A Guide To Postpartum Hip Realignment With Pelvic Tilting
Does this posture look familiar? Perhaps this is you… Maybe your butt looks a little bigger, but your gut hangs a little lower than you’d like? This body positioning is actually called an anterior pelvic tilt and its not a good long term posture.
An anterior pelvic tilt is when your pelvis tilts forward. See in the picture above, how the pant line around my waist is dipped down, my back is arched and my stomach is sticking out? All indicative of the pelvis tilting forward.
What caused this posture?
Many men and women are now accidentally adopting anterior pelvic tilts, as apart of their normal posture. There are a few things that can cause the pelvis to rotate forward, but there are 3 main reasons I see often.
1. Sitting a lot, because sitting tightens the muscles around the hips (more explained later), which can cause the pelvis to tilt forward.
2. Some people are born with an exaggerated anterior pelvic tilt 🙋♀️ … Something I have always had to work on!
3. Many moms develop it because of the structural change that happens with the pelvis from being pregnant.
- So while pregnant, the hips rotated into an anterior pelvic tilt to compensate for the extra weight of the baby sitting up in front. Pretty cool, right! But now, after the baby was born, if the woman never did anything to help re-align herself, she may notice that her butt sticks out a little further and her low back is more arched than normal. She may also experience increased low back pain. That’s because of her pelvis being rotated forward… and from now carrying her baby/ toddler/ kid around with that forward rotated pelvis. 🤪 (Even if she had children 10+ years ago… She can still have a rotated pelvis!)
- This can also happen in men and women who have not had children but who have gained excess weight in their stomach area. The extra weight up front, causes the hips to rotated forward to compensate for the weight. Again leaving strain on the low back, among other areas.
What happens to the rest of your body with an anterior pelvic tilt?
The rest of the body has to compensate, especially after that baby is born and/or the extra weight is lost in the front. The hip flexors (on the front of the body) end up shortening and the hip extensors (back of body) lengthen. This allows the front of the pelvis to dip and the back of the pelvis to rise. Thus, a major muscle imbalance has been made… which is not good.
Muscles that tightened
- Erector Spinae (a lower back muscle)
- Psoas (connects the spine to the leg) – Hip Flexor
- Rectus Femoris (one of your 4 Quadricep muscles- on the front of your thigh) – Hip Flexor
Muscles that weaken and loosen
- Lower Abs
- Gluteus Maximus (butt muscle) – Hip Extender
- Biceps Femoris, Semimembranosus and Semitendinosus (all 3 Hamstring muscles- back of thighs) – Hip Extender
Yes this is me… So how do I fix it?
Doing exercises which help you, 1. Learn how to move the pelvis 2. Strengthen the hip extensors and lower abs, and 3. Stretch the hip flexors and erector spinae, will all help you achieve a more neutral spine.
Moving your pelvis and performing a posterior pelvic tilt is the key factor here. Then performing specific stretches and strengthening exercises, will help you be able to GET into that posterior pelvic tilt position, when you’re exercising and needing a strong base; along with being able to maintain a neutral spine during activities of daily life.
Here you go! Commit to doing all below for a month at least 5 days a week and I guarantee, you will look and feel so much better!
Step 1
Learn how to move your pelvis and how to posterior pelvic tilt.
Laying Pelvic Tilts: 1 set of 20 reps
Practicing pelvic tilts on the ground is an easy first step.
- Lay on your back with your knees bent. You’ll probably notice there’s a space between your lower back and the ground, right? If the gap is pretty big, that is an anterior pelvic tilt.
- Flatten your lower back to the ground (smoosh the grape🍇) by tilting your pelvis and pulling your pubic bone to your rib cage. This action is called posterior pelvic tilt.
- Repeat until you feel comfortable tilting your pelvis and engaging those muscles.
You can also through in a Kegel and a Transverse Abdominal squeeze too if you know how… It’ll benefit you even more if you have just had a baby or if you still pee when you cough, have pain down there or have any bit of diastasis recti. (More on how to do that here!)
Standing Pelvic Tilts: 1 set of 20 reps
Next you want to progress to a standing position.
- Stand relaxed with your feet shoulder width apart. You will most likely be in an anterior pelvic tilt position already.
- Squeeze your glutes and tilt your pelvis into a posterior pelvic tilt by pulling your pubic bone to your rib cage. (Same as you did laying on the ground.)
