A Comprehensive Guide To Fixing Lateral Pelvic Tilt

Feb 03, 2022
fix lateral pelvic tilt

Lateral Pelvic Tilt is a total-body compensatory pattern. In order to understand how to improve this posture, it is important to be able to differentiate and identify different types of lateral pelvic tilt.

I have good news and bad news. The bad news is, posture isn’t correlated with pain or injury. This has been studied enough to the point where we want be fairly sure of this, so I wanted to make it clear before I continue that this isn’t necessarily something that is going to solve everything you feel if there is pain present. If you are in pain, go see a qualified physical therapist.

The good news is, posture can be (an in my experience, very frequently is) correlated with certain movement limitations. If these movement limitations persist over time, we can see nagging overuse injuries pile up over time as well additional layers of compensation build over time. I have seen people feel pretty great after improving their lateral pelvic tilt and associated movement limitations.

In this article I will address:

  • The three most common types of lateral pelvic tilt
  • How to identify which type you are
  • How to address the different types of lateral pelvic tilt

If you'd rather watch than read, click below:

Common Types of Lateral Pelvic Tilt

#1: The Baseline

It is first essential to understand that almost every human that walks this earth is naturally asymmetrical. Almost everyone has lateral pelvic tilt to a relative extent, it’s just a matter of how much.

I have a full, very detailed webinar here on why we are asymmetrical:

I also have an extensive article on this pattern here.

In short, we have:

  • A diaphragm that is larger on the right side
  • A heavy liver on our right side
  • An asymmetrical brain that allows us to sense our right side better (partially explaining why most people are right-handed)
  • Slightly more overall body mass on our right side

Basically, we have gravity, our brain, and also organ asymmetry setting us up to bias the right side of our body.

This causes the right hip to become higher (initially), which causes our right hip to be biased towards more internal rotation and our left side to become more biased towards external rotation. This type is founded by Postural Restoration Institute and they named it the “Left AIC”.

The left side is more forward than the right, which means it is more anteriorly oriented (more like anterior pelvic tilt) and the right side is relatively in more “posterior pelvic tilt”. The pelvis is overall oriented to the right:

I'm exaggerating the visual side of things a bit for illustrative purposes.

This is the baseline layer. We can (and often do) layer more compensations on top of this, but this is Step 1 for most humans. Yes, this often applies even if you are left-handed.

#2: Oblique Orientation

Some of you reading this may be asking, “Well, what if my left hip is higher?”

You very well may be correct. It’s impossible to know exactly why someone would compensate into a higher left hip, but the common causes I have seen correlations with are:

  • Injury to the right side of the body – particularly significant ankle injuries because they limit our body’s trust to load that side of the body
  • Sports that require a repetitive shift into the left side – often rotational athletes
  • Genetics

In this pattern, the higher left hip limits range of motion on both the left and right sides. It's important to note that there are many different types of these orientations. In this context, we refer to them as Oblique Orientations (credit to Bill Hartman for this term), as the pelvis slowly begins to orient itself as a whole on that oblique, or "diagonal" axis:

 

It depends on the variables above and also how far they are into developing a lateral pelvic tilt compensation.

There are two common types of oblique orientations that I see. The first is where the left hip is higher than the right, and it is oriented as if it was pushed up from the left side of the pelvis.

The other common type of oblique orientation is one that is not only higher on the left, but also significantly more forward on the left side as well. This is more representative of a pelvis that is oriented on an oblique axis.

This is the other type of lateral pelvic tilt where the left hip is higher. In this case, the left hip is coming “up and over the top”.

This is a case where the left hip now very far forward, but the now also higher than the right.

How To Identify Which One You Are

There are several different simple, objective assessments you can use to help determine which one you most likely are biased towards.

The three assessments we will use are hip flexion, straight leg raise, and shoulder flexion. These all measure different joint actions which will give us an idea of what side of the body is better at certain ranges of motion.

It is very, very important that you pay close attention to these videos and how I coach them. Slight differences in degrees can make the difference between interpretations of the results. So please go slow and carefully.

I'm usually looking for a difference of 10 degrees or more between sides before I am thinking about significant lateral pelvic tilt.

