Posterior Pelvic Tilt (PPT) or “hip tilt” as it’s often informally referred to is a common problem that affects many Americans. A person can be affected by PPT if they don’t lead an active lifestyle or have poor posture whilst sitting at their desk. While severe PPT can cause joint, knee, and hip pain, it also makes your butt and gut protrude a lot more. These effects can cause pain and discomfort in other areas of the body. In addition to the pain, this can affect the way your clothes fit, and maybe even your self-confidence. Unfortunately, because this is a muscular/ skeletal problem, no amount of weight loss will help you get rid of that gut. Here’s some information to help you understand PPT a little better, as well as a few suggestions on how to combat it.

What is Posterior Pelvic Tilt?

Posterior pelvic tilt is the medical term for hips that are excessively tilted forward or backward. There are a few different forms of pelvic tilt. Anterior pelvic tilt presents as an overly forward arched lower back. Individuals suffering from anterior pelvic tilt often appear to be sticking their belly and buttocks out. This is the result of the pelvis tilting forward forcing the lumbar spine into hyper-lordosis. Posterior pelvic tilt presents with the opposite causes and effects. Individuals suffering from posterior pelvic tilt can appear to be tucking their buttocks. This is the result of the pelvis tilting backward pulling the lumbar spine flat. The most common causes of unhealthy posterior tilt are sedentariness and lack of everyday activity.

How Posterior Pelvic Tilt Happens

If we sit a lot, our hip flexors “shorten” causing compensatory tension in the hamstrings. If you stand up and you have short hip flexors, the hamstrings will pull on the hip, as well as your lower back. This is what causes the hip to tilt backward and the curvature in your lower back to flatten, thus making your butt and gut seem more prominent. Interestingly anterior pelvic tilt is caused by similar sedentary lifestyle choices, with opposite results.

How can I tell if I have Posterior Pelvic Tilt?

To a certain extent, a slight pelvic tilt is common in humans. It depends on the way your body is built, your genes, etcetera. In fact, a slight pelvic tilt is more common in women than in men. However, one of the ways you can figure out if you have PPT is to perform the Thomas Test. To do so, get a friend to observe you, or film it with your cellphone/webcam.

1. Sit on the edge of a table or another stable surface
2. Grab both of your knees and lean back until your back is flat on the surface
3. Now, let go of one leg and extend at the hip until your thigh touches the table

You don’t have PPT if: your thigh touches the table and the knee is bent with neither hip nor leg rotating or moving outward.

You might have PPT if: you need to extend the knee (i.e. straighten it) to touch your thigh to the surface of the table. This means your rectus femoris is short. Also, if your thigh cannot touch the table even after you’ve extended your knee, your psoas is short. If your leg and hip need to move to the outside for the thigh to touch the surface of the table, your tensor fascia latae is short. If you notice any of these things, and your spine is even slightly curved, you will benefit from a few PPT corrective drills or exercises.

What can I do to fix it?

• Exercises and drills. If you’re suffering from severe PPT, there are a number of valuable exercises and drills videos available online to help you fix it. Focus on drills that strengthen your psoas and quads, and stretching your glutes and hamstrings. For anterior pelvic tilt focus on abdominal muscles and core strength as well as stretching your glutes and hamstrings.
  • Leg Lunges – Lunges strengthen your glutes, hamstrings, and quads. Building strong leg muscles is necessary for repairing and preventing posterior tilt. To perform lunges start in a standing position with your feet about shoulder-width apart. Step forward with your right leg then bend at your knee to about a 90-degree angle. Your left knee should touch the floor. Push off your right foot to return to a standing position. Repeat this process with your left leg. Each set of left and right is one repetition (aka a rep). Start with a set of 10 reps if you’re not used to this type of exercise. Work your way up to at least 3 sets of 15 reps. Be careful to avoid bonking your knees on the ground.
  • Leg Raises – Leg raises are a low-impact exercise that strengthens your legs and your core to fix and prevent issues with pelvic tilt. To perform leg raises lie on the floor either on your back or your side. We recommend doing side leg raises (lie on your side) as well as front leg raises (lie on your back). Start by slowly lifting your leg up then down. Do this in a controlled way several times. Try to keep the rest of your body on the ground and still.
  • Superman Stretch – This exercise is similar to the leg raises except you start by lying on your stomach with your hands outstretched above your head. Each repetition consists of lifting your chest and arms (which kind of looks like Superman flying). Hold this position for 15-30 seconds. If you have to lift your feet to counterbalance your body that’s okay.
  • Hamstring Stretches – There are a lot of different ways to perform hamstring stretches. The most common is performed in a seated position. However, we believe that the most effective hamstring stretches are done while sitting in a chair. To perform this type of hamstring stretch start by sitting in a sturdy chair. Extend one leg out and straighten it. Then bend forward reaching for your toes until you feel a stretch. Hold this position for 15-30 seconds. Then repeat for your other leg. Doing several sets of stretches like this at a time will improve your hamstring flexibility and will allow you to perform deeper, more meaningful stretches in the future.
• Be more active. Sedentariness is the number one cause of PPT, so get out there and move your body. If your PPT is mild, something as simple as walking for a half-hour a day will help improve your flexibility and posture.
• Chiropractic Adjustment. Tense, overused muscles from overcompensating for weak muscles can contribute to PPT. A regular chiropractic adjustment can help recover from issues with pelvic tilt. During your visit, your chiropractor will instruct you on exercises and stretches like the ones mentioned above and will provide more information on how you can work to prevent further issues with pelvic tilt in the future.