legs. 

Functional differences in leg length are related to posture. They can be corrected with physical therapy. With an anatomical difference, one leg is physically longer than the other. They can be corrected with physical therapy, but shoe inserts will also help.

Summary

A tilted pelvis usually happens because of poor posture. The condition can lead to back pain. 

Your pelvis should be in a nuetral position while you are standing or sitting. If it isn't, it may cause pain and other problems.

Forward or backward pelvic tilt can usually be corrected with an exercise program. Pelvic obliquity, where one hip is higher than the other, is more complicated. 

Pelvic obliquity is usually caused by a difference in leg length. This may be due to posture or a physical difference in the length of your legs. 

Both types of pelvic obliquity can be treated with physical therapy. When the problem is the physical length of your leg, a shoe insert can also help. 

Was this page helpful?
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Falk Brekke A, Overgaard S, Hróbjartsson A, Holsgaard-Larsen A. Non-surgical interventions for excessive anterior pelvic tilt in symptomatic and non-symptomatic adults: a systematic reviewEFORT Open Rev. 2020;5(1):37‐45. doi:10.1302/2058-5241.5.190017

  2. Puntumetakul R, Chalermsan R, Hlaing SS, Tapanya W, Saiklang P, Boucaut R. The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: a randomized controlled trialJ Phys Ther Sci. 2018;30(11):1390‐1395. doi:10.1589/jpts.30.1390

  3. Zhang Y, Cheng T, Zhang XL. Changes in intra-pelvic obliquity angle 0-2 years after total hip arthroplasty and its effects on leg length discrepancy: A retrospective studyChin Med J (Engl). 2015;128(10):1346‐1350. doi:10.4103/0366-6999.156780

  4. Strauss A. Your child has scoliosis: Now what do you do?

  5. Sheha ED, Steinhaus ME, Kim HJ, Cunningham ME, Fragomen AT, Rozbruch SR. Leg-length discrepancy, functional scoliosis, and low back pain. JBJS Rev. 2018;6(8):e6. doi:10.2106/JBJS.RVW.17.00148