What causes a lateral pelvic tilt?

The simple answer is that a lateral pelvic tilt is caused by an underlying neuromuscular pattern that leads to tight muscles on one or both sides of the pelvis. These tight muscles hold the pelvis in a tilted position.

In a laterally tilted position, the pelvis assumes a position where one side appears higher than the other.

Some people will refer to it as a “twisted pelvis” or “rotated pelvis” because along with one side being higher, their pelvis may feel twisted. In fact they are correct, their pelvis is twisted and tilted.

So while the simple answer is technically true, it’s only a partial answer to a more complicated answer.

The more complicated answer, and one that virtually no one realizes, is that a lateral pelvic tilt IS NOT a local pelvis and muscle issue.

A lateral pelvic tilt is a total body issue!

Once you actually understand that lateral pelvic tilt is a total body issue, resolving a lateral tilt becomes easier because you don’t have to search for any one muscle in particular that is causing the problem.

Lateral Pelvic Tilt: My Struggle

 
The traditional thinking of a lateral pelvic tilt is that there is one or two muscles that can be identified as being tight, and that the tilt is a result of these tight muscles pulling the pelvis in one direction or another.

For a long time I thought this, too.

After all, this is the paradigm through which much of physical therapy operates: stretch tight muscles and strengthen weak ones.

Unfortunately, this understanding of a lateral pelvic tilt, while completely understandable, is seriously flawed and generally leads people on a wild goose chase.

We search in vain for a tight muscle to stretch or massage that will release the tilt and return the pelvis back to its normal resting state. Sometimes we have a little success, and feel some relief, but then the tilt returns.

I went through this for years!

The two pictures above were both taken in 2011 after a particularly vicious lower back spasm that kept me from straightening my back for two entire days. The pain was horrendous.

I could not get up off the floor. Trying to straighten my back would just result in more spasm. So I stayed on the ground for two days.

Once the spasm resolved, I remained with a tilt as seen in the picture on the right. From my notes (I started taking extensive notes of my physical experiences during this time) I got out of the first tilt by stretching my right QL.

Unfortunately, I spasmed again into the position on the left.

It’s like my body was playing ping-pong with my pelvis.

Still in pain, I started researching every possible solution.

I tried physical therapy, which did nothing. Strengthening the core is often nothing more than a cruel joke.

Stretching and massage gave me a bit of relief, but nothing lasting.

After many months of pain and confusion, much of my tilt had gone away because the muscles had finally relaxed, but my left SI joint was still killing me.

Also, oddly, I realized I had one leg shorter than the other and this was tilting my pelvis and stressing out my SI joints. Was I born with a leg length discrepancy?

More confusion!

I put some paper towels in my shoe to make my right leg longer, effectively leveling out my pelvis, and the pain would go away.

But unless I wanted to live with paper towels in my shoe for the rest of my life, I had to address the underlying structural dysfunction.

Two years later, the situation hadn’t changed and I wrote this on my blog:

Two years of physical misery and no one could get to the origin of the problem.

Then I took Myokinematic Restoration from the Postural Restoration Institute and discovered the truth about lateral pelvic tilts.

Lateral pelvic tilt is caused by your pelvis being stuck in an asymmetrical position due to faulty sensory processing.

The typical asymmetrical position consists of a left side of the pelvis rotated forward compared to the right side (in PRI terms, a left AIC pattern).

In this position, some muscles are constantly short and tight and some muscles are constantly stretched and weak.

To see how the wrong eyeglasses will put me into a lateral pelvic tilt and give me a scoliotic looking back, check this page out.

Lateral Pelvic Tilts are Total Body Issues

 
Let me begin by stating this clearly: you can not stretch or massage your way out of the underlying pelvic asymmetry that is causing the lateral pelvic tilt.

The “tight” muscle that is holding your pelvis in a tilted position (quite often your right or left quadratus lumborum) did not just one day decide to get tight.

Muscles do not tighten independent of the rest of the body. 

While it is a local muscle (such as a right QL) that is holding the pelvis in a tilted position, that local muscle was forced into that situation by the asymmetric resting position of the pelvis. The QL is more a victim than perpetrator.

As an example, let’s examine the right QL, the position it can be forced into, and it’s role in a pelvic tilt.

The Right QL

 
The quadratus lumborum is not actually considered a back muscle, it’s considered a posterior abdominal muscle. But really, that is not important at all.

What is important is the QL’s three attachment sites:

  1. at the top of the pelvis
  2. transverse processes of the lumbar vertebrae L4,L3,L2, and L1.
  3. bottom portion of the last rib.

The QL also has a direct connection and influence on the SI joint because the ilio-lumbar ligament has its embryological origin in the QL, and this ligament plays a vital role in stabilizing the SI joint.

In addition, the ilio-lumbar ligament has a plethora of nociceptors and mechanoreceptors, so it will be quite sensitive to abnormal pelvic mechanics.

When the QL is tight, more often on the right side (in the left AIC pattern, our bodyweight is shifted to the right), it can contribute to abnormal pelvic mechanics (and thus intense pain) in the form of a lateral tilt as it pulls the pelvis and ribcage closer together on that right side. Hence it’s nickname, the “hip hiker”.

