Lateral pelvic tilt

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 lateral 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)
  • Elongate your right leg by pushing your foot away from you.
  • 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!

g) Side plank with upper leg lift

 

Instructions:

  • Assume the side plank position with the left side down.
  • Ensure that you keep your left lower torso muscles engaged.
    • Think about using the muscles that would crunch your body towards the left.
  • Elongate your right leg by pushing it away from you.
    • (This should pull the right side of the pelvis towards your feet)
  • Whilst keeping your pelvis still, lift up your right leg.
    • Make sure you feel your right glute muscle contract.
  • Hold this position for as long as you can maintain good technique.

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 for my lateral pelvic tilt, 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.

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202 thoughts on “Lateral pelvic tilt

  1. Hi Mark, I have pelvic tilt (left side hitched) and suffer significant pain in my hip just above the illiac crest and at the ASIS.
    I have beem seeing an osteopath who feels that his work isnt having any positive effect and has effectively indicated I will nees to just manage the pain.
    I am training for a marathon and the only time it doesnt hurt is when I am running or walking. Soon after stopping I get the pain.
    I have been rolling the surrounding area (glutes, legs, lumbar) but this causes increase in pain through my hip. Stretching also causes a significant increae in pain.
    Am not sure whether i should continue to roll/stretch and use NSADs to manage the pain in the hope that the continued stretching helps improve things?
    Any advice?

    1. Hi Becky,

      Sounds like there is some inflammation/tendon issue going on there. When the area is warm and moving, it will feel better. But when you are stationary and cool down, the pain usually will increase.

      Can you draw on a diagram where you are experiencing the pain.

      And also – did the osteo look at your running technique or single leg balance?

      Mark

  2. Hello Mark. Thank you very much for all of this detailed information for lateral pelvic tilt. I have been doing most of these every other day for a little over two weeks now but pain has developed in the right hip area (my right hip is where the hike is located) particularly in the QL and glute medius. It seems to get worse after I do the stretches & exercise. I do want to mention that I have injured this area several times during squats and deadlifts at the gym. Should I wait for several weeks for the area to heal?

    Thanks again for all the time you spend writing up these guides and responding to every question and comment!

    1. Hi Cody,

      Looks like you are engaging those muscles. You want to feel your right glute med fire off for addressing a right hip hike. Be careful not compensate with the Right QL though!

      Perhaps let the pain subside for now, and go more gentle with the exercises. You may just have to let the body get used to the exercises.

      Mark

      1. Thanks for the fast reply! I iced it several times yesterday and took an NSAID and it feels better today. I will try the gentler exercises the next time I do the routine. I did want to ask how frequently do you recommend doing the exercises? Also, should I do them in the order you listed? Finally, do you recommend doing all of the listed exercise in one sitting?

        1. Hi Cody,

          You can do them 3-4 times a week. But this really depends how much you push yourself.

          You don’t have to do them in order. And you don’t need to do in one sitting.

          Mark

  3. Hey mark
    I have sacroiliac dysfuntion ,The left hip is higher than the right hip by 2 mm. Do the lateral pelvic tilt exercises first or do pelvic rotation exercises or work at the same time.
    I have pain in the right knee ,ankle and sciatic nerve in the left side( piriformis syndrome)
    How to send you detailed x- ray images.
    Thank you.

  4. Hi Mark. I have a higher right hip so Could I do these exercises that you told us just in the one side or in the both? Another question is I’ve just knew about labrum crush in the left side of my hip.. could i do more carefully in these exercises? Thanks.

    1. Hi Phelipe,

      You want to do both sides.

      You can still do these exercises with issues in your left hip, but just be weary of any pain/discomfort around the left hip.

      Mark

  5. Hi Mark
    It is about 5-6 months that i have noticed that at the pelvic region,my left side seems more laterally sposted than my right side.I have been frequenting gym maybe 10-12 months before noticing this problem ,and I never thought actually that it could be due to that.I wanted to ask ,is it a problem,and is it necessary for a surgery on this cases or some exercises will help as well ?
    p.s I took some photos but i’m not finding a way how to upload them

  6. Hi mark,
    I have noticed that my right hip is higher than my left and also my right shoulder is higher. I had a shoulder reconstruction on my right shoulder six months ago and also had two hip operation 9 months ago. I have noticed I have been getting a lot of headaches and nerve pain on my left side, and often feel great tension and the left side with the lowered hip. Could this be of result of compensation from my injured shoulder which was torn for two years, as I feel the nerve pain came from that period on.

    1. Hey Nicholas,

      In the absence of any other injuries, it sounds like it may be due to compensatory changes from your shoulder recon.

      I would prioritise your nerve pain first though!

      Mark

  7. Hey Mark,
    About six years ago I had my tenth rib on the right side completely tear loose in the front where it connects to the rib above it at the end. So for six years I slept on my right side and drove leaning to the left and stood with my left hip up. Anyways, about nine months ago I got 2 and a half inches of that rib cut out to fix the problem because I have muscle imbalances everywhere now especially laterally tilted hips with the left one being the high one. Question…why does everyone say release the lower hip glute med….It is tight for sure but my problem is the left high side all the glute muscles are super tight and yes probably very weak but they are constantly flexed because of the high hip and when I exercise them it makes it feel even tighter…should I just do more release time? And as the muscle strengthens will it loosen up? thanks

    1. Hi Jared,

      You release the glute medius (hip abductor) on the LOWER side as that hip is in a position of HIP ABDUCTION.

      You can still feel tightness in your glute med in your HIGHER side, but this is likely a feeling of tension of an overworking elongated muscle. (feeling of tightness does not mean that the muscle is tight)

      Strengthening this higher side will help bring your pelvis back to a more neutral state and causing this muscle to work more efficiently.

      Mark

  8. Hello! I am so grateful to have found your guide to fixing the lateral pelvic tilt. I’ve gone to so many doctors hoping to find a way to fix my hip and everyone has told me , nope you’re going to stay like this forever sorry. I have a pretty bad right hip hike that visually really stands out – clothes don’t fit properly,finding a pair of pants that fit right is almost impossible unless they’re baggy. Being just 18 that’s kind of a big concern. The hike was most likely caused by bad posture habits- all which I’ve corrected as of now.

    Anyway, my question is, with doing these exercises 2-3 times a week or even daily, is there a probability for the hip hike to completely go away or at least diminish in appearance?

    Thank you so, so much!

  9. Hi Mark,

    I apologize if you have already addressed this but do these exercises help with rib pain on the right/hip hiked side?

  10. Hey Mark,

    I’ve been suffering from lower back pain (predominantly on the right side) for close to 2 years, the severity has varied through this period, including pain in the glutes and nerve pain when straighten my leg in a seated position.

    I believe the initial cause was during a bent over row, i ‘released’ my core mid rep and felt a muscle pull in my back on the right side.

    I’ve seen multiple physios during the first year of my injury who all stated my core is weak and that I needed to work on the inner core.
    I just had a quick assessment from a massage therapist today and he stated that my left hip is hitched up.

    I will try the above routines but I was wondering if I can continue training as per normal? I’ve substituted barbell squats to goblet squats and I do not dead lift. As a matter of fact, training my legs is what got rid of the pain in my glutes.

    Thanks,

    Ray

    1. Hey Ray,

      You can continue your normal training in conjunction with your rehab work.

      Work your rehab work as hard as your normal training.

