What causes a lateral pelvic tilt and how do you fix it?
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.
I realize that “neuromuscular pattern” is a scary word, but in reality it simply means “brain-muscle habit”. All movement is controlled by your brain, and it just so happens that we humans develop a habit of overusing the right side of our body. The reasons for this habit will be explained shortly.
It is this “habit” that results in a laterally tilted 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 situation.
The more complicated answer, and one that virtually no one realizes, is that a lateral pelvic tilt IS NOT a pelvis and muscle issue.
At its core, most lateral pelvic tilts are a symptom of a larger pattern found inside the body and its origin resides in the asymmetric organization of the human body that leads to habitual dysfunctional breathing.
The Cranium and Jaw Influence
To be complete, some lateral pelvic tilts occur due to a faulty position of the mandible (jaw). In fact, if you examine the image below, my jaw position was probably the greatest influence on my lateral pelvic tilt. But even if the mandible is playing a role, it leads to the lateral pelvic tilt through the development of dysfunctional breathing because of the influence of the mandible on our neck muscles, and our neck muscles are compensatory breathing muscles when we lose our diaphragms.
I want to be clear: most people’s lateral pelvic tilts are not being created due to their jaw position. Most people have lateral pelvic tilts due to what I describe in the remainder of the post.
Lateral Pelvic Tilt or Lateral Mandibular Tilt?
The Origin of the Lateral Pelvic Tilt: Human Asymmetry
Look at the picture below. You’ll see the human lumbar (lower) spine, and attached to that lumbar spine are the right and left diaphragms. The diaphragms are our primary breathing muscles.
Interestingly, virtually all sources of information refer to the diaphragm in the singular, giving the mistaken impression that we have just one diaphragm.
In reality, the diaphragm is two separate muscles, and they aren’t even remotely close to being equal! The right diaphragm is larger with a thicker attachment site on the lumbar spine. A larger and thicker muscle is a stronger muscle.
With every breath you take, as the diaphragms contract during inhalation, the right diaphragm exerts a stronger pull on the lumbar spine than the left side does.
Overall, humans are designed to be better at centering our bodyweight more to the right because it allows us to use our bigger right diaphragm to breathe. It allows us to have a dominant side (regardless of handedness). This asymmetry is normal.
However, the stress and tensions of life often cause our normal asymmetry to become abnormal asymmetry. It is this abnormal asymmetry that is the origin of lateral pelvic tilts, back pain, and so much other bodily dysfunction.
In this picture taken from a YouTube video of a dissected human, you are looking up into a human rib cage towards the head.
You see that this individual’s ribcage is completely asymmetric, oriented to the right, and the spine looks slightly scoliotic. This is due to the influence of the larger right diaphragm.
This is normal.
I’ll repeat that.
This is normal.
This is how we all exist to one degree or another. We all have to deal with this inherent asymmetry.
The problems occur when this normal right sided orientation/dominance becomes too dominant and you lose your left side.
The YouTube playlist below is full of videos about the influence of our asymmetric diaphragms on movement and posture.
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 believed 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 the influence of the larger right diaphragm above it. Over time, the pull of the right diaphragm overpowers the pull of its counter-part on the left side and our body’s center of mass shifts to the right. This causes our lower back to become hyper-lordotic (increase lumbar curve, or lordosis) and results in compressive forces through the low back and pelvis that cause pain.
The typical asymmetrical position consists of a left side of the pelvis rotated forward compared to the right side (in Postural Restoration terms, a left AIC pattern). The larger right diaphragm pulls the lumbar spine and sacrum to the right and that’s where we end up stuck, with a pelvis and ribcage that is oriented to the right.
In this position, some muscles are constantly short and tight and some muscles are constantly stretched and weak. Traditional physical therapy attempts to treat these muscles. But the muscles can’t be treated because they are a symptom of the underlying pattern that has its origin in our asymmetrical design. You have to resolve “the pattern” that is causing those muscles to be tight and painful.
Lateral Pelvic Tilt, the Psoas, and the Quadratus Lumborum
Let me state 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 identified as holding your pelvis in a tilted position (quite often your right or left quadratus lumborum and psoas) did not just one day decide to get tight.
Muscles do not tighten independent of the rest of the body and certainly not independently of respiration.
While it is local musculature (such as a left psoas or right QL) that holds the pelvis in a tilted position, that musculature was forced into that situation by the asymmetric resting position of the pelvis that itself was influenced by the respiratory induced pull of the right diaphragm. The QL and psoas are more victims than perpetrators.
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 and an accessory breathing muscle.
What is important is the QL’s three attachment sites:
- at the top of the pelvis
- transverse processes of the lumbar vertebrae L4,L3,L2, and L1.
- 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 the respiratory 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 and lumbars spine that are oriented to the right.
If the right QL is tight, it means the entire pelvis is oriented to the right. It will then begin to increase its role as an accessory breathing muscle because the left diaphragm loses its ability to pump as a breathing muscle.
A right QL will not be tight if the pelvis is oriented to the left and we can start using our left diaphragm again. 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 appropriately when you shift your weight to the left and can breathe with the left diaphragm.
Weight on the right foot, right pelvis and ribs closer together, pelvis oriented right. Right QL should be on and right diaphragm pumping.
Weight on the left foot, left pelvis and ribs closer together, pelvis oriented to the left. Left QL should be on and left diaphragm pumping.
The picture on the left, where I am standing with my body centered over my right leg, is normal “right stance” position. In this position, my right diaphragm is optimally positioned to pump as the primary breathing muscle. This is the position that our brain likes to habitually place us for easier breathing and stabilization.
The picture on the right, I am standing with my weight centered on the left leg. In this position, my left diaphragm is optimally positioned to pump as the primary breathing muscle.
Over time, this is the position that we struggle to attain because of our brain’s habit of placing us more to the right for easier breathing and stability. Doesn’t it makes sense to make use of the larger and more powerful right diaphragm?
Additionally, whenever there is repetitive overuse, prolonged sitting/computer usage, sedentary lifestyles, general inactivity, injury to the body, or any type of trauma, the right side is our “safe side”, further reinforcing our natural tendency to overuse our right side and underuse the left side.
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. You have to make the left-weight bearing picture, and thus the left diaphragm, become part of your gait and respiratory cycles.
The Solution
The only way to resolve the underlying structural issue that is leading to lateral pelvic tilt is to reposition the pelvis into a more symmetrical resting position via Postural Restoration techniques that use the appropriate hip musculature and also correct dysfunctional breathing, all at the same time!
You can not separate movement from breathing because it involves all the same muscles. The psoas and QL muscles are directly connected to the diaphragms. If diaphragmatic breathing, particularly on the left, can not be restored, nothing you try to do with the hip musculature will work long term because the psoas and QLs won’t relax.
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.
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 this Postural Restoration technique. In this technique you should be able to feel both hamstrings. All you have to do is put a small ball between your knees (not a foam roller or yoga block), sense your heels, and lift your hips off the ground. Your lower back should remain flat on the floor so make sure you don’t lift too high.
Breathe in through your nose and out through your mouth, focusing on getting all your air out! This focus on exhalation positions your ribs properly for diaphragmatic breathing.
If you can’t feel your hamstrings too easily, you can compare your right and left sides by taking your left foot off the wall while keeping the right foot on the wall. Take five breaths. Then put the left foot on the wall and the right foot off. Compare the two sides of your body.
Do you feel each hamstring equally? Do you feel them at all?
If you don’t feel your hamstrings it means that your hip flexors, low back muscles, and/or neck muscles are overactive and you aren’t able to breathe with your left diaphragm.
This type of situation is what a Postural Restoration program addresses.
Such an awesome article . Thank you so much Neal . You are a true PRI expert.
Thanks for reading Jazz, and thanks for the kind words!
Hi. I have the strain on my left side and my pelvis is raised on that side. Should I use this exercise on both legs, the pained side (right foot off the wall), or the seemingly unaffected side to help trigger the change?
Also thanks for keeping track of this!
Also should I do repetitions
Waw!!!
What an article you’ve got here Neil. I saw a video of yours about lateral pelvic tilt exercises on YouTube and which directed me to this website. I have a high hip on my left side and this article talks about a high hip on the right side. Will this techniques still apply to my left high hip?
Try a two legged version of the exercises so you have both feet on the wall at the same time, or try the Left ZOA exercise on my beginner program page.
Hi, i work at a factory and my right thigh and hip started hurting, then my left knee which i had a surgery to fix a partial tear in my quad started hurting. And then my right knee started hurting also, i went to PT for 2 months and the knee pain has gone mostly away. Currently my left calf a d shin is super tight and feels strained, right hip feels foward and it feels like the right leg is shorter. I also get pain in the right of my sacroiliac joint from time to time. And my right thigh still feels tight. Should i follow your process or could more be wrong?
My left shoulder is high than my right, and the pain I have is in my right mid back. Does this truly mean my left pelvis needs the work, or am I an outlier with a right lateral pelvic raise?
Jessica, you are the norm. Higher left shoulder, higher right hip, is the most typical presentation. It is the most normal “posture” seen when in the left AIC right BC pattern that results in the lateral pelvic tilt.
My pelvis has dropped down on the left by 1 cm and all beds seats & chairs hurt me. Standing is little better. How can I get my pelvis to lift up on left again. I have lumbar disc damage & have had many laporotomies for bowel resection in the
past that have damaged my abdominal muscles & I have mesh in place to support abdomen
Hi Neil! Amazing insight into lateral pelvic tilt, the best one I read so far. I have a question that’s rather simple but very confusing to understand for me maybe I’m dumb (lol) when I stand on my right foot I am almost an inch taller than when I stand on both or left foot particularly. Could you explain which side do I need to strengthen and which to stretch, furthermore what would be my real height in a neutral pelvic position? Thanks for the article, awaiting response. Regards
It doesn’t really work like that, in the sense it’s not about stretching and strengthening in the conventional sense. It’s a “total body” issue. Your brain has a “habit” of overusing the right side of your body (left AIC/right BC pattern). The pattern has to be addressed, not the pelvic tilt. I recommend watching all my YouTube videos on the subject to get a better understanding of what’s going on. It’s complicated, I know.
https://www.youtube.com/playlist?list=PLrCKdG5Gnh84vf0OzKonZJdock3e2nqkv
Hi Neal
thank you for a very informative explanation. my understanding is it doesn’t matter what side is higher. the exercise is the same with left leg as instructed in video. in my case I have a tilt to the right and a left hip high ..about 1/2 inch difference. I would absolutely come see you unfortunately I am in Australia.
