Best Supine Positions for Anterior Pelvic Tilt (APT)
Supine lying on your back is my favorite position for getting out of APT because you can immediately tell if you’re in a neutral pelvic position. All you have to do is to flatten your whole back to the ground to know if you’re neutral.
Technically, this is going into a posterior pelvic tilt, but since flattening the back can heavily recruit the obliques, I think it’s better than simply bringing your low back to a stick on the floor. However, for some individuals using a stick under the low back is still fine.
For this article, we’re not going to go over the best exercises because exercises alone won’t do anything. It’s your position that matters, so we’re going to go over the best supine positions to help you get out of APT.
The progression for supine exercises is pretty straightforward. The only guideline is:
Your low back must start out flat and stay flat throughout the whole movement.
Getting into these positions will be very easy for some of you. However, keeping the back flat in the different supine positions while you are doing exercises like presses and rows will be much more challenging or even impossible at first.
If it is too difficult to keep your back flat for the majority of your reps, you should use an easier variation.
Here are the variations progressing from easiest to most difficult:
We’ll begin in the 90-90 position which looks like this:
In this position, most people’s low back will already be flattened, but some will not. Regardless, you should feel that you can still flatten the low back using your obliques. Press into your sides to make sure they are activated. Some people will only use their rectus abdominis to flatten the back, but you should be using your obliques because these will be weaker than the rectus abdominis.
While the 90-90 position is the easiest position to flatten your back, many individuals will have a hard time doing presses or rows without their low back coming off the ground. If this is the case, you don’t need an easier variation, you just need to reduce the intensity of the exercise, the range of motion, or both, and focus on keeping your low back flattened throughout the exercise.
The next progression is flexing the hips to a 45 degree position like this:
Most people will probably be able to flatten their backs in this position. If necessary you can bring the legs down further to 30 degrees or 15 degrees.
The next progression is having the legs straight.
If you find it challenging to simply flatten your back in any of the positions above, you can use this as a a dedicated strength training exercise.
Feel free to mix things up. For example, if you find it’s difficult to flatten your back with the straight leg position, you may want to do all your pressing and rowing in the 45-degree position, but include some dedicated sets flattening the back with the legs straight.
Some women and men carry most of their body fat in the lower body including the gluts. These individuals may need to use a stick or small pad about half an inch to an inch thick under their low backs for the 45 degrees and legs straight position.
Using any one of the three positions above, you can do a variety of exercises including:
· Dead Bugs (which we’ll go through in the next article)
· DB or BB Floor Presses
· DB Fly’s (probably off bench)
· Band Rows
· Band Reverse Fly’s
· DB Pull Over’s
· Band Extensions
I’m not a huge fan of the standing, kneeling, or even straight leg prone positions when someone is in APT. Quadruped is possible, but usually only with limited range of motion. These positions encourage and reinforce the APT position unless one can start and stay neutral with a stick on their back.
Do your pressing, rowing, or extension exercises in whatever of the three supine positions allows you to keep your back flat. Once you can consistently keep your back straight during the straight leg supine position, you are ready to try prone, kneeling, or standing.
Moving with APT
After about ten years of training, I realized I had to tackle my own anterior pelvic tilt (APT). It was not pretty:
I thought it would be an easy fix since I thought I knew what to do.
At first, I thought postural changes like focusing on sitting and standing would help me get out of APT. Nope.
That’s fine, I added in extra strength training for my obliques, glutes, and hamstrings. This would definitely get me out of anterior pelvic tilt, right? Nope.
Okay, I’m going to throw in some stretching for my hip flexors and my low back. This would be the clincher, right? Nope.
Then, I thought if I make sure I start every exercise neutral, this would help me get out of anterior pelvic tilt. Once again, nope.
After this, I really questioned whether I had anterior pelvic tilt because nothing seemed to be changing.
I had my wife check my anterior pelvic tilt using the SEA test, and both sides were clearly in anterior pelvic tilt. I felt stuck. I thought I was doing everything I could. I began to take a closer look at how I was doing my strength training exercises.
One of my favorite lifts is the deadlift. I did a video analysis of my form and realized that while I started out in a neutral pelvic position, I quickly reverted to anterior pelvic tilt at the top of the lift. I also saw this in other lifts when I looked at the video like squats, ab wheel rollouts, and even bench pressing.
I knew I had to go back to the basics. This meant reducing the intensity and range of motion for all of my exercises.
