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

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

So what’s the cause? Is it your longer leg that is causing you to have uneven hips, or did you just happen to be born with uneven hips?

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

There’s nothing to worry if you do have a lateral pelvic tilt as it is a fairly common phenomenon. We aren’t perfectly symmetrical and everyone experiences some asymmetry through how we carry our bodies throughout our lives, however, there can be times where a little too much asymmetry can leave us prone to injury and reduce our physical performance.

The good thing to note is that a lateral pelvic tilt can be fixed through basic self-massage, stretching, and corrective exercises, which is what this post looks to teach. I’m not an expert, but I have had slightly uneven hips and have done research on how to correct it. This is what I am looking to share in this post.

What is a Lateral Pelvic Tilt?

There are several kinds of pelvis tilts that are unhealthy for our body:

  • There is the anterior pelvic tilt, where the front of the pelvis is tilted downwards.
  • There is also the posterior pelvic tilt, which is the opposite of the anterior pelvic tilt, where the front of the pelvis is tilted upwards.

However, the lateral pelvic tilt is unique, in that the pelvis is tilted to the side where one side will be higher than the other.

 

Symptoms of a Lateral Pelvic Tilt

Other than one hip being higher than the other, the presence of a lateral pelvic tilt can have a drastic chain effect which reverberates not only from the pelvis downwards, but also up to the shoulders.

  • Uneven Hips – This is the obvious symptom. Now that we have briefly discussed what a lateral pelvic tilt, we now know that this is a tell-tale sign of its presence.
  • Uneven Shoulders – From the image above, you will see how the hip which is higher will usually result in the shoulder on the same side, being lower than the other side. This can cause someone to notice or think that they have uneven shoulders, when in fact it is a problem that stems from having a lateral pelvic tilt.
  • Leg Length Differences – Someone with a lateral pelvic tilt may think they have one leg longer than the other, or one leg shorter than the other. However, this is a myth as it is the tilt in the pelvis which makes it feel like the hip that is lower down is longer because the other leg doesn’t reach the ground when you stand. There are such things as true differences in leg length but most of the cases are misdiagnosed. The truth is that uneven hips creates this illusion. The best way to rule out a true leg length difference is to measure both legs. If you do have a true leg length discrepancy, then it is unlikely that these exercises I am about to discuss will be of use to you.
  • Leg Rotation – You can see from the diagram that the bones of the leg usually rotate internally as a result of a lateral pelvic tilt. What’s not to be ruled out, is that the internal rotation of all these bones could also be the cause of the lateral pelvic tilt. If it is the cause, then it starts all the way down at the foot. Typically, one foot will be pronated where the ankle is rolled inward, this could be a flat foot or a collapsed arch. When one foot becomes pronated, the shin bones and the femur rotate inward and the hip will drop.

How to Test for a Lateral Pelvic Tilt

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

Of course, there is the possibility you may not have a lateral pelvic tilt and that you really do have one leg longer than the other. Although this is rare, you should keep this in mind when testing yourself for uneven hips.

Causes of a Lateral Pelvic Tilt

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

  • Bad Posture Habits – If you hold your body in the same positions for hours each day, every day, for several months or years, your body’s tissues will adapt to this position. They will shorten or lengthen to hold your body in these positions even when you are not intentionally in them. Therefore if you constantly hold your body with one hip hiked up, your body may adapt to that position. We’ll discuss some of these positions later in the post.
  • Injuries and Structural issues – If you hurt yourself on one side in the past, then it’s possible you may raise one hip higher than the other to avoid pain or there is some structural damage. There’s also the other problem we mentioned of a true leg length discrepancy. In addition, if you’ve had reconstructive surgery on your leg, one leg may have changed length. In all of these situations, you will want to go and see a medical professional.
  • Pronated Foot – A flat foot or a collapsed arch on one side will cause the foot to roll inwards. With this inward rolling, the tibia and fibula (muscles of the shin) will internally rotate and the knee will turn inwards. With the inward turn of the knee (knee valgus) the femur also internally rotates and the hip will drop, causing the lateral pelvic tilt.

In the next section we’ll look at some techniques and exercises we can do to fix uneven hips.


How to Fix a Lateral Pelvic Tilt

There are a couple of angles that can be taken to fix a lateral pelvic tilt. The first is to fix the flat feet (if you have them) and the other is to correct any muscle imbalances that may have developed that causes your body to hold onto the lateral pelvic tilt position. The final step is to address the bad posture that causes the problem in the first place.

1. Fixing Flat Feet or Foot

If you have flat feet then it could be the main cause of your uneven hips. Fixing flat feet is a problem of its own, and if you have it, your priority should be to fix this rather than the lateral pelvic tilt because the foot is the foundation of the body, and any problem in the feet will affect everything above. By fixing your flat feet, your shins, knees, thighs and hips should begin to align properly.

