How to Evaluate a Posterior Pelvic Tilt: A Practical Guide for Therapists and Movement Professionals

A posterior pelvic tilt (PPT) is a common postural pattern where the pelvis rotates backward, flattening the lower back and often leading to muscle imbalances, restricted mobility, and discomfort. While it’s less discussed than anterior pelvic tilt, PPT can be just as disruptive—especially in individuals who sit for long periods, overtrain the abdominals, or have poor hip mobility.

In this article, we’ll cover what a posterior pelvic tilt is, how to recognize it, and the step-by-step process to evaluate it in a clinical or movement-based setting.

🧠 What Is a Posterior Pelvic Tilt?

In a posterior pelvic tilt, the front of the pelvis lifts upward while the back drops down, causing the lumbar spine to flatten or reverse its natural curve (hypolordosis). This posture is typically associated with:

• Tight/overactive: hamstrings, glutes, and rectus abdominis
  
• Weak/inhibited: hip flexors (iliopsoas), lumbar extensors, deep spinal stabilizers
  
  

This can lead to:

• Low back discomfort or stiffness
  
• Decreased spinal shock absorption
  
• Reduced hip mobility
  
• Compensatory upper body tension
  
  

🔍 How to Evaluate a Posterior Pelvic Tilt

Proper evaluation includes visual analysis, palpation of bony landmarks, movement assessment, and muscle tone testing. Below is a systematic approach to identifying PPT.

✅ 1. Visual Postural Assessment (Side View)

Have the client stand naturally and observe from the side.

Look for:

• Flat or rounded lower back (decreased lumbar curve)
  
• Glutes tucked under or lacking natural contour
  
• Pelvis “pulled under” the torso
  
• Forward head and slouched upper posture may also accompany PPT
  
  

💡 Compare the height of the ASIS (anterior superior iliac spine) and PSIS (posterior superior iliac spine). In PPT, the ASIS is higher than the PSIS.

✅ 2. Palpation of Bony Landmarks

• Palpate the ASIS and PSIS to assess pelvic angle
  
• A significantly higher ASIS in relation to the PSIS indicates posterior tilt
  
• Also palpate the glutes, hamstrings, and lumbar erectors to check for tone and tension
  
  

✅ 3. Supine Pelvic Tilt Awareness Test

Have the client lie on their back with knees bent (hooklying position). Ask them to:

• Arch the lower back (anterior tilt)
  
• Flatten the back (posterior tilt)
  
  

If they are already in a flattened or overly flexed lumbar position, this suggests a posterior pelvic tilt. Many clients with PPT will struggle to find or control an anterior tilt due to inhibition of the lumbar extensors and hip flexors.

✅ 4. Thomas Test (Hip Flexor Length)

Same setup as for anterior tilt assessment. A posterior pelvic tilt may be compensating for tight hamstrings, so here you’re checking whether the hip flexors are long and underactive.

In PPT cases:

• The hanging leg might fall too far or hyperextend (suggesting weak iliopsoas)
  
• Knee may stay bent (but test results can vary based on compensations)
  
  

✅ 5. Functional Movement Assessment

Check pelvic motion in dynamic tasks:

• Hip hinge: Client may struggle to hinge properly and compensate by bending the upper back
  
• Squat: May demonstrate a posterior pelvic tuck at the bottom (loss of lumbar curve)
  
  

Leg lowering test: Excessive flattening of the spine throughout = lack of lumbar control

📍 Muscle Imbalances Common in Posterior Pelvic Tilt