Posterior pelvic tilt is an unnatural, painful phenomenon causing the lower back to lose its natural curve - tightening a predictable set of muscles and leaving you in pain wondering what the hell to do. I recently triggered a posterior pelvic tilt, spent a few days in the pain cave, and got out of it days later - here is what I did and what you can do to correct your posterior pelvic tilt.
Healthy Pelvic Tilt (left) vs. Posterior Pelvic Tilt (right)
What Is Posterior Pelvic Tilt?
Posterior pelvic tilt (also referred to as PPT) is the term for a pelvis tilted backward into a "tail tucked in" position. Looking at the lines in the image above, the pelvis is supposed to be neutral for the best balance of forces and minimal pain/strain in the hips and lower back. When the pelvis is tilted backward or "posteriorly", the lower back loses its natural curve, placing a ton of excess, unnecessary strain on the lower back.
Some symptoms of posterior pelvic tilt include:
- Flattened lower back
- Highly tense and sensitive glute muscles
- Difficulty and/or pain bending forward
- A strange resistance to arching the lower back
- General lower back pain all the time
What Causes Posterior Pelvic Tilt?
Posterior pelvic tilt can have a variety of triggers, but most commonly the source is muscle spasm. Many muscles in and around the lower back act as stabilizers and protectors, and when the back is put in a compromised position they are forced to lock up and tense (see lower back trigger points for more on this). The primary muscles that tense up and pull the pelvis into posterior pelvic tilt are the glutes - which we will correct thoroughly in the exercises below.
Posterior pelvic tilt typically results from straining activity. PPT can result from lifting objects all day doing manual labor, stretching your lower back's capacity with high-rep movements in the gym, or participating in a high-impact sport without properly warming up. My recent posterior pelvic tilt trigger was burpees (of all things... burpees really?) towards the end of a grueling circuit workout - involving sprints, bodyweight squats, pushups, and burpees - without warming up and going as fast as I could for time. I also lacked lower ab engagement, which is something I will get to later in this post.
How To Fix Posterior Pelvic Tilt
To correct posterior pelvic tilt, we need to perform a set of corrective exercises to a) relieve our lower back of the current constant muscle tension, b) correct our spinal curvature, and c) strengthen specific areas that are lacking that caused us to fall into posterior pelvic tilt in the first place. The following section will walk you through this step by step, but it is helpful to understand the "why" behind each step first.
The order and full completion of these exercises are crucial. Do not pick 1 or 2 of these and expect results - make sure to thoroughly focus and complete all 4 steps daily to fix posterior pelvic tilt as quickly as possible. For reference - after 2 days of this system my lower back and hips felt 90% better.
Posterior Pelvic Tilt Exercise Correction Steps
A quick preface to exercise 1 - if you simply can't stretch the glutes because they are just way too tight, rigid, and angry, you may need to do deep tissue glute massage as step 0. Thorough deep tissue massage will break up any knotting, trigger points, and rigid muscle fiber that currently can't stretch. If you own a QL Claw or another massage tool for the glutes and lower back, I would recommend breaking the muscles up first so they are more susceptible to stretch.
Posterior Pelvic Tilt Exercise 1: Standing Glute/Ham Stretch
Glute-emphasized Single Leg Hamstring Stretch
For the first posterior pelvic tilt corrective exercise we have the one-leg-glute-emphasized hamstring (I don't know if this has a mainstream name). The goal of this is to load the upper hamstrings and Glutes Maximus muscles with constant-tension pulse reps in this stretched position. Doing this exercise with intensity and time in the stretch essentially tells our body that we need this muscle to be longer, so we're going to lengthen this by brute force.
The key queue for this movement is to orient the body in a way that emphasizes the stretch on the glutes (in the red circle), and not the lower hamstrings. Make sure to leave a bend in the knee, and position your upper body in a way that targets the glute during the stretch. The orientation in the image is what worked for me and is a good place to start.
Sets/reps: 2 sets of 20 pulse reps on each leg - holding a 1-2 second pause at the end range of each rep. Try to get further and further into the stretch with each repetition.
Posterior Pelvic Tilt Exercise 2: Pigeon Glute Stretch at 2 Angles
Pigeon Stretch at Angle 1 (head to knee)
Pigeon Stretch at Angle 2 (head to foot)
Next up we have the pigeon glute stretch. This is going to attack the glute muscles at a different angle - and yes we need to do both glute stretches because the glutes are the primary reason we are here in the first place.
This stretch targets the smaller, outer glute muscles including the Piriformis and Gluteus Medius (the first stretch targets Gluteus Maximus). Opening up these muscles will directly help the pelvis settle back into its neutral position because the glutes are the ones that directly pull the pelvis backward into our posterior pelvic tilt.
The recommendation for this exercise is to perform pulse reps at two angles on the glute muscles. The first angle is head-to-knee, and the second is head-to-foot. Each angle is going to target different glute muscles, and you will likely find head-to-knee is much easier. Start with your pulse rep set towards the knee (do all 12), then go straight into 12 head-to-foot pulse reps on the same leg before switching.
Sets/reps: 2 sets of 12 pulse reps for each angle on each leg - holding a 1-2 second pause at the end range of each rep. Try to get further and further into the stretch with each repetition.
Posterior Pelvic Tilt Exercise 3: Back Extension
Back Extension Beginner Level
Back Extension Advanced Level
Now that the glutes are loose and the body is primed to release its posterior pelvic tilt, we can work our lower back into alignment with back extensions. The goal of back extensions is to restore the natural lumbar curve to the spine, giving our back and hips a healthy, strain-free position.
The extent to which you push this exercise is incredibly case by case. You may feel a large strain just getting up on your elbows (beginner-level image), or you may need to get all the way up to your hands to feel a stretch. Either way - work with your range and breathe deeply into the belly to get comfortable and establish time in an arched back position.
Sets/reps: 2 sets of 12 slow press-ups OR 60 seconds of deep breathing in the back extension position.
Posterior Pelvic Tilt Exercise 4: Lower Ab Strengthening (Hanging Leg Raise Variation)
Hanging Leg Raise On Pull-up Bar
Do not neglect this step, this is arguably the most important principle. The reason this is important is that a lack of lower ab and hip flexor strength is likely the reason you fell into posterior pelvic tilt in the first place. The hip flexors/lower abs and glutes fight each other for pelvic position (tight hip flexors -> anterior pelvic tilt, tight glutes -> posterior pelvic tilt... you get the idea), and a lack of strength and stability on the front of the pelvis in the hip flexors and lower abs is what left us susceptible to posterior pelvic tilt initially.
There are plenty of lower ab and hip flexor exercises you can do for this step, but my personal favorite is the hanging leg raise variation shown here. Nothing lights up the lower abs specifically quite like this movement, and if you can do it I'd highly recommend it. That being said, do not overexert yourself and choose a lower ab exercise that works for you.
Sets/reps: 2 sets of 15-20 reps.
There you have it - how I used corrective exercises to fix my posterior pelvic tilt in a matter of days. Best of luck with your lower back pain relief journey, read these next for more on how to get out of pain and stay there!