In the case of someone with a lateral pelvic tilt, the problem is most likely to stem from a problem with a flat foot rather than flat feet. So this section should be called ‘fixing your flat foot’ rather than ‘feet.’ This is the problem I find myself in, which is having a collapsed foot on one arch and not the other.

I have written a post on how to fix flat feet, so it would be a good idea to read that post and add the exercises on that page to your daily routine. I will, however, lay out a short summary of what fixing your flat foot may look like.

Step 1. Massage the arch

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

Step 2. Strengthening the arch

It is possible to strengthen the arch so that the right muscles become strong enough to pull the arch back up. Popular arch strengthening exercises include:

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

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

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

Fixing a flat foot should help the ankle to stop rolling inward and hopefully restore proper alignment in the bones above. It is not a full proof solution, however, as there are likely to be other muscles imbalances that still exist in the legs, particularly the side with the lower hip.


2. Stretching Out the Tight Side

If you have uneven hips, it is likely that the muscles on the high hip side of the torso are short and tight. If you look at the diagram below, if the muscle that is highlighted red is short and tight, it will pull that side of the pelvis up and towards the rib cage which it is attached to.

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

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

It is the quadratus lumborum.

We will need to first release any knots that are causing tightness, followed by stretching techniques on the tight side. If we can begin to create length in the quadratus lumborum, this should help increase the chronic tightness that pulls the hip up and the shoulder down.

I have an in-depth article on how to stretch the quadratus lumborum and recommend reading that for instructions on how to do it effectively.

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

My favourite stretch for the quadratus lumborum is one which is a modification of the classic child’s pose. You can see how to do this stretch, as well as a few other quadratus lumborum stretches in the video below.

An additional fix concerning the quadratus lumborum could be to strengthen the opposing quadratus lumborum which could be too weak. By strengthening the weak side (the side with the lower hip), the quadratus lumborum may become stronger and pull up the lower hip slightly. There is a small section on how to strengthen the weak quadratus lumborum on the page mentioned above.


3. Fixing Your Bad Posture Habits

All these corrective exercises and stretches won’t be of any use if you don’t eliminate the times when you intentionally, or unintentionally raise one hip higher than the other. Your body tissues will adapt to the positions in which you hold them for long periods of time, therefore we want to avoid putting the quadratus lumborum in a shortened position.

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

Here are some common situations:

  • Sleeping on your Side –  If you have a favourite side you like to sleep on, then the hip that is in the air will be in a ‘hiked up’ position throughout the night. To avoid this it would be preferable to try to sleep on your back.
  • Uneven Sitting – There may be times where you tend to sit with one hip higher than the other. For example, in my own case, I have a habit of preferring to lean over to my left armrest when I am sitting at my desk. Perhaps you may rest your arm on the window when you are driving unknowingly tilting one of your hips? Or maybe when you are using a computer mouse you tend to lean towards it? In any case, try to maintain a neutral level pelvis when sitting.
  • Standing posture – A lot of people, including myself, tend to have a favourite side to lean towards when standing. A further example of this could be when people are holding things. A common example is when parents who hold their babies may lean towards one side to balance out the extra weight.

If you notice you have a habit of tilting one hip up, then you will need to correct this whenever you find it occurring. By doing this, it gives you a greater chance of fixing your lateral pelvic tilt.


A Couple Other Things

Hopefully, the steps outlined here should help towards correcting a lateral pelvic tilt. I believe these are the main things you want to address, however, there are a couple other things to consider.

From my own experience, my lateral pelvic tilt was a result of having a more pronounced flat foot on my right side which caused a lot of dysfunction from that foot upward resulting in a depressed hip. The dysfunctions that occurred were much like what happened to the skeleton in the diagram at the beginning of the article.

Therefore, you will want to look for further muscle imbalances in both legs, but particularly the side with the hip which is lower. For me, I had a lot of muscles that were too tight, weren’t firing or weren’t strong enough.

Here are some further things that you should investigate to fix your lateral pelvic tilt fully:

  • Are your glutes activating properly? If not you may have a glute imbalance, where one glute is stronger than the other.
  • Do you have weak glute medius muscles? This is a muscle that many people are lacking strength and can lead to many other problems.
  • Are your knees also caving in? Then you may want to see if you have knee valgus.
  • You may also have tighter glutes on the lower hip side. Consider releasing and stretching your glutes to retain balance.

Seek Professional Help

Once again I want to repeat that I am not an expert. I am just sharing what has worked for me and the things I have learnt on this topic.

If you are feeling lost or in doubt, see a physical therapist who can give you advice.

I hope this article helped and can be a great step forwards towards fixing your lateral pelvic tilt.

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