What I found was the difference-maker for getting me out of excessive anterior pelvic tilt.
However, this meant me being a complete newbie again. I really had to humble myself in my old exercises by focusing on two things.
1.Reduce the intensity
I could no longer have hundreds of pounds on my deadlift. I literally had to go back to a bodyweight deadlift. I couldn’t even have a bar. Instead, I had a stick on my back to make sure my pelvis was neutral.
My preferred way to make sure I stay neutral is using a stick on my back with my thumb placed behind the biggest gap. I then touch my low back to my thumb (and my thumb is about one inch in thickness). I keep the low back in contact with my thumb throughout the whole range of motion.
This brings me to the second tip if you cannot keep neutral throughout the whole range of motion.
2.Reduce the range of motion
If you find that you cannot be neutral throughout the whole range of motion, simply reduce it. However, you should only use a range of motion you can stay neutral in. Don’t go beyond that. Over time, the more you practice simply staying neutral, the more you will find that your range of motion will increase.
Staying neutral reminds me of product recalls where the car manufacturer makes a bolt which should have been a sixteenth of an incher larger to prevent the screw from falling out. It might work for awhile, but there will be problems at some point, and likely a massive recall.
The same is true for not being neutral with your lifts. If you keep lifting in anterior pelvic tilt, there will likely be a breakdown. Don’t let this happen and stay neutral.
Neutral Pelvic Position to Fix APT
Stretching and strength training exercises alone will not fix your anterior pelvic tilt. In training clients who did correct their anterior pelvic tilt, I’ve noticed the real key is the position in which you do your exercises.
By position, I’m not talking about whether you are lying on your back, standing, or kneeling. I’m talking about being in a position of a neutral pelvic position.
So what is neutral pelvic position? It means you have the ability to either place a stick on your back and touch your low back to your thumb (like in this video below):
If you’re lying on your back, it means you can touch the stick with your low back. It’s also fine if you flatten your whole low back to the floor although not everyone needs to do this.
Why does your pelvic position matter so much? If you start a stretch or a strength training exercise in anterior pelvic tilt, you are reinforcing that anterior pelvic tilt.
One of the biggest issues I see in many new clients is they don’t think about their pelvic position before exercising. For example, they will set up to do deadlifts in anterior pelvic tilt, perform the deadlifts, and think they are getting out of anterior pelvic tilt. This is wrong. This merely reinforces the anterior pelvic tilt position. Don’t forget: if you have anterior pelvic tilt, your default position is anterior pelvic tilt. You need to think about your pelvic position before every exercise you do.
Beginning an exercise already in anterior pelvic tilt places the low back muscles and hip flexors in perfect position to assist, the opposite of what we want. Remember, getting the hip flexors and low back stronger will only reinforce anterior pelvic tilt.
The bottom line is if you start out in anterior pelvic tilt, you will stay in anterior pelvic tilt. However, starting out in a neutral pelvic position doesn’t guarantee you will stay neutral.
Anterior pelvic tilt is both an alignment problem and a movement problem. This means that even when you fix your alignment problem or if you start out neutral, you’re still very likely to move into anterior pelvic tilt as you perform your exercise. Notice how in the two pictures below, the individual starts out in neutral posture, but quickly moves into anterior pelvic tilt with their movement.
In the next video, we’ll talk about the best ways to handle movement problems associated with anterior pelvic tilt. However, if you don’t start neutral, you’re already dead in the water! It doesn’t do any good to try to fix a movement problem if you don’t start out correctly.
This is why you need to make sure your initial position is neutral. To do this, test it. Remember our standing test in the last video? One of the main goals of the last video was to see if you could touch your thumb behind your low back with a stick. If you already tested yourself in standing, then you need to test the other positions listed below.
Supine (lying on your back): Can you touch your low back to the floor or your low back to a stick or fingers under your low back?
For the rest of the positions, can you touch your low back to your thumb with a stick on your back?
Half Kneeling (Check both sides)
Standing Split Stance (Check both sides)
Here is your new guideline: Only use the positions in which you can start from a neutral position. For example, if you can get neutral in supine, prone, quadruped, standing, but not half kneeling and tall kneeling, then you should not do exercises in half kneeling and tall kneeling (at least for now). You can do exercises in the other positions however.
Only using positions in which you can start from a neutral position will enable you to train effectively in those positions and allow you to eventually progress to the other positions. In our next series, we’ll go over how to stay neutral when actually performing your exercises. For now, stay neutral!
