Anterior Pelvic Tilt Sells. But Your Posture is not the Problem!

There is a lot of money to be made by telling someone they are broken and “I have the key to fix you with my program.” Those with a dubious course or treatment that will fix you, often shout the loudest about how we are at risk of imminent injury unless we heed their advice.

In fact this is simply one part of the bigger sales of pitch of how “correcting” posture will ease pain and any other problem we might have! It’s tempting to say “it’s not so simple”. But perhaps it is even simpler, do not assume there is anything wrong with your body - or anyone else's! Bodies are made to move and movement is one of the very best things we can do for them. Worry less about how we move and just get moving!

Research shows it's very hard for "experts" to see exactly how the pelvis is moving - or not. They took a group of weight lifters moving into a squat, put sensors on to check the movements of the pelvis and lumbar. At the same time a group of physios, observed the movement and assessed who moved the most. The results - they got it so wrong! (Far et al, 2021, Physical Therapy in Sport.

Nor can therapists accurately assess pelvic tilt - at best they are guessing and I think as yoga teachers we would come into this category also. Preece et al 2008 PMID 19119397

How do we measure Pelvic Tilt? 

On the front of your pelvis, you have two bony landmarks known as the Anterior Superior Iliac Spine, or ASIS for short. Similarly, on the back of your pelvis, you have two bony landmarks known as the Posterior Superior Iliac Spine, or PSIS. Pelvic tilt is often portrayed as the angle created by an imaginary line drawn from the PSIS to the ASIS Therefore, when assessing static standing posture, 3 positions are usually described:

Posterior Pelvic Tilt, in which the line is sloped down toward the PSIS.

Neutral Pelvic Tilt, in which the line drawn is straight across.

Anterior Pelvic Tilt, in which the line is sloped down toward the ASIS and our pelvis is tipped forward.

Let’s back up and look at where the idea came from that the pelvic caused such problems.

The most commonly cited reason I see and hear about on social media or otherwise is Lower Crossed Syndrome, which was a theory proposed by a medical doctor and researcher, Vladimir Janda, in 1979.

According to Janda, anterior pelvic tilt is a result of muscle imbalances: the abs and glutes are weak, while the hip flexors and low back extensors are tight.

A website that now shares his ideas acknowledges that associating pelvic position with muscle imbalances is not proven. “While Vladimir Janda was the first to recognise Upper Crossed Syndrome (UCS) and Lower Crossed Syndrome (LCS), few studies have validated the specific pattern of muscle imbalance and postural abnormalities associated with these common muscle imbalance syndromes.”

The imbalances in physiotherapy terms came to be called “upper cross syndrome and lower crossed syndrome. BUT evidence-based physios state they are made up conditions!

What does the research say?

Few studies have validated the specific pattern of muscle imbalance and postural abnormalities associated with these common muscle imbalance syndromes.

Since over 45 years of research has been conducted since 1979, let’s explore seven reasons why you don’t need to try to manage or fix anterior pelvic tilt, according to research.

Anterior pelvic tilt is normal. 

• Most of us have anterior tilt- without it causing any problems. A study by Herrington in 2011 found that “85% of males and 75% of females presented with an anterior pelvic tilt.” 

Anterior pelvic tilt is NOT associated with low back pain. 

• A systematic review by Laird et al in 2014 demonstrated that “Compared to people without low back pain, on average, people with low back pain display no difference in lordosis angle…” and “no difference in standing pelvic tilt angle…”
• Even more notable is a systematic review by Chun et al in 2017 reported that “Overall, patients with low back pain tended to have smaller lumbar lordotic angles than healthy controls.” in others words having a less curved lumbar spine, is more likely to cause pain!
• A study with pregnant women by Franklin and Conner-Kerr in 1998 concluded the following: “This study suggests that from the first to the third trimester of pregnancy lumbar lordosis, posterior head position, lumbar angle, and pelvic tilt increases; however, the magnitudes and the changes of these posture variables are not related to back pain.”
• None of this is new information. A study by Dieck et al published in 1985 followed women for 25 years to determine the association between postural changes and neck and back pain. They found that women with an “…increased degree of kyphosis, lordosis, or pelvic tilt were not at an increased risk of subsequent spinal pain.”

Anterior pelvic tilt is NOT associated with weak abs. 

• Walker et al in 1987 “…found no correlation between abdominal muscle function, pelvic tilt, and lumbar lordosis.” They go on to state: “Patients often are taught abdominal muscle “strengthening” exercises as a means of altering their standing posture. The theoretical basis on which this practice has been built is not supported by our data. No apparent relationship exists between abdominal muscle function and standing pelvic tilt, abdominal muscle function and lumbar lordosis, and lumbar lordosis and pelvic tilt.”
• Youdas et al in 2000 concluded that “In patients with chronic low back pain, the magnitude of the lumbar lordosis and pelvic inclination in standing is not associated with the force production of the abdominal muscles.” 