- ❓ If that doesn’t work, try placing your hands on your hip bones and rocking your hips forward and back manually. Once you grasp that feeling of both an anterior pelvic tilt (hips dip forward ) and a posterior pelvic tilt (hips are flat), then go back and try it again without using your hands.
- NOTE: Make sure you don’t round your shoulders over as you do this. If you find you are having trouble with it, either go back to the ground and practice some more, or try standing against a wall until you have mastered it.
Step 2
Strengthen the hip extensors (Glutes and Hamstrings) and Abdominals.
Bodyweight Hip Lifts (with Transverse Abdominal Engagement): 3 sets of 10+ reps
The first exercise is body weight hip lifts:
- Lay on the ground, tuck your shoulder blades down and bend your knees.
- Lift your butt up and keep your shoulder blades on the ground. Now many people go past a neutral spine and just lift their hips as far as they can. Which, sure, it’s still working the glutes and hamstrings to some extent, however your reversing everything you just practiced above and putting more pressure on your spine. We want to try not to get into positions which cause our hips to rotate forward. 😉 So really squeeze your glutes, look in a mirror if you need to, and stop when your body is flat.
- Repeat going at a 3 count up and a 3 count down. If you feel like you need it, add some weight onto of your hips (or a small child)… just watch your form.
- Once you have mastered that, try to engage your transverse abdominal muscles as you lift your hips up. Think about pulling your hip bones together… you’ll feel your lower abs sink in slightly. It’s a very small movement, but its a muscle many people forget to activate (…and its the main one that got stretched out when you were pregnant… more on this here.)
Plank / Quadruped Plank : 2 sets of max holds (start with 15 seconds and work your way up to 1 min)
So a plank is the most powerful core exercise… if done right! Some people go for time, but their form lacks greatly. You have to make sure you keep that posterior pelvic tilt, or you will negate the exercise and strain your back.
Option 1 Plank: Here are some key points for proper execution to remember:
- Shoulders over hands (or elbows if your wrist bother you), feet hip width apart, upper back engaged and head neutral (looking slightly in front of you).
- Activate your abdominals into a posterior pelvic tilt (like practiced above) by thinking about pulling your pubic bone to your rib cage and squeezing your glutes.
- Hold this position for as long as possible without letting your lower back arch. As soon as you feel your stomach dropping or low back hurting, then either re-tuck your hips or come down from the plank.
⚠️ If you feel like you cannot hold this position for longer than 15 seconds, then start with the quadruped plank ⬇︎ and work your way up to a full plank. Even if one day your not feeling as strong or have children climbing over you, the quadruped plank is just as effective and sometimes even better!
Option 2 Quadruped Plank:
The quadruped plank is my favorite! Keep in mind all the same rules apply as for a regular plank.
- Shoulders over hands, knees right under hips, knees raised off the ground about 2 inches, head is neutral (looking at your hands).
- Activate your abdominals by pulling your pubic bone to your rib cage… or in this position it may be easier to think about drawing your belly button to your spine.
- Hold this position for as long as possible without letting your lower back arch. As soon as you feel your stomach dropping or low back hurting, then either re-tuck your hips and pull that belly button to your spine again or come down from the plank.
Step 3
Stretch the overactive hip flexors (Psoas and Rectus Femoris) and Erector Spinae.
Lunge Hip Flexor / Psoas Stretch: 1-2 sets of 30 second holds each leg
The lunge hip flexor stretch or lunge psoas stretch is such an important stretch… and most people forget one important part that really allows the psoas muscle to release. Tight hip flexors can also contribute to pulling the hips forward into an anterior pelvic tilt (the opposite of what we want). For example: Put your thumb on the front of your hip bone and your middle finger on the front of your thigh. Then pinch your fingers together; that motion is what happens when your hip flexor, psoas and quadriceps muscles are tight. They literally pull your hips forward and down into an anterior pelvic tilt.
- Get into a lunge position. Scoot your front foot forward until you feel a little stretch in the front of the hip of your back leg. Make sure you don’t allow your knee to go over you toe (as this may bother your knee joint).
- Contract your abdominals by thinking about that posterior pelvic tilt and sink deeper into the stretch. Take about 5 deep breaths in this position.
