Feeling like one side of your pelvis is higher than the other? Or maybe your hips feel “uneven” to a degree?
This is not uncommon, as humans tend to have a side they favor more than the other. Due to our underlying natural asymmetries as humans, it is often (but not always) the right side.
I will be addressing the following:
- How hips can become uneven
- Consequences of uneven hips
- What we can do to fix them
TL;DR: Lateral pelvic tilt is often a result of a compensatory strategy the body has adapted to because of an imbalance of musculature within the pelvis. We want to address that by giving more “pushing” muscles on the higher side and more “weight-bearing” muscles on the lower side.
Causes of Uneven Hips
There are two types of causes for lateral pelvic til: Structural and functional.
Structural causes are related to significant skeletal alignment issues, like scoliosis or leg length discrepencies (Lowe, 2009).
These can be much harder to fix because they are deep patterns that are often hard-wired into the individual. For these cases, seeing a physical therapist is probably the best option.
Lee et. al, 2017 found that there was a relationship between lumbar disc degeneration and lateral pelvic tilt as well.
On the other hand, functional lateral pelvic tilt is usually the result of excessive uneven muscular imbalances between sides of the body.
Lowe (cited above) found that there is commonly a tilt a lateral direction if the low back muscles become tight, like the quadratus lumborum, which is responsible for laterally tilting the trunk towards one side.
There can be a wide-ranging of reasons why this happens, but the main ones are:
- Injury to one side of the body & compensatory patterns follow
- Repetitive use of one side of the body in one’s job, sport, or lifestyle habit
- A genetic predisposition
In walking, this usually takes the form of a Trendelenburg Sign, when the hip hikes up excessively during stance-phase of gait.
Consequences of Uneven Hips
Gogu & Gandbhir, 2020 report that this lateral pelvic tilt is associated with a weakness within the lateral pelvic musculature, primarily the gluteus medius and minimus, which are primary abductors of the hip.
When this occurs, the side that is higher becomes biased towards internal rotation, or a “weight-bearing” state, and the other becomes biased towards external rotation, causing the femur to turn outward.
A second option would be for the femur to compensate inwards on the lower side, causing the leg and ankle to follow and collapse.
This can cause excessive pronation at the foot (see this thread for how pronation & this issue are related).
This can also cause a leg-length discrepency which will cause the higher side to present with a “shorter” leg, but in reality it is just a malaigned pelvis.
What we can do to fix it
If you do have this issue, hope is not lost.
We can focus on re-orienting the pelvis to a more even state by facilitating muscles that will help us restore balance.
The higher side needs more musculature that will help “push” you out of that side. These muscles are:
- The Gluteus Medius (posterior fibers are more abductors) & Minimus
- The Glute Max
On the lower side, we want to facilitate more “weight-bearing” muscles that will assist with proper, non-compensatory, internal rotation. These muscles are primarily the:
- Adductors
- Gluteus Medius (anterior fibers are more internal rotators)
- Obliques
- Hamstrings