The Perfect Standing Exercise (How to Stand)
So far in our series about reducing anterior pelvic tilt, you’ve learned:
· What is anterior pelvic tilt
· How to test for it
· How to sit properly
Can you stand properly to get out of anterior pelvic tilt? Absolutely. However, there is no one perfect way of standing for everyone. This is why you need to individualize the way you stand. We’re going to find the perfect standing exercise for you to get out of anterior pelvic tilt. Here’s how:
Section 1: Flatten the back
We are going to do a posterior pelvic tilt which is basically flattening your low back.
We need to see how much you can do a posterior pelvic tilt. To do this, you’ll need a broom handle, dowel stick, long ruler, or whatever straight thing you can get to put on your back.
If you can touch, awesome! You can proceed onto section 2 below.
If your thumb can’t quite touch or your thumb is really far away from touching your low back, you need to work on getting your thumb closer to your low back. Whenever you stand, practice flattening your low back as much as possible.
Now that we’ve assessed quantity, we need to look at quality. Quality in our assessment is measured by which muscles you use to accomplish your posterior pelvic tilt. Let’s test this below.
Section 2: Activation Test
While standing up, I want you to press into your obliques and glutes. Now, flatten your back like just like we did with the stick.
Did you feel a significant contraction, protrusion, or hardness in both of the muscles? If you did, that’s great! If not, you need to focus on the one(s) which didn’t activate as much. For example, let’s assume you didn’t feel it in the obliques, but your glutes activated a lot. This means that whenever you stand, you should try to perform a posterior pelvic tilt with mostly your obliques.
If you didn’t feel much activation in your obliques and your glutes, you should try to activate both them while standing.
Some of my clients get discouraged because when they exclusively try to use the deactivated muscle, their range of motion is small. Don’t worry about your range of motion when practicing with your weaker muscle. As you practice, your range of motion will get better. You will also notice that your weaker muscle will get stronger and more activated too.
Congratulations! You’ve now found the perfect standing exercise to get out of anterior pelvic tilt. Remember, focus on quality first by using your weaker muscle. Don’t worry about your range of motion. However, once your weaker muscles get stronger, go for full range of motion. How do you know if what you are doing is working? If your thumb gets closer and closer to your low back, you are making progress. Eventually, you will find your thumb can touch behind your low back and your glutes and obliques are activating sufficiently.
You Don't Know Jack Sit (How to Sit)
Which one of these guys is more likely to get out of anterior pelvic tilt?
Guy 1: Greg
Greg is a rock star in the gym. He prides himself on his perfect technique for every exercise. Greg also does exercises to offset his all-day computer job including deadlifts, planks, and push ups. In other words, he’s awesome.
However, outside the gym, Greg sits with a hunchback posture, doesn’t use a backrest, and has forward head posture when looking at his computer. He sits like this roughly twelve hours out of the day when he’s at work and at home.
Guy 2: Adam
Adam is new to the gym and thinks he’s getting the hang of things. But, his form still sucks. He rounds his back while deadlifting, flares his arms during bench pressing, and is lumbar extension while doing planks. However, Adam has decent posture while sitting. He does his best to sit upright, takes breaks about every thirty minutes off of his seat, stretches his arms while at work, and has his computer set up about chest level.
Both Greg and Adam have been working at their jobs for 10 years. Who is more likely to get out of anterior pelvic tilt?
Adam is the winner. In fact, Adam doesn’t even have anterior pelvic tilt, forward head posture, or rounded shoulders, because of how he has been sitting. While Adam’s exercise technique is lacking, he is actually training with great form outside of the gym an average of 12 hours a day at sitting.
If you train at ANYTHING 12 hours a day, it’s going to show. If you sit terribly for years on end, anterior pelvic tilt is likely already present. If you dominate your sitting, you can get out of anterior pelvic tilt and stay out.
This is my point: Why would you have perfect technique for lifts, which require no more than twenty to thirty minutes of actual lifting in the gym, but you sit horribly outside of the gym for 12+ hours? You need to train where it counts inside and outside the gym.
Just because you grew up sitting in school does not make you an expert at sitting. Just look at how most people sit. I’m here to tell you that how you sit will affect your anterior pelvic tilt more than anything else.
Why does sitting cause anterior pelvic tilt and how can you fix it? Here are 4 tips:
1. By it’s very nature sitting increases hip flexor and erector spinae muscle activation which cause APT. These muscles are activated because they help us be upright while sitting.
