Lower Back Pain and Anterior Pelvic Tilt

A possible reason for your lower back pain. This article explains what anterior pelvic tilt is, its signs and symptoms, risk factors, and how you can fix it! Nurses Stress 101 Article


Lower Back Pain and Anterior Pelvic Tilt

Lower back pain is such a … well, a pain! A study done in 2014 found that 84.2% of nurses deal with lower back pain. 66.7% of those nurses said that this pain was of “moderate severity”. Back pain can be caused by many things. Here we are going to talk about one in particular,  anterior pelvic tilt (APT).

What is APT?

Your pelvis plays a key role in your body. It helps you to move around, lift things off the ground, and it allows you to have good posture. APT occurs when your pelvis begins to rotate forward, curving your spine, and increasing lordosis. This usually affects the lowest two levels of the back, L4-5 and L5-S1. If this curvature is not fixed long-term problems can arise. This can include:

  • Compressed degenerative discs
  • Disc tears (annular tears)
  • Disc bulges
  • Disc herniations

The muscles involved with APT fall into two groups, the primary postural muscles, and the phasic muscles.

The primary postural muscles involved in APT are the iliopsoas, erector spinae, rectus femoris, and quadratus lumborum. When these muscles are fatigued, they tend to tighten. The phasic muscles involved in APT are the gluteus maximus, gluteus medius, and rectus abdominis. When these muscles are tired, they become weakened and loose. This is exaggerated by the law of reciprocal inhibition. The law of reciprocal inhibition tells us that when one muscle gets a signal to contract, the opposite muscle's ability to contract is inhibited.

So the tight primary postural muscles rotate the pelvis anteriorly, and the phasic muscles may not only be tired and weak but are being neurologically inhibited by your own body. This combination creates APT.

What are its Signs and Symptoms?

There are a few things you can look at to help you decide if you have APT. If you have:

  • Lower back pain
  • Exaggerated lumbar curve
  • Bulging abdomen despite having low body fat
  • The waistline of your pants diagonal to the floor
  • Failed the Thomas test

The Thomas test is simple to do and can help you determine how well your pelvis is aligned. All you need to do is:

  1. Find a safe and sturdy table.
  2. Lie back on it in a way that allows your legs to hang off the edge at your knees.
  3. Pull your right leg in towards your chest.
  4. Grab your leg under your knee and hold it against your chest (or as close as you can), for a few seconds.
  5. Repeat steps 3 and 4 with your left leg.

You know your hips are aligned if the back of your resting leg is touching the table, while the other leg is against your chest. If you have to extend your resting leg or rotate your leg or pelvis, there is a good chance you have APT.

What are the Risk Factors?

APT can be caused by the following:

  • Genetics
  • Back injury
  • Too little physical activity
  • Poor posture
  • Sitting for long periods of time

When we sit, our hip flexors are in a shortened position. Our glutes aren’t doing much, and your spinal extensors are continuously firing to keep you sitting up. When people stay this way for the majority of the day, it isn’t hard to see how they might develop APT.

How Can I Fix it?

Much of the time APT can be fixed through exercise. You want to find exercises that strengthen those phasic muscles. This includes planking, glute bridges, and squats. You can find entire videos on Youtube that are dedicated to strengthening these muscles and fixing APT.

You can also help fix it through stretching. You want to focus on stretching, you guessed it, the primary postural muscles. This includes the half-kneeling hip flexor stretch, the kneeling quad stretch, and the runner’s lunge. Again, you can find entire Youtube videos demonstrating stretches to help fix APT.

Lastly, you can change your lifestyle. In addition to adding some exercise and stretching your life, you can set reminders for yourself to get up and move around more if you work at a desk all day. Make the effort to be aware of your posture and fix it when you notice you are tilting.


Pletcher, P. (2018, September 17). 5 exercise of anterior pelvic tilt. Healthline. 

Derring, S. (2021, June 24). How to fix anterior pelvic tilt. Spineuniverse. 

Garnas, E. (n.d.). What is anterior pelvic tilt (and how to fix it). The Personal Trainer Development Center.

Leonard, J. (2017, May 11). Six fixes for anterior pelvic tilt. MedicalNewsToday. 

Lowe, W. (2009). Orthopedic massage (second edition). Elsevier. 


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2BS Nurse, BSN

700 Posts

A very helpful article! Thank you!!

Specializes in Emergency.

Very helpful and a reminder to watch your back and take care of your back. I would love to see a PT or such post here about recommended exercises for people on their feet all day, pushing, pulling, etc.

Specializes in Med nurse in med-surg., float, HH, and PDN.

Wish I read this article when I was in my 20's. Back then, the models you'd see in VOGUE magazine all stood or walked, leading with flat bellies kind of slung forward. We considered it sexy (as long as the belly was flat!) to stand that way. It reeked of "attitude"!

And yep, all the things that I went through ... it is all there in this article!

Well written, very clear explanations. Thanks!

klone, MSN, RN

14,785 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Ooh, great article!! I had a laminectomy/discectomy of L5/S1 about 10 years ago and have been back pain-free until the last 9 months, and I suspected that my lower back arch is hyper-arched, causing the pain (as it is relieved when I crouch on the ground and hug my knees, and can feel those muscles stretching). This article explains exactly what I believe is going on.

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