Lateral Pelvic Tilt

Lateral Pelvic Tilt may present on the Left side of the body or on the right side of the body. It is the asymmetric positioning of the pelvis area.

• Left pelvic tilt: left pelvic tilt is when the right side of the pelvis is raised higher than the left side. Right pelvic tilt: Right pelvic tilt is when the left side of the pelvis is raised higher than the right side.

What is a Lateral Pelvic Tilt?

• It is the asymmetric positioning of the pelvis area where:
• one waist height is higher than the opposite side. (Hip hike)
• one waist height is lower than the opposite side. (Hip drop)
• It is also called having uneven hips.

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

How can you find out if you have a lateral pelvic tilt?

• Stand in front of a large mirror(glass) with your feet shoulder-width apart.
• Place the heels of your ha on the front of your hip bones, also called the anterior superior iliac spine.
• Hold a piece of string stretched between both hands, or imagine a parallel line between your hands.
• The line between your hands should be parallel to the floor, rather than tilted up or down. If the line isn’t similar, you may have a lateral pelvic tilt.

What are the symptoms of a lateral pelvic tilt?

• Tight muscles in the pelvic area and whole thigh areas.
• weak gluteus maximus muscle and stomach muscles.
• bed posture with the lower spine curving in, and a protruding stomach.
• Uneven Hips & Gait: The most obvious symptom of a lateral pelvic tilt is having an uneven walk or gait due to one hip dropping lower than the contrary side.
• Uneven Shoulder Heights: The hip which is higher will usually result in the shoulder being on the same side, being lower than the contrary side.
• Apparent Leg Length Discrepancies: A lateral pelvic tilt is often confused with another condition called leg length discrepancy. Someone with a lateral pelvic tilt may think they have one leg longer than the opposite, or one leg shorter than the other.
• Internal Rotation of the Leg: The bones of the leg generally rotate internally as a result of a lateral pelvic tilt. What’s not to be ruled out is that the internal rotation of the leg could also be the cause of the lateral pelvic tilt, rather than the outcome(result). If it is the cause, then the problem starts all the way down at the bottom. Typically, one foot will be pronated where the ankle joint is rolled inward, this could be a flat foot or a collapsed arch. When one foot becomes a pronated position, the shin bones and the femur rotate inward and the hip will drop.
• other symptoms: While mild to moderate cases of left or right pelvic tilt generally do not produce any noticeable symptoms, severe or longstanding cases of left or right pelvic tilt may cause muscle tightness and low back area pain.
• If left untreated, a lateral pelvic tilt may lead to more serious medical conditions, such as Disc degeneration – lateral pelvic tilt may cause disc degeneration due to the deformation of the lumbothoracic spine. One study found that individualities with a high degree of pelvic tilt also had a higher incidence of disc degeneration within the L4 to L5 segment of the lumbar spine, anyhow of age or gender. Sacroiliac joint pain – Lateral pelvic tilt can lead to an asymmetrical positioning of the sacrum in relation to the ilia, or bodies of the pelvic girdle. This asymmetry may affect sacroiliac joint dysfunction.

Causes of left and right pelvic tilt :

Bad Posture Habits

• If you clasp your body in the same positions for hours each day, every day, for several months or years, your body’s tissues will adjust to this position
• Therefore if you continually hold your body with one hip hiked up, your body may adjust to that position.

• Lateral pelvic tilts caused by major structural disorders, like structural scoliosis, are much more difficult to treat.

• Traditional treatment of lateral pelvic tilts are functional disorders and caused by muscular tightness usually involves physiotherapy, stretching, and in some cases muscle relaxants.

Sitting Too Much with Incorrect Posture

• A lateral pelvic tilt is frequently seen in individuals who practice poor(bad) posture when sitting for long periods of time.

• Prolonged sitting not only places undue stress on the spinal column but also changes how the muscles and ligaments of the lower body interact.
• If not corrected, this muscle imbalance can lead to a negative feedback loop of injury, overcompensation, and re-injury of the muscles and ligaments that stabilize and mobilize the pelvis area.

Muscular imbalances: (Sagittal plane)

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

Other muscles involved: Obliques, Tensor fascia latae

• The pelvis will hip hike to the side of relatively weak glute medius muscle, tight quadratus lumborum, and tight adductors muscles.
• The pelvis will hip drop to the side of relatively tight glute medius, weak quadratus lumborum, and weak/elongated adductor muscles.

Leg length discrepancy

• Having one leg that is structurally longer than the opposite side will lead to a lateral pelvic tilt.
• The side of the longer leg will generally have the upper hip.

