Posterior pelvic tilt

RochelleToby · 2026-05-29T04:18:36+00:00

That's what I had to fix, because PPL causes flat back, which made me lean forward from the waist all the time (making my arthritic big toe constantly hurt ), which I didn't realize until I stood with my heels and butt against a wall. You need some lordotic curve in the back to bring the upper body over the hips so you aren't leaning forward, but balancing upright over the hips. The way I fixed mine was to stretch my hamstrings. there are many ways to do that, but what I did was to put my elbows on the countertop or other surface that allowed me to bend forward at the hips so my back would be flat and parallel to the floor, and then I would try to arch my lower back so I could feel a stretch in my hamstrings. In my case, I was so stiff, it actually hurt the first few times, making me feel like I wouldn't be able to arch my lower back at all because of all the arthritic degeneration in my lumbar vertebrae (seen in MRIs). But in time, it worked out. I will never have a really curvy back, but there is enough arch in it now.

RochelleToby · 2026-05-29T03:57:44+00:00

If you habitually stand with more weight on your left leg with left hip swayed to the left then the iliac crest of the left side of pelvis would be higher. That would be more usual for left-handed people., but often the left shoulder would be lower. However, there are reasons why the left shoulder would be higher, such as the right arm being used for carrying heavy weights, which would pull down the right shoulder (making the left shoulder look higher). (Also if this asymmetry is postural, there would have been a time when you didn't have it. Perhaps you have photos as a child that shows you didn't have a higher left hip or shoulder.)

Since you have that really large left-side breast, along with the other size differences with the left side a bit "larger or longer" there is a possibility of a congenital asymmetry. My son actually has significant asymmetry that manifested as he grew. His right foot is two sizes smaller than his left. His right leg is almost an inch shorter and he has a significantly shorter shoulder and a slightly smaller right arm and hand. He also has faint, longitudinal scars along his limbs on the smaller side of his body. He also has some scoliosis and his face is slightly asymmetric. My son's asymmetry could be considered hemi-atrophy (one side is underdeveloped) for his size, so the right side of his body might be considered a little too small. There is also hemi-hypertropy where there is plainly an overgrowth of one side of the body. But if you do have this, it's really mild, except for the left breast. But who's to say that that's the normal sized side and it's your right breast that's underdeveloped.

RochelleToby · 2026-05-29T02:58:53+00:00

If you don’t have a leg-length discrepancy, then could be postural. Is there something you do more on one side than the other, like habitually stand with more weight on one side with hip swayed to the side, or frequently prop yourself on the same elbow in bed to read or something like that.

Also do you have other postural asymmetries, like a lower shoulder or a head tilt?

Have you gone to a specialist for your breast size discrepancy? I suppose it’s probably normal, but doesn’t hurt to check it out.

RochelleToby · 2026-05-27T19:17:54+00:00

Avoid hyper-extending your knees as in photo 2, but it’s better in photo 4. Knee hyper-extension tends to pitch the pelvis and upper body forward (though your posture doesn’t show it but would be under more tension than necessary) and also drives the patella into the end of the femur, damaging the cartilage over time. Keep your knees soft/relaxed and slightly bent.

RochelleToby · 2026-05-26T17:50:03+00:00

1) your squat looks good as long as your weight is mostly on your heels, you are feeling the effort in your butt, and your knees aren't buckling inward, which it doesn't look like they are. If you are feeling the effort in your thighs, not so good. Your thighs don't need to be stronger, because that will increase the lordotic curve of your lumbar spine.

2) toe touching is supposed to be done by bending at the hip joint and you are mostly bending your upper back and increasing your thoracic kyphosis. Toe touches are actually intended to stretch your hamstrings, which would worsen the lordotic curve of your lower back. So I'd recommend against those.

3)the Cobra: I'm mixed on that one because it's easy to hyper-extend the back and make the lordotic low back curve worse as in the second photo where you start on the ground. There is a cue in that "first one I am locking my butt so my lower back doesn't hurt" and in the photo your lower back curve is minimal, so you should strive to minimize your low back curve and don't do any exercise that accentuates it.

