Lateral pelvic tilt

What is a Lateral pelvic tilt?

It is the asymmetric positioning of the pelvis where:

  • one waist height is higher than the other side. (Hip hike)
  • or similarly… one waist height is lower than the other side. (Hip drop)

 

How do I know if I have it?

a) Whilst standing: (Static)

Instructions:

  • Stand in front of a mirror.
  • Place your hands on the highest point of your waist line.
    • Keep your hands flat to the floor.
  • Compare the level of your hands.

If one side is higher as compared to the other side, then you have a Lateral pelvic tilt.

Note: Look out for a prominent waist crease! This is usually observed on the side of hip hike.

 

b) Whilst moving: (Dynamic)

Trendelenburg sign

Instructions:

  • Stand in front of a mirror.
  • Place your hands on the highest point of your waist line.
  • Stand on one leg for 10 seconds.
  • Perform a single leg squat.
  • Observe for any tilt in the pelvis throughout test.
    • (… Is there a change in waist height?)
  • Compare both sides.

If your pelvis tilts, this may suggest that you have weakness +/- lack of control of the glute medius muscle (see below) on the side of hip hike.

Why is it a bad thing?

A lateral pelvic tilt can lead to a whole range of other postural issues. (see above)

So.. if have you have any issues in your foot/knee/hip/spine/shoulder/neck (… which is pretty much every part of your body!), I would suggest that you check to make sure that you don’t have it!

 

Causes of a Lateral pelvic tilt

a) Muscular imbalances: (Sagittal plane)

A Lateral pelvic tilt can result from an imbalance between the Quadratus Lumborum, Adductors and Glute medius muscle.

Other muscles involved: Obliques, Tensor fascia latae

Summary:

  • The pelvis will HIP HIKE to the side of a weak glute medius, tight quadratus lumborum and tight adductors.
  • The pelvis will HIP DROP to the side of a tight glute medius, weak quadratus lumborum and weak/elongated adductors.

 

b) Sub-optimal habits:

Do you lean on one leg?

Do you sit more on one butt cheek than other other?

Do you always sleep on the same side?

If you do… then you have postural habits that may encourage the tilting of the pelvis!

 

c) Leg length discrepancy

Having one leg that is structurally longer than the other side will result in a lateral pelvic tilt.

The side of the longer leg will generally have the higher hip.

How to measure the length of your legs:

Personally – I do not worry about this unless it is more than 2-3cm.

 

d) Neurological conditions

Any condition that impacts the nerves that supply the control of the pelvic musculature may result in a laterally tilted pelvis.

(The superior gluteal nerve supplies the glute medius)

 

 


How to fix a Lateral pelvic tilt

Image courtesy of Master isolated images at FreeDigitalPhotos.net

 


Note: The following exercises are designed to be safe and gentle. They should not be performed if they are causing you any pain or discomfort.

If in doubt, please contact me on the Facebook page.


 


*** READ THIS ***

I will be explaining these exercises to fix a Right sided pelvic tilt (Right hip hike).

If you have a LEFT sided tilt, then do the opposite side muscle to the side mentioned.


1. Releases

a) Quadratus Lumborum

Instructions

  • Place a massage ball directly on the Quadratus lumborum. (Right side)
  • Apply your body weight on top of the ball.
  • Roll your body over the entire length of the muscle.
  • Aim for 1 minute.

 

 

b) Glute medius/TFL

Instructions:

  • Place a massage ball directly on the Glute medius/Tensor fascia lata. (Left side)
  • Apply your body weight on top of the ball.
  • Roll your body over the entire length of the muscle.
  • Aim for 1 minute.

 

c) Adductors

Instructions:

  • Place a foam roller directly underneath the Adductors. (Right side)
  • Apply the weight of your right leg on top of the foam roller.
  • Make sure to cover the entire length of the muscle.
  • Aim for 1 minute.

 

2. Stretches

a) Quadratus Lumborum/Obliques

Instructions:

  • Start with your feet wide apart with your left foot turned out to the side.
  • With arms outstretched, start to bend all the way to your left side.
  • Reach your upper arm as far to the left as possible.
  • Keep your body in line with your left leg.
    • Do not rotate your body.
  • Keep your legs fairly straight.
  • Aim to feel a stretch on the right side of your body.
  • Hold for 30 seconds.

