Management of Anterior Pelvic Tilt
For anterior pelvic tilt, implement targeted strengthening exercises for the gluteus maximus, hip extensors, and abdominal muscles, combined with custom-molded foot orthoses when musculoskeletal malalignment is present.
Assessment and Identification
Anterior pelvic tilt often presents with associated musculoskeletal features including:
- Mild lumbar lordosis and hyperextension at knees and elbows 1
- Increased width of base of support, genu valgum and recurvatum, hindfoot valgus, and forefoot varus 1
- Biomechanical disadvantage in abdominal muscles, hip extensors, and hip abductors 1
The pelvic tilt creates postural compensations that can lead to weakness in trunk and proximal muscles, particularly affecting abdominal muscles, hip extensors, and abductors 1.
Primary Treatment Approach
Strengthening Exercises
Target the following muscle groups with individual resistance exercises:
- Gluteus maximus - This muscle plays the most important role in correcting pelvic position and shows the strongest correlation with changes in pelvic tilt 2
- Hip extensors and abductors - Address the biomechanical disadvantage created by anterior tilt 1
- Abdominal muscles - Strengthen to counteract the anterior rotation 1
Individual strengthening exercises for anterior pelvic tilt muscles (erector spinae, iliopsoas, rectus femoris) have demonstrated recovery of pelvic tilt angles to normal ranges, increased lumbar ROM, and decreased low back pain 3.
Orthotic Intervention
Custom-molded foot orthoses should be prescribed when distal malalignment is present:
- Improves distal alignment at feet and ankles 1
- Secondarily decreases genu valgum 1
- Leads to improved weight-bearing alignment for long-term musculoskeletal protection 1
- For more severe malalignment, instability, or distal weakness in adults, taller orthotic intervention with ankle-foot orthoses may be necessary 1
Exercise Considerations
Aerobic conditioning is recommended with specific precautions:
- Regular aerobic exercise training may be beneficial, though firm evidence is limited 1
- Approach maximal effort exercise with caution to avoid potential muscle injury 1
- Resistance exercise and strength training should be implemented cautiously pending appropriate studies 1
Functional Adaptations
Direct and functional assessment of strength and endurance should guide individualized exercise programs 1. Standardized gross and fine motor testing helps identify specific areas of impairment and optimize participation 1.
Important Caveats
Current evidence limitations:
- The overall quality of evidence for non-surgical treatment of excessive anterior pelvic tilt is very low 4
- Different individuals use varying muscle activation patterns to correct pelvic posture, with the gluteus maximus consistently involved across all patterns 2
- This suggests therapy should account for individually preferred motor strategies rather than a one-size-fits-all approach 2
Common pitfall: Anterior pelvic tilt may be related to postures assumed to accommodate increased abdominal girth (such as from hepatomegaly in certain conditions), which can alter postural development when present from a young age 1. Address any underlying causes contributing to the postural adaptation.