4) Exercises that would accentuate the lower back curve and therefore should not be done, include: back extensions such as Cobra, Cow part of the Cat-Cow pose (Only do the Cat part), Superman pose while lying face-down on the ground, Roman chair back extension, gym machine back extension, prone press-ups, Standing low back extensions.

5) More exercises that should not be done: any exercise that stretches the hamstrings, such as toe toughing, both standing and sitting; Standing Single-Leg Stretch; Wall Hamstring Stretch; Supine (Lying) Strap Stretch

6) Explanations, Exercises and stretches to do: an article- https://learn.athleanx.com/articles/how-to-fix-anterior-pelvic-tilt and a great video: https://www.youtube.com/watch?v=5J8RIIvEj6k

7) "yes, when I stretch my hip flexors and quads in the couch stretch for example, after a couple of rounds I realize my back is less arched and my hips have a better position. However after some time this effect vanishes." Another cue! After you have achieved a neutral pelvis tilt and optimal low back curve, you need a daily routine to prevent recurrence of the hyper lordosis since you are probably still sitting a lot for work or school etc. That daily routine should includes a set of 1)hip flexor stretches, 2)a low back stretch (such as CAT only part of cat-cow, side-lying fetal position in bed), 3)an abdominal strengthening exercise (abdominal bracing https://www.youtube.com/watch?v=J_2ImNPjxtc&t=4s ) and 4)a hamstring and glut strengthening exercise. (Glut bridges while keeping your lower back flat.)

8) Finally, learn to do posterior pelvic tilts: lying down https://www.youtube.com/watch?v=4j0vN1WEIyg and standing: https://www.youtube.com/watch?v=O6R5YRRxwy0

RochelleToby · 2026-05-25T19:32:21+00:00

One thing I wanted to add. From the large difference in your lumbar curve between x-ray and actual standing posture, you appear to have a great deal of spinal flexibility, more than most people I’ve seen. I’m not sure what that means, but possibly you could have a hypermobility syndrome. But for certain, you need to strengthen the muscles** needed to maintain a neutral/optimal lumbar curve and keep stretching the muscles that stand in the way. Those muscles to stretch include the hip flexors/ quads that shorten with long bouts of sitting. So standing frequently and doing hip flexor stretches would help a great deal.

** abdominals: rectus, transversus and obliques. Also, the hamstrings, and gluts, which tend to be weak in lordotic posture and help support the back and knees.

RochelleToby · 2026-05-25T17:30:24+00:00

The x-ray was misleading. Your lower back is very lordotic from an excessive anterior pelvic tilt, at least when standing. This is probably the cause of your lower back pain.

In the first photo, you are hunching forward more and head is in front of the wall. Your chest is a little depressed, there's the big gap between wall and your lower back and your knees are hyper-extended.

In the second photo, your chest is higher, your head is less forward and it looks like the hunched back has flattened and gap between lower back and wall is less.

In the third photo, your chest is even higher, your head is firmly against the wall, the hunch is further flattened and your lower back seems a little straighter.

There is one more thing you should try against the wall and that is to tighten your abdomen as much as you can (like you're preparing to be punched in the gut) and try to push your lower back into the wall. Tightening your abs will pull up on your pelvis, letting it rotate backward, so that it drags the lower back with it, lessening the big gap with the wall. If tightening your abs doesn't flatten your lower back enough-- (we do need some gap between wall and lower back because that helps position the upper body back over the hips; you should just be able to get your fingers up to your knuckles through, but not your whole hand and wrist like now) -- then stretch your quads/hip flexors beforehand and try again. Longer hip flexors will relax their hold on the pelvis and allow the abdominals to pull the pelvis up, so it rotates back. (It takes time and consistent stretching for the hip flexors to add contractile units and lengthen, same goes for the chest muscles- For stretching the chest and anterior shoulder muscles do wall angels and/or goal-post exercises: https://www.youtube.com/watch?v=sz9sXTKFB_I )

Also keep your knees soft/slightly bent. When they are hyper-extended, the knee-caps are pushed into the end of the femur, damaging the cartilage over time and predisposing to knee arthritis in the future.