- After your breaths, breath in and reach up as high as you can with the same arm as your back leg.
- As you release your breath, reach up and over to the side of your front leg, all while keeping your core engaged and arm in line with or behind your ear. Also, recheck your alignment and make sure your hips are still pressed forward. Hold for another 5-10 breaths. (The goal is to reach up and out of your ribs, which will really allow the psoas muscle to lengthen!)
Laying Erector Spinae Stretch: 1-2 sets of 30 second hold
The Erector Spinae muscles are basically the muscles that travel the length of your spine. If they are really tight, they will contribute to the pulling the back of the pelvis up (allowing the front to drop) into an anterior pelvic tilt.
- Lay flat on the ground, engage your abdominal muscles and bring your knees to your stomach.
- Grab the back of your legs, re-engage your abs by tucking your hips under and pull your knees closer to your chest. The goal is to feel a little separation of your vertebrae or a slight pull in your low back allowing those muscles to lengthen and relax. Take a few deep breaths in this position as you hold it.
- If you need a deeper stretch, and your neck is healthy, bring your head up and your nose to your knees. Pull your belly button to your spine and take a few deep breaths as you hold the position. You can also rock if that feels good… or just stay neutral.
Kneeling or Standing Quadriceps (Rectus Femoris) Stretch: 1-2 sets of 30 second holds each leg
If the quads are tight, they along with the hip flexor and psoas muscles, can contribute to tilting the hips forward.
Option 1 (medium difficulty):
- Get into the lunge hip flexor stretch as stated above. Again, make sure your knee is not over your toe, but that your hips are pressed forward so you feel a slight stretch in the front of your hip.
- Then place your back foot up on a bench or couch. You want to contract your abdominals by drawing your belly button towards your spine and sit up tall. You should feel a deep stretch down the front of your thigh. Take a few deep breaths and allow yourself relax and sink deeper into the stretch.
Option 2 (harder version):
- If that is easy, move away from the bench or couch and hold your back foot with your hand. Just make sure you do not loose any of your positioning! If you are off balance, re-engage your core and perform the exercise next to the bench or couch and hold on with your other hand to stabilize your body.
Option 3 (easier version):
- Stand up. If being in a hip flexor and quad stretch is just way too intense, then stand up and just focus on stretching your quadriceps.
- Position yourself near a wall or pole to hold onto for balance.
- Grab your back foot and pull your back leg up towards your butt. Now STOP 🛑 Look at your positioning because many people void this stretch by leaning forward and pulling their back leg out too far. Make sure you keep your ribs in, knees next to each other and your hips tucked under into the posterior pelvic tilt (picture below).
- Hold each side for about 10 deep breaths.
Review:
If you want to decrease back pain and flatten out that momma belly by fixing your alignment, perform these exercises and stretches to get your pelvis and body back to its most natural position and alignment.🙃 If you really want to get serious about it, perform each exercise and stretch at least 5 days a week for about a month. You will see the results your looking for!
To provide you with a takeaway, here’s the corrective routine summarized for you. There is also a pdf link here.
Laying Pelvic Tilts: 1 set of 20 reps
Standing Pelvic Tilts: 1 set of 20 reps
Hip Lifts/ Bridge: 3 sets of 10+ reps
Plank / Quadruped Plank: 2 sets of max holds
Lunge Hip Stretch: 2 sets of 30 second holds each leg
Laying Back Stretch: 1-2 sets of 30 second hold
Kneeling or Standing Quadriceps Stretch: 1-2 sets of 30 second holds each leg
One more thing to keep in mind…
Try your best to be aware of your posture throughout the day. I catch myself quite often, especially while I’m holding my kids, that my hips dip forward and my shoulders round. If a flatter looking stomach 😉, better posture, good alignment, back health and a strong core are important to you… then check yourself through your day. An easy time to remember may be while you’re working out by yourself, but the most challenging will be when you’re just moving through life with your kids or at your job. Use what you’ve learned today to keep your pelvis in a more neutral position.
And PLEASE don’t forget to relax your stomach and take some deep belly breaths, expanding the abdominal wall. I know I always forget about the relaxation part too! And remember to LOVE your stomach and all it is capable of doing!
Feel free to let me know if you have any questions down below. And please follow me on Instagram , Facebook, Pinterest and Youtube if you like what you read!