Most of the exercise advice on fixing anterior pelvic tilt is focused on stretches and strength training. Cardiovascular exercise, on the other hand, rarely gets a mention. So is doing cardio worth the while?

Usually, when we talk about pelvic tilt (be it anterior or posterior), we mean the degree of the tilt of the pelvis during standing still. However, the same tilt is evident during cardio exercises such as running as well. As a result, the spinal curvature increases during running, which may cause lower back pain in runners.

There is evidence to suggest that too much pelvic tilt is linked to injuries around the hip and lower back area (1). Furthermore, these injuries account for 14% of all injuries in distance runners and sprinters (2).

This suggests that doing aerobic exercise, especially running, in itself will not fix anterior pelvic tilt. In fact, it may even worsen the problem by stressing the excessively curved spine and causing lower back pain. It is better to deal with the excess tilt before engaging in distance running or sprinting.

To determine your own anterior pelvic tilt during running, it is best to ask someone to observe you run. The curvature of your spine and the movement of the pelvis gives a rough idea of whether you're leaning more towards anterior or posterior pelvic tilt. Another method is to take a video of yourself running an watch it in slow motion. The video below shows an example of posterior and anterior pelvic tilt during running:




The method of running will also determine whether back pain or other injuries will occur in time. Currently, there is a lot of debate whether barefoot running (or wearing shoes that emulate barefoot running, such as Vibram FiveFingers) results in a more natural gait and thus less injuries than wearing shoes with a lot of heel support. There is, however, limited evidence to prove either way.

If you have excess anterior pelvic tilt, trying out different shoes may help to relieve or eliminate pain during running. However, it is recommended to fix anterior pelvic tilt before engaging in any serious running. Note that not all of the exercises commonly recommended are in fact related to anterior pelvic tilt. For example, no connection between abdominal muscle strength and pelvic tilt has been found so far.

References

(1) Geraci MC. Overuse injuries of the hip and pelvis. Journal of Back and Musculoskeletal Rehabilitation 1996;6:5-19.

(2) Bennell KL, Crossley, K. Musculoskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport 1996;28:69-75.