Blessings Rob
Correct, it doesn’t matter which side is higher, the underlying asymmetrical pattern is that of a left side rotated forward compared to the right side. Good luck with the exercise.
Neal
Just not sure I understand. If I have lateral pelvic tilt with my LEFT side hiked up then I would focus on strengthen the Right hamstring, Right IC adductor, Right glute medius, and Right internal obliques using PRI exercises. Correct?
Plus also if using a standing desk I should focus on putting weight on my right leg?
Hi John.
No, you would not want to do that because it would only strengthen the underlying pelvic asymmetry that is causing the tilt. The tilt is the symptom, is the visible manifestation, of an underlying asymmetrical position of the pelvis.
In the typical pattern (Left AIC), your pelvis is oriented to the RIGHT. This corresponds with “right stance”. You are stuck in this position.
If you did PRI exercises emphasizing the right leg, you would simply be reinforcing this pattern.
Don’t get thrown off by the visual. It doesn’t really matter which side of the pelvis is higher. The underlying pattern of “pelvis oriented to the right” is still the cause. Your pelvis is stuck in a position that it can’t get out of (rightward orientation), and over time this causes hyperactivity of certain muscles.
It just so happens that because so many muscles attach to the pelvis, you never know which muscle will spasm and pull the pelvis upwards (and the offending muscle may not even hurt). In general, the two QLs and left psoas are the most likely muscles to spasm, but treating one muscle directly will not change the underlying pattern. Only a new pattern will turn off the old pattern.
Teaching the pelvis to shift into “left stance”, which orients the pelvis to the LEFT (and thus breaks the right-sided pattern), is what eliminates the tilt by giving you a new “left-sided” pattern.
That’s why we use the left leg, because your pelvis is stuck to the right, so we need the left hamstring to orient the pelvis to the LEFT.
Hope that helps.
This seems to be exactly what is going wrong with my body down to the T. Did you fix your issues by doing the excercises you have here and on your YouTube channel? Additional does the right QL eventually start to loosen itself or did you also stretch that our as well?
Yes, the exercises that I have displayed. But you should seek help from someone who knows PRI. It’s not always so simple as just a few exercises.
Hi Neal,
I have found your information very informative as have not got very far with 2 different podiatrist and a Physio for 12 months. Pain in left foot, leg and left buttock. Lower back pain and left higher shoulder and right higher hip. Can’t stand for long and only walk short distances. Some improvement with focusing on strengthening gluteus muscles especially left but my pelvis feels twisted and walking stance is not correct at all. Feel as though I lean to the left. Have tried these exercises this morning…not sure if I’m focusing on the correct side. It’s a bit confusing. Thanks for this info.
Well, if you are in the US, I’d advise seeing a PRI certified physical therapist. It’s not easy to do on your own. Or you may want consider some online training.
Hi, Can a long standing hip hike cause pain in pelvic floor and upper abs?I’m talking about 40 yrs history.
Thanks
Definitely, yes.
makes sense to me. If you are in left stance, and rotated right to left it would seem you need to be in right stance, and reverse procedures. I do not understand the answer
I feel like I may have finally figured out the answer to so many of my problems. A lot of your info sounds like what is going on with me. How can I tell which side has the problem? Also, I’ve already looked for PRI therapists near me and there are none, is a chiropractor or physiotherapist going to be able to help me?
Thanks
Where do you live Denaye?
I’m a little confused by your pelvis being “oriented” to the right. An x-ray showed that the left side of my pelvis is higher then the right side and that the right side is rotated forward. Also while standing I tend to stand with my pelvis facing to the left. Is this the opposite of what you are explaining?
Hi Miles,
In over six years of testing the pelvic positions, I haven’t yet found a right side of the pelvis rotated forward compared to the left. The right side CAN be rotated forward, but it is always in conjunction with the left side. There is a very good reason for this: the larger right diaphragm exerts a stronger pull on the spine than the left diaphragm does.
PRI has standard orthopedic tests that show the position of the pelvis. That’s what I go by. X-rays may not always accurately portray what’s truly going on.
Without examining you I can’t really comment on your situation, unfortunately. I can just relay my experience.
Hi! My name is Manu! I did not really understand this technique but I’m interested in getting it know better and test it. I’m dealing with a tight LEFT ql that would send tightness also in the LEFT hip, TFL and groin. I’m right handed. I noticed that my pelvis is higher on the LEFT of about 2 cm and my LEFT shoulder is lower than right. My LEFT foot tend to turn a lil bit outside (away the centerline of the body). I tried stretch QL, strenght gluteus and hips, but nothing really helped. Lately I also noticed that if I stand on one my LEFT leg with my foot pointing straight forward, my pelvis rotates towards the right. Instead of I stand on the right leg, I can keep pelvis stable… I’m freaking out and would really like to get some help from you. Thank you in anticipation! Kind regards, Manu
Manu, if you check my YouTube channel, there are many many videos that will help you understand the underlying asymmetries of the human body that can cause these issues. What you are describing is the left AIC pattern.
https://pritrainer.com/left-aic-pattern/
Hi again! All the symptoms describe very well my condition! I will watch more of your videos and I hope to fix my shit as soon as possible. Another consequence of that left hip hike is a difficult to engage fully my left glute when my foot is straight forward and my left foot arch would cramp, sign of a dysfunction in the foot too due to the hip instability. It was a really good found this website and your help is very appricieted! I have been dealing with left knee pain for 2 years and I saw a lot of professionalas, spent a bunch a money to never get a real fix. I m now 5 months into a personal research and I am already seeing a lot of improvmenet. Knee pain is gone and the left hip is going to fix it along with the strenghtening of anterior fibers of gluteus medius, and strenghtening of left groin muscles. Kind regards, Manu
Hello Manu. I have the same issues like you and I have painful knees and nobody can explain this cause. My left pelvis is higher and my foot rotate out. Please can you tell us more about your experience ?
