Correcting Pelvic Imbalances–Anterior, Posterior, & Lateral

Pelvic imbalances are all too common as people spend more time sitting and leaning over screens with poor posture. The pelvis can be imbalanced in several ways, including forward and backward tilts and lateral imbalance. 

The result of these discrepancies is back pain, hip pain, neck pain, knee pain, and poor spinal alignment if not corrected. The good news is that this can all be fixed. If you work with clients who complain about back pain, in particular, check them for pelvic tilts and prescribe stretches and exercises to restore balance. 

Types of Pelvic Imbalance

The pelvis is like a bowl in the center of the body. It supports the spine, protects organs, and contributes to the movement of the hip joints, walking, running, and lifting. The structure should be aligned evenly forward and backward and side to side but can easily tilt one way or another. 

Pelvic tilt can lead to other issues, including pelvic floor dysfunction. The pelvic floor muscles aid in organ function through muscle contractions, so inability to control the pelvic floor muscles can cause pelvic pain and other problems within the body.

Anterior Pelvic Tilt

An anterior pelvic tilt occurs when the pelvis rotates forward. It causes the lower back to curve inward and can lead to pain in the lower back, hips, and knees. It is very common among people who sit for most of the day. A study of 120 people in their early to mid-20s found that up to 85% of the males and 75% of the females had anterior pelvic tilt. Just 18% of females and 9% of males had a neutral pelvis. 

A forward tilt is usually a result of imbalanced muscles. The posterior chain of muscles—lower back, glutes, hamstrings—are weak and often loose or overstretched. The anterior chain, including hip flexors, the psoas, and quadriceps, are tight and stronger. These muscles take over for the posterior muscles and pull the pelvis forward.  

Posterior Pelvic Tilt

The opposite of an anterior tilt, a posterior pelvic imbalance occurs when the pelvis rotates backward. The top of the pelvis tilts back, pulling the glutes inward and flattening the curve of the lower back. This is less common than an anterior tilt because sitting a lot tends to tighten the hip flexors. 

Sitting and inactivity cause posterior tilt in some people. If you have this type of imbalance, it is the chain of muscles in the back that are too tight, especially the hamstrings. The posterior chain of muscles overcompensates for weak muscles in the front of the body, pulling the pelvis backward. Symptoms include low back pain and hip pain. 

Lateral Pelvic Imbalances

When the pelvis tilts more to one side of the body than the other, it signifies a lateral imbalance. You might be able to see the lateral pelvic tilt by looking at the front of your hip bones for an uneven hip. Another way to identify a lateral pelvic tilt is if one leg appears to be longer than the other. 

This type of imbalance could be functional or structural. For the latter, a physician, physical therapist, or chiropractor should take a look at it and make recommendations. 

For functional issues, exercises to strengthen the muscles on the weaker side can restore balance. Unaddressed, a lateral tilt can cause back pain, hip pain, and mobility issues. 

Muscle imbalances while running can cause significant issues and pain. Here’s how to identify and correct them. 

How to Correct Pelvic Tilts and Imbalances

Correcting a pelvic imbalance involves three main strategies: improving posture and sitting less, stretching tight muscles, and strengthening weak muscles. 

Correcting an Anterior Tilt

The anterior, or forward tilt of the pelvis is so common because people spend a lot of time sitting at a desk and on the couch. This tightens up the hip flexors and weakens glutes, creating the kind of imbalance that pulls the pelvis toward the front of the body. 

The first step to correcting the problem is changing habits. If you have a client with this complaint who sits all day, encourage them to use a standing desk for at least part of the day. If they don’t have access to one, getting up regularly to walk and stretch the hips will help. 

You can also provide these clients with a stretching and strength training recipe for rebalancing the affected muscles: 

• Hip flexor stretches. Any stretch that lengthens the front of the hips will help. Try a deep lunge with the back knee resting on the ground and the 90/90 stretch. You can also stretch the hips passively by letting one leg hang off the edge of the bed or a sturdy table while lying on the back. 

