The effect of Pilates and TRX exercises on the pelvic tilt angle of females with excessive anterior pelvic tilt

Document Type : Research Paper


1 Department of Corrective Exercise and Sports Injuries, Faculty of Physical Education and Sport Sciences, Allameh Tabatabai University, Tehran, Iran.

2 2. Department of Physical Education and Sport Sciences, Faculty of Literature, Humanities and Social Sciences, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran.

3 Ph.D. in Corrective Exercise and Sports Injuries, Faculty of Physical Education and Sport Sciences, Tehran University, Tehran, Iran.

4 Department of Corrective Exercise and Sports Injuries, Faculty of Sport Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran.


Background: Excessive anterior pelvic tilt (APT) is a common condition that can lead to musculoskeletal problems in females. Pilates and TRX exercises have been suggested as potential interventions to address APT.
Aim: The present study aimed to investigate the effect of these exercises on the pelvic tilt angle (PTA) in females with excessive APT.
Materials and Methods: The current study utilized a pre-test post-test design and was conducted as a quasi-experimental study. Twenty females between the ages of 35 and 55 were purposefully selected to participate in the study. The pelvic tilt angle (PTA) was measured using an inclinometer. The study participants were randomly assigned to the two groups. Then 8-week TRX and Pilates exercises were carried out. The data was analyzed by paired-sample t-test and analysis of covariance (ANCOVA) at a significance level of P<0.05 using SPSS V. 16.
Results: The results showed a significant decrease in PTA in both Pilates (t(9)= 16.74, P= 0.001) and TRX (t(9)= 9.73, P= 0.001) exercises groups. But, there was no a significant difference between the two groups (F(1, 17)=0.01, P= 0.922, partial eta squared= 0.001).
Conclusion: The results of the study demonstrated a significant decrease in the pelvic tilt angle (PTA) of participants with excessive anterior pelvic tilt (APT) following 8 weeks of Pilates and TRX exercises. These findings highlight the importance of these exercise interventions in correcting postural deformities.


[1] F Brekke AF, Overgaard S, Hróbjartsson A, Holsgaard-Larsen A. "Non-surgical interventions for excessive anterior pelvic tilt in symptomatic and non-symptomatic adults: a systematic review". EFORT Open Reviews. 2020; 5(1): 37-45. doi: 10.1302/2058-5241.5.190017. PubMed PMID: 32071772 PubMed Central PMCID: PMC7017593.[2] Frank C, Page P, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Humankinetics 2009.[3] Magee DJ, Manske RC. "Orthopedic physical assessment-E-Book". Elsevier Health Sciences. 2020.[4] Levine D, Whittle NW. "The effects of pelvic movement on lumbar lordosis in the standing position". Journal of Orthopaedic & Sports Physical Therapy. 1996; 24(3): 130-135. doi: 10.2519/jospt.1996.24.3.130.[5] Neumann DA. Kinesiology of the Musculoskeletal System Foundations for Rehabilitation. 2nd Edition, 2017.[6] Oatis CA. Kinesiology: The Mechanics and Pathomechanics of Human Movement. Wolters Kluwer. 2017.

[7] Karukunchit U, Puntumetakul R, Boucaut R, Sinsurin K.  "Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers". Patient Preference and Adherence. 2015; 9: 785. doi:10.2147/PPA.S81898. PubMed PMID: 26124645; PubMed Central PMCID: PMC4476481.

[8] Alizadeh S, Mattes K. "How anterior pelvic tilt affects the lower extremity kinematics during the late swing phase in soccer players while running: A time series analysis". Human Movement Science. 2019; 66: 459-466. doi:10.1016/j.humov.2019.06.001. PubMed PMID: 31176257.

[9] Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ. "Surgical biomechanics of the patellofemoral joint". Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007; 23(5): 542-553. doi:10.1016/j.arthro.2007.03.006. PubMed PMID: 17478287.

[10] Hertel J, Dorfman J.H, Braham RA. "Lower extremity malalignments and anterior cruciate ligament injury history". Journal of Sports Science & Medicine. 2004; 3(4): 220. PubMed PMID: 24624006; PubMed Central PMCID: PMC3938060.

[11] Laird RA, Gilbert J, Kent P, Keating JL.  "Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis". BMC Musculoskeletal Disorders. 2014; 15(1): 1-13. doi: 10.1186/1471-2474-15-229. PubMed PMID: 25012528; PubMed Central PMCID: PMC4096432.

[12] Lim HS, Roh SY, Lee SM. "The relationship between pelvic tilt angle and disability associated with low back pain". Journal of Physical Therapy Science. 2013; 25(1): 65-68. doi: 10.1589/jpts.25.65.

[13] Patel RV, Han Sh, Lenherr Ch, Harris JD, Noble Ph C. "Pelvic tilt and range of motion in hips with femoroacetabular impingement syndrome". JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020; 28(10): e427-e432. doi:10.5435/JAAOS-D-19-00155. PubMed PMID: 31599764.

