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.
Hip hike.
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.
Hips straight
Hips tilted
Straight.
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.
Alana
February 25, 2015
Hello – Thank you so much for all of the great information. I am wondering if you have seen any connection between a lateral pelvis tilt that can lead to GI issues as well as constant “nerve” like pain in the middle back? I’ve been trying for 4 years to figure out what is causing my constant pain and I have a prominent tilt on my left side that definitely causes hip/lower back pain. Wondering if it is all connected?
reddyb
February 25, 2015
Hey Alana,
I can’t say I’ve seen a connection between certain movements / positioning and internal organ issues. I could see this contributing to some mid-lower back problem definitely, but things like digestion I just don’t know. I know others out there believe there is a connection, and I can understand some of the thinking there, but I haven’t had experience working with people in this capacity, so I’m not sure.
My random guess with these sorts of things: I have a hard time believing all the aspects of movement don’t relate somehow to how the internal organs work. Movement influences blood vessels, the brain, digestion (I’m talking general exercise here), the joints, certain cancers, etc. It influences a lot of structures is what I’m saying. Like, all of them. To think these things somehow evade more specific movement elements seems unlikely. I doubt someone who say, has lower back pain due to how they lift an object, isn’t also pissing off other structures. Again though, I can’t say I’ve seen someone with digestion issues, we work on X, Y, or Z, and those issues were improved. I haven’t attempted to help someone like this either though.
Madi S
March 23, 2015
Brian,
This post is great. I’ve had so many problems and have been out of running for 3 years now. It started with pain in the interior of my left knee and then eventually both of them. One PT said my left leg was shorter and left hip was lower and gave me a heel lift. BAD IDEA. I only lasted walking in it for 5 minutes because the pain it caused in my back was unbearable. Next PT seemed to be a little more helpful. He said my glutes and core was much weaker on my left side so the left side of my pelvis was rotating down and inwards. That was about a year ago and things aren’t any better. I still have pain in my left lower back, knees, and now my hips are starting to feel sore to touch and just way out of place. EVERYTHING I do feels wrong and crooked and my left side seems so unresponsive and still weaker.
I feel like Ive tried everything from strengthening, stretching, aligning, and correcting my posture. I know this is a very broad question but is there anything you can suggest for me? I’ve been working on my posture and thanks to you will start changing the position I sleep in and avoid twisting movements while strengthening my core. Also, do you think its something a chiropractor could help with?
Thank you!
reddyb
March 24, 2015
Hey Madi,
I don’t believe a chiropractor can help, no.
What you want to be working on is *how* you move, not only what’s strong / weak / tight / etc.
With so many things going on, I can’t really give much in the way of advice. For the knees, particularly with knees that have become troublesome with running, this may be of help:
http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
Beyond that, I’d really have to take a good look at you. You can take a look here and see if you may be a good fit:
http://b-reddy.org/2013/06/20/the-remote-client-process/
Omar
May 1, 2015
Hi Brian,
Great post. You have mentioned that in order to fix a laterally tilted pelvis you need to stop side bending or laterally tilting the pelvis during those times. But how would the tight adductors on the high side and abductors on the low side relax?
Would you recommend doing some stretching and strengthening for abductors and adductors? It is difficult to really do any exercises with a pelvis that is not neutral as this would further facilitate the imbalances and pain.
I have had a lateral pelvic tilt for quiet sometime now, the left hip being on the high side. I have noticed probelms such as anterior femoral glide and hardly any internal rotation on the left hip. If I attempt to internally rotate it, it would cause a pinching sensation.
Your feedback on this will greatly be appreciated.
Many thanks,
reddyb
May 4, 2015
Hey Omar,
In terms of correcting a lateral pelvic tilt in just standing, and most positions, no extra stretching or strengthening is typically required for that. Concentration is, but it’s unlikely the muscles in their current state aren’t strong / relaxed enough to move the pelvis into a neutral state. (Holding it there may be a different story.) This is more about patterns / habits than it is about strength / length. That doesn’t mean some strengthening or lengthening isn’t helpful, but it’s not where the focus should be.
I would recommend moving the legs in a fashion where the pelvis is in neutral. This will then (likely) generate the stretching / strengthening one is looking for. For instance, in a side lying leg lift:
If the exercise is done where the pelvis laterally shifts:
Then the abductors aren’t working like we want. They still may be being strengthened, but not in the way we want. If the pelvis doesn’t laterally shift, then on the way up we get some strengthening in the abductors, and some lengthening for the adductors. On the way down, we get get some lengthening of the abductors, and shortening (not really strengthening) of the adductors. That one movement can generate a lot of different effects. But how it’s done is critical. Just throwing the leg in the air trying to generate a burn in the abductors is unlikely to get people anywhere.
