Do you suffer from back pain and have heard that your anterior pelvic tilt might be the cause of it? Then let me reassure you – that’s not true. If you want to know why this is a myth and what science has to say about it, you’ve come to the right place.
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How can we identify an anterior pelvic tilt?
Usually, this is done through observation by doctors or therapists. We have seen, in numerous studies, that diagnosis by observation is neither a reliable nor valid method for predicting joint angles.
If we want to objectively measure pelvic tilt, we have to draw a line between two bony landmarks (the ASIS and the PSIS).
This results in three positions:
- Posterior Pelvic Tilt (PPT): Line slopes down
- Neutral Pelvic Tilt (NPT): Line is perfectly horizontal
- Anterior Pelvic Tilt (APT): Line slopes up
What are the supposed problems of a swayback?
Most commonly, this relates to the Lower-Crossed-Syndrome, invented by Dr. Vladimir Janda in 1979.
According to this, pelvic tilt and thus the position of the lumbar spine are determined by opposing muscle groups.
Anterior pelvic tilt is supposedly caused when the hip flexors and lower back are “tight,” while the abs and glutes are too weak. This combination is said to lead to back pain, movement dysfunctions, SI joint pain, etc.
What does science say about this?
An anterior pelvic tilt is completely normal
This is shown by the work of Herrington from 2011.
In his study, 75 % of females and 85 % of males presented with an anterior pelvic tilt and had NO lower back pain. He even found that men had a significant asymmetry between the right and left side of the pelvis. And again – there was no connection to lower back pain.
Interestingly, the paper by Chun et al. 2017, shows that people with back pain actually have less anterior pelvic tilt than people without back pain.
One could argue that the study by Herrington only looked at asymptomatic people. Don’t worry – I got you covered. The studies by Laird et al. 2014 and Swain et al. 2019 looked at people with and without back pain and found no connection between anterior pelvic tilt and lower back pain.
Lower Crossed Syndrome isn’t a real thing
The strength of the abdominal muscles does not affect the position of the lumbar spine, as nicely demonstrated by Walker et al. in 1987 and Youdas et al. 1996.
As you can see from the dates of these papers, we’ve known this for over 35 years, yet we still hear it in clinical practice every single day.
The strength of the gluteal muscles does not affect the position of the lumbar spine.
Mills et al. 2015 investigated this in their study and found no difference in strength between subjects with tight hip flexors (and thus presumably more likely to have an anterior pelvic tilt according to Janda) and subjects with “normal” hip flexors.
If that’s not enough for you, Herrera et al. 2021 specifically looked at pelvic and lumbar spine position and found no influence from the strength of the hip extensors (including the gluteal muscles).
“Tight” hip flexors don’t affect the pelvic tilt
Heino et al. 1990 found no link between hip flexor flexibility and pelvic or lumbar spine position in their study. Schache et al. 2000 show in their study that even during jogging, hip flexor flexibility does not affect pelvic or lumbar spine position.
Before anyone argues that weak hip flexors are the issue, let me mention the paper by Herrera et al. 2021 again. They also looked at the strength of the hip flexors, adductors, abductors, internal and external rotators: none had any impact on pelvic or lumbar spine position.
The number of hours per day one sits also seems to have no impact on pelvic or lumbar spine position, as shown by Koumantakis et al. 2021.
The biggest takeaways for you
This means you don’t need to worry much about your pelvic position. Posture is highly variable and doesn’t seem clearly linked to pain.
But Gino, when I do these corrective exercises for my anterior pelvic tilt, I feel much better afterward. Of course – if your anterior pelvic position currently causes you pain, then change it!
But an anterior pelvic tilt itself is not something bad that must be changed! Ultimately, it’s just another normal and healthy variation of your posture.
There are also numerous myths about posture. Read this article to find out how important your posture really is.
Literature
- Chun, S. W., Lim, C. Y., Kim, K., Hwang, J., & Chung, S. G. (2017). The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 17(8), 1180–1191. https://doi.org/10.1016/j.spinee.2017.04.034
- Heino, J. G., Godges, J. J., & Carter, C. L. (1990). Relationship between Hip Extension Range of Motion and Postural Alignment. The Journal of orthopaedic and sports physical therapy, 12(6), 243–247. https://doi.org/10.2519/jospt.1990.12.6.243
- Herrera, M. C., Amasay, T., & Egret, C. (2021). Lack of Correlation Between Natural Pelvic Tilt Angle with Hip Range of Motion, and Hip Muscle Torque Ratio. International journal of exercise science, 14(1), 594–605.
- Herrington L. (2011). Assessment of the degree of pelvic tilt within a normal asymptomatic population. Manual therapy, 16(6), 646–648. https://doi.org/10.1016/j.math.2011.04.006
- Koumantakis, G. A., Malkotsis, A., Pappas, S., Manetta, M., Anastopoulos, T., Kakouris, A., & Kiourtsidakis, E. (2021). Lumbopelvic sagittal standing posture associations with anthropometry, physical activity levels and trunk muscle endurance in healthy adults. Hong Kong physiotherapy journal : official publication of the Hong Kong Physiotherapy Association Limited = Wu li chih liao, 41(2), 127–137. https://doi.org/10.1142/S1013702521500128
- Laird, R. A., Gilbert, J., Kent, P., & Keating, J. L. (2014). Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders, 15, 229. https://doi.org/10.1186/1471-2474-15-229
- Mills, M., Frank, B., Goto, S., Blackburn, T., Cates, S., Clark, M., Aguilar, A., Fava, N., & Padua, D. (2015). EFFECT OF RESTRICTED HIP FLEXOR MUSCLE LENGTH ON HIP EXTENSOR MUSCLE ACTIVITY AND LOWER EXTREMITY BIOMECHANICS IN COLLEGE-AGED FEMALE SOCCER PLAYERS. International journal of sports physical therapy, 10(7), 946–954.
- Schache, A. G., Blanch, P. D., & Murphy, A. T. (2000). Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. British journal of sports medicine, 34(4), 279–283. https://doi.org/10.1136/bjsm.34.4.279
- Swain, C. T. V., Pan, F., Owen, P. J., Schmidt, H., & Belavy, D. L. (2020). No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of biomechanics, 102, 109312. https://doi.org/10.1016/j.jbiomech.2019.08.006
- Walker, M. L., Rothstein, J. M., Finucane, S. D., & Lamb, R. L. (1987). Relationships between lumbar lordosis, pelvic tilt, and abdominal muscle performance. Physical therapy, 67(4), 512–516. https://doi.org/10.1093/ptj/67.4.512
- Youdas, J. W., Garrett, T. R., Harmsen, S., Suman, V. J., & Carey, J. R. (1996). Lumbar lordosis and pelvic inclination of asymptomatic adults. Physical therapy, 76(10), 1066–1081. https://doi.org/10.1093/ptj/76.10.1066