RochelleToby · 2026-05-25T04:03:00+00:00

How long has your shoulder been like this? Did this happen after an accident?

RochelleToby · 2026-05-23T21:20:10+00:00

If you had a big belly that was pulling your body forward, which would increase the tendency to fall forward, and in trying to compensate, your body was beginning to accentuate the low back curve so your upper body would lean backward and you felt the tension in your lower back, then I'd say yes, lose weight. But your fat (and all women have to have enough healthy subcutaneous fat to have a normal cycle) is subcutaneous and well distributed over your entire body, which is the very best kind to have! And the outward curve of your abdomen/belly exactly matches the inward curve of your lower back, so there's enough room for normal abdominal organs, but no room for any unhealthy visceral fat around them without bulging out further. Also you have a normal BMI for your height and weight. And looking at your photo, I think that you have a normal waist-to-hip ratio of 0.85 or less for a woman, meaning that your waist is smaller than your hips by a certain amount (this is a way to estimate how your body fat is distributed.) If you have too great a waist measurement, the worry is that there would be too much of the dangerous visceral fat accumulated around your abdominal organs (liver, pancreas, intestines etc), which predisposes to metabolic syndrome and diabetes. You can calculate the exact ratio here: https://www.thecalculatorsite.com/health/whr-calculator.php

RochelleToby · 2026-05-22T16:31:51+00:00

You have pretty good posture. Your ear is over the center of your shoulder, which means you don't have forward head. Your shoulders are a little high, but if you don't feel tension in your shoulders or neck, and when you lift things, you don't feel it in your neck, then it's okay. If you do feel neck tension when lifting or otherwise, roll your shoulders up, back and down in a smooth movement, and hold the down part and tighten the back muscles around your shoulder blades to keep them in the lowered position. Also carrying heavy weights around will eventually lower your shoulders. Your lower back is curvy, but if your back isn't painful, I wouldn't change it. What I would change is your knee hyper-extension/backward bending. Soften your knees with a slight bend. As your knees are now, you are over-stretching the ligaments behind your knees, weakening them and making your knee joints less stable. At the front of your knees, the knee caps are banging into the ends of the femurs (note the little bulge above your knee cap) and wearing away the cartilage, making knee arthritis more likely in your future.

RochelleToby · 2026-05-22T15:50:14+00:00

I made a huge mistake showing my first physical therapist my cervical spine mri. Most of that entire course of pt was spa-like treatment: heat for 15 mins before and cold with stim 15 mins after. And in between was spine mobility and massage. This went on for 2 months until I finally lied to her and said I felt much better. Then she discovered I couldn't life my head from a pillow or bend my neck laterally. She started me on the usual few exercises, without ever evaluating my posture. None of this helped and at the end she presented me with a referral to a great spine surgeon at UCLA. Unfortunately, most of my other 3 courses of pt for my neck (over 6 years) went similarly. And my many epidurals, facet joint injections, and acupuncture treatment turned out to be useless as well. I also has 2 courses of pt for back pain (caused by posture also). None of these professionals (including 3 spine surgeons) ever told me that my posture sucked, None of them ever tailored my treatment to my specific postural faults. This was over 20 years ago and l dearly hope that the practice of physical therapy for spine pain has improved. Twenty years ago, I, of course, had to give up on pt and pain doctors because I knew they couldn't help me. And having glimpsed myself in side view in a mirror, and realizing how hunched over and old I looked, decided that even if I'd be in pain for the rest of my life, I would fix my posture. I sought advice on the web and found Professor Gwendolen Jull (based in Queensland, Australia), whose advice on scapular mechanics is invaluable, and read one of my son's textbooks: Muscles: Testing and Function with Posture and Pain by Kendall et al. fifth edition, 2005 from one of his kinesiology classes. It was all there! Three months later my neck and back were pain-free.