Neal… you’re a legend for posting this. First off, thank you. I’ve been struggling with this pain for the last 10 months. It’s been brutal. Was extremely active before this randomly took over my life. SI pain, tight R Psoas and QL, R leg weakness, all quad muscles spasming, etc.
No doctor has been able to help (70+ appointments). Have had MANY injections for where people thought the pain was coming from with bo luck. Multiple si joint injections… no relief. I’ve found a PRI doc in Austin and am going to meet with him ASAP. From your experiences, how long does something like this typically take to show some resolve? And once resolved, does it hold or is this a forever issue? As I’m sure you know, something like this takes a toll on the mentals and I want to make sure my goals are reasonable. Thanks again for your knowledge and willingness to share on this topic.
It really depends on the individual and how many compensations are involved.
Hi, I too have a lateral tilt (left side higher than right) with my pelvis oriented to the left. Are you saying this right forward rotation is impossible? I am aware of the fact you can’t examine me but I am confused.
I’m saying that I have never seen a right side of a pelvis that is rotated forward compared to the left. The reason is simple:
https://www.youtube.com/watch?v=Y_25eAthmaA&t=4s
A pelvis can potentially be oriented to the left (but still with the left ilium rotated forward compared to the right) but for that to happen there has to be an extra twist at one of the lumbar vertebrae. This is considered a pathological issue (doesn’t fit normal biomechanics) and I’m not sure I’ve come across it yet.
At any rate, we have orthopedic tests that determine the position of the pelvis.
Is the exercise you provided in this article the only one we should be doing? Are there other exercises to complement this? Thanks!
You can try these. But keep in mind that without working with you directly, I can’t know exactly what you need.
https://pritrainer.com/pri-left-aic-right-bc-beginner-example-program/
Hi Neil,
Unfortunately I live in a Australia and there are no PRI trainers here 👎
For many years now I have had severe muscular spasms in my lower right back. As a result I have a lateral pelvic tilt; a ‘left hip hike’. As such, my right leg feels shorter and my right shoulder is higher and I have chronic pain in my lower right back and backside.
I read you had this issue in 2011. I however, am finding it difficult to grasp your articles, as I get confused with what the fix is because of my issue being a left hip hike oppose to a right.
Should I be doing the 90/90 on the right hamstring or will this only make things worse?
Regards
Bradley
I would strongly advise against using the right hamstring. It would simply reinforce the pattern.
hey guys, I was trying this out and it really relieved my pain! I am having similar issues; got pain in my lower left back and my body looks discombobulated (left hip higher than right).
anyways, after hours and hours of searching, seeing chiropractor, and xray; I found out that it’s Gluteus Medius Tear Syndrome. https://www.duncanhipandknee.com/gluteus-medius-tears-stephen-duncan-md.html
Lateral Pelvic Tilt and Gluteus Medius Tear has similar visual symptom as it causes a pelvic tilt to one side.
So glad I found your article
I felt my right hip pop about 4 months ago which gave me gtps pain and a limp, referred physio who gave me stretches to do which resulted me getting severe si joint pain in the right which left me virtually bed bound for three weeks, 6 weeks later and I’m still in agony, on 4 types of pain medication with hip, lower spine and sacrum pain and can’t go from sitting to standing as I can’t straighten.
I kept telling the physios my right leg feels higher ( my trouser legs look uneven ) and I feel like I’m walking to my left almost sideways and they don’t listen,
No one has examined my posture as NHS services in England have to be triaged through physio first,
I stood against a wall tonight and measured my hip heights and I’m at least 5cm higher in the right !!!
waiting for msk tier 2 referall now so I’m going to take your article with me and make them examine me properly.
I went from being active to totally incapicated since quickly
There is a physio in London, Martin Higgins, who knows what I’m talking about. Perhaps you can see him.
Is any body you know in australia
I have lateral pelvic tilt. The left pelvis is higher
Though I had PRI PTBIN WHEATON IL. CLOSED
CANT FIND A PRI PT OR CENTER
I LIVE SIUTH SUBURBS OF CHICAGO.
ANYPLACE YOU KNOW OF IN NORTHWEST INDIANA?
Oh I. I’ve found this really interesting and helpful however I am really confused still (sorry). I have overactive TFL and GMed on my right side And limited ROM around right hip. Also a weird tightness/nerve type pain down my right posterior leg. Weak GMed left side and when I bend down I always shift weight onto left leg. Do I have right AIC or is this very unlikely?
I feel like Im finding new caveats to my postural issues every week.. At least a couple every month. But this one really hit home!
I look exactly like the pictures, and recently Ive been working alot on my left leg balance due to poor foot arch and left TFL/glute medius strength.
However, trying to balance on my left leg after reading this I realized that I am certainly not in a “left weight-bearing” position. When I now consciously shift my weight and hip to the left I immediately felt the left QL contract, which it probably havent done correctly in 15 years..