SOLUTION: This means when you don’t have to sit, DON’T! When I attend physical therapy and even some fitness seminars, we end up sitting way too much. This is why I sit and stand in the back.
2. Not using a backrest increases the activation of the hip flexors and erector spinae even more than sitting with a backrest.
Solution: You need to use a backrest. If you don’t have one, get one or get a different chair. There is nothing that kills a back like sitting without a back rest for hours, days, weeks, or even years on end.
3. Many individuals exhibit thoracic kyphosis while sitting. The erector spinae muscles attach from the pelvis to the up through the thoracic and even cervical vertebrae. When the back rounds during thoracic kyphosis, this puts the erector spinae on stretch which can cause excessive passive tension pulling up on the posterior pelvis and contributing to greater APT.
Solution: The solution to this is to sit upright! This puts the back muscles on slack and will prevent them from pulling up the back of the pelvis. But, don’t sit with military posture which is sitting as tall as possible. You need to be tall, but about 1-2 inches lower than your maximum sitting height. The best strategy I know of for correcting this is to use a McKenzie Roll (or the like) behind your low back.
4. Many people sit without their feet being able to touch the ground. The problem with this is it causes the hip flexors to work extra hard trying to keep the body upright. This problem can happen when individuals are shorter, chairs or stools are too tall, or when sofas are too deep.
Solution: If you need to, use a foot rest, cushions, or pillows to rest your feet on. This will significantly turn off your hip flexors. If you have a deep couch, put two cushions behind your low back, so your feet can reach the floor. If you sit on a tall barstool, make sure you feet can rest on the stool’s mid stands. If you’re stool doesn’t have that, avoid sitting on it or for too long.
5. Muscles possess a property called creep in which if they are in a set position for a long period of time, they will lose their elasticity.
Solution: You need to at least stand up every 30 minutes… even if it is for 10 seconds. Set a timer on your phone, get up after every episode you watch on Netflix, or use some external cue.
There are other principals which are critical for proper sitting, but these are the most important for correcting excessive anterior pelvic tilt. I’m confident that if you sit properly, it will not only help you stay out of anterior pelvic tilt, you will be taller, be more confident, and feel better too.
The Gold Standard for Checking for Anterior Pelvic Tilt
If I had to choose one test for checking anterior pelvic tilt, it would be the Sidelying Extension Adduction (SEA) test. I use it for all incoming clients because anterior pelvic tilt is a global alignment problem, and this test can detect it in under two minutes. This test is also more reliable and precise than the Thomas Test. It is the gold standard in my book.
(A variation of this test is offered by the Postural Restoration Institute. It’s a great test. I however position my clients at 45 degrees and I check for the first sign of passive tension.)
Here’s how to do the test:
This test is ideal for checking for anterior pelvic tilt because it succeeds where other tests fail. The SEA test is a stiffness test, not a length test. One of the problems with the traditional Thomas Test is that the Thomas Test measures only the length of the hip flexors. What the Thomas Test doesn’t do is measure the stiffness between the muscles which produce anterior pelvic tilt (hip flexors and erector spinae) and the muscles which produce posterior pelvic tilt (abdominals, hamstrings, and glutes).
Why is this important? Anterior pelvic tilt is not caused by short hip flexors or erector spinae muscles. It is caused by greater stiffness of the hip flexors and erector spinae muscles over the hamstrings, abdominals, and glutes. What’s the difference between stiffness and shortness?
Think of a slingshot. For those with excessive anterior pelvic tilt, the hip flexors and erector spinae muscles are like a thick rubber band which actually can stretch very far. If you launch a rock with this band, it’s going to go a long way.
This is why it doesn’t matter if the hip flexors or erector spinae are very flexible, the SEA test will detect the stiffness by checking for tension, not length. I encourage you to test this out for yourself with your most hypermobile client. What you’ll find often is that you can bring their leg back very far. However, if you pay attention to where you actually begin to feel any hint of tension, you’ll often find these individuals have excessive anterior pelvic tilt because their leg does not make it back to neutral alignment.
If you perform a Thomas Test and find the hip flexors are short, they are guaranteed to have a positive SEA test (meaning they do have anterior pelvic tilt). Why is this? Whenever the hip flexors are short, their stiffness is so great that even with the weight of the leg and gravity assisting, it is not enough to bring the hip into a neutral position of zero degrees of hip extension. This is easily seen if you do the SEA test with someone who has short hip flexors from the Thomas Test.
