Anatomy and biomechanics relevant to sports massage

Sports Massage

Working with athletes or active clients


My personal reviews of products and services


Research articles regarding massage therapy and sports massage

Orthopedic Assessment

Tips for finding the root cause of the injury

Home » Anatomy, Orthopedic Assessment

Anterior Pelvic Tilt and ITB Pain

Submitted by on February 8, 2009 – 6:13 pm2 Comments

When working with clients with lateral knee pain or tenderness along the iliotibial band (ITB), it is important to address not only the tensor fascia latae, but also the muscles that promote an anterior pelvic tilt posture.  The reasoning is clear when you look at the associated anatomy and effect of an anterior pelvic tilt (APT).
The ITB originates on the lateral iliac crest and inserts on the proximal lateral tibia as well as blends into the iliopatellar band.  The tensor fascia latae muscle originates on the anterior superior iliac spine (ASIS) and blends into the ITB just anterior to the greater trochanter.  Posteriorly, the gluteus maximus originates along the posterior iliac crest and sacrum (yes, I’m simplifying this a bit) and 80% of the gluteus maximus blends into the ITB just inferior to the greater trochanter.

When the hip flexors, piriformis and QL are short or tight, they contribute to an anterior pelvic tilt (APT) that causes the sacrum to rise superiorly, increasing the distance between the origin and insertion of the gluteus maximus, placing the gluteus maximus in a lengthened posistion.

Try this yourself:  Stand up, and place your hands over your glutes so your fingers on your greater trochanter and thumbs over the lateral border of the sacrum.  Now, tilt your pelvis anteriorly.  You will notice the distance between your fingers and thumbs has increased.

When the gluteus maximus is in an elongated position, the tension can be transmitted inferiorly to its insertion on the ITB.  Thus, an APT can be a major factor when a client complains of a painful ITB.

Many therapists mistakenly work only the area at which the client experiences the pain and attempt to stretch the ITB.  But, this structure is fascia and does not respond well to stretching.  Some therapists extend their protocols to the muscles attaching to the injured tissue, in this case the TFL and gluteus maximus.  Unfortunately, the gluteus maximus is too often in a long position and additional stretching will not help.  To properly address an ITB dysfunction, you must look at the balance of the pelvis.

In my practice, I find good success releasing the TFL, iliopsoas, rectus femoris, piriformis, and quadratus lumborum with myofascial techniques before elongating them with Active Isolated Stretching (AIS) or Muscle Energy Techniques (MET).  In addition, I will perform myofascial work on the lateral thigh to release any adhesions between the ITB and vastus lateralis as well as the patellar retinaculum.



  • So if we release the muscles you mentioned above (TFL, Ilio etc) will that essentially bring the pelvis back in balance & then Maximus won’t be so elongated and/or would you also suggest strengthening exercises for maximus?

    I am also interested in finding a good thera-band strengthening exercise that targets Medius ~ your protocols from class yesterday mention this but I forgot to ask you about it. Thanks, Heidi

  • admin says:

    Hi Heidi,

    Yes, releasing the hip flexors is the primary step in reducing an anterior tilt. Strengthening gluteus maximus (and medius) will help the pelvis regain balance & hopefully maintain the corrected position for a longer period of time. In athletes, keeping gluteus maximus properly strengthened and activated will also help reduce hamstring and hip issues.
    Thanks again for attending my course!