Looking at pelvic tilts -The hips only tell you part of the story (an anterior pelvic tilt doesn’t mean your hips are flexed)

Posted on July 21, 2013

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I’m going to cover some oversights when assessing pelvic alignments.

The most common condition people seem concerned with is an anterior pelvic tilt.

anterior pelvic tilt alignment

Because the hips are rotated anteriorly and the hamstrings pull the pelvis posteriorly, it’s common to assume the hamstrings are “weak / lengthened” in an anterior pelvic tilt. However, the hamstrings play a role in what happens at the hips and the knees.

Hamstrings with cadaver

Hamstring muscles.

If we only look at the hips we’re missing half the picture.

Neal Left Side (Less Quality)

Neal Left Side Plumb Line

A person who appears to have some anterior pelvic tilt:

Neal Side Pelvis Close Up

May also appear to have some knee flexion going on:

Neal Side Knee Lines Close Up

The hamstrings may appear lengthened at the hip attachment, but they are, if anything, shortened at the knee connection. Think of a rubber band, if you pull the rubber band out from one end but bring it in from the other, what happens to it? Nothing. It doesn’t get stretched.

Because muscles aren’t exactly like rubber bands, from the above photos we could deduce: The hamstrings are perhaps underactive in hip extension but overactive in knee flexion. Helping to understand why, “Strengthen the hamstrings” isn’t a solution for an anterior pelvic tilt. Or, contrary to the internet world, why “Just deadlift” does not solve everything. This is the type of person who should probably stop deadlifting for a while. (It promotes lumbar extension / anterior pelvic tilting and knee flexion.)

We need to look at the knees in a posteriorly tilted hip as well. Even though the hamstrings are tightened at the hip attachment, they may be lengthened at the knee attachment. The knees may be in hyperextension:

Posterior Pelvic Tilt hips extended

Posterior Pelvic Tilt hips extended with lines

So again, our rubber band is being pulled from one direction but getting slacked from the other.

What the hell is going on here?

It’s all relative

When faced with these types of situations we’re forced to asked things such as the following:

  • Is the amount of anterior pelvic tilt greater than the amount of knee flexion?

For instance (numbers are for example purposes), if the pelvis rotates anteriorly 5 inches (lengthening the hamstrings 5 inches), but, the knees flex 8 inches (tightening the hamstrings 8 inches), then overall, the hamstrings have been tightened 3 inches (8 – 5 = 3).

  • Is the amount of posterior pelvic tilt greater than the amount of knee extension?

For instance, if there’s a posterior pelvic tilt of 5 inches, then the hamstrings are tightened 5 inches. If there’s a simultaneous 2 inches of knee extension, lengthening the hamstrings 2 inches, then they have been, overall, tightened 3 inches (5 – 2 = 3).

Another example. Apparent anterior pelvic tilt with significant hip extension going on:

Neeraj Side (Less Quality)

Neeraj Side (Less Quality) Plumb Line

Neeraj Close up Pelvis

Even though the presence of an anterior pelvic tilt causes one to assume the hips are automatically in flexion, you can see quite a bit of hip extension going on:

Neeraj Side (Less Quality) Hip extension lines

And what extends the hips? The hamstrings. If the hips are in extension the hamstrings may actually be shortened, as well as the glutes, even with an anterior pelvic tilt going on. An APT is not a clear indication the hips are flexed.

The above is a perfect example of someone who reads the internet, deduces they have an anterior pelvic tilt, then goes off and stretches the hell out of their hip flexors, not realizing their hips are already in extension plenty. Where actually, the last thing they need is more hip extension.

hip flexor stretch standing

hip flexor stretch with arrow and line

Neeraj Close up Pelvis Lower Back and Hip lines FLIPPED

Their psoas is not shortened.


Psoas anterior pelvic tilt

The psoas pulls the lower back and femur closer together. While the lower back has been pulled down,

Neeraj Close up Pelvis Lower Back FLIPPED

The femur has been pulled back. The rubber band has not been brought closer together. If anything, it has been pulled apart (stretched).

Neeraj Close up Pelvis Lower Back and Hip lines FLIPPED

All that hip flexor stretching may not only be not helping, it very well could be making things worse. 

The hamstrings are rarely “weak” in hip extension

Hopefully, now you can see often when the hamstrings appear lengthened they may actually be shortened. Bringing me to my final point: Strengthening the hell out of the hamstrings rarely does anything to help correct issues like the above, especially strengthening them into extension. If anything, the hamstrings are normally too active in hip extension, with the glutes not being active enough. Often it’s actually knee flexion the hamstrings could use more work in.

Get someone to perform knee flexion without their lower back moving and they’ll often struggle like this:

They’ll really want to move that lower back:

For those where their knees are held in extension so much (pictures above) they have a rough time trying to flex them.

And it’s not always a strength issue with the glutes. You can see in the above photos some good gluteal definition. By definition, the size of a muscle is correlated to the strength of it. The above people are not necessarily those with atrophied or weak glutes. No, their problem, and many a people’s problem, is not the strength of the hip extensors, but the timing between them. Primarily where the glutes are not initiating hip extension. They’re firing too late. All those RDLs, deadlifts, and heavy squatting, they aren’t getting the job done.

As far as I know the best way to assess what’s going on in hip extension is not pelvic alignment, but to pay attention to the person’s symptoms and, finally, make them move. Pelvic alignment may help, but it’s not your only indicator.

To learn more about correcting an anterior pelvic tilt, I have a program called “8 Weeks Towards Correcting Your Anterior Pelvic Tilt.”

See more about that hereor Buy Now

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