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If you’re working ergonomically, constantly pulling your shoulders back and engaging your core, only to find yourself still in a slump, the answer may actually be in your pants.

As it turns out, the position of your pelvis can affect the alignment of your whole body. “And while someone may be trying to correct their posture ‘up top,’ a pelvic tilt is often a piece of the puzzle for upper back and neck issues,” says Judith Meer, PT, DPT, a pelvic rehabilitation specialist and founder of The Pelvic PT.

Below, we’ll dive into how your pelvis influences your posture and some common misalignments to look for. Plus, Dr. Meer shares how you can create a healthy spine from the bottom up.

If you want good spinal posture, align your pelvis first

First, let’s get through some basic anatomy. Your spine has three segments: the cervical (upper) spine, the thoracic (middle) spine, and the lumbar (lower) spine, according to the University of Maryland Medical System (UMMS).

Each part of the spine relies on the strength and stability of the others to function properly. When you look from the side, a “healthy” spine curves in an “S” shape—the upper spine curves inward, the middle curves outward, and the lower curves inward—which helps lessen stress on the vertebrae, per UMMS.

The sacrum, a large bony structure that sort of looks like a shield, connects the lower spine to the pelvis. “The pelvis acts as a foundation for the spine, so its position absolutely affects your posture,” Dr. Meer says. “You’ll notice this, for example, when you curl your tailbone underneath you versus when you stick it out behind you. Both of these ‘tilts’ alter the alignment of the whole spine.”

“While someone may be trying to correct their posture ‘up top,’ a pelvic tilt is often a piece of the puzzle for upper back and neck issues.” —Judith Meer, PT, DPT

Pelvic tilts and your posture

What’s interesting is, having an anterior pelvic tilt (where the pelvis tilts forward) is pretty common. As many as 85 percent of people assigned male at birth (AMAB) and 75 percent of people assigned female at birth (AFAB) have an anterior pelvic tilt without any symptoms.

“An anterior pelvic tilt can create an exaggerated curve in the lower spine, which pushes the belly forward—what we call lumbar lordosis,” Dr. Meer says. “This puts additional stress on the lower back, core, hip flexors, hamstrings, and glutes.”

It becomes more difficult to stand up straight without strong, engaged core muscles supporting you, so other muscle groups will try to compensate in order to hold you up, Dr. Meer says. Specifically, you’d feel it in your upper back, shoulders, and neck. Those overworked muscles become tight and lead to more serious issues, like rounded shoulders and forward head posture.

And while less common, posterior pelvic tilts (where the pelvis tilts backward) still affect many people—6 percent of people AMAB and 4 percent of people AFAB have asymptomatic posterior pelvic tilts.

“A posterior pelvic tilt can flatten the natural curve of your lower spine, which puts more pressure on the discs and ligaments, leading to muscle strain and pain,” Dr. Meer says. “From that, I also see tightness in the glutes and hamstrings, weak and overstretched hip flexors, and less hip flexibility.”

Interestingly, posterior pelvic tilts can also lead to excessive bending of the middle (thoracic) spine and forward head posture, according to a small 2021 study in The Journal of Physical Therapy Science.

In other words, if your pelvis is tilted, you’re probably slouching.

How to tell if your pelvis is tilted

If you think you may have an anterior (forward) tilting pelvis, try this test from the National Academy of Sports Medicine (NASM):

Put a belt around your waist and stand as you normally do while looking at yourself in a mirror from a side-view with a belt around your waist. If the belt buckle is lower than the back of the belt when you look at yourself from the side, you have an anterior pelvic tilt. In a squat, your lower back arches at the bottom of the squat.

If you suspect you have a posterior pelvic tilt, try this exercise from the NASM:

Put a belt around your waist and stand as you normally do while looking at yourself in a mirror from a side-view with a belt around your waist. With a posterior pelvic tilt, your belt buckle will be higher than the back of the belt when viewed from the side so that you can see both at the same time. In a squat, you can see a posterior pelvic tilt if the hips tuck under at the bottom of the range of motion. This is commonly known as a “butt wink.”

Building healthy posture from the pelvis up

“The ‘kinetic chain’ idea basically means that movement or alignment in one part of the body affects all of the others,” Dr. Meer says. “Working on pelvic mobility and strength can help you see improvements throughout the entire kinetic chain.”

According to Dr. Meer, there are a few things to note if you want to build good posture from the ground up: