Thoughts on correcting a lateral pelvic tilt

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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. 

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.

 

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.