Tilted Pelvis: Symptoms, Treatments, Causes, and Distinctions

A tilted pelvis is the abnormal positioning of the pelvis in relation to the thighs and upper body. This causes imbalance and misalignment of the spine, leading to low back pain. It is also relevant to several other conditions that can exist elsewhere in the body. Depending on the direction of the pelvic tilt, it can cause pain in the knees, legs, hips, buttocks, shoulders, and neck.

A tilted pelvis is often the result of poor posture. It can also be due to altered anatomy of the pelvis and/or hips caused by joint degeneration or a condition present from birth.

This article describes three different types of tilted pelvis, including their causes and symptoms. It also explains how each is treated or corrected with exercise, physical therapy, or medical interventions.

How Pelvic Tilt Is Related to Back Pain

The pelvis is a group of bones held together by joints that is connected to your spine at your lower back (known as the lumbar spine). The pelvis can tilt forward and back and rotate forward or back. It can hike up or down on either side. It can do a combination of two or more of these movements at the same time.

Your pelvis is considered well-aligned or "neutral" when it's tilted neither too far forward nor too far back. Problems can arise, however, if your pelvis falls consistently out of this neutral position while standing or sitting.

A tilted pelvis disrupts what is known as the kinetic chain, meaning the normal orientation and interaction of joints, muscles, and body segments that enable movement. When the kinetic chain is disrupted by the abnormal pelvic tilt, all other body segments are thrown off, leading to instability, mobility problems, and, most commonly, low back pain.

Anterior Pelvic Tilt

A forward tilt is called an anterior pelvic tilt. It is caused by the shortening of the hip flexor muscles (which allow you to bring your knee to your chest) and the lengthening of the hip extensor muscles (which move your knee away from your chest). This increases the curvature of the lower spine.

One of the most common causes of an anterior pelvic tilt is extra belly weight, including pregnancy weight. As the pelvis tilts forward, you are forced to compensate by flexing your back into an abnormal "C" curve.

Prolonged sitting in combination with physical inactivity can also lead to an anterior tilt.

Symptoms of Forward Pelvic Tilt

With an anterior pelvic tilt, the front of the pelvis drops in relationship to the back of the pelvis, causing symptoms like:

• Low back pain
• Tight pelvic and thigh muscles
• A protruding belly
• Possible knee, hip, and feet pain

Treatment and Correction

An anterior pelvic tilt can be relieved by changing certain habits at home and in the office. Among them:

• Avoid sitting for prolonged periods, taking regular breaks so that you can stretch and walk.
  
• Avoid sitting on the edge of your work chair, which tilts your pelvis forward even further.
  
• Place a pillow or blanket between your knees to keep your pelvis in a neutral position while sleeping.
• Lose weight, if needed.

There are also certain exercises that can help correct an anterior tilt by strengthening the lower back and abdominal muscles:

• Squats
• Lying pelvic tilts
• The plank
• Hip flexor stretches

Posterior Pelvic Tilt

A backward tilt is called a posterior pelvic tilt. It is caused by an imbalance between your leg muscles and core muscles, which include the pelvic floor muscles, transverse abdominis muscles, erector spinae muscles, and diaphragm.

A posterior tilt can be caused by many of the same things as an anterior tilt. But, rather than flexing your back muscles, you end up slouching forward. This elongates the muscles past their normal tolerance for stretch.

Your sleeping posture can also contribute if it restricts the natural curve of the lumbar spine. Research shows that pelvic angles differ drastically in a supine position contributing to the degree of the tilt.

Symptoms of Backward Pelvic Tilt

With a posterior pelvic tilt, the front of the pelvis rises while the back of the pelvis drops, leading to symptoms like:

• Low back pain
• A slumped posture
• Rolled-forward shoulders
• Upper back tension
• Tight hamstrings
• Possible knee and hip pain

Treatment and Correction

As with an anterior pelvic tilt, a posterior pelvic tilt will improve with simple changes in posture. Among them:

• Ensure your desk height, chair height, and computer screen are all at the right level so that you do not slump.
• Get a chair with lumbar support, or place a small pillow behind your back while you sit.
• Place a small rolled-up towel beneath the arch of your lower back as you sleep.
• Wear a weight-training belt to keep your spine in a more neutral position.

There are several exercises that can also help correct a posterior pelvic tilt, such as:

• Abdominal press-up (a.k.a. the Cobra pose)
• Seated hamstring stretches
• Glute bridges
• Straight leg raises
• Back extensions (a.k.a. Superman exercise)
  

Pelvic Obliquity

Pelvic obliquity is more complicated than an anterior or posterior pelvis tilt. It is caused when one hip is higher than the other and/or one hip is rotated in the opposite direction to the other.

With pelvic obliquity, one or both of the following will occur:

• One hip will be hiked up while the other is dropped.
• One hip will be rotated forward and the other backward.

Pelvic obliquity is also called side-to-side pelvic imbalance.

This may be related to scoliosis, an orthopedic disorder in which the spine curves abnormally to the side.

Pelvic obliquity is more often due to differences in leg lengths. With that said, hip misalignment caused by hip dysplasia or scoliosis can lead to differences in leg length, particularly in developing children or adolescents.

Degenerative diseases, like hip osteoarthritis, can also lead to pelvic obliquity in adults by causing hip joint weakness on one side of the body.

Symptoms of Side-to-Side Imbalance

Pelvic obliquity causes symptoms due to the compression and misalignment of the spine as it compensates for the imbalance in the hips.

This can lead to symptoms like:

• Back pain
• Leg or hip pain
• An uneven "rolling" gait
• An uneven stance
• Shoulder or neck pain
• Difficulty walking

Treatment and Correction

If the cause of pelvic obliquity is anatomical, such as caused by scoliosis or hip dysplasia, bracing or surgery may be needed.

If there are differences in leg lengths due to degenerative or congenital conditions, shoe orthotics or corrective orthopedic shoes can not only correct the imbalance but help relieve pain.

Physical therapy exercises can also be used to strengthen the weaker hip. This usually involves core strengthening exercises that work the hips selectively.

Examples include:

• Step ups/step downs
• Bird dog exercise
• Single leg lunges
• Single leg squats
• Single leg balance

Summary

A tilted pelvis usually happens because of poor posture. A forward (anterior) or backward (posterior) pelvic tilt causes back pain because it forces the back to compensate for the misalignment, either by overarching or slumping. They can usually be corrected with exercise and changes in sitting and sleep habits.

Pelvic obliquity, where one hip is higher than the other, is usually caused by a difference in leg length but can also be due to conditions like scoliosis, hip dysplasia, or hip osteoarthritis. The treatment of pelvic obliquity varies by the cause, although physical therapy exercises and orthopedic shoe inserts can help.