Lateral Pelvic Tilt: How to Fix Uneven Hips and (Apparent) Leg Length Discrepancies

If you’ve landed on this post, then you may be someone who has noticed that you have one hip that is raised higher than the other? Or alternatively, that you have one leg longer than the other?

So what’s the cause?

Is it your longer leg that is causing you to have uneven hips, or did you just happen to be born with uneven hips?

These are some things to consider but the most realistic option is that you may have a lateral pelvic tilt.

We aren’t perfectly symmetrical and everyone experiences some asymmetry through how we carry our bodies throughout our lives, however, there can be times where a little too much asymmetry can leave us prone to injury and reduces our physical performance.

The good thing to note is that in most cases a lateral pelvic tilt can be fixed through basic self-massage, stretching, and corrective exercises.

In this article, we’ll take a look into the idea of a lateral pelvic tilt. We’ll explore how this condition develops, how it’s treated, and what you can do to correct it.

What is a Lateral Pelvic Tilt?

As its name suggests, a lateral pelvic tilt (LPT) is a common postural misalignment characterized by the tilting of the pelvis to one side.

Individuals with this condition will appear to have unbalanced hips, with one side sitting lower than the other.

There are several known causes of a lateral pelvic tilt, including scoliosis and leg length discrepancy, but one of the most common culprits of this postural discrepancy is poor posture.

In order to understand how improper posture contributes to a lateral pelvic tilt, it’s important to consider how the pelvis is structured.

The pelvic bone sits at the top of the thigh bones (femurs) and is supported by a network of muscles that help stabilize the hips and allow for a full range of movement of the legs.

These muscles and ligaments include:

  • Adductors
  • Gluteus medius
  • Obliques
  • Quadratus lumborum
  • Tensor fascia lata (TFL)

When a muscle imbalance occurs between these muscles, whether due to injury or overuse, a lateral pelvic tilt may develop.

Specifically, a lateral pelvic tilt is the result of the tightening and shortening of the adductors, gluteus medius, and quadratus lumborum on one side of the body, and the simultaneous weakening and lengthening of the same muscles on the opposite side of the body.

This imbalance causes the hips to raise, or hike, on one side and drop on the other side, hence the term lateral pelvic tilt


Symptoms of a Lateral Pelvic Tilt

Structural Symptoms

Other than one hip being higher than the other, the presence of a lateral pelvic tilt can result in a drastic chain effect which reverberates up and down the body.

Here are a few of the structural symptoms:

– Uneven Hips & Gait

The most obvious symptom of a lateral pelvic tilt is having an uneven walk or gait due to one hip dropping lower than the other.

– Uneven Shoulder Heights

From the image above, you will see how the hip which is higher will usually result in the shoulder on the same side, being lower than the other side.

This can cause someone to believe that they have uneven shoulders, when in fact it could be down to a lateral pelvic tilt.

– Apparent Leg Length Discrepancies

A lateral pelvic tilt is often confused with another condition known as leg length discrepancy (different leg lengths).

Someone with a lateral pelvic tilt may think they have one leg longer than the other, or one leg shorter than the other. However, this is a myth as it is the tilt in the pelvis which makes it feel like the hip that is lower down is longer because the other leg doesn’t reach the ground when you stand.

While in some cases, one leg may actually be longer than the other, most cases of leg length discrepancy are caused by a muscle imbalance.

In fact, it is estimated that fewer than 30 per cent of leg length discrepancy cases can be attributed to anatomical leg length difference (“true” leg length).

The majority of leg length discrepancy cases are considered to be functional – that is, the difference in leg length is due to lifestyle factors such as improper walking, standing, running, or sitting.

The best way to rule out a true leg length difference is to measure both legs. If you do have a true leg length discrepancy, then it is unlikely that these exercises in this post will be of any benefit.

– Internal Rotation of the Leg

You can see from the diagram that the bones of the leg usually rotate internally as a result of a lateral pelvic tilt.

What’s not to be ruled out is that the internal rotation of the leg could also be the cause of the lateral pelvic tilt, rather than the result.

If it is the cause, then it starts all the way down at the foot.

Typically, one foot will be pronated where the ankle is rolled inward, this could be a flat foot or a collapsed arch. When one foot becomes pronated, the shin bones and the femur rotate inward and the hip will drop.

Other Symptoms

While mild to moderate cases of lateral pelvic tilt usually do not produce any noticeable symptoms, severe or longstanding cases of LPT may cause muscle tightness and low back pain.

If left untreated, a lateral pelvic tilt can lead to more serious medical conditions, such as:

  • Disc degenerationResearch suggests that lateral pelvic tilt may cause disc degeneration due to the distortion of the lumbothoracic spine. One study found that individuals with a high degree of pelvic tilt also had a higher incidence of disc degeneration within the L4 to L5 segment of the lumbar spine, regardless of age or gender.
  • Disc herniation – Although not directly correlated to lateral pelvic tilt, disc herniation may occur as a secondary effect of disc degeneration.
  • Sacroiliac joint pain – Lateral pelvic tilt can lead to an asymmetrical positioning of the sacrum in relation to the ilia, or “wings”, of the pelvic girdle. This asymmetry may result in sacroiliac joint pain.

The good news is that lateral pelvic tilt can be corrected if diagnosed early enough.

In later sections, we’ll explore a few treatment options for lateral pelvic tilt, and provide you with a few simple exercises that can be done at home to correct this common postural imbalance at home.


How to Test for a Lateral Pelvic Tilt

The main test to check if you have a lateral pelvic tilt is to stand in front of a mirror and place a finger on either side of your hip bone. If one finger is higher than the other then it’s likely that you do have a lateral pelvic tilt.

Of course, there is the possibility you may not have a lateral pelvic tilt and that you really do have one leg longer than the other.

Although this is rare, you should keep this in mind when testing yourself.

Causes of a Lateral Pelvic Tilt

There are a couple of things that can cause a lateral pelvic tilt:

  • Bad Posture Habits – If you hold your body in the same positions for hours each day, every day, for several months or years, your body’s tissues will adapt to this position. Therefore if you constantly hold your body with one hip hiked up, your body may adapt to that position. We’ll discuss some of these positions later in the post.
  • Sitting Too Much – A lateral pelvic tilt is frequently seen in individuals who practice poor posture when sitting for long periods of time. Prolonged sitting not only places undue stress on the spinal column, but it also changes how the muscles and ligaments of the lower body (specifically, those that support the pelvis) interact. If not corrected, this muscle imbalance can lead to a negative feedback loop of injury, overcompensation, and re-injury of the muscles and ligaments that stabilize and mobilize the pelvis (1).
  • Injuries and Structural issues – If you hurt yourself on one side of your body in the past, then it’s possible you may raise one hip higher than the other to avoid pain in that area. In addition, if you’ve had reconstructive surgery on your leg, one leg may have changed length. In all of these situations, you will want to go and see a doctor just to be safe.
  • Pronated Foot – A flat foot or a collapsed arch on one side will cause the foot to roll inwards. With this inward rolling, the tibia and fibula (muscles of the shin) will internally rotate and the knee will turn inwards. With the inward turn of the knee (knee valgus) the femur also internally rotates and the hip will drop, causing the lateral pelvic tilt.

In the next section we’ll look at some treatment options for a lateral pelvic tilt.


Treatment Options for Lateral Pelvic Tilt

If caught in its early stages, a lateral pelvic tilt is a manageable condition that can usually be corrected with chiropractic care, massage, physical therapy, or an individualized treatment plan consisting all three of these therapies.

Your physician will determine the right course of treatment for you depending on the severity of your condition.

Chiropractic care

Chiropractors take a holistic approach to correcting a lateral pelvic tilt in order to treat pain and restore a full range of motion to the muscles, ligaments, and joints surrounding the pelvis.

A chiropractic treatment plan may include chiropractic adjustment, massage therapy, physical therapy, and stretching.

The goal of chiropractic treatment is to bring the body into better balance without the use of medications or injections.

Physical therapy

Not only can a physical therapist suggest muscle strengthening and stretching exercises that can be done at home to alleviate the discomfort associated with a lateral pelvic tilt, but he or she will also offer advice about managing your condition through lifestyle changes.

The goal of physical therapy is to restore symmetry to the pelvic girdle by strengthening weak and/or elongated muscles while stretching tight, constricted muscles.

Massage

A massage therapist will use a number of manual techniques to relax the muscles that support the pelvis.

Massage therapy also helps improve blood flow in the affected area which, in turn, helps reduce inflammation and alleviate pain.

Among the techniques used by professional massage therapists are deep tissue massage, myofascial release, and Gua Sha – a traditional Chinese therapy involving the scraping of the skin with a massage tool in order to boost circulation.


How to Fix a Lateral Pelvic Tilt Caused by Bad Posture

In this section, we’ll look at a few simple exercises that can be performed at home to correct mild to moderate lateral pelvic tilt.

It should be kept in mind that these exercises are not meant to replace professional medical treatment.

If you’re experiencing severe pain or limited range of movement due to an asymmetrical pelvis, it’s important to consult with your doctor in order to pinpoint the exact cause of your condition and formulate a treatment plan.

Steps to Fix a Lateral Pelvic Tilt Caused by Muscle Imbalances

There are a couple of angles that can be taken to fix a lateral pelvic tilt.

The first is to fix flat feet (if you have them) and the other is to correct any muscle imbalances that may have developed that causes your body to hold onto the lateral pelvic tilt position.

The final step is to address the bad posture that causes the problem in the first place.

1. Fixing Flat Feet or Foot

If you have flat feet then it could be the main cause of your uneven hips.

Fixing flat feet is a problem of its own, and if you have it, your priority should be to fix this rather than the lateral pelvic tilt because the foot is the foundation of the body, and any problem in the feet will affect everything above.

By fixing your flat feet, your shins, knees, thighs and hips should begin to align properly.

In the case of someone with a lateral pelvic tilt, the problem is most likely to stem from a problem with one flat foot rather than having two flat feet.

So this section should be called ‘fixing your flat foot’ rather than ‘feet.’

We already have written a post on how to fix flat feet, so it would be a good idea to read that post and add the exercises on that page to your daily routine.

In the meantime, here is a short summary of what fixing your flat foot may look like.

Step 1. Massage the arch

If you have a flat foot, the arch of that foot could be tight. A simple fix is to roll a massage ball up and down the arch whilst putting pressure on the ball by standing on it.

Step 2. Strengthening the arch

It is possible to strengthen the arch so that the right muscles become strong enough to pull the arch back up.

Popular arch strengthening exercises include:

  • Towel crunches – This is where you place a towel on the floor and then place your affected foot at the bottom edge of the towel. You then scrunch up your toes and try to pull the top of the towel towards you without lifting your foot off the ground. Repeat this motion until the whole towel has been pulled down.
  • Pen Penny – This exercise is probably the best one for arch strengthening. This involves placing a coin under the base of the toe on the affected foot. You would then try to balance on that foot whilst keeping pressure on the penny at the same time.

Both these exercises are explained in more detail on this page. Slight modifications of these exercises are shown in the video above.

Not everyone responds well to exercises, and the arch could remain flat even after a few months of arch strengthening exercises. If this is the case you may have to opt for shoe inserts to help support the arch.

Fixing a flat foot should help the ankle to stop rolling inward and hopefully restore proper alignment in the bones above.

It is not a full proof solution, however, as there are likely to be other muscles imbalances that still exist in the legs, particularly the side with the lower hip.


2. Stretching Out the Tight Side

If you have uneven hips, it is likely that the muscles in the torso of the hiked hip side are short and tight.

If you look at the diagram below, if the muscle that is highlighted red is short and tight, it will pull that side of the pelvis up and towards the rib cage which it is attached to.

This chronic tightness will pull one side of the pelvis up, and at the same time pull the shoulder down.