How to measure the whole length of your legs:

• Lie on your back.
• Measure the gap from the ASIS to the Medial Malleolus.
• Do both sides.
• Results: If these lengths are significantly different between the legs, then you’ll have a leg length discrepancy.

Neurological conditions

• Any condition that impacts the nerves that supply the control of the pelvic musculature may lead to a laterally tilted pelvis.
• The superior gluteal nerve supplies the glute medius muscle.

Diagnosis:

How Do I Know If I Have Uneven Hips?

a) Whilst standing: (Static)

Instructions:

• Stand in front of a mirror.
• Place your hands on the highest point of your waistline area.
• Keep your hands flat on the floor.
• Compare the level of your hands.
• Results: If one side is higher as compared to the opposite side, then you have a Lateral pelvic tilt.

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

b) Whilst moving: (Dynamic)

Trendelenburg sign

Instructions:

• Stand in front of a mirror.
• Place your hands on the highest point of your waistline area.
• Stand on one leg for 10 seconds.
• Perform a single-leg squat.
• Observe for any pelvic tilt in the pelvis throughout the test.
• Is there a change in waist height?
• Compare both sides.
• Results: If your pelvis tilts, this may advise that you have weakness +/- lack of control of the glute medius muscle on the side of the hip hike.

Treatment:

• Initially symptomatic medical treatment with a combination of Physiotherapy treatment & exercise corrects the posture, severe surgery is the last prescribed option.

Medical Treatment:

• An-inflammatory medicines can relieve pain.
• Over-the-counter pain relievers: Acetaminophen (Tylenol), ibuprofen, (Advil, Motrin IB), naproxen (Aleve)

Treatment of Left pelvic or Right pelvic tilt:

Physical therapy

• Not only can a physical therapist suggest muscle strengthening and stretching exercises that can be done at home to help the discomfort associated with a lateral pelvic tilt, but he/ she will also offer advice(suggestion) about managing your condition through lifestyle changes.
• The aim of physical therapy is to restore symmetry to the pelvic girdle by strengthening weak and/or elongated muscles while stretching tight muscles, and constricted muscles.

Massage

• A massage therapist will use a number of manual methods to relax the muscles that support the pelvis area.
• Massage therapy also helps improve blood flow(income) in the affected area or muscles which, in turn, helps reduce inflammation and pain.
• Among the techniques used by professional massage therapists are deep tissue massage techniques, myofascial release, and Gua Sha – a traditional Chinese therapy involving the scraping of the skin area with a massage tool in order to boost circulation.

Physical Therapy treatment for left / right pelvic tilt:

Navigation box:

• Releases
• Stretches
• Activation
• Strengthening exercises
• Improving your function
• Fixing bad habits
• Addressing Scoliosis
• The following exercises are in terms of fixing a Right-sided lateral pelvic tilt.
• If you have a left-sided tilt, then do the exact same exercises but on the opposite side mentioned.

Releases :

a) Quadratus Lumborum (Right side)

Instructions:

• Place a massage ball directly on the right Quadratus lumborum muscle.
• Apply your body weight(load) on top of the ball area.
• Roll your body over the whole length of the muscle.
• Aim for 1 minute.

Tensor fascia latae Releases

b) Glute medius/TFL (Left side)

Instructions:

• Place a massage ball directly on the left Glute medius/Tensor fascia latae muscle.
• Apply your body weight(load) on top of the ball.
• Roll your body over the whole length of the muscle.
• Aim for 1 minute.

c) Adductors (Right side) muscles release

Instructions:

• Place a head roller directly underneath the Right Adductors muscles.
• Apply your right leg’s weight(load) on top of the head roller.
• Make sure to cover the whole length of the muscle.
• Aim for 1 minute.

Stretches:

a) Quadratus Lumborum/Obliques (Right side) Stretch

Instruction:

• Start with your bases wide apart with your left foot turned out to the side.
• With arms outstretched, start to flex 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.

b) Glute medius (Left side)

Instructions:

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

c) Tensor fascia latae (Left side)

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 backward.
• “Tuck your tailbone underneath you”
• Lean towards your right side.
• The goal is to feel a stretch on the upper side of the left leg.
• Hold for 1 minute.

Adductors Stretch

d) Adductors (Right side)

Instructions:

• Perform a side lunge to the left side.
• The goal is to feel a deep stretch in the inner right calf muscle region.
• Hold each stretch for 1 minute.