Unless I see someone who say has really stiff abductors, where I may then have the person completely avoid abduction for a while, then it’s more about how you’re doing things than what you’re doing.
If your hip is very limited into internal rotation, I’d gives this a read: http://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
You may have something structural going on where you want to be very careful about working the hip into internal rotation.
Hope that makes sense.
foxhole
May 3, 2015
Hey Brian,
I believe I have lateral pelvic tilt. I seem to land harder on my right leg and when standing my left hip bone juts out a bit more than the right. When running I look very awkward. I think my pelvic tilt is due to the fact that I ran on a slanted country road on the same side for a few years consistently. Hope you can give some insight.
Thanks,
foxhole
reddyb
May 5, 2015
Hi foxhole,
Not sure what insight you’re looking for here. If you’re wondering if running on a slanted road could cause some adaptations, then sure, I could see that.
Paul
June 26, 2015
Hello Brian,
Thanks a lot for the very informative information. This is the only time I’ve found good info on lateral pelvic tilt on the web. However, I do have a few questions but I would first like to inform you of my situation. I’m a runner and about a year ago in the summer I started feeling hip pain mainly in the left hip, some in the right as well but not near as severe. I was hurt for the majority of my cross country season and so I went to a PT. She saw that I had my right leg an inch longer than my left and adjusted in through a series of exercises. Following this, she decided I had such weak hips they were actually in pain due to there inability to handle my weight when running. As I said it is now a year later and my pelvis doesn’t seem to be misaligned. When i walk my pelvis shifts down to the right when landing on my left leg and stays neutral on the right. When I run it is much worse, although. I seem to run with trendelen rug gait. My spine twists to the left when landing on my left leg and then the right side drops. I began obsessively strengthening the left gluteus medius and quadratus lumborum through clamshells and leg lifts lateral and side planks. My left side seems way stronger than my left however I still run with trendelenburg gait. With all the strengthening I’ve done and with proper posture how is it possible I still run with trendelenburg gait
reddyb
June 26, 2015
Hey Paul,
Strengthening things doesn’t guarantee anything. For instance, say you’re doing those clamshells etc. with your right hip lower relative to your left…You could have made things worse then, by getting even stronger in a position you’re trying to avoid. (And further ingraining the habit.)
There is more to this than just strengthening things. The last words of this article are poignant, although I do have to say, maybe I didn’t do a good enough job getting them across.
Next, say you did have great form on the exercises you’ve done. I doubt this is true, and this is no offense to you as I don’t know you, but it’s rare I find someone whose form didn’t need a lot of work. But then one still needs to address the movement they’re trying to address- you need to work on how your pelvis is during walking and running. First, walking. Because if you can’t walk the way you’re looking for, you’re pretty much guaranteed running isn’t going to improve matters. You can have the strongest muscles in the world, right where you need them, that doesn’t mean they’ll work the way you want. They need to be specifically trained in the specific movement.
In terms of your own situation, feel free to take a look at this if you’re interested in more specific help. I need to know and see more about a person in order to really be of help: http://b-reddy.org/2013/06/20/the-remote-client-process/
Hallie
July 17, 2015
Hi, Brian.
I essentially have acquired scoliosis: various lateral shifts, rotations, etc. I am hypermobile. My muscles on the left side (traps, back, glutes, quads & even pelvic floor) are overly developed compared to the right ones (which are weak and more prone to pain.) When the pain began 5 years ago there was no scoliosis but the uneven muscle development was noted.
The right side of my pelvis rotates towards the front from the pull of the adductors which are like concrete unless diligent trigger point release is maintained. The pelvic rotation & the back/psoas pain go hand in hand (chicken and egg syndrome). Why the adductors can’t be permanently released is a mystery. We’re currently trying the “pelvic floor dysfunction” route but too early to tell if that will be the missing link in all this.
The thing is, I took my son (11 yr. old) in for evaluation of his in-toeing and discovered he, too, has a tight adductor on the right side pulling the pelvis forward… as well as a downward sloping right shoulder (elevated left shoulder), which is just like me as well. He looks like a much less messed up version of myself. We have no short leg or obvious structural defect other than his in-toeing (but I am not in-toed unless I have some tibial torsion but ballet corrected my in-toeing – not sure if that’s possible) But, any clue what could cause this (as it seems to be somewhat hereditary).
reddyb
July 20, 2015
Your son hasn’t been diagnosed with scoliosis?
I don’t think something like a tight muscle group, or overly developed muscle group, would be hereditary. Not in this sense anyways. (You may see bodybuilders who say, have great biceps, and that typically has a hereditary component.) My thoughts on this are more kids acquire a lot of what they encounter. If your son has learned to move partially based on watching you move, then there may be something in that realm.
I discuss this type of stuff more here: http://b-reddy.org/2014/01/05/implementing-the-concept-of-mirror-neurons-into-an-exercise-setting/
Hallie
March 27, 2016
Just recv’d an alert of a recent post on this thread that I had forgotten that I posted on. Anyway, just as a follow up (and per your suggestion in the article to make sure it’s nothing structural) I recently discovered that I have hip dysplasia, extreme laxity in the hip ligaments (partial dislocation in extreme ROM) and other hip issues. Of course there’s also some anterior femoral glide, hyperextended knees and so forth. Consulting PT is a Sahrmann disciple so hope to learn some new, good habits but surgery will be needed. Its’ just one step in a long road of rehab ahead. My son will also be evaluated although we may need to wait for his teens for a better assessment.
reddyb
March 29, 2016
Glad you were able to connect with someone who likely knows what they’re doing! Out of curiosity, where were you able to find this therapist?
Little surprised it seems surgery is so matter of fact. Were you told why that is?
Hallie
March 29, 2016
PT is at WashU in STL. Surgery not matter of fact. I’ve gotten 3 different opinions, had to wait, do more PT, see PMR, try injections, etc. At best PTs give “fair” prognosis for PT alone. The sad thing is it’s taken so long to get an accurate diagnosis, arthritis may limit my surgical/recovery options.
reddyb
April 1, 2016
Gotcha. At least being in St. Louis should up your chances of PT alone working.
Lauren Johnson
August 11, 2015
Reddy, I am an aspiring ballet dancer with a history of many tears at the base of my hip flexor. So frequently in fact, that my orthopedic dr on staff gave up and basically told me to live off steroid injections in my hip. I am not kidding. Your articles have me thinking.. Especially because my knees are also in awful shape from constant hyperextension, and my lower abs are extremely weak even with consistent training. My pelvis is in a total rut and I am becoming frustrated because I just can’t keep up with all those little issues that add up. Any advice on stretches, exercises or treatment? Thanks!
reddyb
August 13, 2015
Hey Lauren,
It’s common for ballet dancers to really stretch the hell out of their hips. I talk about how certain types of hip stretching can cause issues here: http://b-reddy.org/2012/10/08/you-shouldnt-stretch-your-hip-flexors-if-you-have-hip-pain/
I talk about getting out of hip extension while being upright here: http://b-reddy.org/2013/12/09/cueing-people-out-of-hip-extension-while-standing/
Then there are the recommendations in this article, should you fit the profile.
Beyond that, you may be interested in this: http://b-reddy.org/2013/06/20/the-remote-client-process/
wesley
August 25, 2015
sorry to say but alot of the info in here is wrong. so much more to consider than just this. for example the way you “determine” true leg length difference has faults. the major one is the fact if you have an under developed butt cheek you will lean to that side when laying down and there fore your left leg would appear to be structurally shorter when in fact its the glute thats not as thick as the other side making you lean. be careful people on what you do.
reddyb
August 27, 2015
Hey Wesley,
Alright, so first, I went over two methods to determine leg length discrepancy. One of which consists of standing. Your rebuttal doesn’t address that method.
Second, this reminds me of when clients tell me they can’t keep their lower back flat against a wall, because their butt is too big. If the lower back is completely flat, and the legs are far enough off the wall (knees may need to be bent), then this isn’t a problem.
Because while on the ground the knees are however long the legs are away from the floor (wall), it’s not a problem. Again, so long as the lower back is flat.
Furthermore, I’ve trained people who were upwards of 400lbs, and they could keep their back flat against a wall. Tissue is not a factor.
If you were really concerned about this, you can posteriorly tilt the pelvis enough so the butt isn’t even on the floor.
So no, this isn’t something to worry about. (Perhaps something to keep in mind.) But I appreciate the line of thinking.
Edited “something to keep in mind”
lili
June 22, 2016
Hi,
I feel like I might have an underdeveloped left butt cheek because when I sit my body falls towards the left and I always feel like my right side sitting bones are bigger causing my right hip to go up. How can I know for sure if this is the cause or m bones have an inequality? And how can I fix this?
Scott
November 11, 2015
Hey Reddy,
Just had a recent back strain in the middle back area and I can’t for the life of me figure out how to get my right side adductors free from pain. Feels like my right side is hiked up but all the doctors say my leg lengths are the same and everything looks fine. Been to physical therapy and they always want me to strengthen that side with no luck after numerous visits. I have anterior pelvic tilt but am trying to figure out best movement to change?
reddyb
November 12, 2015
Hey Scott,
If your adductor pain is high up, I’d look at it as a hip issue.
If the pain is further down, like mid to lower, I’d look at it as probably a lower back issue.
I wouldn’t go based on how you feel your hips are, I’d go based on how they look. So, not whether it feels hiked up, but you need an objective look at if you really have a tilt going on, or something else.
You can test your leg length quickly on your own: http://b-reddy.org/2012/12/14/properly-assessing-leg-length-discrepancies/
ach
November 18, 2015
Hey Reddy great article! I’m a marathoner who has similar issues as to what you’re describing here and to what Jeremy describes in the case study: http://b-reddy.org/2013/02/06/example-of-a-postural-assessment-2/
Left QL/extensors over developed, right hip generally looks higher when standing. Left hip sags lower in a deep squat (which I struggle to get in to). Left knee always wanting to flare up, more pronation on that side, and femur seems more internally rotated. Left glute is also underdeveloped, offline. I also notice I have a bit of hip pain on the right side and struggle to fully flex that right side even when lying on my back (I feel like my right side is taking a beating from compensations for weakness on my left side?) In this model it would seem like the left leg is “short” either functionally or structurally, although self assessment usually shows me a short right leg if i’m sitting on the floor legs out front of me. I have had some success stretching all tissues around the hip, chiropractor visits, but struggle with finding a recipe that works always. Left psoas may be underactive and need some tone? Stretch psoas? Hamstrings?
reddyb
November 19, 2015
Hey ach,
Not sure if you saw the bottom of that post on Jeremy, but the section focusing on movement is where I’d be spending my time. Using him as an example, it’s not as if Jeremy and I did a bunch of stretching for this on muscle, for that muscle, strengthen this one muscle. We did a bunch of work doing different movements. We didn’t let his back rotate at all, during anything, we didn’t let his elbows go behind his shoulders, during anything, we didn’t do anything where his chest caved in (thoracic flexion), we didn’t do anything pulling his shoulders down (we did a lot of work lifting his shoulders up).
Focusing on one muscle rarely gets the job done. You want to step back and change how everything is working together. Some specific muscles can be part of that, but not the sole approach.
For instance, if your right hip is functionally higher than the left, never letting it be higher during everything you do will get you much further than a couple specific stretches / exercises aimed at *hoping* that helps the hip not be as high. Chances are, if you look in a mirror, and not let your hip be higher, you’ll be able to do it. Meaning not much needs to strengthen or loosen, but a lot needs to be focused on changing how you use your body.
Dijan Marmullakaj
March 26, 2016
Hey what’s up Reddy. I have pelvic tilt too.My right hip is higher than the left one and this is causing me muscle imbalances like the lower back on the left side is too strong and in the right side is very soft.Can you give me any advice ? If yes id be very thankful.Have a good day.
reddyb
March 27, 2016
My advice would be to go with the recommendations in the article.
Tim Elson
April 12, 2016
Hi there, this is a great article so many thanks for your work. I have been suffering from sciatic pain down my right leg and onto my big toe since October when I put my back out. I do feeI as though I’m lucky though that my pain is relieved when I sit or lie down, so my work isn’t effected. It is a massive ball ache though. I have the typical flattened arch left foot, high hip on the right, and extremely high left shoulder. I currently have a spine specialist who is adamant that surgery is required as I have a bulging L4-L5 disc. I am very sceptical of this, especially as I have started seeing an osteo that seems to straighten me out. This makes the pain subsides, and then returns a day or so later when my wonkiness returns. I have had nerve pain shooting down my left arm, and back pain, prior to this episode so have a feeling that my uneven pelvis has been causing me minor problems for sometime. I was doing lots of running on pavements (sidewalks) before my injury and this would probably have exacerbated my pelvis issue. Anyway – I am trying to limit my pelvis bending but I have tried lying on my back but I feel pins and needles in this position. Would you in this instance sleep on the high hip side? Would some of these exercises make a bulging disc worse and should therefore be left alone? Thanks in advance.
reddyb
April 12, 2016
Hey Tim,
I’d recommend the sleep manual. That’s going to be way more comprehensive than I can be in a comment: http://b-reddy.org/2012/08/06/sleep-with-less-pain-tonight/
Typically with a disc like you’re talking about, you worry about 1) Flexion of the spine 2) Rotation of the spine. So in regards to the exercises in this post, you’d likely want to be careful about rounding the spine too much. A little is often fine, but you wouldn’t want to be really rounding. While the hip rocking is almost always fine, the toddler may be something to avoid.
Check this out for more about rotation: http://b-reddy.org/2013/09/09/some-quick-notes-on-piriformis-syndrome/
Sorry as it’s tough to be too specific with something like this. This is really much more applicable to the remote client process, if you want to take a look: http://b-reddy.org/2013/06/20/the-remote-client-process/