QuadratuslumborumSo what is this pesky muscle that we need to lengthen?

It is the quadratus lumborum.

We will need to first release any knots that are causing tightness, followed by stretching techniques on the tight side.

If we can begin to create length in the quadratus lumborum, this should help decrease the chronic tightness that pulls the hip up and the shoulder down.

For more information, see our in-depth article on how to stretch the quadratus lumborum effectively.

The quadratus lumborum is quite an easy muscle to stretch once you know where it is. Any stretch which involves creating length between the hip and the shoulder of the same side will work.

One simple yet effective stretch for the quadratus lumborum is one which is a modification of the classic child’s pose.

You can see how to do this stretch, as well as a few other quadratus lumborum stretches in the video below.

An additional fix concerning the quadratus lumborum could be to strengthen the opposing quadratus lumborum which could be too weak.

By strengthening the weak side (the side with the lower hip), the quadratus lumborum may become stronger and pull up the lower hip slightly.

There is a small section on how to strengthen the weak quadratus lumborum on the page mentioned above.


3. Fixing Your Bad Posture Habits

All these corrective exercises and stretches won’t be of any use if you don’t eliminate the times when you intentionally, or unintentionally raise one hip higher than the other.

Your body tissues will adapt to the positions in which you hold them for long periods of time, therefore we want to avoid putting the quadratus lumborum in a shortened position.

You will have to become aware of the times throughout your day when you may hike one hip higher than the other.

Aside from cases involving scoliosis, most instances of lateral pelvic tilt can be avoided by making a few simple lifestyle changes.

Below are a few simple tips and things to consider for preventing a lateral pelvic tilt from developing or worsening.

  • Sleeping on your Side –  If you have a favourite side you like to sleep on, then the hip that is in the air will be in a ‘hiked up’ position throughout the night. To avoid this it would be preferable to try to sleep on your back.
  • Uneven Sitting – There may be times where you tend to sit with one hip higher than the other. Perhaps you may rest your arm on the window when you are driving unknowingly tilting one of your hips? Or maybe when you are using a computer mouse you tend to lean towards it? In any case, try to maintain a neutral level pelvis when sitting.
  • Standing posture – A lot of times people tend to have a favourite side to lean towards when standing. A further example of this could be when people hold heavy objects. A common example could be when a parent is carrying a young child or grocery shopping against their torso.
  • Consider purchasing a kneeling chair – Using a kneeling chair forces the body to maintain a straight spine. Kneeling chairs also help stretch tight hip flexors.
  • Swap your sitting desk for a standing one – Sitting for long periods of time not only causes the hip flexors to contract, but it can also impede blood flow to the muscles of the lower body. If your work requires a significant amount of time at a desk, consider switching to a standing workstation.
  • Use a chair with lumbar support – An office chair with lumbar support will protect the delicate structures of the lower back and promote better posture overall. If your chair doesn’t have a lumbar support, consider using a lumbar support cushion.

If you notice you have a habit of tilting one hip up, then you will need to correct this whenever you find it occurring.

By doing this, it gives you a greater chance of fixing your lateral pelvic tilt.


Other Fixes Worth Considering: The Glute Medius and Adductors

Aside from the three steps mentioned above, there are some additional corrective exercises and stretches that may be worth a closer look if the above fixes do not work.

These additional tips target the glute medius and the adductor muscles.

In particular, on the side where the hip is higher, the glute medius muscle is likely to be weak and the adductors too tight.

Whilst on the lower hip side, the glute medius will be tight and the adductors too weak.

As a general rule, you will want to ensure proper care of these muscles through adequate stretching and strengthening to keep them well balanced.

The following pages on our site may be of help

Seek Professional Help if Necessary

Mild to moderate cases of a lateral pelvic tilt can usually be treated without invasive treatments like medications, injections, or surgery.

You can try to incorporate the above tips into your lifestyle to improve your lateral pelvic tilt and restore a full range of movement to your hips and legs.

However, If you are feeling in any doubt always consult a medical professional before attempting any corrective exercises on your own.

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