Hip Flexion: This is measuring how much external rotation you can access on this side of your pelvis

Straight Leg Raise: This is measuring how much internal rotation you can access on this side of your pelvis

Shoulder Flexion: This is measuring how much this side of your pelvis is “forward” or anteriorly tipped:

If you are very forward on that side of your pelvis, you won’t be able to get very far overhead because you are compressing your shoulder blade against your ribcage as seen here.

Interpreting Results

Left AIC: In this pattern, we should see:

  • Hip Flexion: Left > Right
    • This is due to the left side having more external rotation than the right.
  • Straight Leg Raise: Left < Right
    • This is due to the right side having more internal rotation than the left.
  • Shoulder Flexion: Left < Right
    • This is due to the left side being more forward than the right.

Oblique Orientation: Depending on how far you are into an Oblique Orientation, you may see one of the following assessment results:

#1: Left Hip Higher

  • Hip Flexion: Left > Right
    • This is due to the left side still having more external rotation.
  • Straight Leg Raise: Left > Right
    • This is due to the right side being “pinned down” by the left side.
  • Shoulder Flexion: Left < Right
    • This is due to the left side still being slightly more forward than the right side.

#2 Left Hip Higher & More Forward: In this pattern, things get slightly more complicated. The left side is now so far forward that now both sides of the pelvis are in "anterior pelvic tilt". Because if the left side comes very far forward, the right side will follow to an extent.

  • Hip Flexion: Left < Right
    • This is due to the left side being too far forward to access any external rotation.
  • Straight Leg Raise: Left > Right
    • This is due to the right side being “pinned down” by the left side, but sometimes in this orientation the right side can be better than the left.
  • Shoulder Flexion: Left > Right
    • This is because the left side is now so forward that the person is essentially starting in a position where the left side is so far forward/extended that the shoulder blade is tipped up and forward, which will be give the impression that they have more left shoulder flexion, but really it is not "real" shoulder flexion:

Another confirming assessment for an Oblique orientation is going to be a loss of right femoral external rotation. In this orientation, the left side is so far forward that it pulls the right side forward with it, which significantly limits right external rotation. If you can't determine if you are a Lateral or Oblique orientation, then use this to determine it. If you have less than 20 degrees of femoral external rotation on the right, then chances are you are Oblique:

What If I Don't Fit The Expected Assessments?

If you took your measurements and don't fit 100% into one of the three types of lateral pelvic tilt, I would encourage you to first watch each assessment video and re-check your measurements to see if you are unknowingly compensating. I address each common compensation in each video. A lot of people at my own gym have a hard enough time doing these without compensating at first, so these can seem simple, but they do have a degree of intricacy to them.

Also remember that lateral pelvic tilt is a gradient. The three presentations above are the most common, but there are plenty of "transition" phases between each of these three. You can be in between a lateral and oblique, or in between a Left AIC and a lateral.

If you are unsure which you are, go with the one that most closely matches your assessment results rather than what you think is the case. Visual presentation can sometimes be misleading and objective assessments will give you the best idea of what your true movement limitations are.

How To Fix Lateral Pelvic Tilt

In order to address this, there are some steps we can take. I am going to give you a few examples, but by no means is this comprehensive. I have over 200+ exercises in my library as well as specific case studies and further detailed steps in my Biomechanics Program.

Left AIC: For this, we want to be able to pull the left side back via muscles like the left hamstring and internal rotators. Then, we want to help push the right hip forward with the right glutes and external rotators. Here are some example exercises in the order you can do them:

PRI 90/90 Supported Alternating Crossover with Left Foot on Wall

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com  

PRI Left Sidelying Knee Toward Knee

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com  

PRI Right Sidelying Right Apical Expansion with Left Arm Reach and Left Adductor

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com  

Oblique Orientation: For this orientation, the good news is that Obliques tend to benefit from a similar approach. There are intricacies I discuss thoroughly in my Biomechanics Program, but for the purposes of this article, I will keep it digestible. If you are curious to learn more, or see how they fit in the context of an progressed program, I highly recommend you check out my Biomechanics Program. 

I have seen a lot of success doing the following:

1. