Original Editor - Lucinda hampton Top Contributors - Lucinda hampton, George Prudden, Kim Jackson, Sultan Eylem Demirhan, Daan Vandebriel, Laura Ritchie, Joao Costa, Claire Knott and Tony Lowe[edit | edit source]
Definition[edit | edit source]
Pelvic tilt (PT) is a position-dependent parameter defined as the angle created by a line running from the sacral endplate midpoint to the center of the bifemoral heads and the vertical axis. The average ranges of anterior and posterior pelvic tilting are 13.0 ± 4.9°, and 8.9 ± 4.5°, respectively. The image shows starting from the left demonstrates- the pelvis in neutral followed by a posterior tilt through to an anterior pelvic tilt. For more information on posture variants with altered pelvic tilts see sway back posture and low back pain related to hyperlordosis.
Importance of Pelvic Tilt[edit | edit source]
Pelvic tilting exercises in the sagittal plane are generally used to correct the alignment of the lumbar spine of patients with chronic lower back pain (LBP). A posture that reinforces lumbar lordosis was identified as one of the main causes of LBP. When treating LBP, it is important to reduce the use of the posture causing lumbar lordosis. Anterior pelvic tilting strengthens lumbar lordosis whereas posterior pelvic tilting has the opposite effect. Posterior pelvic tilting exercises are often utilized as a rehabilitation exercise.
Research suggests that the local muscles may be related to anterior and posterior pelvic tilting and these local muscles control motion in the pelvic sagittal plane. Training of the local muscles may be effective for the improvement of lumbar alignment in the sagittal plane of patients with LBP. It might be effective to train the transversus abdominis in the patient with excessive lumbar lordosis, and the multifidus in decreased lumbar lordosis.
People with chronic low back pain exhibit reduced proprioception in the pelvic region and are less ‘movement-aware’ with potentially reduced postural control. This raises a question of whether postures or activities performed using extremes of certain movements (e.g. excessive or restricted movement) may predispose people to LBP.
Image: Bony pelvis (highlighted in green) - anterior view
Pelvic Tilt Measurements[edit | edit source]
"Pelvic tilt angle" to measure anterior pelvic tilt. This measurement is typically calculated as the angle between a line connecting the anterior superior iliac spines (ASIS) and a vertical line.. Goniometer could be used to measure the angle, with the patient lying supine on a table and the examiner palpating the ASIS to locate the landmarks for measurement.
"Supine pelvic tilt test," which involves asking the patient to lie supine with their knees bent and feet flat on the table. The examiner then observes the patient's pelvic position and notes any asymmetry or deviation from neutral position. Other tests such as "prone hip extension test," which assesses posterior pelvic tilt, and the "Thomas test," which assesses hip flexor tightness and can indicate anterior pelvic tilt.
Recent research has explored the use of artificial intelligence (AI) in assessing pelvic radiographs. In a study published in the journal International Orthopaedics, Schwarz et al. (2023) used a deep learning algorithm to evaluate over 500 pelvic radiographs and found that the AI software had an accuracy rate of over 90% in detecting fractures and other abnormalities in the pelvic region. The authors suggest that the use of AI-powered software can potentially improve the accuracy and efficiency of radiographic interpretation, particularly in cases where multiple images need to be reviewed. However, further research is needed to evaluate the software's performance in other clinical settings and with different types of radiographs. This study highlights the potential of AI in medical imaging and its ability to support radiologists in their clinical practice.
Anterior Pelvic Tilt[edit | edit source]
Anterior pelvic tilt (APT) is a common postural deviation characterized by an excessive forward rotation of the pelvis. This posture can have implications for movement patterns, muscular imbalances, and injury risk .
APT is defined as a forward tilt of the pelvis, resulting in an increased lordosis of the lumbar spine and a protrusion of the abdomen (Suits, 2021). It can be caused by a variety of factors, including tight hip flexors, weak gluteal muscles, and poor postural habits . Some individuals may have a structural variation in their pelvis, such as acetabular retroversion, which can contribute to APT .
Recent research has highlighted the potential implications of APT for injury risk and athletic performance. Mendiguchia et al. (2021) found that changes in APT were associated with hamstring strain injuries in soccer players. Specifically, a reduction in APT through targeted training interventions was linked to a lower risk of injury. Brekke et al. (2022) investigated the feasibility and benefits of exercise interventions for patients with acetabular retroversion and excessive APT. They found that targeted exercise programs improved symptoms and function, suggesting that addressing APT can have positive outcomes for patients with this structural variation.
Assessment of APT can be done through a variety of clinical measures, including the pelvic tilt test and the Thomas test. Management of APT often involves a combination of stretching and strengthening exercises to address muscular imbalances and improve posture. Targeted interventions for individuals with structural variations may also be necessary to optimize function and reduce symptoms .
Pelvic Tilt Exercises[edit | edit source]
This video gives a good overview of pelvic exercise progression.
Pelvic Tilt exercises activate the intrinsic core stabilizers so that the core is working and the low back doesn’t take as much strain. The Basic Pelvic Tilt is an isometric hold to engage the intrinsic core stabilizers. Once this is learnt teach the client to use this bracing movement to protect the low back during eg lifting.
The following exercises should be progressively taught and mastered.