(Note: Check out this post. It shows 12 different ways to stretch your quadratus lumborum muscle!)

b) Glute medius

Instructions:

  • Assume the position as above with the left leg crossed over the right leg.
  • Sit up tall and arch your back.
  • Pull the left knee up towards your right shoulder.
  • Rotate your torso towards the left knee.
  • Aim to feel a stretch on the outer left hip.
  • Hold for 1 minute.

c) Tensor fascia lata

Instructions:

  • Assume the lunge position with your left leg at the back.
  • Maintain a narrow stance.
    • Keep both of your feet in line with each other.
  • Lunge forwards.
  • Rotate your pelvis backwards.
    • “Tuck your tailbone underneath you”
  • Lean towards your right side.
  • Aim to feel a stretch on the upper side of the left leg.
  • Hold for 1 minute.

 

d) Adductors

Instructions:

  • Perform a side lunge towards the left side.
  • Aim to feel a deep stretch in the inner right thigh region.
  • Hold each stretch for 1 minute.

 

3. Activation exercises

a) Hip hitch (Left side)

Muscle: Quadratus Lumborum

Instructions:

  • Sit tall on a chair.
  • Lift your left buttock off the chair.
  • Hold this position for 3 seconds.
  • Aim to feel your left lower back muscles activate.
  • Repeat 10 times.

 

b) Leg lift (Right side)

Muscle: Glute medius/TFL

Instructions:

  • Lie on your left side with your upper leg straight. (see above)
  • Lift your right leg
  • Keep your pelvis completely still.
    • Only your leg should be moving.
  • Aim to feel your right hip muscle activating.
  • Hold the top position for 3-5 seconds.
  • Repeat 10 times.
  • Progression: Apply a resistance band between the ankles.

 

c) Leg lift (Left side)

Muscle: Adductors

Instructions:

  • Lie on your left side with your upper leg bent forward and bottom leg straight. (see above)
  • Lift your left leg up towards the ceiling.
  • Keep your pelvis completely still.
    • Only your leg should be moving.
  • Aim to feel your left inner thigh activate.
  • Hold the top position for 3-5 seconds.
  • Repeat 10 times.
  • Progression: Apply a weight to the left ankle.

 

4. Strengthening exercises


The aim of the following exercises is to get all of the involved muscles to work together to achieve a more neutral pelvis.


 

a) 90/90 Hip shift

Instructions:

  • Lie on the floor.
  • Place your feet on the wall with your hips and knees bent at 90 degrees.
  • Dig your feels into the wall and lift your tail bone off the floor.
    • Keep your back flat on the ground.
  • Without moving your feet:
    • push out your right knee forward
    • pull in your left knee towards you.
  • Feel then tension in your left inner thigh and right outer thigh.
  • Hold for 10-15 seconds.
  • Repeat 3 times.
  • Progression: Hold for a longer period.

b) Knee to Knee

Instructions:

  • Lie on  your left side with both knees bent.
  • Lift up your right knee.
  • Whilst keeping this position, lift up your left knee towards right knee.
  • Hold for 5-10 seconds.
  • Repeat 10 times.
  • Progression: Hold for a longer period.

c) Side wall push

Instructions:

  • Lift your left hip to ~90 degrees and place the side of that leg against a wall. (see position above)
  • Bend your planted leg to ~10 degrees.
  • Push the lifted leg into the wall.
  • Aim to feel the the side of your right hip engage.
  • Hold this position for 5-10 seconds.
  • Repeat 10 times.
  • Progression: Hold for a longer period.

c) Hip hitch (Standing)

Instructions:

  • Stand sideways with your right leg on the edge of a step.
  • Keep your legs fairly straight throughout the exercise.
  • Movement:
    • Start: Drop your left leg as low as possible.
    • Finish: Lift your left hip as high as possible.
  • Repeat 20 times.
  • Progression: Go slower!

d) Crab walk

Instructions:

  • Set up a resistance band as shown above.
  • Pull the band with both of your arms to increase tension.
  • Proceed to take ~1cm side steps with each leg over a 1 metre distance.
  • Keep your pelvis level through the exercise.
  • Aim to feel the side of your hips activating.
  • Continue for 1 minute.
  • Progression: Use more resistance in the band.