Activation Exercises :

a) Hip hitch (Left side)

• Muscle: Quadratus Lumborum

instructions:

• Sit tall on a chair.
• Lean slightly towards the right side.
• Lift your left buttock off the chair.
• The goal is to feel your left lower back muscles activate.
• Hold the contraction for 3-5 seconds.
• Repeat 10 times.

b) Leg lift (Right side)

• Muscle: Glute medius/TFL

Instructions:

• Lie on your left side with your upper leg(muscle) straight.
• Outstretch your right leg by pushing your foot down from you.
• Lift your right leg.
• Keep your pelvis completely still.
• Only your leg should be moving.
• The goal is to feel your right hip muscle activating.
• Hold the top position for 3-5 seconds.
• Repeat 10 times.
• Progression: Apply a weight between the ankle.

c) Leg lift (Left side)

• Muscle: Adductors

Instructions:

• Lie on your left side with your upper leg flexed forward and bottom leg straight.
• Lift your left leg up towards the roof.
• Keep your pelvis completely still.
• Only your leg should be moving.
• Make sure that you do not rotate the pelvis area.
• The goal is to feel your left inner thigh activate.
• Hold the top position for 3-5 seconds.
• Repeat 10 times.
• Progression: Apply a load to the left ankle.

Strengthening Exercises

• The goal of the following exercises is to get all of the involved muscles on both legs to work together to achieve a more neutral pelvis.

a) 90/90 Hip shift

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

(b) Knee to Knee

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

c) Side wall push (Stand on the Right side)

• Lift your left hip to ~90 degrees and place the side of that leg as opposed to the wall area.
• flex your planted leg to ~10 degrees.
• Push the lifted leg into the wall.
• The goal is to feel the side of your right hip gain.
• Hold this position for 5-10 seconds.
• Repeat 10 times.
• Progression: Hold for a longer period.

d) Hip hitch (Right side on step) (Standing)

• Stand sideways with your right leg on the border of a step.
• Keep your stance leg fairly straight during the all-over exercise.

Movement:

• Start: Drop your left leg as low as possible.
• over: Lift your left hip as high as possible.
• Repeat 20 times.
• Progression: Go slower

e) Crab walk

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

f) Single leg tap (Stand on Right side position)

• Place your hands on your waist area 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 ground as far as you can.
• Cover every direction. (Front/back/side/diagonal)
• Imagine patting an ant’s head with your base of support and Be gentle.
• Continue for 1 minute.
• Progression: Reach additional and/or Tap your foot softer.

g) Step down/up (Right side on step)

• Stand on your right leg on the border of a step.
• Maintain a level pelvis throughout the exercise.
• Slowly lower your left leg away to the floor.
• The right knee should flex as you do this.
• Do not touch the ground.
• Let it hover ~1cm above the floor.
• Return to the starting position.
• Repeat 10 times.
• Progression: Go slower.

h) Side plank with upper leg lift (Right side up position.

• Assume the side plank position with the left side down position.
• Insure that you keep your left lower torso muscles engaged.
• Suppose about use the muscles that would crunch your body towards the left.
• Outstretch your right leg by pushing it down from you.
• Although keeping your pelvis still, lift up your right leg.
• Ensure you feel your right glute muscle contract.
• Hold this position for as long as you can maintain good methods.

Improve Your Function

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

a) Sitting:

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

b) Standing:

• Distribute your weight evenly between both feet.
• Do not lean to one side!
• If you are not sure if you stand evenly, you can check it by standing on 2 separate scales (1 for each leg).
• If you evenly distribute your weight, both readings should be the same.
• A simple way you can cover your pelvis position is by placing your hands on your hips.

Pay particular attention to your uneven hips in the following:

• Walking
• Stepping up/down stairs
• Lunging
• Squatting
• Consider purchasing a kneeling chair – Using a kneeling chair forces the body to maintain a straight spine posture. Kneeling chairs also can help stretch tight hip flexors muscles.
• Swap your sitting desk for a standing one – Sitting for long periods of time not only causes the hip flexors muscles to contract, but it can also impede blood flow to the muscles of the lower body. If your work requires a significant amount of time at a desk, consider switching to a standing workstation.
• Use a chair with lumbar support – An office chair with lumbar support will protect the delicate structures of the lower back area and promote better posture overall. If your chair doesn’t have lumbar support, consider using a lumbar support cushion(pillow).

Fixing Bad Habit

• 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
• Always sleeping on the same side
• (Tip: Try placing a small rolled-up towel under the waist crease to prevent the pelvis from tilting.)
• Holding baby on side of the hip
• If you notice you have a habit of tilting one hip up, then you will need to correct this whenever you find it occurring.

Chiropractic care

• Chiropractors take a holistic approach to correcting a lateral pelvic tilt in order to treat pain and restore a full range of motion(ROM) to the muscles, ligaments, and joints surrounding the pelvis area.
• A chiropractic treatment plan may include chiropractic adjustment, massage therapy, physiotherapy, and stretching.
• The aim of chiropractic treatment is to bring the body into better balance without the utilization of medications or injections.