A pelvic tilt is about the smallest back exercise there is: lie on your back, flatten your lower back into the floor, hold, let go. After a flare-up, or in pregnancy, it is often the first thing a physical therapist asks for, because it teaches you where your spine is and how to move it on purpose without asking much of it.
What the exercise actually trains
Not strength. Your deep abdominals and glutes do the work, but the load is tiny. What you are practising is awareness and control: finding neutral, moving a few degrees out of it, and coming back. Many people with back pain cannot feel arched from flat.
Why gentle movement comes first
The NICE low back pain guideline (2016) tells clinicians to encourage people to continue with normal activities, and exercise is the first treatment it lists. The American College of Physicians' 2017 guideline makes the same call: non-drug treatment first, with exercise and motor control exercise on its list for chronic pain. A 2021 Cochrane review of 249 trials (24,486 people) found exercise probably reduces chronic low back pain more than no treatment, though the effect on function was small. None of this makes the tilt special; it says moving beats waiting, and the tilt is a safe place to begin.
How to do it lying down
- Lie on your back, knees bent, feet flat and hip-width apart.
- Breathe out and gently draw your lower belly in, so the small of your back presses into the floor. Nothing else moves.
- Hold for about 5 seconds, breathing normally. Do not push through your feet.
- Release and let the curve return. That is one rep.
- Do about 10 reps, two or three times a day, small and pain-free.
In pregnancy
The same movement works on hands and knees or sitting once lying flat is uncomfortable. Ask your midwife or physical therapist which position suits you.
When to move on
Once 10 tilts feel easy and you can find the flat-back position without thinking, your therapist will usually add load on top of it: glute bridges, where you lift the hips with the pelvis tucked, and dead bugs, where the back stays flat as one arm and the opposite leg reach away. Both are tilts with load added.
For the bridge, the dead bug and what follows, see our core exercises for lower back guide
Doing this exercise in a guided session
Because the movement is so small, it is easy to get wrong without knowing: lifting the hips, pushing with the feet, holding your breath. In a KineTrue guided session the camera tracks hip and trunk position, and your therapist reviews the recorded reps before progressing you.
Stop and contact your clinician if the tilt sharpens your pain, sends pain or tingling down a leg, or if you notice numbness around the groin or changes in bladder or bowel control. In pregnancy, stop if you feel dizzy lying flat.