e) Single leg tap

Instructions:

  • Place your hands on your waist to make sure your pelvis is level.
  • Stand on your right leg
    • Keep it bent at ~15 degrees.
    • Maintain your balance!
  • Whilst keeping your pelvis level, proceed to reach and gently tap your left leg on the floor as far as you can.
    • Cover every direction. (Front/back/side/diagonal)
    • Imagine you’re patting an ant’s head with your foot. Be gentle!
  • Continue for 1 minute.
  • Progression: Reach further and/or  Tap your foot softer.

 

f) Step down/up

Instructions:

  • Stand on your right leg on the edge of a step.
  • Maintain a level pelvis throughout the exercise.
  • Slowly lower your left leg down towards the floor.
  • Do not touch the ground.
    • Let it hover ~1cm above the ground.
  • Return to the starting positon.
  • Repeat 10 times.
  • Progression: Go slower!

5. Improve your function

It is important to practise maintaining a level pelvis as you go throughout your normal movement throughout the day.

 

Sitting:

Distribute your weight evenly between both buttocks. Do not lean to one side!

For more information: How to position your pelvis properly.

 

Standing:

Distribute your weight evenly between both feet. Do not lean to one side!

If you are unsure, try standing on 2 scales (1 for each leg).  Both readings should be the same.

 

A simple way you can monitor your pelvis position is by placing your hands on your hips.

Pay particular attention to the following:

  • Walking
  • Stepping up/down stairs
  • Lunging
  • Squatting

 

6. Fixing bad habits

“So… I just have to do exercises, and I’ll be all fixed?”

No!

In addition to exercises, it is essential that you address the following bad habits that may be predisposing you to have a lateral pelvic tilt in the first place.

Common habits associated:

  • Favoring one leg when standing
  • Leaning to one side whilst sitting/driving
  • Sleeping on one side
    • (Tip: Try placing a small rolled up towel under the waist crease.)
  • Holding baby on side of hip

 


Please leave me a comment down below.

I would love to hear from you!

 

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

View all posts by

24 thoughts on “Lateral pelvic tilt

  1. Hi Conner! Thanks for this post. I have right hip hike, and I have had it for years!! When I was younger I use to do leg raises a lot, and I overworked the right side more than I did the left side which resulted in my imbalance. It took me a while to actually realize. I am in school and try to do stretches everyday to correct it, but sometimes my schedule is so busy I do not always have time.
    Would a SI Joint Belt be something I can substitute the days I am busy instead of working out?
    Also about how long does alignment actually take?

    1. Hi Kris,

      Not sure who Conner is, but I’ll assume you are asking me a question!

      SIJ belt is good for people with SIJ instability (ie. lax ligaments, poor muscular strength/control)

      It does not directly address a lateral pelvic tilt.

      Hope this helps.

      Mark

  2. Hey Mark,

    Unbelievable helpful thank you so much! I had one query, my left hip is higher, my adductors and QL on the left side feel very tight as you said, but my gluteus medius on the left side feels very tight also. So I’m hesitant about stretching my right gluteus medius which feels very loose and elongated already, I’m really confused and would sincerely appreciate your thoughts. Thank you!

  3. Hi Mark,
    Would you recommend stretching the weaker side. For example after doing the strengthening exercises for the left adductor, the adductor feels tight the next day. Would you stretch it the or not? Thanks

  4. I’ve seen chiropractors and physical therapists who have done nothing but measure my legs and turn me away when I’ve told them about this problem! Always leaning to my left, and it’s prevented me from squatting for over a year! I’ve spent countless hours researching for solutions, but this is the first time I’ve seen something so well articulated and USEFUL! I’m trying to go to bed but this post got me so pumped for the gym tomorrow because I feel as though there is some hope. Thank you!!

  5. Hi, Mark…is it true you can not have a lateral pelvic tilt/rotation…without having an anterior pelvic tilt or hyperlordosis? (Meaning can a leg really drop without being forward) …I ask because I have been treated by 4 physical therapist with fruitless results…they all seemed to have missed or ignored that I had a pretty significant lateral pelvic tilt with a posture that very much resembles the skeleton above only that I also have a leaning head that moves away from low shoulder as well…consequently you can imagine what pulling on bands trying to strengthen muscles etc., was like when you look like the skeleton above…needless to say it never helped no matter how faithful I was at the exercises and trying to practice great posture..many times making things tighter…so on to question…I would presume based on the looks of the above skeleton one would want to correct this posture before any others…is this correct? At what point do you start the others? I mean until the shoulders are even and the head is sitting in the right spot how could one retract head or pull on bands For shoulders? And…at what point would you start strengthening same muscles for both sides or does this ever happen? Your help is very much appreciated….HANDS DOWN BEST WEBSITE AND BEST HELP I HAVE RECEIVED…so Thank you so much for what you do…I have spent thousands and seen plenty of professionals and didn’t get 1/4 the help I have gotten visiting your site…been thru a lot on this issue…you wouldn’t believe….Thank you!

    1. Hey Crystal,

      You can have a lateral pelvic tilt without APT/hyperlordosis.

      In terms of your question about where to start… You can start anywhere really, however, you will gain more if your pelvis/spine and head are all in the correct alignment. Otherwise – you will be fixing your posture in relation to a misaligned foundation.

      Mark

  6. Very clear and gives the guidelines to treat the imbalances. How do you convince the patients about their daily habits of years being the culprit? What type of functional limitation the patient present with? QL pain, coccydynia, PF pain, flat feet. The patient is always interested in getting the immediate functional component sorted. Once that done the rehabilitation goes for a toss.

    1. Hi Utpal,

      Convincing a patient to do the exercises is half the battle.

      Changing bad habits can take a long time to break! Some studies show that it takes more than 66 days to start to change a formed habit.

      The main thing that I focus on is their meaningful task. As in – what activity is it that they can’t do because of this postural issue.

      Mark

  7. In your example, you’re showing a right sided hip hike, and a right sided dropped shoulder.

    – I am certain I have a left sided dropped shoulder
    – I feel like I have hip-hike on my right side

    Is that possible?

    I feel a pretty big side-to-side imbalance, but have been compensating so long I have a hard time determining which muscles on which sides

    Pain presenting as

    Left side: serratus anterior region (most significant)

    Right side: Tight traps / chest, hip and back of knee

    Any thoughts? Been following your site and working through for several months. Been helping, but any other tips would be much appreciated.

    1. Hey Dan,

      Yes – you can have a Right hip hike AND have a lower left shoulder.

      This will probably mean you have some sort of over compensatory pattern which may involve your torso being rotated/tilted.

      Did you want to post a picture of your posture?

      Mark

      1. Took a few. I’m at my computer all day (use a standing desk), so tried to approximate that posture in some.

        [IMG]http://i67.tinypic.com/n3q2wo.png[/IMG]

        [IMG]http://i65.tinypic.com/r0s7t2.jpg[/IMG]

        1. Looks like left shoulder is higher to me…the right shoulder looks like the one that is dropped…and head/neck have had to move to left to avoid resting on an angle.

        2. Hey Dan,

          It’s a bit hard to see (and it’s slightly diff in each photo) but it looks like your tilting towards the right around the upper lumbar region, however, it also seems like your right shoulder is more protracted.

          In this position, it is forcing your left serratus anterior and right upper trap/rhomboids to work hard to hold your arms up. (esp. if you are on the computer all day.

          I would stretch the right quadratus lumborum and work on the rounded shoulders.

          Mark

          1. Thank you! I will continue working with the tips you’ve provided. I have made a number of lifestyle type adjustments and have been working at it for about 6-8 months now. Understand fixing these learned issues is a long process!

            I have tried some PT, but find that most focus on treating the symptoms as opposed to working towards a fix. It’s a shot in the dark, but anyone in the Tampa, FL area you recommend for some personalized help/training?

            Thanks again,

            Dan

          2. Hey Dan,

            Treating the symptoms in the initial stages is fine to do, but eventually, the root cause of your issue needs to be addressed!

            I unfortunately do not know anyone in Tampa 🙁

            Mark

Leave a Reply

Your email address will not be published. Required fields are marked *