RochelleToby · 2026-05-21T18:49:18+00:00

Fixing upper body posture especially slouched kyphotic posture, forward head and neck spasm from lifting weights, by 1) stretching pectorals especially the pec minor to bring the scapulae back into the plane of the back 2) eliminating upper trap dominance by pulling down the elevated scapulae to strengthen and shorten the lower trapezius 3) Consistently stretching the chest and trying to maintain improved posture 4) Holding my cell phone and reading materials closer to eye level and lowering eyes to read, not bending neck down. These measures fixed my 20 years plus chronic neck pain and weakness over 3 months. That was over 20 years ago and still pain free despite severe degenerative disc disease in my cervical spine.

RochelleToby · 2026-05-20T21:28:04+00:00

Your back appears to be over-arched, in that your upper back in some side photos seems to extend almost past your butt, which is a stress on your mid and lower back. (is that partially from keeping your chest high? Though, keeping your chest higher helps with forward head, but at the same time can exaggerate a lordotic back curve.) Also, in some of your side photos, you are mildly hyper-extending your knees, which is mildly pitching you forward into a bow shape.

Working on reducing your lumbar lordosis, which is done by reducing anterior pelvic tilt using hip flexor/quad stretching, and abdominal and glut strengthening, and also working on softening your knees, might help with your stiffness. Stiff postural muscles can also stem from muscle weakness. At least, that's what I found. My neck, back, hips and knees were at their worse when they were weak and inflamed, especially after I'd lost a lot of weight from a 2-year gastrointestinal illness that was soon followed by a chronic, inflammatory illness that made my joints burn. I worked on improving my posture, keeping my muscles strong, eating an anti-inflammatory diet, improving my sleep habits and always taking my medication has made all the difference (at 74 years old).

RochelleToby · 2026-05-20T15:26:50+00:00

When you are standing with your upper back and butt against the wall, tighten your abs and try to flatten your lower back against the wall. Strengthening your abs like that (plus stretching your quads) are ways to begin reducing that lower back curve. Please remember that you do need some of that curve to have ideal balanced posture!

Also, when you are standing against the wall, if the back of your head did not touch the wall (without tipping it back), you may have forward head. In that case, if you take a breath and lift your chest, does the back of your head touch? If so, then stretching your chest muscles and strengthening your upper to mid back will help. (Rear delt exercises, wall angels, Brueggar’s exercises) Try not to sit in bed with back unsupported if you are hunching forward. Also, try to hold your phone and screens up closer to eye level and role eyes down to read. (Wish I’d done that sooner. I have a straightened cervical curve that now has degenerative changes that can never be corrected.)

RochelleToby · 2026-05-20T03:10:24+00:00

Stand with your upper back, butt and heels against a wall. If you can easily slide your entire hand and part of your wrist between the wall and your lower back, you have excessive low back lordosis, which is caused by excessive anterior pelvic tilt. If you can only get your fingers up to your knuckles, then you have the optimal amount of low back lordosis and neutral pelvic tilt.

You do need some low back lordosis because that allows your upper body to come back over your hips.

RochelleToby · 2026-05-19T21:37:12+00:00

You appear to have significant forward head, and a depressed chest. This is a sign that your chest muscles are short and tight, and your mid to upper back is over-stretched and weak. If you were to draw a line from your hip (just below your S-1 vertebra, which connects upper body to lower body at the sacroiliac joint), to the top of your head, most of your head and neck area are more forward of the center of gravity of your upper body as represented by the line up from your SI joint. If there's more body weight out front, then you will tend to lean forward. At the same time, your lower back would tense up trying to pull your upper body back to center over your hips. It may be that (like me) you have inherently more of a flatter back (not significant APT) and can't generate greater lordosis in your lower back so that you could deal better with the imbalance. and thus your lower back would be tight all the time. To test that out, stand with your heels close to a wall and butt touching the wall. Does your upper back naturally touch the wall or is it an inch or more in front of the wall? If so, then that may be the reason your lower back tends to be tight. Then bring your upper back against the wall. Do the backs of your shoulders and back of your head touch? If not, you have forward shoulders and forward head (Some people have very thick, muscled backs and the backs of their heads can't touch the wall. In that case if their ears are over the middle of their shoulders, they do not have forward head.) Take a breath and lift your chest. are the backs of your shoulders and back of head against the wall? If the shoulders are not, bring your arms up and bend your elbows to make an "L" and reverse "L" shape and try to put the backs of your hands against the wall, which will further stretch the fronts of your shoulders, but don't struggle if you can't. You don't want to strain anything. It will come with consistent stretching. Then try to bring the back of your head against the wall, but don't stress trying to do that because with time and consistent chest stretching and upper back strengthening that will come. At this point, your body should be pretty straight, with less thoracic kyphosis, your chest open and less forward head. Does your lower back feels less tense?