Why can’t you simply do a Thomas Test to determine if a person has anterior pelvic tilt? The problem is that you can get a false negative result (meaning the person could appear to have normal length of their hip flexors, but in reality, they still have greater stiffness of the hip flexors over the muscles which produce posterior pelvic tilt (PPT).
The reason why you can get a false negative is because gravity and leg weight can cause the leg to appear to be of adequate length, but in reality, it’s not. The power of the SEA test is that it takes gravity and leg weight out of the equation and strictly measures the tension between the hip flexors and erector spinae and the abdominals, hamstrings, and glutes.
Another reason why the SEA test rocks is that it checks for compensatory movement with the low back. Even if you can get the hip to neutral during the SEA test, if you see extension in the low back, anterior pelvic tilt is present. The passive tension of the hip flexors is greater than the abdominals, glutes, and hamstrings.
What happens if you find a positive result for the SEA test? You need to do a length test for the hip flexors and erector spinae. You should measure the hip flexors with the Thomas Test. You can measure the erector spinae using the prone rock test (as found in the SFMA).
If either the hip flexors or erector spinae are short, you should lengthen them. How you lengthen them is of importance which we’ll cover later. However, even if you don’t find the hip flexors or erector spinae are short, there is still greater stiffness in the hip flexors and erector spinae. This definitely calls for strength training the abdominals, glutes, and hamstrings.
If for whatever reason you’re in solitary confinement reading this article and no prison guard is going to perform the SEA test on you, you can do it by yourself. The key is simply allowing your leg to go back in the same way as the regular SEA test. You must however, relax your whole body and even your leg when it is lifting up (as much as possible). Bring your leg back very slowly and at the slightest hint of tension, that is your stopping point. Once you find this point, you should look down and if you can see your leg. If you can see it, you probably have anterior pelvic tilt.
If you can’t see your leg, you probably don’t have anterior pelvic tilt. However, if you felt your back extend at all, then anterior pelvic tilt is present. Again, DO NOT tense up your abdominals or your hips, just let your leg go back very lightly, and see how far it goes.
While the sidelying extension adduction test does a great job measuring stiffness between the muscles which produce APT and PPT, there are some things which the SEA test doesn’t measure. This includes potential anterior pelvic tilt that could present in your alignment, movement, and motor control. We’ll go through these tests and treatments later.
What is Anterior Pelvic Tilt?
How do I know if I have anterior pelvic tilt?
Check out this video:
However, even if all of your tests showed you didn't have anterior pelvic tilt (APT) in standing, you could very well have excessive APT when sitting, walking, squatting, planking, or really doing anything. It's during these movements that even a slight tendency towards APT can directly contribute to back pain or other issues.
What causes APT?
APT happens for many reasons. For example:
What muscle groups are involved in APT?
There is a two-way relationship between APT and certain muscle groups. On the one hand, if you have APT, your body uses some muscles to stabilize you (making them tighter or stronger) and not others (which become looser). On the other hand, as these muscles become tighter and looser respectively, it will reinforce your APT. It’s a self-perpetuating cycle.
Muscles that are “tight” with APT include:
Muscles that are “loose” or weakened with APT include:
These tightened and loosened muscles are the key to fixing APT. Simply by activating the right muscles, you can get out of excessive APT. For some, it will take months. For others, it might be a year or longer. However, it will happen with consistent work.
How do I fix my APT?
The secret to fixing APT is to “activate” or engage the loose muscles listed above. You do this by consciously changing your posture to bring the front of your pelvis up. Basically, you want to stand as if you are tucking your booty in. Here I am standing with APT (on the left) and practicing the corrective posture with my pelvis forward (on the right):
Standing this way can be awkward at first. You will feel like you must have your pelvis way too forward—like everyone will wonder what you’re doing. But you’ll actually look very normal. It only feels like you’re thrusting forward because you’re not used to it.
You don’t have to do this all day, every day. All you have to do is make a conscious effort to do this posture when you find yourself standing. The more you practice it, the easier and more natural it will get.
There are also exercises you can do to fix APT faster and get relief from pain. I’ll describe my full APT-busting routine in future blog posts.
Do any of the above signs of APT ring true for you? When you get a side view of yourself, does it ever look like you’re sticking your butt out? What are the APT symptoms you struggle with most? Leave a comment below and tell us what your APT is like.