What is Lateral pelvic tilt?

A Lateral Pelvic Tilt is the asymmetric positioning of the pelvis where there is:

• One hip higher than the other side. (Hip hike)
• One hip lower than the other side. (Hip drop)

It is also known as having Uneven Hips.

In This Blog Post:

• How To Determine If You Have It
• Causes
• Exercises To Fix Lateral Pelvic Tilt

Lateral Pelvic Tilt Test

Perform the following quick tests to determine if your hips are uneven.

a) Standing Position (Static):

Instructions:

• Stand in front of a mirror.
• March on the spot for 5 seconds.
• Assume a comfortable standing position.
• Place your hands flat on the highest point on both sides of your waist line.
• Compare the level of your hands.

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

b) Standing X-Ray

Get an X-ray whilst in the standing position.

Compare the height of the Iliac Crest on either side.

c) Trendelenburg Sign

Instructions:

• Stand in front of a mirror.
• Place your hands flat on the highest point on both sides of your waist line.
• Stand on one leg for 10 seconds.
• Perform a single leg squat.
• Observe for any tilt in the pelvis throughout this test.
• Compare both sides.

Note: The side that hikes during the Trendelenburg test DOES NOT necessarily mean that the hip hike will be on the same side during a natural standing position.

(In fact – it is common to see the hike on the other side as most people prefer to stand on their stronger leg!)

Causes

Here are some of the main causes of a Lateral Pelvic Tilt:

a) Muscular Imbalance: (Sagittal plane)

A Lateral Pelvic Tilt can result from an imbalance between the following muscles: Quadratus Lumborum, Adductors and Gluteus Medius.

Other muscles involved: Obliques, Tensor Fasciae Latae

(I would recommend that you have a look at the location of these muscles on Google.)

b) Weaker On One Side

The body will naturally tend to stand on the stronger leg and away from the weaker leg.

This can cause the pelvis to hip hike towards the stronger side.

For this situation, it is likely you will get more improvement by performing single leg exercises on the weaker side.

These exercises might include:

(Check out the Single Leg Exercise section in this blog post for more information.)

c) Sub-Optimal Habits:

Answer these questions:

• 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?
• Do you have groin pain?

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

d) Leg Length Discrepancy

Having one leg that is structurally longer than the other side will result in a Lateral Pelvic Tilt.

Which side will have the higher hip?

• If the body weight is evenly distributed between each leg, the side of the longer leg will generally have the higher hip.
• If you tend to lean your body weight on the shorter leg, the hip will be higher on this side.

Note: If there is a significant difference in the length of the legs, using a heel insert to make up the difference may be helpful.

e) Neurological Conditions

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

(For Example: The Superior Gluteal Nerve (L4-S1) supplies the Glute Medius.)

If this is your issue, you will need to address the nerve issue before addressing any muscular imbalances.

How to fix Lateral pelvic tilt

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.

STEP 1: Releases
STEP 2: Stretches
STEP 3: Activation
STEP 4: Strengthening Exercises
STEP 5: Single Leg Exercises
STEP 6: Improving Your Function
STEP 7: Fixing Bad Habits
STEP 8: Addressing Scoliosis
STEP 9: Sleeping Position

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READ THIS

I will be explaining the following exercises in terms of fixing a Lateral Pelvic Tilt with a RIGHT hip hike.

If you have a LEFT hip hike, do the exact same exercises but on the opposite side mentioned.

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1. Releases

The first step is to release the tight muscles that may be holding your pelvis in a sideways tilt.

These muscles include: Quadratus Lumborum, Gluteus Medius, Tensor Fasciae Latae and Adductors.

(You may need to Google the location of the mentioned muscles if you are not sure where they are.)

Please take note of the SIDE mentioned.

a) Quadratus Lumborum  (Right Side)

Instructions:

• Place a massage ball directly underneath the RIGHT SIDE of the lower back.
• Apply an appropriate amount of body weight on top of the massage ball.
• Roll your body over the entire length of the muscle.
• Continue for 1 minute.

b) Glute Medius/Tensor Fasciae Latae (Left Side)

Instructions:

• Place a foam roller directly underneath the outer hip of the LEFT SIDE.
• Apply an appropriate amount of body weight on top of the foam roller.
• Roll your body over the entire length of the muscle.
• Do not place the bony part of the hip on the foam roller.
• Continue for 1 minute.

c) Adductors  (Right Side)

Instructions:

• Place a foam roller directly underneath the inner thigh region on the 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

Following the Releases, the next step is to stretch the tight muscles that are holding your pelvis in the tilted position.

a) Quadratus Lumborum/Obliques  (Right Side)

Instructions:

• Stand on your left leg and hold onto something for balance.
• Lean your torso towards the left side.
• Allow your right leg to lift off the floor. Keep this leg completely relaxed.
• Allow gravity to pull your right leg down.
• Do not let your pelvis rotate.
• Aim to feel a stretch in the RIGHT SIDE of the lower back.
• Hold for 60 seconds.

(For more stretches: 13 Quadratus Lumborum Stretches)

b) Gluteus Medius  (Left side)

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 60 seconds.

(See also: 13 Gluteus Medius Stretches)

c) Tensor Fascia Latae  (Left side)

Instructions:

• Assume the kneeling 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.
• Push your hips out towards the left.
• Lean towards your right side.
• Aim to feel a stretch on the upper side of the left leg.
• Hold for 60 seconds.

(See also: Tensor Fasciae Latae Stretches)

d) Adductors  (Right Side)

Instructions:

• Assume the side lunge position.
• Perform a side lunge towards the left side.
• Aim to feel a deep stretch in the inner right thigh region.
• Hold for 60 seconds.

… Is your groin really tight? Check out this blog post for 14 different ways to stretch the Adductors.

3. Activation exercises

The next step is to activate the muscles can help address the Lateral Pelvic Tilt.

a) Hip Hitch

Target Muscle: Quadratus Lumborum (Left Side)

Instructions:

• Sit tall on a chair.
• Place your hands on the chair on either side of the body.
• Slightly lean your body weight onto the right hip.
• Lift your left buttock off the chair.
• Aim to feel the muscles activate in the left lower back.
• Hold contraction for 3-5 seconds.
• Repeat 10 times.

b) Leg Lift (Top Leg)

Target Muscles: Gluteus Medius and Tensor Fasciae Latae (Right Side)

Instructions:

• Lie down with your left side on the floor.
• Keep the right leg completely straight throughout this exercise.
• 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 the activation of the muscles on the side of the right hip.
• Hold this top position for 3-5 seconds.
• Repeat 10 times.
• Progression:
  • Apply a resistance band between the ankles.

c) Leg Lift (Bottom Leg)

Target Muscles: Adductors (Left Side)

Instructions:

• Lie down with your left side on the floor.
• Keep the left leg completely straight throughout this exercise.
• Place the right foot on the floor in front of you to stabilize your body. (See above)
• Lift your left leg upwards.
• Keep your pelvis completely still as you move the leg.
• Aim to feel the activation of the muscles in the left inner thigh.
• 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 on both legs to work together to achieve a more neutral pelvis.

a) Standing Weight Shifts

Instructions:

• Stand up right.
• Have your feet shoulder-width apart.
• Shift your weight towards the left side.
• Perform 20 repetitions.

b) Pelvic Shift

Instructions:

• Lie down on your back.
• Keep your legs locked completely straight throughout this exercise.
• Reach your right foot away from you.
• Push your left leg into your right leg.
• Aim to feel the left inner thigh and right outer hip engage.
• Repeat 20 times.

c) Side Wall Push (Stand on Right side)

Instructions:

• Stand sideways with left side closest to a wall.
• Stand on your right leg with your knee slightly bent.
• Lift your left knee to waist height and push the side of the knee against the wall.
• Make sure that your left waist is higher than the right side.
• Aim to feel the activation of the muscles in the right outer hip and left lower back.
• Hold this position for 5-10 seconds.
• Repeat 10 times.
• Progression:
  • Hold for a longer period
  • Push harder into the wall

d) Standing Hip Hitch (Stand on Right side)

Instructions:

• Stand on your right leg on the edge of a step.
• Keep your stance leg fairly straight throughout the exercise.
• Alternate between lifting and dropping your left hip.
• Aim to feel the activation of the muscles in the right outer hip and left lower back.
• Repeat 20 times.
• Progression: Go slower!

e) Modified Copenhagen Exercise

Instructions:

• Lie down with the right side to the floor.
• Bend your knee to 90 degrees.
• Place your inner left knee on top of a chair.
• Reach your right leg away from you.
• Push the inside of the knee on the chair to lift your hips off the floor.
• Aim to feel the activation of the muscles in the right outer hip and left inner thigh.
• Perform 10 repetitions.

f) 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 small side steps with each leg over a short 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.

g) Single Leg Tap  (Stand on Right side)

Instructions:

• Place your hands on your waist to make sure your pelvis is level.
• Stand on your right leg
  • Keep it slightly bent.
  • 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.

h) Step Up/Down (Stand on Right side)

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.
  • The right knee should bend as you do this.
• Do not touch the ground.
  • Let it hover above the ground.
• Return to the starting position.
• Repeat 10 times.
• Progression:
  • Go slower

i) Side plank with upper leg lift (Right side up)

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. Single Leg Exercises

If you have one leg that is generally weaker than the other side, it is common to distribute more body weight onto the stronger leg.

This can shift the pelvis towards the strong leg and result in a higher hip on that side.

To address this – focus on single leg exercises that load the weaker side.

a) Single Leg Balance

Instructions:

• Stand on the weaker leg.
• Shift your pelvis sideways towards this side.
• Make sure to keep your pelvis level throughout this exercise.
• Maintain your balance!
• Aim to keep your body as still as possible.
• Continue for 1 minute.

b) Single Leg Squat

Instructions:

• Stand on the side of the weaker leg.
• (You can hold onto something for balance if required.)
• Place your hands on each side of your hips.
• Maintain level pelvis throughout this exercise.
• Perform a single leg squat.
• Make sure to keep your foot and knees facing forwards.
• Repeat 10 times.

c) Single Leg Hinge

Instructions:

• Stand on the side of the weaker leg.
• Keep your pelvis leveled throughout this exercise.
• Hinge forwards.
• Make sure to keep your foot and knees facing forwards.
• Repeat 10 times.

d) Step Up

Instructions:

• Place the foot of the weaker side onto a step.
• Shift your body weight onto the foot.
• Without using momentum, step up onto the step.
• Straighten your leg completely.
• Feel the contraction in your thigh muscles.
• Repeat 20 times.
• (If required – You can hold onto something for balance.)

e) Step Down

Instructions:

• Stand on top of a step with the weaker side.
• Hold onto a stationary object for support.
• For the leg that is on the step, keep the knee in line with your toes throughout this exercise.
• Slowly reach your other foot down to the floor.
• Return to starting position.
• Perform 20 repetitions.
• Progression:
  • Perform the exercise slower.
  • Use a higher step.
  • Use less arm support.

6. Improve your function

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

a) Sitting

Whilst sitting – Distribute your body weight evenly between both buttocks.

… DO NOT lean to one side!

This is commonly seen when you rest your arm onto one arm rest.

b) Standing

Distribute your weight evenly between both feet.

… DO NOT favor one side when standing.

If you are not sure if you stand evenly between your two feet, you can check it by standing on 2 separate scales (1 for each leg).

If you are evenly distribute your weight, both readings should be the same.

Pay particular attention to your uneven hips in the following:

c) Address Hip Bursitis

If you have a significant amount of pain in the side of your hip, you may have this condition called Hip Bursitis.

The presence of pain in the hip will make it difficult to perform many of the suggested exercises.

For more information: Hip Bursitis Exercises

7. Fix bad habits

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 side sleeping on the same side
• Holding/carrying on side of hip

8. Fix your Scoliosis

Scoliosis involves side bending on of the spine.

It is very common to have a degree of Scoliosis with a Lateral Pelvic Tilt.

In this situation – the pelvis laterally tilts towards one side to help compensate for the side bending that is occurring in the spine.

If you would like to know how to address the spinal alignment:

See Post: Scoliosis Exercises

9. Sleeping Position

If you are wondering how to sleep with a Lateral Pelvic Tilt, consider the following points:

If you sleep on your side:

The main aim is to maintain the straight alignment of the spine.

This will encourage a level pelvis as you are lying down on the side.

I recommend using 4 pillows to help support your body in this position.

a) Pillow for Head

• Make sure the entire side of your head AND neck is supported by the pillow.
• If you have broad shoulders, you will need to use a thicker pillow.

b) Pillow for Arm

• Hug a pillow.
• This will help support the weight of the arm.
• It will also help minimize rounding of the shoulders. (to an extent)

c) Pillow for Knees

• Place a pillow in between your knees and ankles.
• This will support the weight of your leg and help prevent the pelvis from twisting.

d) Pillow for Waist

• Place a small pillow underneath your waist crease.
• This will help minimize side bending of your torso and pelvis

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Conclusion

A Lateral Pelvic Tilt is where the pelvis is in an asymmetrical position where one hip is higher than the other.

This is usually associated with an imbalance of muscles around the pelvis region.

Follow the steps mentioned in this blog post to address your uneven hips.

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Medical Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content on this blog post is at your sole risk. Please seek medical guidance before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.