A rotated or tilted pelvis is often a symptom of muscular imbalance, contributing to chronic back pain via an excessively curved spine and increased stress on the back. Individuals with a pelvic tilt also often experience lordosis in the lower back (duck posture), or kyphosis (rounded shoulders and hunched neck) from excessive sitting.
While a tilted pelvis might not initially cause pain, its structural effect on the rest of the spine eventually contributes to aggravated symptoms, as is in general a sign of poor physical health due to weak and imbalanced muscles. It’s estimated that as many as 85 percent of men and 75 percent of women show signs of a rotated or anterior pelvic tilt.
What Is a Twisted or Rotated Pelvis?
The pelvis is a complex bone structure that supports and balances the trunk and serves as the base of the spine. It attaches directly to the femurs (thigh bones) as well and is also known as the hip bone. Ideally, the pelvis should be in a neutral position which allows the spine to stack naturally and avoid excessive shearing and compression forces, which could contribute to spine issues ranging from compressed nerves to slipped discs.
But certain imbalances often related to excessive sitting and lack of exercise cause specific muscles attached to the hip bone to become tight, while others are weakened. Hip flexors, which describe a set of muscles attaching between the hip bone and the thigh bone and work to bring the knee to the chest, become tight and shortened due to long periods of sitting, while the glutes and hamstrings primarily act as hip extensors (straightening the leg, i.e. standing up or thrusting the hips forward), get weaker.
The result is a pelvis that tilts forward as tight hip flexors pull it closer to the femur, while the weak glutes fail to counteract this shift. This can be diagnosed either by observing a patient’s posture, or by administering the Thomas test. The Thomas test assess hip extensibility by having a patient lie on their back on the edge of a table, with one knee pressed to their chest, and the other leg hanging off the table, while controlling pelvic tilt (to avoid giving the false impression of adequate extensibility).
Similarly, overly active hip extensors and weakened hip flexors can lead to a posterior pelvic tilt. In a posterior pelvic tilt, the difference is a more rounded lower back (curving the opposite way), often accompanied by a hunched or “collapsed” posture.
Excessive Sitting, Poor Posture and Back Health
Both the anterior and posterior pelvic tilt are common signs of inactivity and poor posture, most attributed to a long sedentary lifestyle. Genetics may play a part, as our posture and natural inclination towards one stance or another is at least partially a matter of bone structure, but most cases of a rotated or tilted pelvis are addressed via strengthening exercises one way or another.
By addressing the muscular weaknesses that contribute to the pelvic tilt (i.e. weak hip flexors, weak glutes, weak hamstrings, weak quadriceps, weak abdominal muscles), a proper exercise plan set up and guided by a specialist can often correct the issue, and lead to overall lower risk of back pain as a result of a stronger and more resilient trunk and lower body.
Stretching and Strengthening Exercises for a Rotated Pelvis
The exercises used to address a rotated pelvis primarily address the hip flexors and hip extensors. The abdominals and spinal erectors are also important muscles, as they ensure a stiff and neutral trunk, and act to support and straighten the spine.
These exercises require no equipment and no weight, although they can be performed with weight. This is not an exercise plan – every patient will require a different plan formulated around their specific abilities, limitations, and so on. Do not attempt an exercise you have not attempted before if you suffer from back pain, knee pain, or have a history of injury.
This is an exercise that trains hip extension through the glutes and hamstrings and can be performed on one leg to involve the glute muscles responsible for hip abduction.
Performed without weight, this exercise is like a deep bow. Maintain a completely stiff trunk while bending over, stretching through the glutes and hamstrings before contracting them powerfully to stand straight.
Performed on the hands or elbows, the focus here should be on keeping the abdominal muscles braced. Take slow deep belly breaths, rather than quick shallow chest breaths. Flex the glutes to avoid pelvic tilt.
Again, flex the glutes at the top to prevent a pelvic tilt. Lightly stretch the hip flexors with each repetition. Unilateral (one-sided) exercises like the lunge also train the hip abductors and adductors and help work on lateral imbalances.
A more advanced version of a lunge, this exercise is performed with the back leg on an elevated surface. This allows for a deeper stretch.
Best performed with a resistance band of your choosing, these exercises train the muscles that rotate the leg inward and outward. Weak abductors may contribute to a pelvic tilt. Incorporating hip abduction during regular glute bridges (via a resistance band above the knee) can greatly help in treating anterior pelvic tilt.
Correction and Prevention Tips
While prevention is often more important than the cure, strengthening exercises can go a long way to correcting the problem, including (but limiting to):
- Take breaks from sitting: walk in long strides and lightly stretch your hips, with hip circles or donkey kicks. Do not go from being seated into strenuous stretches without a warmup – stick to light, easy movements with no pain.
- Exercise regularly: even if the exercises seem easy, or if you only have time for a light session, try to get moving and break a sweat at least three times a week. Long walking sessions, a light jog, or a series of calisthenics can help.
- Remain conscious of your hips and overall posture: keep your hips and back in mind both while seated and while standing. Keep your chest up and shoulder blades back and down. Avoid slumping over (hips tilting up) and avoid arching your lower back excessively (hips tilting down).
By taking breaks from sitting and regularly exercising the hips, trunk, and legs, the pelvis can typically be pulled into a neutral position. It’s still a good idea to keep posture in mind, and continue to exercise even after the problem has been resolved.