Balancing also felt a lot easier.
One step closer to an even hip. I hope one day to start deadlifting again.
Thank you
Hello…
I have uneven shoulders and uneven hips(lateral pelvic tilt) since childhood. (10 years of age)
I have been trying posture balancing exercises now at 35 years of age …but not gaining noticeable results..
Is it possible that my bone structure might have changed due to this imbalances in hips and shoulders??
Also, is it wise to expect perfect balance posture from exercises.. at this age… I am 35 now.
If I want to do strength training … can I do it with unbalanced hips and shoulders…
I have an athlete that presents with a pretty significant tilt when bilaterally loading (trap bar deadlifts and front/back squat). The tilt doesn’t occur until around 60 degrees of knee flexion. His tilt when standing is mild at most – typically presents without. Any thoughts regarding this?
I don’t get too caught up in measurements and degrees. If I see a tilt, or a rightward shift of weight, particularly during the ascent out of the hole, it’s just a normal result of the left AIC pattern’s effect on pelvic mechanics. Overactive right adductor pulling to the right. That’s my guess.
My right pelvic is high tilted to left my right hamstring and knee is pain nearly a two year seen physio osteopath but issue is. It resolve yet I have pain my right lower back very stiff and very limited knee extension tibia rotation too much going in right leg what you think please advised me. My right inner thigh muscle is switched off it’s so painful.
Hi Neil, thank you for this helpful article.
Im 26 and have quite some issues with my right ishias nerv since 6 years. Doctors usually blame the piriformis, which I think might be the reason, however not the cause in first place.
In my specific case a lot of patterns are the the oppsite than what was written. My left pelvis is 1,5cm higher than my right pelvis, my pelvis (at least subjectively) is rotated to the left, my upper body rotated to the right. I feel that my left QL and my right psoas are tight.My right leg seems to be externally rotated while the left one internally.
Do you have any advise or is it best to advance with strenthening left hamstring, glute medius, adductor and right glute max.
Hi Sir!!
I really found this article useful.
I have my right side hip gone up, my left shoulder slightly lower and my right side of hamstring are all tight and giving a pain.
Do I still do the same exercise with the LEFT leg?
Try a two legged 90-90 with no hip shift, but don’t do just your right leg right now. Or try the left ZOA exercise on my beginner program page.
Is there someone in my area that could help me with these things? I live in Mobile, AL and I am having trouble finding a provider/physical therapist that understands these concepts.
I don’t think there is anyone in Alabama, but there are many in North Carolina and Texas. Check the Postural Restoration Institute website.
Hi, I definitely have the left AIC/right BC pattern and a pelvis rotated to the right. It seems I also have an anterior pelvic tilt. Is this possible? Which tilt do I address first?
It’s all the same thing: an asymmetrical resting position of the pelvis. Try the exercises on the beginner program page.
Thanks so much in advance atleast I self diagnosed but I do not know how to fix this please be advised god bless you man could not run or walk properly limping on right no life with this agony
Try the exercises on the “beginner program” page. Start with the All Fours Breathing exercise.
thanks for replying it was very hard to live with this uncomfortable body posture i will following your exercise plain i can do gym prone curls for left hamstring as well please advised.
Hi, I have similar symptoms but the pain has been in my left calf/peroneals and with limited mobility in my left ankle (anterior ankle impingement). I’ve had the pain for about 2.5 years now. Even though the pain is on my left side, would I do the exercises exactly like you describe or would I switch legs? My left leg muscles and glutes feel weaker than my right.
If the pain is over on the left, I’d have to make the educated guess that you are a PEC, meaning both sides of your pelvis would be rotated forward. In that case, I’d recommend you start with the two legged version found on this page and see how it goes.
https://pritrainer.com/pri-left-aic-right-bc-beginner-example-program/
Thank you. I will check it out.
Why is the QL tight more often on the right side, vs the left?
Because in right stance (when you are standing on your right leg during walking), it should be active. In the left AIC right BC pattern, you are essentially standing on your right leg all the time. So it’s normal to be tight.
Hi Neal,
Thank you for this article. I’ve been struggling with chronic LBP, right SI disfunction, right hamstring tightness for almost a year now and I’m finally figuring out what is really going on. I have a lateral pelvic tilt – right side is hiked up. However I believe I have a LEFT orientation (rotation) given that my right ASIS is more forward and my bellow button points left. It looks like your suggestions/exercises pertain to right orientation. Could you help me make sense of the exercises given my different orientation?
Hello Allie. Watch the video I link to. The exercises stay the same regardless of orientation because the left AIC pattern is not the same as orientation. Some people can be oriented to the left (as I explain in the video) but it is rare. If you are truly oriented to the left, then something screwy would have to happen in your lumbar spine (ligamental loosening probably) and in that case things won’t be as simple as resolving a pattern. I’d suggest finding a PRI certified physical therapist.
https://www.youtube.com/watch?v=HL4sclfUvWI&t=415s
Hi Neal,
I stumbled across your blog on fixing lateral pelvic tilt yesterday and I wanted to thank you for making what seems like a really useful guide to fixing this problem. For whatever reason it’s been incredibly difficult to find help online for this. Anyway, I read the majority of your site and the way you describe the problem fits to a tee the way my pelvis/whole body feels. Just doing those 4 exercises last night and this morning already makes me feel slightly better. However, I’ve had this problem for almost 10 years at this point (and maybe earlier, but that’s as long as I can remember). How long does it typically take someone to recover from this if they’re doing those exercises every day? I also wanted to ask if there’s anything I can do while working in a chair or driving in a car that would help me. I’ve basically been just focusing on the way my pelvis feels and trying to sit with my right knee/hip a bit forward, and trying to pull back the left a bit. Also slight flexion of the left QL a bit, and pulling back with the left hamstring. Please let me know any advice you have. Lastly, is there a good exercise for pulling the right side of the pelvis down? I have both the rotation to the right that you describe and a hip hike on the right side. The exercises you’ve given seem to help me a lot with counter-rotating the pelvis to the left, but less so with the hip hike on the right.
Thank you
I am being treated by a PT trained in PRI. I am aware of my weakness in left hamstring, right glute max and lack of sensation of my right arch. My left ZOA is pretty good. I searched your site for “strengthen hamstring” and this article came up. I totally “get” the theory here. What I want is a more advanced way to strengthen my left hamstring than simply pulling with my heel on the wall. I am good at that, but my weakness has not improved much. What else can I work on for left hamstring?
Well, if you have a left ZOA and can maintain it (meaning you test neutral when you go in for a PT session) then from a PRI standpoint your left hamstring is likely strong enough. PRI is less about traditional strength and more about restoring the ability to walk and breathe without compensation. You could start strengthening it through weight training if it’s a concern. But I never examined you so I can’t make any recommendations since I don’t know the particulars of your situation.
Thanks Neal,
I find your web site very helpful as a supplement to the posture restoration I am getting through my PRI trained PT. Your videos and blog posts explain PRI and its complicated terminology and acronyms so well. When my brain is having trouble catching up to the exercises I am subjecting it to, I often find information on your site that helps me understand. I am a bit obsessed with PRI because it has been such a monumental positive change in my everyday life. At age 66 I have a LOT to undo, (PEC with pudendal nerve pain, coccydynia,and lumbar scoliosis). Your information here is making a big positive difference. Keep on with your wonderful videos and blog posts and be assured that they are making a big difference for a lot of us.
Thank you Margaret. Patterns can be tough to undo when you’ve been in one for so long. I’m happy to hear you’ve experience positive benefits!
Hey there,
I have been looking everywhere for answers on what is going on. Some of this is a little confusing I have a left hip hike, pelvis rotated to the right and the right shoulder is lower and embarrassing to say you can visible see that the right butt cheek is much lower. My pants always pull to the right.. Hamstrings on left feel tighter and right ql I’m told is right. Physical therapist has me working on my external rotation the the right side, abdominals and right glute strengthening. I do feel like the flute imbalance is actually becoming more noticeable…it’s very frustrating and affects the quality of my life greatly. If you please advice me on if this is normal and what I should do?
Pants always pull to the left*
Audrey, my advice is to seek help from a PRI certified PT. Everything you mentioned is normal. Regardless of what you visual presentation looks like, the underlying pattern is the same. Your left hamstring isn’t tight in the conventional sense. It’s probably tense. The right QL probably is tight. Addressing just the pelvis isn’t going to work because it’s a total body issue.
I tried the exercise the other day keeping in mind all your pointers. It worked. Which is is great! Thank-you! But I wanted to suggest that people make sure to take it easy the first time trying it. I was super sore the next morning. It was bad. I think I did the exercise four or five times.
Thanks for the comment, Meredith. Some people do indeed get sore in the hamstring, but I’d say that most do not. On the other hand, the left adductor is what most people will experience quite a bit of soreness from. But I agree, people need to ease into it.
Yes, I believe it was the upper adductor. I tried again last night making sure to do only three reps. I am okay today.
Hi! Very helpful info. However, I seem to be opposite. When my weight is on my left foot, I seem to be normal to leaning slightly left but when my weight is on my right foot, I still lean left. When I am standing with weight distributed between both feet, my right hip is higher and my right shoulder is higher. I can easily bend my right QL to the left but bending my left QL toward the right is extremely difficult and I feel quite a bit of pain in my right lower back/hip. Which way do you think I’m tilted and which exercises do I do?
Hello Tami. My experience tells me that you have likely developed some extra compensations on top of the normal left AIC right BC pattern. I’d suggest trying my beginner program and starting with the All Fours Left ZOA exercise and then experimenting with a two legged 90-90 for both hamstrings.
Hi, Ive been reading your blog with keen interest. Literally been in pain my entire life since a young kid.
Couple things Ive noticed about me that dont seem to exactly line up with what I am reading.
(Note: All my pain is on my right. Literally, From my eyes/face to my toes. And its severe and constant. Literally no pain ever on my left)
1- My neck is side bent to left with my left SCM tight and over active.
2 – several PTs have told me my right glute medius is weaker than left
3 – I have been told by several PTs that my right obliques and psoas are over active and tight
4 – trigger point therapy on my right QL immediately causes my body to flip flop appearances.
Exactly the opposite of how I typically look. Pain is immediately reduced.
After releasing the right QL, my pelvis is facing left, my upper body is bending to the left with left shoulder lower, my neck is side bending to right. Weight appears to be more on my left vs right.
5 – during last round of PT, midway through, my body was now putting more weight on my left foot vs right.
Have you ever encountered those odd appearing findings?
Hello Riley. Everything you wrote is normal.
Pain can be on either side. The entire right side of the body is in a state of compression, while the left side is too decompressed. So while both sides are living in different “states of being”, pain can happen anywhere, or many places at once. It still reflects a body stuck in the left AIC right BC pattern. All we see visually are the compensations, not the underlying pattern. Different people can compensate in different ways, but the underlying pattern is the same.
Neal
All pain on right side
Left side does feel less grounded than right
Sleep on right side
Laying on back legs straight up, right foot is higher by 1/4 inch+
Standing up left hip looks lower than right
Shoulders look pretty close
Right side feels sore/tight. Could it be overworked causing that soreness/tightness? I been wearing two heel lifts to bring the left leg/hip higher to help compensate. Maybe 1/4 of an inch.
A doctor measured a 1cm difference. He also ordered a scanogram which showed 1 mm difference. I am in my 30s. I reckon I spent lots of time using my right side to do physical labor for years at a job. The funny thing is I can do more repetitions of hamstring curls with my left leg. I don’t know if my right side is just overworked and ‘bigger’ than my left.
Hello Jeff. Everything you describe is normal in the Left AIC right BC pattern. You are “over-grounded” on the right and “un-grounded” on the left.
The hamstring curl issue does seem counter-intuitive. However you have to realize that doing hamstring curls and “walking and breathing” are different activities. Since you are in a pattern, I have no doubt that you are using way more than your left hamstrings to do those left hamstring curls. You are also using your left lower back and even right sided musculature. It can’t be any other way because you already described the fact that you are in a right dominant pattern. You’re still using that right dominant pattern to do your left hamstring curls, plus the part of the left hamstring that is doing work is likely the larger biceps femoris, which is technically part of the Left AIC musculature.
The right biceps femoris is often weak on the right side, also due to the left AIC pattern, so you are probably relying more on your weaker medial hamstrings.
Another issue is that the femurs and tibias end up in a “patterned” relationship, too. So when you place your patterned lower legs on the hamstring curl device, they probably aren’t placed in the exact same way. This can further reinforce the already dominant pattern.
Hi Neal! To start, thank you for writing all this up and posting these videos.
I am a nineteen year old track/cross country runner. Is it normal that my right leg is the one that feels weak, and not my left? When I run, I get all my power from my left; the knee drive is better, the swing is more fluid, my hamstrings/glute engage. My right leg, however, pretty much gets dragged along like a dud. I can’t get my right hamstring and glutes to engage well, and the hip flexor gets tired easily. It’s almost as if I have to manually focus on moving my right leg while hte left moves naturally. Does this fall along you definition of being stuck in the left AIC/Right BC pattern? I appreciate any help!
Seth
Hello Seth. Yes, it’s normal. The right glute and lateral hamstring are probably dormant while the right adductor/medial hamstrings are overactive.
While you might get power from the left side, it’s mostly compensatory power. It’s coming from the quads/lateral hamstring/some left glute. In addition, you’ll be using your hip flexors and back extensors to stabilize the left side of your pelvis. None of these are good situations.
The problem is that these are all external rotators of the left leg (while the left outer quad is a compensatory internal rotator of the left leg). In the left AIC pattern, the left leg is already “living” in a state of external rotation, so these muscles are only “feeding” the pattern.
It’ll work for now, but you aren’t getting into true “left stance” internal rotation with the your left hamstring, adductor, glute medius/internal obliques when your weight is on your left leg, so eventually your body may suffer from so much compromised movement.
Hi Neil, thank you for this helpful article.
Im 26 and have quite some issues with my right ishias nerv since 6 years. Doctors usually blame the piriformis, which I think might be the reason, however not the cause in first place.
In my specific case a lot of patterns are the the oppsite than what was written. My left pelvis is 1,5cm higher than my right pelvis, my pelvis (at least subjectively) is rotated to the left, my upper body rotated to the right. I feel that my left QL and my right psoas are tight.My right leg seems to be externally rotated while the left one internally.
Do you have any advise or is it best to advance with strenthening left hamstring, glute medius, adductor and right glute max.
Hello Stephan, regardless of what you see visually, or even feel, the underlying pattern is the same. From your description, you’d likely test as a Patho PEC. In that case you start with a two leg version of the 90-90 for both hamstrings. After that, it’s the same muscles as always, but it’s not always straight forward and not simple without professional help.
I have sciatica down right leg into heal / foot. MRI shows moderate bulging discs. My right hip is higher and I have some right hip pain / tightness, as well as upper right neck and back tightness. Upper back has spasm’d several times. I am seeing PT and they are focusing on standard bulging disc treatment (side glides, prone press). I have noticed my hip musculature looked crooked for sometime but didn’t really think anything of it until reading this. Is it possible my problems are caused by the hip alignment issue?
Hi!
This is a very usefull article. I think you might give me some more answers. I have this problem for a while now and some issues have been resolved athough some are still present and prevent me from doing some activities.
I have a very tight right QL accompanied by some issues you had yourself such as constantly tight right caf, hamstring and hip flexor + less mobility in my right ankle. I know my right leg is shorter than my left (1.2 cm) which is not that disturbing I guess.
The main problem is that when I look in the mirror my whole body looks like its is shifted/tilted upwards toward te right side. so my ribe cage on the right side sits higher and more to the right. When standing on my right leg, I feel like i have less stability than when standing on my left leg.
