Does Anterior Pelvic Tilt Cause Low Back Pain?
Question: What is anterior pelvic tilt?
Answer: It means the front end of the pelvis tips forward and the back end hikes up.
Question: Will that make my gut look bigger?
Answer: Yes.
Question: Is that why my low back hurts?
Answer: Let's check the internet...
What Google Says
An internet search for anterior pelvic tilt and low back pain returns 54,000 articles, almost all of which claim that anterior pelvic tilt causes low back pain.
The articles usually argue one of more of the following points - that anterior tilt is a postural distortion; which is caused by caused by excessive sitting; which tightens the hip flexors; which pull the front of the pelvis down; which creates an excessive lumbar lordosis; which causes strain and pain.
The cure for pain is usually presented as involving one or more of the following elements: stretching the hip flexors, strengthening the glutes and abs, or making a conscious effort to suck in the gut or otherwise modify the pelvic angle in standing.
There are many different variations on this prescription of course, but you can find some version of it almost anywhere you look in the world of manual therapy and corrective exercise. But is there any evidence to support it? And does it really matter so long as it makes our guts look smaller?
The sad thing is that there is a a lot of evidence bearing on the pelvic tilt theory of low back pain, and it is easy to find. And as you may have guessed by the tone of the post so far, the evidence provides little support for the theory.
What Pubmed Says
If it is indeed true that excessive anterior pelvic tilt is a risk factor for back pain, then you would expect that studies would find a clear association between anterior pelvic tilt and/or lumbar lordosis and back pain. However, as described below, this is simply not what we see. It appears that most of the studies looking at these issues have found little or no correlation between these factors. Here is a brief sampling of some of the results.
Studies looking for correlations between low back pain and pelvic tilt or related spinal curves have found:
- no difference in lumbar curvature between people with and without low back pain;
- no difference in lumbar lordosis between people of different ages or in people with and without pain;
- no difference in thoracic kyphosis, lumbar lordosis and sacral inclination between people with acute low back pain and chronic low back pain;
- low back pain is not associated with the degree of lumbar lordosis or pelvic tilt;[4. http://www.ncbi.nlm.nih.gov/pubmed/12322811]
- 2008 systematic review of 56 studies finds no strong evidence of an association between measurements of spinal curves and pain.
To be fair, I found a couple studies that found some correlations between spinal curve measurements and pain. But the weight of the evidence appears to be that if any correlation exists, it is weak. And, even if a weak correlation exists between pelvic tilt and back pain, this does not prove that the pelvic tilt is causing the pain. It is just as plausible that pain causes the tilt, and in fact there are studies to show that pain causes postural changes that are presumably protective in nature. And, even if anterior pelvic tilt does predispose you to back pain, it is yet another leap to conclude that it can be corrected. And yet another to prove that correction will reduce back pain.
So what can we conclude from this?
First, that trying to correct anterior pelvic tilt may be an unproductive way to treat back pain. Second, we shouldn't take back pain advice (including mine!) without looking for references. And third, if you want to sell a fitness/wellness concept, make sure it makes people’s guts look smaller.
If you want this see this myth die, spread the word.
And if you want to read more on related topics, check out one of the related articles below: