I recently got this email and thought I’d put up my response as a post.
Hey Brian.
I have been reading through your blog, and I have to say you have some very good insights on “pain” haha. I have been using that internal ration movement from your subscapularis strengthening article. It seems like just what I needed! I have been doing it the other way with the elbow down to the side as everyone kept saying to perform it that way, and as you said it just wasn’t working.
There is another issue I would like to get your input on. How would you fix a lateral pelvic tilt on someone? With me specifically my left hip is hiked up more than my right, which always causes me some pain in my lower back, and is always tight. The right side of my back is fine though.
Of course there are a host of other problems that come with this, but to just to keep it simple as you probably already know the problems that come with this.
So how would you go about fixing this issue on someone Brian?
Hey Mark,
Thanks for the words. Glad my stuff as been of help to you.
Re: Correcting a lateral pelvic tilt
I’m going to rattle off some random thoughts on this.
Make sure it’s not structural
This is really rare, but sometimes the person has a lateral pelvic tilt because one leg is longer than the other. It’s important to assess whether the person has a true leg length discrepancy or just muscular imbalances. For more on how to assess leg length check out Properly assessing leg length differences.
If there is a true difference, some type of orthotics may be necessary.
Exercises / stretches that can give some immediate relief
Like you mentioned, some lower back pain can often accompany this, and it’s typically more on one side. Often the side that is getting “scrunched” together.
To elongate things, and give some relief to the lower back, I like to do the Backward Rocking stretch and Toddler Squat.
This will often give people some immediate relief when they’re extending or rotating the lower back too often. (Like in a lateral pelvic tilt.)
Stop obsessing over the gluteus medius
While this muscle is certainly important, it’s not the only factor in a lateral pelvic tilt. And simply strengthening the muscle through Monster Walks, Side Lying Leg Lifts, Hip Hikes, or whatever, is not a treatment. It may be a (small) part of the treatment, but it’s not THE treatment.
Never mind the fact most people’s form on glute medius exercises are horrendous. Most often people are actually exacerbating their issues; not resolving them. For an extensive write-up on training the glute medius check out My visit to the Washington University in St. Louis.

This is not good. Notice how the person has a lateral pelvic tilt in an exercise that is supposed to help PREVENT lateral pelvic tilts?!?!
Because while people seem to understand the glute medius can pull the hip down (preventing the hip hike), they forget there are also muscles that pull the hip UP.
Pay attention to the abdominals
The obliques play a big factor here, as they can hike the hip up. I’m not going to go over much anatomy here; just keep this in mind for the following.
Pay attention to side bending
Excessively leaning or side bending to one side can be a big factor in a lateral pelvic tilt. For instance, if you’re always driving like this:
Or if you’re always leaning on one elbow. Whatever it may be. I see these sorts of things a lot.
Sleeping
This is more of an issue in women than men. Look at the sleeping position of a woman with wide hips.
See the curve of the top side? And the lateral pelvic tilt accompanying?
This brings me back to the futility of solely going after the glute medius. You can do all the Jane Fonda leg lift shit you want, but if you’re sleeping with that dramatic of a side bend / pelvic tilt hours upon hours every night, you aren’t going to get anywhere.
For more on sleep positions, like how to correct this, check out Sleeping without pain.
Training considerations
Because there is almost assuredly a strength discrepancy going on at the abdominals, specifically the obliques, it’s a good idea to train these muscles and even things out. Planks, side planks, pallof presses, are all good ideas here. Crunches, bicycle crunches, ANYTHING RESEMBLING TWISTING, are not good ideas.
Other things to look at are the ABductors and ADductors. When there is a laterally tilted pelvis, on the side that is hiked up the abductors are long / weak but adductors are tight / overactive. On the other side the abductors are tight / overused; adductors weak / need more work.
This is because when the hip is hiked up that side’s leg is ADducted, while the other leg is ABducted.

Tilted w/person’s right side of pelvis hiked up. Notice the adduction (person’s right leg) and abduction (person’s left leg).
The “complicated” treatment
While various exercises can help things, in the end, you need to figure out where / when you are side bending or laterally tilting your pelvis.
And then… *drum roll*…
Stop side bending or laterally tilting your pelvis during those times.
Hopefully this gives you some ideas Mark.
Lili Khachatryan
June 20, 2016
Hello,
I am wondering if you can help me. I was told that I have a leg length difference as a result of a higher right hip and lower left hip and also a bit of left lumber scoliosis. My right side glute area is always tight and overactive. Also my right side middle back is always tight. I always find myself tightening the right side glute area. My right muscles get so tight that I have trouble sleeping. Any help would be greatly appreciated. Also, I was exercising a lot lately and I started having pain in the left lower back. Thanks.
reddyb
June 21, 2016
Hey Lili,
Did you see the link in the post about assessing your leg length discrepancy? Can find out for sure that way. Would start there.
lili
June 22, 2016
Hi. Thanks for the reply. I tried measuring the hip height standing up and feet together and the right hip bone is higher. Also I measured it standing with legs spread apart and again the right hip is higher. Also I tried lying down and putting something on my knees and still right side seems higher or I’m not doing it correctly I’m not sure.
lili
June 22, 2016
I have seen a few different physiotherapists and also a chiropractor about the right side middle back tightness and left pelvic pain. One physiotherapist told me it wasn’t an anatomical leg length difference just caused by the pelvic tilt. Another physiotherapist told me I might have a bigger right hemi-pelvis which causes the right hip to go up. One physiotherapist told me I have bulging disc and another told me it’s a sacroilliac joint pain that’s causing t left side pelvic /lower back pain. I’m really confused confused and seems like no one can tell me for sure what’s causing the tightness in the right side of my.back. When I sit my back get really tight and tense. When I stand the tightness goes away. When I run t left low back starts to hurt. Please help.
reddyb
June 24, 2016
Hey Lili,
Would look at this: https://b-reddy.org/2013/06/20/the-remote-client-process/
john
June 21, 2016
hello I think I have a lateral pelvic tilt and I am planning to do some light deadlifting. would it be ok for me to do this?
reddyb
June 21, 2016
Would try to make sure while deadlifting you don’t laterally tilt the pelvis. Have an article about this coming.
cohen
June 27, 2016
Hello. Great post.
I’ve just noticed that my right hip seems to be slightly higher than my left. I have no pain anywhere and I’m generally healthy. I do tend to use my right hip as a saddle for my now 3 year old daughter. Could this be causing me to have a pelvic tilt? I also tend to sleep on my right side. When I was 18 my left knee cap popped out and then back in and now at 28 years old the other day I twisted awkwardly getting into bed and it happened again. But it was only a few seconds and didn’t swell or have pain after. Would love to know your opinion.
reddyb
June 28, 2016
-How you hold your daughter can be and is likely a factor with how your hips are. Very common.
-How you sleep is commonly a factor too. More here: https://b-reddy.org/2012/08/06/sleep-with-less-pain-tonight/
-The knee would require a decent assessment. The hips could be related. If the right hips is being hiked up, that tends to pull the left knee in, which can cause tracking issues. Thorough look at knee tracking here: https://b-reddy.org/2016/02/14/the-genesis-of-patellar-tracking-and-instability-issues-and-what-to-do-about-them/
Cohen
June 28, 2016
So I would have to just maybe carry daughter on other side or not Carry her at all?
And sleep on my back
And streghtern leg muscles?
reddyb
June 28, 2016
You would want to do those things in a way which doesn’t tilt the pelvis. (Discussed in the article.)
Lucy
July 6, 2016
Hi Reddy, I was on your other page with full knee extension problem and have been doing very well. I can’t thank you enough. Now I seem to have one other problem remaining. It seems like the last piece to the puzzle for me to walk normal with little or no more knee pain or hip pain is just around the corner.
I saw your page on lateral pelvic tilt and started to wonder about my leg length. With right leg full extension I still get pain in left knee and hip. So I decided to measure my legs lying down ( Supine and then Sitting up. When supine my legs were fairly close to same length not much discrepancy, but as I sat up my right leg lengthened and/or my left leg shortened, did this a few times to make sure what I was seeing was accurate. As I had mentioned before about my displaced meniscus in right knee I was stuck at 15 to 20 degree flexion and because of clot they prolonged my surgery. With this happening I was forced to walk lopsided for 6 months. (I was given crutches but didn’t use them in the house and it got tiresome) After awhile I started to get lower back pain. I figured that walking on my right shorter leg was causing the back pain so I jerry rigged my right leg by using a glide sandal on right and not on my left leg, That sort of helped with the body balance. So after the surgery I stopped using the sandal on right leg, but it was still some degree of flexed position on and off till ((Now)) as per your instructions is finally straight. (yeahhhh 🙂 ) I also looked in the mirror and noticed by placing my hands on top of my hips the right side is a little lower and the left hip is higher. Both of my legs prior to the injury were equal length. Is it possible because of the lopsided walking caused my hips to go high and low? Can you please suggest some exercises to correct this, I feel I’m almost to the finish line. :)) Thank you, Lucy
reddyb
July 8, 2016
Hey Lucy,
This is a bit tough to just do in a comment, but,
-Regarding lateral pelvic tilt exercises, there are some in the article I cover, along with ADLs. Would work on those, and those principles.
-I would check this article out: https://b-reddy.org/2015/11/16/how-weak-calves-can-cause-knee-issues/
And take a good look at how you’re walking. How you walked for 6 months is very likely carrying over to now. Wouldn’t be surprised if you are still bending that knee too much while walking and have a lack of push-off going on, and possibly some weakness in the calf muscles on that side. In other words, you may have the extension ROM now, but could not be using it as well as you could be.
-(I’m not necessarily convinced this can be permanent but) There is also the possibility you notice a difference due to how much of your meniscus was taken out. Discussed here: https://b-reddy.org/2014/02/24/oddities-in-knee-alignment/
Dallas
July 11, 2016
Hello, about 3-4 years ago, I was in auto body school I had started to developing a poor posture from bending over alot to work on the cars, but it didnt feel any different than the normal everyday pains i had experienced, so I didnt think much about it. It was more of a forward head type of deal. My wife bought me a guitar right before graduation, and after playing it about a month,I started to have anxiety attacks. After getting out of class for the summer, the anxiety seemed to subside. In January of the following year, I was moving a heavy box and my right hip twisted and i was in alot of pain. I iced it for a few days and every thing seems to be fine. A few weeks later I started having really painful headaches in my temples, and that made my anxiety flair up again. I finally went to a chiro and found out that i had pulled some vertabraes in my neck and thoracic region. But low and behold the chiro treatments only last for a day or two. I have noticed that my right hip is turned anteriorly and my torso is twisted to the left. Right hip is higher and the left shoulder is higher, so that my torso makes a “c” shape. I walk on the outside of my right foot. Ive done alot of stretches, but im not quite sure on which one i need to specifically do. I just dont want to waste time doing something thats not really gonna help me. Any advice?
reddyb
July 12, 2016
Hey Dallas,
-Headaches and anxiety attacks are not something I have much experience helping. I know many swear there is something related to how they hold their body and these things, but I can’t say I have experience handling this much. Certainly not anxiety attacks.
-There are suggestions in the article regarding the different hip heights. It seems they have not resonated with many commenters, as many keep asking me for suggestions despite the ones given. Perhaps I’ll put together a manual. In the meantime though, I’d go with the article or check this out regarding helping your posture: https://b-reddy.org/2013/06/20/the-remote-client-process/
Muhammad Muteeb Khalid
August 20, 2016
Hi! I need to know that what would be a person’s actual height if he’s measured 5’10” on right leg and 5’9″ on left leg.? By actual I mean after correcting lateral pelvic tilt.
Further more to which side my pelvis is tilted and which muscles are responsible for it and how I would stretch or relax them. P.s I also have an anterior pelvic tilt.
Regards
reddyb
August 23, 2016
1) Whatever the tape measure says when you measure them standing without a lateral pelvic tilt.
2) Discussed in the article.
Kathryn Frost
July 7, 2017
Hi, I thought Hip Hiking would mean the leg is abducted on the high hip and adducted on the low hip? Various other sources suggest this- its caused by tight QL which abducts the leg and takes over from the glute medius as prime mover when the hip abduction pattern is altered. Do you agree or disagee? Good to get your feedback and clear up my confusion! Thank you
b-reddy
July 7, 2017
Hey Kathryn,
If the hip is hiked, the knee / foot will be more medial to the hip than otherwise. That’s adduction.
If the hip is lower, the knee / foot will be more lateral to the hip than otherwise. That’s abduction.
Daniel
July 31, 2017
Hello Brian,
I have a long-term relationship with my left leg being short or my left hip hiked up. PT are able to lengthen it, but it always gets back to where it startet. The information on your website in general is fantastic and your point on how we move in our daily life was an eye opener for me. Since then I am improving every day in catching me in bad postures 😉
Now onto my question. I am serious into cycling, I always get lower left back pain when riding hard. A recent professional bike fit showed that I sit not square on the saddle. The left side of the hip is rotated back and the right site rotated forward. That explains the intense pain in my left upper hamstring/adductor region, as I am potentially digging my thigh into the saddle with every paddle stroke. I have to say that the seat height is not the problem.
Now that I am aware of it I try to rotate the left side of the hip more forward but want to work on my problems off the bike too.
But I have a hard time understanding how a hiked up left side of the hip causes the right hip to rotate forward when in the flexed road bike position?
You mentioned the tight adductors on the hiked side and tight abductors on the right side. Especially the tight left adductors is something I can feel in myself.
Could they cause the rotation? What other muscles could cause the rotation?
Your help would be very much appreciated!
b-reddy
August 1, 2017
Hey Daniel,
What I would be looking at here is your ability to flex your hips. For people who are serious about cycling they lean over the handles a good deal, bringing their chest closer to their knees, which increases hip flexion.
If one hip cannot bend like the other, then it’s common to compensate at the lower back. For example, if the left hip cannot flex straight up as much as the right one, then the person may rotate their back to try and get that movement. Because they can’t move the hip enough, they move somewhere else to try and help.
One has to figure out if this is structural or functional. (Hard to do on your own. See here for help: https://b-reddy.org/2013/06/20/the-remote-client-process/ .) For some, it’s a habit they started at some point. For others, their hip is simply structured in a way where it can’t bend like others. This gets technical, but I’ve discussed this thoroughly in the following:
https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
https://b-reddy.org/2015/08/03/hip-mobility-issues-in-basketball-players-why-the-lack-of-internal-rotation/
https://b-reddy.org/2015/07/29/on-structural-adaptation-limitations-of-the-hip/
Notice how this woman sits into her left hip more than her right (think of her as in a horizontal seated position): https://www.youtube.com/watch?v=3ADrLvF8Vio
Her right hip can’t bend like her left, so it pokes up in the air i.e. the lower back rotates to compensate. Rotation is a two way street. If one side pokes upwards, the other side downwards. (If one side moves backwards, the other side forwards.)
If the issue is functional, then a good deal of practice needs to occur where the hip flexes, but the lower back does not move. Practicing the hip rocking above without allowing the hips to become uneven would be one example. Others:
https://www.youtube.com/watch?v=mezOtmqIZLQ
If the issue is structural then the person needs to change how they bike. One way may be having to turn the hip out more. For instance, in the woman doing the asymmetric hip rocking, sometimes a person’s hips will even out by turning one knee out more (hip external rotation). This is covered more thoroughly in the retroversion post.
The most common way I help this though is adjusting the handle bar and seat height. The lower the seat height, the more the knees are into the person’s chest. The lower the handles, the more the person’s chest is into their knees. The tradeoff of increasing these heights is a cyclist becomes less aerodynamic as they increase their frontal area. Unfortunately not everyone can ride with the upper body parallel to the ground.
Sorry if that’s not the easiest to read. Been meaning to do a post on this. Hard to convey in a comment.
Daniel
August 4, 2017
Hello Brian, thank you very much for your response. Your response is appreciated and I am looking forward to this specific post that you have planned.
I will incooperate the exercises into rehab routine. The hook lying heel slide gave me an intense burning in my abdominals! So I think the exercise deserves its place in my routine.
b-reddy
August 6, 2017
Sure thing. You’re welcome.
Martin Forshaw
May 30, 2018
Hey Brian,
This is a great article and still helping people years after you wrote it!
I have a LPT and after reading this article I think it was caused by exactly the things you mention – driving and side sleeping. I actually had an X-Ray done and by looking at it, I’m surprised I can walk around.
I’ve been addressing the QL but think you’re spot on that the obliques might actually be more of an issue.
When you say train the obliques, would you do that on both sides or just the side that’s hiked up?
Really glad I found this article!
Thanks,
Martin
b-reddy
June 1, 2018
Hey Martin,
Thanks for the nice words!
If you look at the exercises I mentioned for the obliques, it’s not so much about focusing on training one side. It’s more about training them in a way where they keep the pelvis *not* laterally tilted. This has the effect of training both sides. It trains one side to not hike the pelvis up as much; it trains the other side to not let the pelvis be pulled down as much.
Say someone has a lateral pelvic tilt where the right side of their pelvis is higher than the left.
If you think about the right side obliques pulling the right side pelvis up, someone might deduce “let me work the left side obliques to pull the left side pelvis up, balancing things out.”
I wouldn’t do that. Instead, I’d focus on training the pelvis to avoid any lateral pelvic tilt.
This is essentially what changing daily activities would do. Say you’ve been driving in a way which tilts the pelvis. You don’t want to drive the opposite way to tilt the pelvis the opposite way. You instead want to drive in a way where the pelvis is not tilted. If you drive the opposite way, yes, you might balance things out, but you also can just cause the same issue the opposite way. If you drive in a way where the pelvis is balanced out though…then you balance out :).
In some circumstances doing the opposite can make sense. However, when it comes to the pelvis and lower back, it’s routinely much more about avoiding motions than generating them.