This problem is accompanied by some more tightnesses in my back and shoulder muscles all on the right side.
I am trying to find information to resolve all my problems but i think everything is related and it is hard for me to splitt up all the problems in compartments and adress them accordingly.
Hi Neal!
I have a Lateral Pelvic Tilt (left hip is higher, right shoulder higher), my right hip seems to be stuck in an external rotated position, and that I kind of have an Anterior Pelvic Tilt as well. What should I focus on correcting first? What would you do in this case?
So happy t have found your site. everything you say resonates with my issues that have slowly gone from bad to critical on the past 10years. The pain is constant in my front left hip and travels back and forth from my groin. I have very limited leg movement in my left hip and I can’t fire my butt muscles to save my life – but now I have your beginner exercises and I am so hopeful!!
How many times a day should I stop to do the them?
How long before I should notice a change and improvement?
I feel this is what my husband has been dealing with most of his life. He is 57 now. When he was a child they tried to tell him he had a short leg and put a block in his shoe and it made the issue worse. His pelvis will go completely out and he can barely walk. I found this article and am going to have him view the videos. His pelvis is actually out right now. He is in so much pain. Usually he can get it back in after a few days but its going on a week and he is still in extreme pain and walking around all crooked. I feel so bad for him.
I am so glad I found this article!!! I have been in so much pain and told to strengthen my core, but could tell something was just very off. I got some x-rays and my left hip is 8mm higher than my right. I coach figure skating and starting using a tool called a pole harness a few years ago and I am generally lifting people who skate in a counter clockwise direction (I should add that I am a clockwise rotator and lifting cc is my weaker side). My assumption is this repetitive movement led to my lateral pelvic tilt. Getting out of bed in the morning is SOO difficult. I was told to try a lift in my right shoe, in addition to that, what exercises would you recommend?
Thank you!!!
My right side/hip is in front of, or ahead, of my left. So I believe I’m the opposite. Should I just focus on my right hamstring then? Also how many reps and sets for this exercise?
Hello,
My right hip is higher, right shoulder and ears appear lower. In the past various physios have said i have sacroilliac problem/ leg length discrepancy/ tight hip flexors! I have pain on right side of pelvic floor, right hip , groin ,thigh and sacroiliac area. Past 10 years i have had pain below right ribs too, which drs cannot diagnose despite many scans.
I am not athletic and now 65. I am at my wits end with constant pain which no one has been able to definitely diagnose. Do you think all these symtoms could be connected? Drs and physios seem to concentrate on their own specialities.
Thank you so much for reading
Go see a upper cervical chiro and have your C1/C2 looked at. You could be suffering from misalignment
I watch Conor Harris, Jeremy Ethier, Stuart McGill, Jeff Cavalier… but, you are the BEST. Your explanations are perfect. Thank you so much. You have saved my life. I am now on the path back to a more normal life.
Thank you, Kevin. I’m glad you are getting your life back on track.
I definitely have a forward tilt of the right side of my pelvis that spins me around to the left. I’m quite surprised that this would be unusual, as it feels heavily linked to helping to reach out forwards with the dominant right hand. It feels so normal that I struggle to imagine an opposite pattern without picturing being left handed and reaching for something with my left hand. Even then it’s hard to replicate the opposite hip tilt.
I also have a winging of the right shoulder and am having to work at developing the serratus anterior so I can reach out comfortably without helping by tipping the pelvis, or by letting the lower shoulder blade dislodge from my ribs.
I’ve heard engagement of the hip extensors spoken of in terms of pushing out forwards, but it doesn’t work at all in my tilted right side. I’m just learning how to extend the right hip properly, by thinking of both pulling the upper pelvis back and also trying to pull the upper right leg back behind me. I feel the sense of pushing out results in between these, but I can only achieve it by thinking of pulling backward from both points. I’m only just realising that when I previously thought of tipping the pelvis back, I would tend to move the leg with it rather than open the hip joint (possibly working the hip flexors even harder, rather than grounding the leg to extend up from).
This video may explain what you are experiencing.
https://www.youtube.com/watch?v=9KntPsVyKYU
Hey Neil, any chance the pelvic tilt could be caused by C1/C2 misalignment? Effecting the entire nervous system, muscles and spine. I’ve been seeing a upper cervical chiro who has just begun adjusting my C2 vertebra as my initial weight was 20lbs heavier on my right side w/ a shortened R leg and dropped R shoulder. After adjustment my scales became even. Both atlas/axis misalignment and L AIC patterns seem to look the same on a full-body diagram. What is your thoughts on this?
He ain’t gonna reply!
The article really related to what I am suffering from. So far i have observed: 1. When i stand up my left foot externally rotated (not every time). 2. I feel my right leg is shorter than left one. 3. My left jaw near left ear bone has pressure. 4. I feel left hamstring while walking while I don’t feel right one. 5. Any type of exercise worsens my situation. 6. My neck stays tight after sitting sessions. 7. I feel left side of lower abdomen near belly button slightly lower than right one. 8. Left shoulder blade keeps hurting and gets relieved while standing on right foot only and using right side to hold weight and also feels better when i lift left foot slightly off the ground while lifting weight with hands. I will appreciate your help. Thanks
Hello Neal
I been having issues with my left side abdomen, I have issues with left oblique and left QL but most of the time is my left oblique, I feel like it’s overactive my question is where should I start