But why on earth is that right QL tight?

Out of all the muscles in the body, why does this muscle seem to get tight so often? Doesn’t it seem odd that this lonely right QL just gets tight out of nowhere?

It should seem odd, because that isn’t what happens.

Pelvic Orientation to the RIght

 
The right QL only gets tight because it is forced into that position by the two structures it attaches to, the pelvis and the ribcage (remember it attaches to the 12th rib, so action of the ribcage influences the QL, as well.)

The QL’s job is to side-bend, and then stabilize, the pelvis, ribcage, and spine to the same side.

So a right QL will bring the right pelvis and right ribcage closer together by sidebending the spine to the right.

All this sidebending and stabilization produces a pelvis that is oriented to the right.

If the right QL is tight, it means the entire pelvis is oriented to the right. 

A right QL will not be tight if the pelvis is oriented to the left. This is important to understand, otherwise the remedy won’t make sense.

Muscle Behavior

 
Muscles have attitudes and behaviors just like our personalities do.

Once a muscle’s behavior has become habitual, it doesn’t give up its habit easily. In this case the right QL is thinking “I’m doing exactly what you asked me to do, keep the right hip and ribcage stable”.

If you never shift your weight fully to the left, or something is preventing you from shifting your bodyweight fully to the left, why would the right QL ever turn off?

It will only fully turn off when you fully shift your weight to the left because if your weight is on the left foot, the right QL has no reason to stay on. Your left QL will activate when you shift your weight to the left.

The right QL will turn off at that time.

The pictures below show what a lateral pelvic tilt caused by a tight right QL would look like. When my weight is on my right leg, my body looks ok because in reality my right should be slightly higher when my weight is on the right foot.

When my weight is on the left leg, but my pelvis remains oriented to the right, my upper body has to awkwardly compensate.

In addition, am I truly on my left leg?

This is a huge leap in understanding right here. You can put your weight on your left leg without achieving a true left leg weight-bearing position.

But this is “fake” left leg weight-bearing.

It’s phony.

It’s fugazi.

True left leg weight-bearing requires true left leg and hip musculature to activate appropriately. If these muscles fire appropriately then your pelvis will orient TO THE LEFT when your weight is on your left foot. It will happen automatically.

In other words, your pelvis WILL NOT remain oriented to the right if you are truly on your left leg, and your right QL will not remain tight if you are truly on your left leg because the right QL turns off when your weight is truly on your left leg.

Weight on right foot, right pelvis orientation. Normal mechanics.

 

Weight on left foot, pelvis orientation still to the right = fake, phony, fugazi left weight-bearing position

 
This is what the pelvis should look like in right and left weight-bearing.

But this is not happening when you are stuck in a pelvic tilt!

Weight on the right foot, right pelvis and ribs closer together, pelvis oriented right.

 

Weight on the left foot, left pelvis and ribs closer together, pelvis oriented to the left. This should be normal.

 
Because the position of your pelvis and ribcage DO NOT CHANGE when you shift your weight to the left (because of the left AIC pattern), the right QL is habitually stuck in a shortened and tightened position.

It’s doing exactly what it is supposed to do!

If your weight is on the right foot, your right QL should be stabilizing your right side by bringing the right pelvis and right ribcage closer together. That’s normal right stance mechanics.

The right QL will continue to stay “on” if your pelvis stays oriented to the right even when your weight is on your left foot. That is not normal left stance mechanics. It’s fake left stance.

To fix the situation you have to attain a new pelvic behavior that orients the pelvis to the left when your weight is on the left foot.

It’s as simple as that.

The Solution

 
The only way to eliminate the underlying structural issue that is leading to lateral pelvic tilt is to reposition the pelvis into a more symmetrical resting position,

Once pelvic repositioning has occurred, you then train your body to establish and stabilize itself in left stance.

For people who already understand PRI, this means that you need to strengthen the left hamstring, left IC adductor, left glute medius, and left internal obliques using PRI exercises. All these muscles stabilize our body in left stance.

For starters, You can try the exercises on this page. 

I also offer online coaching via Zoom. The information can be found on the Online Consultations page.

Or just start with the one below.

Also, I have soooooo many videos on my YouTube channel about lateral pelvic tilts and Postural Restoration in general, including the playlist below.

This single leg exercise is designed to re-orient your pelvis and ribcage to a *neutral position* so that they are no longer oriented to the right. The left hamstring is what pulls the pelvis into that neutral position and the left internal obliques (via full exhalation) bring the ribs over to the left.

  1. Using a small ball between your knees can help feel the proper muscles.
  2. You should feel your left hamstring working.
  3. Don’t “push into the wall” with your left foot. You need to keep the left foot flat and “pull down” with your heel towards the ground (although the foot should not move).
  4. Make sure you exhale completely so that you feel your left ribs coming “down, back, and in”.
Some people have both sides of their pelvis rotated forward (PEC pattern) and/or may feel like the right side of their pelvis is rotated forward compared to their left.

While this is probably not what is actually happening, you can try a two legged version of this exercise by keeping both feet on the wall and not including any hip shift. In this case you would be recruiting both hamstrings.

If you have any questions, just leave them in the comments section and I’ll answer as soon as I see it.