An exaggerated arch in the lower back is often associated with anterior pelvic tilt, sometimes described as an “arched back” or excessive lumbar lordosis. People with this posture may notice that the pelvis tilts forward, the abdomen appears more prominent, and the lower back feels tight or uncomfortable.
However, posture is not caused by one muscle alone. The position of the pelvis and lumbar spine depends on the coordination of the abdominal muscles, hip flexors, gluteal muscles, spinal muscles, breathing mechanics and movement habits.
Two areas that are particularly important when assessing this pattern are the deep abdominal muscles and the iliopsoas muscle group.
The iliopsoas is a deep muscle group consisting primarily of the psoas major and iliacus, with the psoas minor present in some people. It connects the lumbar region and pelvis with the femur and is one of the body’s major hip flexors. It also contributes to hip and lumbar spine stability.
When the iliopsoas is repeatedly placed in a shortened position—for example, after long periods of sitting—it may become sensitive or restricted in some individuals. However, it is important not to assume that a “tight psoas” is automatically the cause of back pain.
A physiotherapist should assess the entire lumbopelvic movement system, rather than treating one muscle in isolation.
The abdominal drawing-in maneuver (ADIM) is a technique used to activate the deeper abdominal muscles, particularly the transversus abdominis.
The basic idea is to gently draw the lower abdominal wall inward while maintaining a comfortable, relatively neutral spine and continuing to breathe normally.
Research has found that ADIM can be useful for activating the transversus abdominis and developing better trunk motor control. A 2025 review of 16 studies involving 833 participants reported evidence supporting ADIM for transversus abdominis activation and core stability training.
Importantly, drawing in does not mean pulling the stomach in as hard as possible. The goal is controlled muscle activation rather than maximal abdominal tension.
As control improves, the exercise can progress to sitting, standing and functional movements.
A physiotherapist can use tactile feedback, movement observation or biofeedback to help determine whether the correct muscles are being activated.
Core training can be useful, but it should not be viewed as a magic solution for anterior pelvic tilt.
Research suggests that motor-control and stabilization exercises can improve abdominal muscle activation and may reduce pain and disability in people with chronic low back pain.
Another clinical study found that combining abdominal bracing with spinal stabilization exercises improved pain, function and spinal extensor strength, although the addition of bracing did not produce a significant difference in lumbar lordosis angle compared with spinal stabilization exercise alone.
This is an important point: the goal of physiotherapy is not necessarily to force the spine into a perfectly flat position.
A healthy spine naturally has a lumbar curve. Treatment should focus on improving movement control, strength, mobility and the patient’s symptoms rather than eliminating normal spinal curvature.
If assessment shows that the hip flexors are restricted, an appropriate iliopsoas or hip-flexor stretch may be included in rehabilitation.
A basic half-kneeling stretch can be performed as follows:
The most common mistake is compensating for limited hip extension by excessively arching the lumbar spine.
Good technique is therefore more important than pushing into a deep stretch.
Clinical rehabilitation literature recommends paying attention to lumbopelvic alignment during iliopsoas rehabilitation and combining hip-flexor work with abdominal control and appropriate hip strengthening.
The gluteal muscles also play an important role in controlling pelvic movement.
Useful exercises may include:
The appropriate exercise depends on the individual’s strength, mobility, pain and movement pattern.
For example, a person who excessively extends the lower back during a glute bridge may need to first learn how to control the pelvis before increasing resistance.
A comprehensive physiotherapy assessment may include:
1. Postural assessment
Observation of the pelvis, lumbar spine, hips, ribs and overall standing posture.
2. Movement assessment
Evaluation of squatting, walking, hip movement and spinal movement.
3. Muscle strength testing
Assessment of abdominal, gluteal, hip and spinal muscle function.
4. Hip mobility assessment
Determining whether restricted hip extension or other mobility limitations influence pelvic movement.
5. Core motor-control training
Teaching the patient how to coordinate breathing, abdominal activation and pelvic movement.
6. Manual therapy when appropriate
Soft-tissue techniques and joint mobilization may be used as part of a broader rehabilitation program.
7. Individual exercise prescription
Exercises are progressed from simple controlled movements to functional activities.
An anteriorly tilted pelvis or increased lumbar curve does not automatically mean that something is “wrong” with your spine. Many people have naturally different postures without experiencing pain.
However, when excessive pelvic movement is combined with lower back pain, hip stiffness, poor movement control or reduced strength, physiotherapy may help identify contributing factors.
The combination of abdominal drawing-in, appropriate core stabilization, iliopsoas mobility work, glute strengthening and movement retraining can be useful components of rehabilitation.
The most important principle is individual assessment. Rather than simply trying to “stretch the psoas” or “flatten the back,” physiotherapy should determine why the movement pattern occurs and which combination of mobility, strength and motor-control exercises is appropriate for that person.
If lower back pain is persistent, severe, associated with leg weakness/numbness, bowel or bladder changes, fever, unexplained weight loss, or follows significant trauma, professional medical assessment is recommended.
At PAPC, physiotherapy assessment can help evaluate posture, pelvic movement, core control, hip mobility and muscle function to develop an individualized rehabilitation program.
The exercise and anatomical information above is based on current clinical and research literature concerning the iliopsoas, abdominal drawing-in, motor-control exercise and low back rehabilitation.
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