• Quad stretches. The front quadriceps are also typically tight with an anterior pelvic tilt. Stretch these out along with the hips. 

• Glute bridges. A glute bridge provides a double benefit. It stretches the hip flexors while strengthening the glutes. 

• Deadlifts. Do straight-leg deadlifts to build strength in the hamstrings. 

• Glute exercises. Any strength training moves that build the glutes will help with an anterior tilt. Lunges, side lunges, clamshells, and split squats are all effective moves for the glutes. 

• Foam roll. Using the foam roller on the quads and fronts of the hips will help loosen and lengthen them. 

• Stretches to avoid. Both weakness and looseness in the posterior muscles contribute to an anterior tilt, so avoid stretching the glutes or hamstrings until you have corrected the problem. 

Correcting a Posterior Tilt

The posterior tilt is less common, but as with the forward tilt, sitting a lot and poor posture are contributing factors. Correct these while also adding in appropriate stretches and resistance training: 

• Stretch hamstrings and glutes. Tightness in these muscles pull the pelvis back. Do sitting or standing hamstring stretches, and seated glute stretches. Try the yoga poses downward facing dog and pigeon to hit the posterior chain. 

• Foam roll. Use the foam roller on the glutes, hamstrings, and lower back to lengthen and loosen tight spots. 

• Squats. Strengthen the quadriceps by doing squats and squat variations. 

• Standing leg raises. This is a great move for strengthening the hip flexors. Stand and lift one leg up at a time until the top of the thigh is parallel to the floor. Keep the knee bent at a ninety-degree angle as you lift the leg. As the muscles get stronger, straighten the leg. 

Tight hamstrings are nearly as common a problem as tight hips. Try these stretches to loosen them up. 

Balancing Lateral Tilts 

Several muscles can be involved in a lateral tilt, but in general, they are weaker on the side where the hip is lower. Correcting it requires strengthening glutes, especially the gluteus medius, the adductors, and abductors, and stretching the quadratus lumborum. Focus more on the side, but don’t overdo it and swing the imbalance in the other direction: 

• Stretch the quadratus lumborum. This deep core muscle, when tight, can pull your pelvis to one side. To stretch it on the right side, for instance, stand up and cross the right foot over the left foot. Raise the right arm and arch it over the head. You should feel a stretch in your right side. You can do a similar stretch while sitting and letting the right glute hang over the side of a bench as you lean over to the left. 

• Side leg raises. Try both adductor and abductor side leg raises to strengthen these important muscles on the weak side. 

• Clamshell. The clamshell is one of the best exercises to target a weak gluteus medius. This is a small side muscle of the glute group that gets weak due to a lot of time spent sitting. 

• Hip hike. Stand on a step or box on the leg with the higher hip. The foot should be parallel to the edge of the box. Your weaker leg will be hanging off. Lift the hanging side up until your pelvis is aligned. Hold it for several seconds and repeat. This strengthens the core and hip muscles but also realigns the pelvis. 

• Foam roll. For a lateral imbalance, roll out the lower back and along the spine on the side of the body that tilts downward. 

Being at the center of the body, issues with the pelvis radiate outward causing pain and dysfunction in multiple locations. As a personal trainer, you can offer clients a chance to fix these imbalances and have less pain and greater mobility. If you have any concerns about a client’s issues that extend beyond the scope of a trainer, make sure they talk to their doctor before continuing with training. 

Personal training is about so much more than working out. To learn everything you need to know to help clients with preventable low back, shoulder, and knee pain, and muscle imbalances, check out the ISSA’s Corrective Exercise Program. 

Resources

Dr. Radic, G. (2020). Pelvic Imbalance: Why it Happens and How to Fix it. East Gippsland Osteopathic Clinic. Retrieved 17 May 2022, from https://eastgippslandosteopathy.com.au/2020/08/pelvic-imbalance/.

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