Basic Pelvic Tilt.[edit | edit source]
The patient lies on his back with his feet flat on the ground and 60 degrees flexion in the knees.
Now the patient has to press his lower back against the ground while exhaling by tilting the waist/pelvis backwards. On inhalation, the patient then relaxes the lower back from the ground by tilting the waist forward. Try only to move the lumbar spine.
Once you can hold the basic pelvic tilt, you will progress the move and add in movement. Adding in movement will force your core to work harder to stabilize.
The First Progression is the Pelvic Tilt With March.[edit | edit source]
To add the march, you will lie on your back and perform the Basic Pelvic Tilt exercise. However, once you’ve engaged your abs and tilted your pelvis you will lift one foot up off the ground, bringing your knee in toward your chest.
Make sure that as you lift the knee in toward your chest, your low back stays firmly on the ground. Touch that foot back down and raise the other knee in toward your chest.
Keep alternating legs, marching until all reps are complete. This should be a controlled march that you can speed up as you become confident in your ability to keep your low back against the ground and your abs braced.
Progress to the Pelvic Tilt with Double Knee Tuck.[edit | edit source]
To do the double knee tuck, you will perform the basic tilt, but while keeping your low back against the ground, you will tuck both knees in toward your chest instead of simply holding. Move slowly and make sure to keep your low back against the ground as you lift both knees in toward your chest. If at any point your abs aren’t engaged and your low back isn’t firmly pressed into the ground, pause and reset or regress the movement back to the march until you are ready for the double knee tuck. It is very important that you focus on quality movements and not just progressing as quickly as you can.
Progress further when tilt is controlled with the Double Knee Tuck, to the Pelvic Tilt with Single Leg Lowers.[edit | edit source]
To do the single leg lowers, engage your abs with the basic pelvic tilt and raise both legs straight up toward the ceiling. Keeping your abs engaged and your low back against the ground, lower one leg down toward the ground. The closer to the ground you lower the leg, the harder your abs will have to work to stay engaged. The goal is to lower the leg so that your heel is just hovering off the ground. As you lower the leg, make sure to engage your glute as well. Then, keeping the leg straight, raise it back up and lower the other leg. Alternate leg lowers, keeping the other leg straight up toward the ceiling. Work to lower the leg as close to the ground as possible. Don’t feel that you have to lower the leg all the way down if you can’t keep your core engaged. You can increase your range of motion as you become better able to activate your core. If at any point your low back isn’t pressed firmly into the ground, reset and even regress the movement. Either don’t lower the straight leg all the way down or go back to the Double Knee Tuck.
Progress to the Pelvic Tilt with Double Leg Lowers.[edit | edit source]
For the double leg lowers, set up in the pelvic tilt with your legs raised up toward the ceiling (same as for the Single Leg Lowers). Then with your low back firmly against the ground and your abs braced, lower both your legs down toward the ground. If at any point while you lower your legs, your low back comes off the ground, stop and reset. Then either decrease your range of motion or regress to the single leg lowers. However, if you can keep your abs engaged, lower your legs down so your heels are no more than an inch off the ground before raising them back up. You should also engage your glutes as you lower down. And make sure that your legs stay as straight as you can throughout the motion.
With all of these progressions, you can place a towel under your low back to help make sure you are pressing it down firmly into the ground. To use the towel, place it right under your low back and then engage your abs with the Pelvic Tilt.
References[edit | edit source]
- Science Direct Pelvic Tilt Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/pelvic-tilt (last accessed 13.12.2019)
- Takaki S, Kaneoka K, Okubo Y, Otsuka S, Tatsumura M, SHIINA I, Miyakawa S. Analysis of muscle activity during active pelvic tilting in sagittal plane. Physical therapy research. 2016 Dec 20;19(1):50-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342962/ (last accessed 13.12.2019)
- Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders. 2014 Dec;15(1):229. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-229 (last accessed 13.12.2019)
- Bony pelvis (highlighted in green) - anterior view image - © Kenhub https://www.kenhub.com/en/study/bones-pelvis-femur
- Mendiguchia J, Gonzalez De la Flor A, Mendez-Villanueva A, Morin JB, Edouard P, & Garrues MA. (2021). Training-induced changes in anterior pelvic tilt: potential implications for hamstring strain injuries management. Journal of Sports Sciences, 39(7), 760-767.
- Suits WH. (2021). Clinical measures of pelvic tilt in physical therapy. International Journal of Sports Physical Therapy, 16(5), 1366.
- Schwarz GM, Simon S, Mitterer JA, et al. Can an artificial intelligence powered software reliably assess pelvic radiographs?. Int Orthop (SICOT). 2023. Available from: https://doi.org/10.1007/s00264-023-05722-z.
- Brekke AF, Overgaard S, Mussmann B, Poulsen E, & Holsgaard-Larsen A. (2022). Exercise in patients with acetabular retroversion and excessive anterior pelvic tilt: A feasibility and intervention study. Musculoskeletal Science and Practice, 61, 102613.
- redefining health. Pelvic tilt. https://www.youtube.com/watch?v=JPaiq9wd7ko (last accessed 13.12.2019)
- Redefining strength The Pelvic Tilt Exercise – Alleviate Low Back Pain Available from: https://redefiningstrength.com/pelvic-tilt-exercise/ (last accessed 13.12.2019)