Anterior pelvic tilt is NOT associated with weak glutes as reported by 

• Mills et al in 2015 and Herrera et al in 2021

Anterior pelvic tilt is NOT associated with tight hip flexors, statically or dynamically,

• as evidenced by Heino et al in 1990 and Schache et al in 2000. 

The amount of sitting we do does not relate to posture

• On top of that, a study by Koumantakis et al in 2021 discovered that the number of sitting hours per day was not related to lumbopelvic posture. This makes intuitive sense. Despite having my elbows bent most of the day while working at the computer, using my phone, eating, and even sleeping on my side with my hands by my face, my elbows don’t get stuck in this position.

Anterior pelvic tilt is not relate to hamstring flexibility

• Li et al (1996) PMID: 8710963

Does this mean pelvic tilt doesn't matter?

No! It just means that we cannot say that the pelvic tilt is causing the problems. Anterior pelvic tilt can be provocative of discomfort in some people and adjusted for short period to help alleviate pain. Which I believe might be where a lot of the misunderstanding perpetuates. I love a bolster under the knees in shavasana to lengthen the lumbar and it FEELS like natural is better!

But we need to go by the research!

What we do know about pain

There are two things that help us have less pain:

1. Anything that make us healthy

• Nutritious food
• Hydration
• Movement
• Cardio
• Sleep
• Less stress 

 2. Anything that makes us happier

• Loving relationships
• Meaningful work
• Good & frequent sexy time
• Financial security
• Hobbies
• Less stress

What about pelvic floor, incontinence and posture?

A quick look at incontinence, pelvic floor and pelvic tilt. The dynamics of incontinence and pelvic tilt are not understood, we do know the pelvic floor and diaphragm work together as part of an integrated core. So trying to hold the pelvis in a neutral position would inhibit the relationship and responsiveness of the pelvic floor. But as Wang et al, states in this paper  (PMCID: PMC10153777)which looked at dance as a way to improve pelvic floor health & urinary incontinence. While the study was not conclusive “ Our training program demonstrated improvements in perceived incontinence, urinary function, and pelvic muscle activation.”

Does Yoga Improve Urinary incontinence?

A 2023 systematic review has explored exercise as a way to reduce urinary incontinence and while improvements were found the best forms of movement  for the most improvement needs further exploration. (Curillo-Aguirre CA et al.PMID: 37374208; PMCID: PMC10301414.) In other words the research is not there. Although we do know that moving the diaphragm with the breath can improve pelvic floor tone so yoga is well place to help with that. As well as to reduce stress which can help to balance muscle tone.

Let’s think about utkatasana

The received wisdom that is so wonderfully vague and nonsensical is usually the “not too much not too little” approach to anterior tilt. Jump up and try! Have a good explore of the pelvis in all directions. See what feels good to you. There is no one right way and often skillful teaching brings out a specific feature of a pose with to prepare for another pse, or to explore the more subtle work of the “prana” or sensation or awareness. 

In terms of pelvic floor muscles a “scoop” of the pelvis is a fantastic way to recruit the pubococcygeus muscles. The tailbone is drawn towards the pubis through the muscles contracting. At another time we want to let the pelvic floor muscles move through their full descending expressions- eccentric contraction. Because like any other muscle group the pelvic floor benefits from moving fully. 

What does this all mean for us as yoga teachers?!

It means we are free to share the wonderful message that we can move in all ways without worrying! If you are busy “correcting” your students' posture you can back off. We do know that the body maps better in the brain when we vary our  movements, and thai body mapping is associated with reduced pain. So if we/ students have one movement habit that is associated with discomfort- like interior tilt in EVERY post. Then yes there might be a place to offer more movement awareness.

Or if someone is in pain it might be good to explore alternative ways to move. Although if their physio/ doctor has told them to keep moving they might decide to do this.  

Yoga expertise means we do not state our expertise! We know how to let students be the experts in their own bodies and minds. Or if they are concerned we advise they go to a medic because we cannot say what their pain is from- it’s complex. It might be from a break or infection, or that they need to de-stress. SO they need to check then we can help with the rest.

BUT this is still different from pathologising the posture or suggesting it need correcting. Posture is a very individual thing and we can celebrate our difference instead of trying to get everyone into the exact same shape in tadasana. 

Worry less and celebrate all our bodies more.