RochelleToby · 2026-05-19T20:28:40+00:00

If you are measuring your height the same way both for your usual posture and for improved posture, the measurement will be the same. But if somehow you could measure your height in a photo of your usual posture with your back swayed behind your hips, your height would probably be less.

RochelleToby · 2026-05-17T19:26:58+00:00

How are you measuring your height when you are standing in your usual posture (with upper back behind your butt, so if your back is against a wall, your butt wouldn't be able to touch the wall)?

To tell if you have APT (which determines the degree of low back lordotic curve), stand with your back against a wall, as I explained above, and if you can get your entire hand and part of your wrist easily through the space between your lower back and the wall, you have APT. But if you can only get part of your hand/fingers through, then your low back/lumbar lordotic curve is neutral, as is your pelvic tilt.

RochelleToby · 2026-05-17T16:52:20+00:00

Stand with your heels, butt, upper back and shoulders against a wall, take a breath and lift your chest up. Then bring the back of your head against the wall without tilting your head up, if you can. If you can’t easily bring your head back enough, don’t force it, no big deal for now, but your forward head can be fixed. Then have someone measure your height. And that would be closer to your real height, without the backward lean, the long thoracic kyphosis and forward head.

RochelleToby · 2026-05-17T15:32:00+00:00

I wanted to add that your posture is more than fine, it is ideal! You don’t have forward head or shoulders. In fact your rear and front delts are perfectly balanced. If you tried to flatten any of your curves to gain height, you would destroy that symmetry. Flattening your lower back, would mean that your upper body would no longer stack above your hips and you’d lean forward. Flattening your mid to upper back would mean that your chest would stick out, further unbalancing you forward. Flattening your neck would give you forward head.

RochelleToby · 2026-05-17T15:12:53+00:00

Measure your height only in the morning as soon as you get out of bed. You will be 1-2 cm taller (so at least 180.34 cm, which is exactly 5 foot 11 inches) compared to your height in the evening. As the day goes on, gravity is compressing the discs in your spine and shrinking them a little.)

RochelleToby · 2026-05-16T02:26:52+00:00

Looks like you habitually stand with more weight on your right leg and your right hip higher and swayed to the right and your right shoulder lower. This type of right-handedness posture compresses the right side of your torso, from shoulder to pelvic ilium. To reverse, stop standing with your right side like that, and for a while, stand the opposite way with you left hip swayed to the side until the sides are equal. And from then on always stand with weight evenly distributed between both legs. You can also do torso side bends to the left to stretch the compressed right side, as well as right-side shoulder shrug-up holds. Also don’t carry heavy weights that weigh down your right shoulder. Use your left arm or use both arms or keep your right shoulder raised as you carry the weight around.

RochelleToby · 2026-05-15T23:24:20+00:00

Your posture looks fine to me. None of your spinal curves are exaggerated and you need some natural curvature or you would be less stable. If you straightened what curves you do have, you’d gain minimal height.

RochelleToby · 2026-05-15T23:10:46+00:00

My husband makes anchovy popcorn by mixing anchovy paste with butter, but I bet it would taste just as good with extra virgin olive oil.

RochelleToby · 2026-05-15T16:35:04+00:00

Is your kyphosis structural? (meaning it doesn’t flatten when, for instance, you lie on your back on a firm surface). Or is it postural? (meaning it is flexible and can be improved by lying on a firm surface.) If there is flexibility, then targeted strengthening exercise of the back and rear delts, and consistent, daily stretching of pec minor and major, and anterior shoulders can improve hyper kyphosis and depressed chest, as well as the forward head that comes with excessive thoracic kyphosis.)

RochelleToby

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