[14] Schuermans J, Van Tiggelen D, Palmans T, Danneels L, Witvrouw E. "Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence?" Gait & Posture. 2017; 57: 270-277. doi: 10.1016/j.gaitpost.2017.06.268. PubMed PMID: 28683419.

[15] Barbosa AC, Souza TR, de Oliveira NT, de Amorim Lima AM, de Oliveira VC. "Manipulation and selective exercises decrease pelvic anteversion and low-back pain: a pilot study". Journal of Back and Musculoskeletal Rehabilitation, 2013; 26(1): 33-36. doi: 10.3233/BMR-2012-0347. PubMed PMID: 23411646.

[16] Brekke AF, Hongslo E, Haugen AJ, Clarsen B, Bahr R, Andersen TE. "A home-based exercise and activity modification program in patients with acetabular retroversion and excessive anterior pelvic tilt". Gait & Posture. 2020; 81(Suppl. 1): 52-53. doi:10.1016/j.gaitpost.2020.07.049.

[17] Carpes FP, Reinehr FB, Mota CB. "Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: a pilot study". Journal of Bodywork and Movement Therapies. 2008; 12(1): 22-30. doi: 10.1016/j.jbmt.2007.05.001. PubMed PMID: 19083652.

[18] Cottingham JT, Porges SW, Richmond K. "Shifts in pelvic inclination angle and parasympathetic tone produced by Rolfing soft tissue manipulation". Physical Therapy. 1988; 68(9): 1364-1370. doi: 10.1093/ptj/68.9.1364. PubMed PMID: 3420170.

[19] Harrison DE, Harrison DD, Betz J, Colloca CJ, Haas JW, Janik TJ, Holland B. "Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial". Archives of Physical Medicine and Rehabilitation. 2002; 83(11): 1585-1591. doi: 10.1053/apmr.2002.35485. PubMed PMID: 12422330.

[20] Lee JH, Yoo WG, Gwon HJ. "Effect of posterior pelvic tilt taping in women with sacroiliac joint pain during active straight leg raising who habitually wore high-heeled shoes: a preliminary study". Journal of Manipulative and Physiological Therapeutics. 2014; 37(4): 260-268. doi: 10.1016/j.jmpt.2014.01.005. PubMed PMID: 24780371.

[21] Levine D, Walker JR, Tillman LJ. "The effect of abdominal muscle strengthening on pelvic tilt and lumbar lordosis". Physiotherapy Theory and Practice. 1997; 13(3): 217-226. doi: 10.3109/09593989709036465.

[22] Mendiguchia J, Conceição F, Edouard P, Fonseca M, Pereira R, Lopes H, Jiménez-Reyes P. "Training-induced changes in anterior pelvic tilt: potential implications for hamstring strain injuries management". Journal of Sports Sciences. 2020; 39(7): 1-8. doi: 10.1080/02640414.2020.1845439. PubMed PMID: 33172346.

[23] Faul F, Erdfelder E, Lang AG, Buchner A. "G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences". Behavior Research Methods. 2007; 39(2): 175-191. doi: 10.3758/bf03193146. PubMed PMID: 17695343.

[24] Sohrabi S, Aminianfar A, Salavati M, Ebrahimian M, Ebrahimi E. "The effect of eight weeks of Iyengar Yoga with an emphasis on spine and shoulder exercises on the upper cross syndrome in middle-aged women". Journal of Modern Rehabilitation. 2020; 14(3): 159-168. doi: 10.32598/JMR.14.3.3.

[25] Nijhawan LP, Janodia MD, Muddukrishna BS, Bhat KM, Bairy KL, Udupa N. "Informed consent: Issues and challenges". Journal of Advanced Pharmaceutical Technology & Research. 2013; 4(3): 134. doi: 10.4103/2231-4040.116779. PubMed PMID: 24083200; PubMed Central PMCID: PMC3777303.

[26] Kouhkan S, Rahimi A, Ghasemi M, Naimi S, Akbarzadeh Baghban A. "Studying the changes of the lumbar and thoracic curvatures and pelvic tilt inclinations during pregnancy in primigravida women". Rehabilitation Medicine. 2015; 3(4): 42-52.

[27] Herrington L. "Assessment of the degree of pelvic tilt within a normal asymptomatic population". Manual Therapy. 2011; 16(6): 646-648. doi: 10.1016/j.math.2011.04.006. PubMed PMID: 21658988.

[28] Reichert B, Stelzenmueller W. Palpation Techniques: Surface Anatomy for Physical Therapists. Thieme New York, NY. 2011.

[29] Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. "Variation in pelvic morphology may prevent the identification of anterior pelvic tilt". Journal of Manual & Manipulative Therapy. 2008; 16(2): 113-117. doi: 10.1179/106698108790818459. PubMed PMID: 19119397. PubMed Central PMCID: PMC2565125.

[30] Isacowitz R, Clippinger K. Pilates Anatomy. Human Kinetics. 2019.

[31] Lyon D. The Complete Book of Pilates for Men: The Lifetime Plan for Strength, Power & Peak Performance. HarperCollins. 2005.

[32] Dawes J. Complete Guide to TRX Suspension Training. Human Kinetics. 2017.