      Mark

  11. Hey Mark, can you plz help, my left hip and shoulder appear to be higher when standing in neutral and my right hip hip appears to be lower with a lack of glute mass. When I lie down with my back against the ground the left leg appears slightly longer. Which hip would be in anterior vs. posterior position.

    Thanks,
    Daniel

  12. Just wanted to say thank you! I am very grateful you have taken the time to provide all this information here to help people, it has helped me so much. These exercises and stretches aligned my pelvis quickly and helped me strenghthen imbalances.

    It means a lot to me because I’m poor and before I found your website, I went to a bunch of bad physiotherapists, chiropractors and massage therapists but they all ripped me off and never fixed my posture, they just wanted me to keep coming back to give them more money. I think it’s honourable that you care so much about helping people.

    Just had to say your website is a wealth of information and it’s helped me a lot, will definitely recommend it to everyone I know.

    1. Hi Sabrina,

      I love this comment 🙂

      Thank you so much for your kind words and I am ecstatic to hear that the blog has helped you out.

      Mark

  13. Hey Mark,
    Thank you so much for this awesome post! It is my understanding that the short leg will generally have issues with the knee (internal rotation of the femur, knee valgus) and pronation of the foot. Wouldn’t the short leg therefore benefit from strengthening the external rotators? This seems paradoxical, as the gluteus medius – which is involved in the external rotation (correct?) – on the short side is already short and should be stretched and not strengthened. Anyway, even if the gluteus medius is strong enough, the other (main) external rotators of the hip might still be weak, right?
    I have pain in my left knee only and self-diagnosed lateral (and anterior) pelvic tilt. While the above exercises are surely beneficial, the don’t seem to correct my internal rotation of the left leg. What do you think?
    Thank you very much for your answer,
    Arno

    1. Hi Arno,

      If by short leg you mean having a structurally shorter leg bone, then you may tend to stand on that leg in hip internal rotation and with a hip hitch.

      In this case, you would want to target hip external rotation as well as there is likely a degree of pelvis rotation.

      Mark

  14. Hi Mark,
    At 28 yrs old, RN myself. I have been battling with a lateral and rotated pelvis for 2 yrs. Been to over two dozens of chiropractors, physio’s, etc with no results. When standing neutral my left ASIS is higher, rotated pelvis/torso to the left and my left shoulder is higher. When lying flat on my back my left foot appears longer by a cm. I also developed a flat foot on my right side (with knee pain) and I appear to have a loss of glute mass on my right side. I can send you a digital standing xray if you’d like. Pretty much from knee to neck = pain everywhere.
    In my case is it possible to have twisted hips (anterior/posterior rotation) if so which one is which, or would this be just an up-slip?
    If it’s an up-slip again which side, when in supine a chiro told me that I actually have a right up-slip not left which only confused me more?
    Being that my left ASIS is higher when standing in neutral I tried doing the following exercises above based on a left sided hip hike but it felt odd, my left glute and TFL are already tense, strengthening them just made it worse and I feel like my right glute is actually weaker. Finally which would you tackle first rotation or lateral tilt?
    Sorry for so many questions just really sick of dealing with this. Thank you so much, looking forward to your advice!!!
    Daniel.

    1. Hi Daniel,

      Wow – 2 dozen practitioners. That’s a lot!

      It’s hard to know for sure but based on what you have described, it sounds like a left rotated pelvis (left posterior/right anterior).

      This pelvis position falls in line with the symptoms that you have described.

      With the diagnosis of an upslip, was there a traumatic event that caused it?

      Also – which side is your hip hike on?

      You can attach your scans in the comments section if you would like and I’ll have a look.

      Mark

  15. Hi Mark, my elderly mother (81) recently had hip surgery (screw fixation) and I noticed that she now has lateral pelvic tilt because of the lack of use of her weak leg (6 weeks non-weight bearing initially) while recovering. What kinds of simple exercises she should be doing after having your leg operated on. She’s not in pain anymore, but she still can’t balance on one operated leg.

    1. Hi John,

      I would start on Hydrotherapy to practice walking, weight bearing exercises, balance etc.

      As this gets better, progress to land based exercises. (slow marching on the spot whilst supported, side steps, balance etc)

      The focus should be getting as much weight on to that operated leg so that the muscles will adapt and get stronger.

  16. Hi mark! I just wanted to ask does a lateral pelvic tilt means that when sitting, you could observe that my knees are uneven? My left leg is longer than the right. I have scoliosis by the way. And i cant raise my left leg higher than 30 degrees without getting any pain

    1. Hi Izza,

      This sounds more like a pelvic rotation.

      For example – if the left knee appears longer, it may suggest that your pelvis is rotated to the right.

      For more info: Check out this post.

      Mark

  17. Hi Mark,

    Thanks a lot for this post. I’m going to follow it to see if it helps with my imbalances. I have one question. I’ve noticed that the pictures of the exercises and the directions of the exercise on which side to work on don’t match on some of the exercises.

    For example, for Glute medius/TFL, the directions say to work on the left side with a massage ball but in the picture it looks like you’re working on the right side with a foam roller. Do we follow the side the directions tell us to work on or follow the pictures? Same for Adductors. The pictures look like you’re lunging to the right side but the directions say to lunch to the left side. Do we follow the written directions or the pictures?

    Also, do you have any posts on the imbalances of the muscles around the thoracic spine? It’s causing all sort of pain in my thoracic region as well.

    Again, thanks a lot for this post. I’ve been to doctors, orthopedists, chiropractors, physical therapists and I think this blog post may be the answer I’ve been looking for.

    1. Hey Chris,

      Thanks for pointing this out. I will need to fix it.

      Follow the written instructions 🙂

      I don’t have a specific post on that as of yet, but I will definitely have one up in the not too distant future.

      Mark

  18. Hi mark, when I first stand up I sort of lean to the right a little and have a left hip hike but when I straighten myself up I have a right hip hike so I don’t know if I have a left or right pelvic tilt?

      1. Hi Mark

        Thanks for such great information which is the best I’ve seen!

        My default position is left hip up right down and right hip rotated forward
        Get counter rotation which is high right shoulder

        Can you confirm stretching / strengthening routine and which side I should be focusing on please?
        Is it strange I feel my right q l is tighter?

        With thanks

        1. Hey John,

          You can work on either one really. I would tackle rotation first.

          You might be referring to the right erector spinae group (see below)

          If you have a left rotated pelvis with a high right shoulder, it will be common for the muscle to be tight. (Note the close proximity to QL)

          Mark

  19. I just wanted to say you have an awesome page! I have suffered from upper and lower crossed syndrome for years. I have a lateral and anterior pelvic tilt. I’ve scoured the internet for useful information on correcting the issues and your page is by far the most useful I’ve found. I wish I had found this years ago.

    Thanks for providing this incredible resource. I’ll be sure to send you a donation after my next paycheck.

  20. Hi Mark,

    I’m an avid power lifter and have been training for the past 5 years. Throughout college and to where I am now I can certainly say that training and recovery has become increasingly more uncomfortable due to lateral pelvic tilt (right hip hike, left hip drop). Like all college students I have spent many hours sitting in bad positions which have resulted in the pain and discomfort I’m having now and have unwisely trained through over the years. My question to you is what degree should I train the squat, dead-lift, bench press, overhead press, and chin-up while trying to resolve the issue with these stretches and exercises? Should I not do these movements at all or just use light weight? I want to do whatever will be most conducive for healing. Thank for this great post, I feel like there’s hope for me!

    Hunter

    1. Hi Hunter,

      This sounds like what happened to me 🙂

      I addressed it by focusing on single leg work whilst emphasizing neutral pelvis. You will need to go lighter.

      MArk

  21. Hi Mark,
    The activation exercise “Hip Hitch” – what is that supposed to look like? Do I rest one foot on the chair’s foot rest or do I allow both legs to dangle? Do I lean slightly to one side or do I lean slightly forwards? Is it ok if I feel the activation on the adductor of the leg/bum cheek I’m lifting?

    1. Hi Deb,

      I’m glad you pointed this out for me. I forgot to add a picture! OOPS.

      You want to sit TALL on the edge of the chair with your hands on the side of the chair for support.
      SHIFT all of your body weight onto your RIGHT butt cheek and foot as you TILT up the left side of the pelvis.
      (You can lift your left leg if you want)
      Try to remain as upright as possible without leaning excessively.
      Aim to feel the contraction in your right butt and left lower back region.

      Mark

  22. Can I do something for the shoulder drop? I feel that my right shoulder/shoulder blade is more unstable than my left. Like a weak muscle or something? Can you recommend anything?

    1. Hey Sam,

      If your shoulder drop is a direct result of lateral pelvic tilt, then fixing that pelvis position will help with it.

      If you feel unstable, you might need to consider strengthening the right shoulder in full range of motion (with emphasis on the ranges you feel weakest in).

      The end goal would be strong whilst placing your body weight on top of your shoulder.

      Mark

  23. Why do you recommend placing a rolled up towel under the back crease when sleeping on your side? I’m curious what that helps to do? Wouldn’t that support the shortened position?

    1. Hey Todd,

      When you lie on your side, it is more likely that the side on the TOP will get too short.

      By placing the pillow in the waist crease on the BOTTOM, it will help keep more of a neutral spine.

      (The pillow should not be so thick that it achieves the opposite)

      Mark

  24. Hi there,
    There are lots of stretches/exercises suggested. Do you have a recommendation about how regularly to do them? Every day? Every second day? Pre/post exercise? Do them all, or mix them up with a couple of different ones each day?
    Thanks heaps.

    1. Hi David,

      You can start off 2-3/week and see how you go from there.

      Ideally – I would shoot for as many times per week as you can once you are familiar with the exercises.

      Mark

  25. Hi, So last week I just had injured myself and I am a collegiate volleyball player. I jumped up and reached with my right hand and now my right hip is higher and I am leaning towards my left side actually. I also am experiencing pain in my right leg (on the side to be exact) and it can get extremely painful. I’m taking muscle relaxers and ibuprofen which seem to do good. I went to a doctor 3 days ago and he said it should be gone by the end of the week. I still have my right hip higher than my left and still pain. I have a past i jury of my lower back which cause sciatica and it went away. Now I am dealing with my hip, should I stretch it out? Stretching seems to make it hurt even more. My lower back does not hurt at all and I’m pretty good about stretchjng anyways and working out often. do you think it is just a muscle strained ?

    1. Hey Frank,

      If you just recently injured yourself, there may be too much inflammation in the area. This may make certain exercises too painful to do.

      If you developed a right lateral pelvic tilt only AFTER your recent injury, I would wait til the pain has subsided with gentle Range of motion exercises for the hip/lumbar spine, and see how it goes from there.

      Mark

      1. Awesome. I keep pushing myself to stretch out and it causes some pain but you’re right, I need to let the inflamed settle down haha. With inflammation going down how long till my hip goes back to normal? I can’t do even walk for 15 minutes or do something without feeling pain in leg. I played sports all my life but i’m unfamiliar with huge injuries like this. so it worries me some.

        1. Hey Frank,

          As long as you are taking some anti-inflammatory (at adequate dosage), doing pain-free gentle range of motion exercises and not exacerbating it on a daily basis, the inflammation should reduce within the week or so.

          Mark

  26. Hi Mark,
    your website was the first i discovered where i felt a breakthrough of insight to my issues.
    so thanks – and keep up the great work – i’m sure it’s helping alot of people suffering.

    Brief description of problems:
    For about 5 years now – tensions down right side. Achilles Tendonitis, Iliotibial Band symptoms, calf muscle unusally tensing up after little effort. Right Glut, hamstring and quad pains – left groin pain, left lower stomach tension. right lower rib pain. Winged scapula and shoulder pain on right side, lower right shoulder, left arm not rotating correctly about shoulder height, right neck pain… you get the picture.

    I’ve identifed – my left foot is flatter, right hip hike, left leg ‘seems’ shorter (3-5mm). I’m unsure which direction my pelvis is rotated – i’m speculating to the right.

    I believe there is some structural aspect which has always been there, and functionaly i recognise the signals now over the years. Which i had put down to training injuries naively and kept hammering.

    I’m 46 now and up until this point was a moderately competative Triathlete. 4 ironaman competitions being the highest level.. This has been tough – but i’m adjusted now to the idea of Postural Restoration – and the athletic competitor has been buried.

    I’ve not had good progess with the medical side of things. Lumbar tomographioe – slight initial Spondylose in LWK2 & 3, manula therapies – seem to be trying to treat symptoms – but no real improvement. I got a Spinal 3D analysis done with DIERS – are you familiar with this device?
    http://diers.eu/en/products/
    But the Orthapedic doctor only suggested a heel raise of 5mm in insoles.

    The Pelvic issues have caused a slight Scoliosis and rotation through the thoracic.

    So my question to you:
    a) What muscle imbalances would be key to work on?
    Intuatively i would stretch my right glute and left abbductor – as that is where the tension and pain is. But with Right hip hike you article indicates inner right abbductor and left hip/glut…
    Can you confirm and maybe explain why the tension is e.g. felt in left abdutor groin – but should be stretching right.
    b) Is there another way to check which direction the pelvic rotation. From the 4 tests – in your article i got no strong indication – and a contradiction. I assume right rotating – how can i be sure?
    c) How to address the Scoliosis? I believe my issue is pathological scoliosis, due to unstable base of spine and not the non-pathological curve form which would be more Schroth method, and a breathing treatment.

    So for my clarity – based on a right hip hike – which side do i need to activate (left or right) of the following – and would/could the pelvic rotation direction contradict it?
    – ipsilateral hamstrings
    – ischiocondylar adductor
    contralateral gluteus maximus

    Sorry for the long comment..
    Ican hit you up on Facebook PM if you prefer..

    Cheers
    Kevin

  27. Hi Mark I’ve been in hospital with lower back pain and I’ve just been diagnosed with lateral pelvic tilt my right hip is higher than my left and I have a really tight hip and QL in my left side is this normal as I thought it would be the side which is higher where I would get the pain!?!
    Thanks

    Just about to start these exercises and stretches

    1. Hi Tony,

      If anything – I find people get more pain on the opposite side of tightness!

      Eg. With tight chest muscles, people feel pain in their upper trap muscle.

      Mark

  28. Hello mark, do you have a youtube channel? This is a really good information. It will be much better if you can explain and demonstrate it via YouTube.

  29. Hello Mark,

    For someone with lateral pelvic tilt and pelvic rotation, is there anywhere that I can place kiniseology tape that will help reduce the pelvic tilt angle (I think that’s the right terminology)?

    Also, if I have an L4-L5 bulging disc impinging on my nerve causing muscle weakness and sciatica in my right leg, how possible is it to even strengthen the muscles of that leg enough to fix my pelvic tilt? Wouldn’t the nerve impingement just prevent those muscles from holding my pelvis in place, regardless of strengthening? Not sure if this is how it works, just how it feels so far.

    1. Hi Addison,

      In the presence of nerve issues, you would want to sort that out first as it will make the other exercises quite difficult to do. This will include reducing inflammation, getting as much of the bulge back into it’s correct position (debatable topic) and increasing the joint space around the nerve . You can opt for nerve medication, but not the best thing to take when you are trying to get your muscles working properly again imo!

      In regards to taping- there are ways to help recruit the certain muscles to re-position the pelvis, but I personally have not found it to be that effective.

        1. Hey Addison,

          Unfortunately – I don’t have anything else set up to receive donations.

          But thanks for the offer, buddy. I really appreciate it! 🙂

          Mark

  30. I have got a lot of muscle imbalances due to right hip hike. Left pec bigger than right, right lat bigger than left etc. Is it possible to solve this problem? If it is then how long would it take (i know it depends on severity but would it take more than like 6 months)?

    1. Hi Moh Kad,

      Yes – I would say you can improve your imbalances.

      And yes – It can take more than 6 months depending on severity.

      Better start now!

      Mark

      1. Thanks for your answer. Feels good to know that I can make things right. I just got one more question: in some of the exercises above you say I should maintain a level pelvis. How do I do that? What should I do/feel?

        1. Easiest way to monitor this is to place your hands on your waist and feel for the top of your pelvis bone on either sides.

          You will need to try to keep this area as level as you can whilst you are doing the exercises.

          Mark

  31. I read that with a right hip hike the right shoulder often drops. In my case, I have a right hip hike and a raised right shoulder. Is there additional stretches for this or should I just continue with this protocol? The pain is subsiding but I still get so hiked up on the full right side. As always, thanks so much for the info.

    1. Hi Aura Lee,

      With a right hip hike AND a high right shoulder, it may be due to:

      a) tight Upper QL muscle
      b) left lateral flexion along the upper torso (Try: Thoracic translations to the left side)
      c) tight right upper trapezius/levator scapula.

      In your situation – you will benefit from the protocol for a right hip hike in addition to the appropriate exercises as above.

      Mark

      1. Hi Mark
        I think I have scoliosis because my mum was diagnosed with the same thing. I get hip pain but on the inside and get some relief digging a softball into the inside of my pelvic hip area. Sitting is awful and i cant seem to find a good office chair for my job. I cant find your post for tight hip pain. Will you please direct me? Apparently i have tight psoas too. Id really like to find a long term, sustainable solution as i dont want to spend the rest of my life taking ibuprofen. Your advice would be very much appreciated. Im 50 years old.

          1. Hi mary my son met with a small accident at home so his femur bone was fractured and had a surgey with hardware fixed to it and was removed after1 yr this March 4 and now he is having a right pelvic up and walks abnormally and he keeps standing putting all his weight on left leg plz tell me hpw to fix it thanks

          2. Hi there,

            Sounds like your son has compensated by using different muscles to walk after his surgery.

            These exercises will be a good starting place!

            Mark

  32. Quick question – Is having trendelenburg sign when you walk synonymous with having lateral pelvic tilt?

    Also, I’ve always had the habit of foam rolling my entire body first thing when I wake up. Assuming I do everything else in the guide, can I continue to foam roll my entire body rather than selectively foam rolling certain muscle groups and expect to fix my pelvic tilt? I’m so used to foam rolling all my muscles I found that when I tried only doing the muscle groups you highlight here I felt so uncomfortable systemically I was unable to concentrate on work very well.

    1. Hi there Addison,

      Yes – A positive Trendelenburg sign is indicative of weak glute medius (hip abduction) which can lead to a lateral pelvic tilt position.

      If you are equally tight on both sides, then it is fine to foam roll on both sides of your body.

      If you are asymmetrical, try to foam roll the muscles on the side that needs it to help correct your imbalances.

      Mark

  33. My son is 6 yrs old and i noticed his right hip is higher than the left. But it will be hard for him to follow some of these exercises, will pulling his right leg a bit while he is lying on the bed every morning help? His legs and knees are of same length. It’s like im stretching him and he thinks it’s fun. Pls let me know if u think it will worsen the hip hike.. Thanks!

    1. Hey Aileene,

      Getting kids to do exercises is tough!

      Pulling his right leg may help stretch out a tight R QL muscle which can help with a right lateral pelvic tilt.

      Mark

  34. Hey Mark,
    I am interested in knowing whether this is the reason behind my crooked squat.I shift on my right when squatting(even during any hinging).I have limited right thoracic rotation.Right quad is lot bigger than left quad.Right quad is always throbbing after walking and squatting.Also my right knee wants to stay locked and left knee bent.It is hard to tell by the mirror whether I am tilting or not(which I certainly know I am)because of the knees.I guess I prefer my right side more but I cannot identity the side which is hiked.Any thoughts?

    1. Hi Shreyan,

      Do you have a pelvis that is rotated to the right side? Check this post: Pelvic rotation. This may explain your limited thoracic rotation.

      I would also check your ankle dorsiflexion. People will tend to squat towards their more mobile ankle. Check this post: Ankle dorsiflexion.

      A right lateral pelvic tilt (and it’s associated muscles involved) may cause a right lean too.

      Previous injuries to the left side may cause your body to load away from it.

      Mark

          1. Looks like everything is connected. Going to do these exercises. Great information you have here.Thanks.

            Shreyan

      1. Hey mark,I suffer from the same thing he mentioned my left knee bends further back and my right knee perfectly locks is that because I have lateral pelvic tilt and my left knee is lengthen(I went to a physical theraphy and measured my legs and they were around the same length and he diagnosed me with a rotator cuff injury lol which i had but it most likely because of my posture problems because I would workout like that) I been doing these exercises and helped me a lot….also when I retract my shoulder blades my right side goes further back and lower and left side is higher n it feels like it’s more rounded than the other side m.i
        I just want to make sure I’m doing the right thing could you look at my pictures and reassure me I have lateral pelvic tilt or a rotated pelvic.
        FullSizeRender.jpg
        IMG_4310.PNG

  35. Mark – thank you very much for these thorough and easy-to-follow instructions. I am getting started tonight trying to solve this painful problem. I am very grateful for the information you have generously provided here.

      1. Dear Mark,

        Still working on the program. It is slowly getting better I think. At least I feel more confident that I have a path to healing. Went to my PT today here in California, and she basically endorsed everything you say here for this condition. I have a glute med. that is really hard to stretch because I am flexible and seem to compensate in such a way to avoid stretching it. She showed me a way that seems to work that you may find interesting. It is a figure 4 stretch with the tight side ankle (e.g., R) on top of opposite knee (L). The left foot is flat on the floor. One then pushes the right knee down to stretch the glute med. (and maybe other muscles). But – the part that really helped was her suggestion to slightly arch the back at the same time….and holding for 2 minutes. I think this stretch is a winner. Once again – thanks so much for your obvious passion about posture, and your obvious good heart as well.

  36. Hello mark,I been having great results since I been following your advice so I’m very thankful and no longer have pain but my question is I been doing this for a month but my question is by doing the workouts will the pelvis go back to normal eventually or can I also do pelvic workouts to restore my pelvic to neutral by doing some yoga block workouts.also will this take a while I think I been suffering with lateral pelvic tilt for atleast 2yrs but I been seeing great results but my shoulder is still a bit lower and my oblique a bit higher but not what it used to be.

    1. Hey Omar,

      Great to hear your pain is all gone now!

      Your pelvis will eventually get to a more neutral position.

      I would still continue the exercises to make sure it doesn’t go back to what it was though.

      Mark

  37. Hello Mark.

    I am sixteen years old and I play soccer 5-6 times a week. About two months ago I have noticed some discomfort in my outer left hip. The pain has progressively gotten worse the more I play, and now I am experiencing tightness in the hip and pain in my lower-back and hip. I have been to the chiropractor about 4 times throughout these two months, my last appointment being last week. They had told me that my left hip is higher than my right hip. I have noticed instant relief after being adjusted and also after stretching, but my left hip and left lower-back pain seem to be getting a little bit worse each week. After my game yesterday, the pain was bad enough to the point where it hurts to walk normally. I would like to know your opinion on how I should go about my situation.

  38. Hey Mark,

    This is a fantastic article – easily the best on the subject.

    Can a lateral pelvic tilt cause tightness in the piriformis? I’m struggling with (I think) a tight piriformis and can’t seem to relax it. Don’t have any real sciatic related pain though. I have a high left hip, long left leg and it’s my left piriformis.

    Also, why does the leg lengthen if the hip rises? I can’t get my head around it! You’d think it would be the other way around (high left hip, short left leg).

    I’m off to check out the rest of your site!

    1. Hi Martin,

      Yes – a lateral pelvic tilt can cause a tight piriformis if it is coupled with a pelvic rotation. (This is very common)

      If you have a right pelvis rotation, this may explain why the left piriformis is tight. (The left hip would be in external rotation which is what the piriformis is essentially responsible for)

      You can have a long or short leg on the side of the hip hike. It really depends how your body has compensated.

      Mark

  39. Hi Mark,

    When a combination of lateral pelvic tilt, rotated pelvis, knee valgus, but also left rib flare, where do you recommend starting? Also, for extended periods of time, I feel pain/tightness in my right lower abs/groin/adductor area, do you have some recommended muscle releases? Pelvic is an issue, but I also have issues with an overdeveloped left side (lat/pec) and weak right side, and when I stretch, I feel pain in my shoulder and my arm, is that normal? Thanks a lot!

    1. Hi Laurent,

      Where to start? There is really no wrong area to start. I like to start with pelvic rotation/tilt.

      With regards to your groin pain/tightness, my “go-to” movement is the cossack squat. But you really should identify what exact structure is causing your issue first.

      Pain whilst stretching is not normal. You want a deep stretch, but it should never be painful. You may need to find a better angle or not push as hard .

      Mark

  40. Hi Mark,

    I would like to start this message by thanking you for posting this detailed guide with photos-I greatly appreciate it! I am a tennis player and seem to always have the same issue: the left hip is hiked up and my left shoulder can then get slightly higher than the right depending on how bad my left hip is hiked up. I also have typical tennis player stuff like below average ER/IR rotation and tight adductors-especially on the right side. I also rotate a lot more to the right on court because I favor my forehand. I have been working with a great team in the USA to try to get this issue under control, often doing a few of the exercises you outlined, but for some reason they are not working as of late. Last week I “threw out” my back coming out of a serve and have pain around the SI Joint on my right side. I am aware that I have weak glute muscles and my left QL always seems to be tight according to some therapists that have worked with me.

    My main questions are: do you recommend the series of exercises in your “lateral pelvic tilt” article for me? Should I be doing other things to compensate for my rotational sport? I am so frustrated with my whole pelvis, hip alignment situation because I cannot get the left side to drop.

    I hope to hear back from you whenever you get a chance.

    Thank you very much.

    1. Hi Kayla,

      The exercises on this blog post will help with your left lateral pelvic tilt.

      Your asymetrical shoulder height is likely a result of something happening in the upper torso and/or your shoulder girdle.

      A tight Left QL is associated with a left lateral pelvic tilt.

      SIJ issues, from what I’ve seen, are mainly due to some sort of laxity/strain in the structures in the area. Strengthening glutes is always a good place to start.

      I would also suggest to check if you have a rotated pelvis. Check out this post: Rotated pelvis.

      Apart from looking at your pelvis, I would also recommend making sure you have full range of motion in your shoulder girdle. Poor shoulder movements will often result compensations in the spine and pelvis.

      Mark

  41. Hi Mark,
    First of all thanks a lot for such valuable information. Before reading this, I was not even aware of the pelvic tilt. I have back pain for the last 8 years. Went to a lot of doctors, nobody cared to check the pelvis.

    How I feel.

    Right Hip is hiked and left hip is tilted down.
    Always Left QL is tight and in pain. And it becomes horrible after some sports activity.
    Stuck in right stance but with both feet pointing outside.Right side feet is less outward compared to the left feet.
    Strange sensation in the right side gluteus medius.
    Cant feel both the sit bones while sitting. Always feel like I am sitting on the right sit bone.
    Weak glutes on the left side.
    Sitting is very uncomfortable sometimes but when I stretch the right side glutes, it feels better.
    Climbing stairs also sometime gives strange pain kind of sensation in the left lower most back or top most part of hip and back junction.

    What I have done..

    Continuously worked on the trigger points for QL.
    Strengthened the left side Gluteus medius which helps me in leveling the tilt.
    Stretched the right side glutes and hamstring.
    Strengthen the left side glutes and hamstring.
    Stretch the left side quads.
    During the night I try to sleep mostly on my left which helped me with the morning stiffness.

    I started out as a very stiff person but I am fairly flexible now. I do this routine every single day , sometimes twice a day. But I still feel pain very regularly after sitting and sleeping in night.
    I feel my pelvis is rotated. 90 – 90 hip shift helped me with left knee pushing and right knee pulling.

    Can you suggest me what I am doing wrong or missing something.

    Regards,
    Ankur Vashishtha

  42. Hey, should the right hip/butt be weaker if I have right side hip hike and do the exercises as in this post? I feel like my left side butt is a lot weaker so it feels weird to strengthen the right side.. But all the other stretches and strengthening seem to target the correct muscles..

    1. Hi Oskar,

      With a right lateral pelvic tilt, your right glute medius is likely weaker than your left glute medius when it comes to hip abduction.

      If it is otherwise, you may have other pelvic distortions with your lateral pelvic tilt.

      Mark

  43. Hey mark!
    I believe I recently strained my lower back from over training/lifting heavy weights and not listening to my body. I have a history of lower back pain due to my L3 L4 disc herniations. It’s been 2 weeks and I noticed my right hip felt tight, thigh radiates pain, tight glute. My back looked twisted but noticed I definitely have a lateral pelvic tilt. My QL is very tight and in spasm. I also have severe pain in my lower back for the first week. I can’t do many stretches or movements to release the muscles as my lower back hurts too much. I’m seeing a Physio but he hasn’t talked much about anything he just did some Acupunture as I asked but knows I’m in pain. Do I just let everything try and settle down? I can’t walk properly either as I limp around because the tilt in my pelvis is great and I’m in pain. Hard as I’m such an active person. What would your recommendations be? Iv never had a tilt like this before and it came on from the lower back strain. Thankyou caitlan

    1. Hi Caity,

      Sounds like your inflammation is excessive.

      I would consider seeing your doctor with the opinion of getting some anti-inflammatory medication for 5-7 days and see how you feel after that.

      It will be very difficult to do these exercises if you are still very sensitive.

      In the mean time, try to keep your back moving as much as possible within your comfort level. (Knees to chest, knees side-to-side, hip movements, lumbar extensions etc)

      Mark

    2. Hi Mark,
      Started this protocol today. Thank you for the info. My right hip really pops when I do the Side Wall Push, the pop isn’t painful but it pops/adjusts just about every rep. I am hoping for good results. I will check back in a few weeks. Cheers.

  44. Hello Mark, I have lateral and pelvic rotation. I also have IT band syndrome on my right side.

    Give that I have IT band syndrome in my right side, can I also do the 90/90 hip stretch on that side while trying to fix my pelvic rotation? Or should I not?

    Also, in order to start fixing the effects of my pelvic tilt in my upper body, what muscle groups should I work? You don’t have to list specific exercises, I can google them if you could just list the muscle groups.

    Thanks!

    1. Hi Michael,

      You can do the 90/90 hip position as long as it feels comfortable. If not – it is okay to skip for now.

      In regards to the upper body, it really depends on how you have compensated for the lateral pelvic tilt.

      If you have a simple right hip hitch + right lower shoulder (for example), stretch the: lats, QL, intercostal muscles on the right side of ribs and right side obliques.

      Mark

  45. Hi Mark, I have very bad sciatica in my left leg that goes into my knee, and stuff neck when I leave my head down I get a lot of tingling sensation, does that sound like my left hip is lower than the other?

    1. Hi Gabos,

      It could be a factor. But it is hard to say exactly.

      Sounds like you have a bit of neural tension though if your neck position causes your leg symptoms to get worse!

      Mark

  46. Hi Mark, so glad I found these exercises! I think I recently have done something that has made my pelvis tilt out of alignment. If my right hip feels really tight and my right foot slightly points outwards while walking, does that mean I have a left pelvic tilt? I saw a massage therapist who said the right hip seemed very tight but didn’t mention anything about a pelvic tilt.

    Thank you!

    1. Hi Cynthia,

      A foot that points outwards could be some of the following:
      – Tibial torsion (external rotation of tibia)
      – Pronated foot with external rotation of ankle
      – Hips that are externally rotated.
      – Rotated pelvis

      Presence of an outward pointing foot does not necessarily mean you have a lateral pelvic tilt. (although it may be part of it)

      Mark

      1. Thanks so much for your help! I think externally rotated hips or a rotated pelvis is probably what I have. I’m not sure what it’s caused by but I have been taking more spin classes lately and so far I’ve stopped them in case it makes things worse.

        I saw your post on fixing a rotated pelvis but I wasn’t sure which side I have. If the right foot is the one that points outwards and I have a rotated pelvis would that most likely be a right pelvis rotation?

        Thanks again!

        1. Hi Cynthia,

          Using foot position by itself is probably not the best way to determine which way your pelvis is rotated.

          Try doing the quick tests as mentioned in the post to help you figure which way your are rotating towards.

          Mark

  47. Hello Mr. Mark,

    Thank you so much for this valuable information.
    I am suffering from lower back pain from last two years and i am just 24 years old. My work demands for 8-10 hrs seating and this pain started after lifting a heavy bag.
    I tried your left and right leg side rise exercise and that helped me alot but still the pain has not gone completely.
    I live in india and wana know if you can check my reports and suggest me something.
    I had to a lot of doctors and still the problem percist.
    Can i share my MRI and x ray reports if you can see and give your valuable suggeation.
    Thanks in advance

  48. Hi Mark,
    I have the right sided tilt. These exercises seem to be working quite well for me. However my one problem is that for a right side tilt you said to strengthen the left adductors. But my left adductors feel super tight compared to my right. I’m wondering is this due to weakness and should I continue to strengthen them or should I stretch them. I know for sure I’ve got the right side tilt as I have all the other symptoms like tight right ql and tight left glute medius etc.
    Thanks

    1. Hey Jimmy,

      With a right lateral pelvic tilt, the left adductors are usually in a more lengthened state.

      Is your left adductor truly tight, or is it a stretch tension that you are feeling?

      Stretch tension: Imagine a rubber band and now stretch it as far as it will go. This “tight” feel is actually tension.

      Mark

    2. Hey Jimmy,

      With a right lateral pelvic tilt, the left adductors are usually in a more lengthened state.

      Is your left adductor truly tight, or is it a stretch tension that you are feeling?

      Stretch tension: Imagine a rubber band and now stretch it as far as it will go. This “tight” feel is actually tension.

      Mark

  49. Hi Mark, first off thank you for all the great content. My question is in regards to the neck muscles. From everything I’ve seen on the internet regarding lateral pelvic tilt, no one really ever addresses the neck. My understanding is that the body is like a system so some muscles will compensate for others. My right hip is hiked, left hip dropped, right shoulder lower and more internally rotated than the left. I feel a lot of tension in my neck but to be quite honest I can’t really pinpoint it. My initial thoughts are that the front and back of the right side of my neck are possibly more outstretched and the front and back of the left side are more tightened to compensate for everything else that is happening below. Then again I really have no idea so that’s why I’m here asking the expert 🙂 I was wondering if you had any input on any of that, and thanks in advance!

    1. Hey Jonathan,

      You are 100% correct when you say the body is a system Everything affects everything!

      By what you have described with your neck, is your head tilted to the left side? (tight left, elongated right)

      The lateral pelvic tilt indeed influences the neck and may be part of the many contributing factors.

      Mark

  50. bro my left neck and pelvic are tilted and i have stiffen neck,total left side stiffness sometimes but what surprising me is i have lost 30% sensory and strength loss on right side but brain mri didnt find any faults.. i used sit alot of hours in chair infront of desktop by putting my two legs on desktop table with unequal distrbution of weight on pelvises….facing this problem from many years..

  51. Hi Mark,
    Very much looking forward to starting your regimen – all these years I thought I had a neck/shoulder assymetry and now I see I have all the problems you outline. Only I noticed one exception. Though the waist crease is on the predicted (left) side with my left hip hike, my neck seems to tilt to the right so that my left shoulder is also higher on my left than my right. So my spine seems to be on a subtle S curve. Will these exercises still help me? Do I have to additional exercises to address the upper spine or might the hip correction still correct the shoulder/neck tilt?

    Thank you!
    Rick

    1. Hi Rick,

      You will still need to do the exercises for left lateral pelvic tilt.

      However, consider the following as well:

      1. Stretch the Upper QL muscle (and associated muscles) on the right side.
      Post: 12 ways to stretch the QL muscle.
      You can focus on #8 “The Sexy pose”.

      2. Thoracic translations to the right side.
      Post: Thoracic exercises
      Focus on #13 “Translations)

      Sounds like your spine did 1 extra step and bent to the other side of the pelvic tilt.

      Mark

  52. Wow Mark, amazing!

    I have seen physios, chiros, and read for many hours on my leg issues. I wish I had read this article to begin with!!
    I have shin splints in one leg (my “short” leg) and also pain in my peroneus longus in the other leg when running. I was advised to get orthotics but no one addressed the lack of symmetry in my ailments.
    I think these overuse injuries are from my leg length discrepancy.

    I am having trouble sitting and sleeping without one leg bent but I’m glad I know I am now addressing the real issue.

  53. Hello Mark, Ok let me tell you my story. I lift weights pretty often and have hurt my back several times in the past deadlifting. This has hiked my left hip up before but every time before it has always restored itself on it’s on. But this last time it is not wanting to correct itself. I have to been to several chiropractors and physical therapists, relieving some of the pain but the hike is still there. I have all the issues you have mentioned, I’m always standing on my right leg and my left leg is slightly longer than the right. Now I still weight lift all the time. Which would of these exercises would you recommend the best for someone who works up to 13 hrs a day and doesn’t really have the time to do all of these?

    1. Hi Baltazar,

      The best exercise is the one that your body responds to the most and makes the most difference.

      To find out which one is the best, you will have to try them all at least for a couple of weeks to see which one you really need to focus on.

      Since your tilt self corrects usually, I would focus more on the strengthening exercises and less on stretching/releasing.

      Mark

  54. Hi Mark,
    I have degenerative disc and spinal stenosis on L5-S1. I have had a discectomy and multiple steroid shots to different locations (disc, facets joint). So I know I am facing an uphill battle. I have recently noticed that I now have a lateral pelivic tilt on my right side (right side hiking up). Increased pain on my right side seems to have coincided with this condition. I am going to start a program using your exercises above and am looking forward to some relief. My question is about chiropractic care. Would it be beneficial to have some chiropractice adjustment done at the same time? My research on pelvic tilts brings up a ton on chiropractic adjustments too. Just curious as to your thoughts. Thanks, Siggy

    1. Hey Siggy,

      I love chiropractors as much as I love Physios, massage therapists and all the other health practitioners out there who deal with the body.

      Seeing them PLUS doing exercises will take you very far.

      Mark

  55. Hi Mark
    Thanks for your post. When I walk , the right side of my body is always ahead of the left. When i stand in the mirror, my right waist line is higher than the left. I therefore went to have some X-ray of my pelvis and vertebra but every thing looks fine. Please help me. Am desperate because this problem has been there for years. My only hope was the physiotherapist but with the results of the X-ray results he couldn’t offer me any help.

  56. Hi Mark,
    First I’d like to thank you very much for this detailed information! I have had a high right hip since I was a child and have been struggling to find a solution from physios for many years. I’m 64 now. One question I have is about the 90/90 hip shift. Can you give me a link to photos or a video that is more detailed and is specifically for a high right hip please? I have looked on YouTube for videos but none are clear as to whether they are for a right or a left high hip. I don’t want to make things worse. I’m very grateful for all of your help! Thanks again.

    1. Hi Susan,

      Oh! Thanks for bringing this to my attention. I forgot to put a photo along with the instructions. (It’s quite a tricky exercise at first)

      Check this video out. It is essentially the same.

      Mark

      1. Hi mark thanks for the video but i think iys for the left high hip because the man in the video have a left hip higher i think it called left aic pattern

  57. Hi Mark,

    I’ve been doing these exercise for a week now and I have a hip hike on the left side, so I’ve been doing the opposite side to the side mentioned above.

    The thing is I feel tightness on my left hamstring and glutes after these exercises, while my right side is weak on glutes and hamstring. And I have a smaller buttcheek/glutes on the right side than the left.

    Shouldn’t I strenghten my right glutes and hamstring to level my pelvis? Or am I doing everything correct?

    1. Hi Carl,

      The tightness you feel may be due to contracting and exercising those particular dormant muscles… which is good! Does it feel like the sensation you get after doing a lot of unaccustomed bouts of exercises ?

      You can also have a tight AND weak muscles on the right side. So eventually – you will need to strengthen the right side once the pelvis is balanced.

      Mark

      1. Hi mark,
        I understand this more now, thanks for answering and explaining. And yes, I do get that sensation.

        I also have one more question. My left Hip Bursa is wider than my right one, It really looks uneven when i walk and my right side looks better. Will these exercise also help me align that?

        Carl

        1. Hi Carl,

          I’m not sure if you meant to say “bursa”?

          If you are referring to the glute muscle on the side: assymetrical sustained positions of the pelvis can lead to uneven muscle sizes.

          Mark

          1. Oh! I see.

            I think you mean the Greater trochanter. A bursa sits on this bony landmark.

            If the bone is structurally bigger, then there is not too much you can do to change this.

            However – if it appears larger because of the tilting, this may improve as the pelvis regains a neutral position.

            Mark

  58. Hi Mark, my question is a right sided side plank a good exercise for lateral pelvic tilt. Since it would be working right glute medius and left adductor. However it may also strengthen the right ql? Be great to hear your opinion on this. Been doin these exercises for a month now and they have worked brilliantly so far.
    Many thanks.

    1. Hey Conor,

      Noticed you commented a few times.

      (My fault!) I’m a little bit behind on approving comments 🙂

      I’ve answered your questions in your earlier comments.

      Mark

  59. This is a very comprehensive guide to fixing lateral pelvic tilt. Easily the most detailed. Trust me, I have looked everywhere. 😂 brilliant guide and definitely implementing this from today. I have been suffering with chronic lower back pain and after taking pictures again today I have a very obvious lateral pelvic tilt. Thank you for this.

  60. Hi Mark, great post. Was wondering if the side plank would be a good exercise for this on only the right side. Strengthening right glute medius and left adductor? Although does it also strengthen the right ql which might be a problem.
    Thanks Conor

  61. Hi Mark,
    Have been doin the exercises for a few weeks now and the have made a great difference. I was just wondering though is the side plank a good option to add to this. If you do a side plank on your right side this would strengthen right glutes medium and left adductor? Although it may strengthen right ql which is what I’m concerned about.
    Thanks Conor

  62. Hi Mark

    I have lateral tilt toward the right side and I can’t bend sideways to the left side.
    Please suggest me any exercise.

    Thanks
    Akashdeep

  63. Hey Mark!

    Excellent post, I’ve been scouring the internet for information on how to fix my lateral pelvic tilt and yours is the most comprehensive guide I’ve found that includes not only exercises, but stretching too! Well done.

    I’ll be implementing your plan next week and I have a heavy pelvic tilt (hip hike – L, hip drop – R), but am curious what other exercises you recommend folks with lateral pelvic tilt do. I’ve been weightlifting for the last two years, and have just decided to focus on correcting my lateral pelvic tilt but I’m curious if there are any weight lifting exercises I can work into my routine to continue maintaining strength. My fear is that because lateral pelvic tilt creates postural ripple effects across the whole body, I don’t want to hinder any progress made with fixing it by doing exercises that could have adverse effects… but I still would like a well rounded routine for my body.

    Should I just stick to the routine and avoid other lifting until I see progress, or do you have recommendations of “safe” lifts to add here. My thought was to focus on unilateral leg exercises and avoid arm work that could affect the trapezius muscles since those are the areas of my body most affected by my LPT.

    Thanks and I would love to update you on my progress in a month or so!

    1. Hello Megan,

      Thanks for the comment!

      I would be careful when adding weights to your leg exercises when trying to address your lateral pelvic tilt.

      The reason behind this: People with lateral pelvic tilt (generally speaking) can’t control their own body weight, let alone controlling their body PLUS weights.

      Suggestion: I would try to focus on the corrective exercises first.

      However – I do see where you are coming from. I would stick to perhaps to machine work (leg extension, hammy curls, hip abductor, hip adductor etc). It should be easier to maintain a more neutral pelvis in this seated position.

      You can do upper body exercises also, but perhaps stick to the sitting down ones. You may need to reduce weight to focus on symmetry.

      Mark

  64. Hi, Mark, first of all, I thank you for the great material!

    I have a couple of questions, I’m not sure if you made a technical mistake or I just don’t understand, in 1.Releases
    b) glute medius

    in the picture you put the ball on the right side but in the text you say to put it on the left side (for a right hip hike, that’s what I have).

    Is the picture wrong or the text, it seems logical to put it on the right side?

    Also, at 2.Stretches, c)Tensor fascia lata, for a right hip hike shouldn’t the right leg be on the back, not the left?
    Same for 3. Activation exercises, c) leg lift, shouldn’t I be doing that with my right leg if I have right hip hike? Same goes for 4. Strenghening exercises – standing hip hitch, should I be dropping and lifting my right leg? Same for f) step down/up …

    I’m sorry, it just sounds more logical to me this way, but I’m not a specialist, I just need to get this fixed.

    Also, how do I keep my pelvis leveled, when the right side is always hiked?

    I’m sorry for being so full of questions, but no doctor really wants to help me so far, and I have this hip hiked for 10 years (I’m 25 now), not sure if it will ever be fixed…

    1. Hi Dannie,

      Thanks for the questions. I will answer them as best I can!

      Is the picture wrong or the text, it seems logical to put it on the right side?

      The picture is wrong. The text is correct. The left glute medius is the one you want to RELEASE when you have a RIGHT hip hike as it tight/overactive.

      Also, at 2.Stretches, c)Tensor fascia lata, for a right hip hike shouldn’t the right leg be on the back, not the left?

      You want to stretch your LEFT tensor fascia lata for a right hip hike as it is tight/overactive.

      Same for 3. Activation exercises, c) leg lift, shouldn’t I be doing that with my right leg if I have right hip hike?

      You want to strengthen/shorten your LEFT adductors for a right hip hike.

      Same goes for 4. Strenghening exercises – standing hip hitch, should I be dropping and lifting my right leg? Same for f) step down/up …

      You want to strengthen the right hip glute medius. So for a right hip hike, you want to drop the left leg to challenge the right leg.

      It sounds like you are thinking opposite to me?

      Please let me know if you need further clarification.

      Mark

  65. Hey mark ! I’m having very bad lateral pelvic tilt and now i try to fix it. I want to ask about sleeping side. If my right hip hike should i sleep on the left side or the right side? im sleeping on the right side bcause its hard for me to breath when i sleep on the left side? Which side should i sleep to fix my uneven hips?
    **(My right hip more higher than my left hip)

    1. Hi Nurul,

      For a Right hip hike, I recommend sleeping on the Right side (right side down).

      Alternatively – you can sleep on your left side with a small rolled up towel in your waist crease on the bottom side.

      Mark

  66. Great Post!!

    Quick question, while I do these exercises everyday to balance out my pelvis, would it be ok to do my strength training workout at the gym? For now i am thinking of focusing just on upper body until my pelvis is balance so that i can resume my lower body workouts…

    Also what cardio options are safe with this condition?

    please let me know what are your thoughts. Thanks.

    Alec

    1. Hey Alec,

      It is fine to continue you gym workouts (as is with any form of cardio training) just as long as you are placing an emphasis on these above exercises.

      Just be mindful of the pelvis position as much as you comfortably can.

      Mark

      1. Thank you for the quick response. I do have a chronic lateral tilt condition and feel a little better when I put a heel lift in my short leg.

        Can I use the heel lift and wean off it as I build strengthen in the weak muscles or should I avoid it totally ? Thanks again.

  67. Hi Mark,

    Thanks so much for this detailed information. It’s honestly the best tips I have found since trying to find answers about how to fix my hips.

    I have a question about sleeping on my side. Last night I tried really hard to sleep on my back the whole night and it was pretty miserable and I didn’t get great sleep. I have a left hip hike and prefer sleeping on my right side. I read above that you recommend rolling a towel up and putting it under the waist crease. Which side would I use the towel technique on?

    I’m also wondering if I could possibly sleep on my left side and do the towel technique. Is this something you’d recommend or should I continue to try to sleep only on my back? I am planning on investing in better pillows to help make sleeping on my back more comfortable, but in the meantime, I’d like to be able to sleep on my side at least a little.

    Thanks again for your help! I’m looking forward to implementing all your advice and tips.

    1. Hello Josie,

      If you are sleeping on your right side, the tendency is that your upper side (ie. the left) while hike upwards. By placing a small pillow/rolled towel underneath the right waist line, it may help with reducing the hike on the other side. (.. esp if your mattress is really soft!)

      Alternatively – you can also sleep on the left side to do the opposite of what your body is used to… But I would still recommend to keep the spine as neutral as possible.

      Mark

  68. Hello!
    So I have been dealing with chronic sciatica that I have assumed was from a lingering herniated disc for 3 years now. The sciatica has been so bad I’ve practically avoided my right side completely. I was in extreme pain about a week ago and noticed my entire body was leaning forward and to the left. The lateral pelvic tilt was obvious. I went to the doctor and they just gave me steroids, then again to the ER because the pain and they did nothing. I started my own research and doing stretches and exercises and the pain has gone down tremendously. Now to my question, while the pain isn’t constant and lingering I’m constantly having to be on my feet walking on concrete all day. I’m trying to correct my posture but standing up and aligning my shoulders and hips with a straight spine send excruciating sciatica down my right leg. When I go to stretch all the muscles on the right side are super super tight. I’ll stand up 100% straight in 0 pain after stretching really good but after a few minutes of walking I literally feel the muscles tightening again and pulling my back to my left with sciatica every time I put weight on my right leg. Is this something that will work itself out with time and continued stretching? Or is me letting it get that tight just “taking two steps forward and three steps back” as far as progress goes? Sorry for the long comment, just literally no one has helped me with any of this and my insurance won’t cover chiro or PT without a referral that my doctors not wanting to give.

    By the way, I’m 26 yo male, 6 ft, approx 150 lbs

    1. Was told by my mother in law she’s seen me leaning for 2 years now. I don’t believe my disc is herniated anymore or at least not causing the pain. After stretching good I can straighten my legs and do all the movements I never could when I first hurt my disc.

    2. Hey Alex,

      Sounds like you have an impingement of one of your nerves in the right side of your lumbar spine. (You can google : Foraminal stenosis)

      This will cause you to lean AWAY from the site of pain (Eg. Left lateral flexion + Forward flexion) to free up the nerve.

      1. If you have a disc bulge and have already had cortisone injection, I would consider doing McKenzie Extensions:

      … BUT is must be PAIN-FREE and not cause issues down your leg.

      This will help re-absorb at least some of your disc material back into a better position where it is less likely to pinch that nerve.

      2. If you have degenerative changes in the joint where it causes the hole as to which your nerves exits your spine to decrease in size, I would try to stretch out that area as much as you comfortable can.

      I suggest doing these exercises listed here to start off with. Make sure you are not flaring up any pain.

      Once you regain the size of the “nerve hole”, then you can start to consider fixing the posture.

      Mark

  69. 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

  70. 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!

  71. 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

  72. 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!!

  73. 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

  74. 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

  75. 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

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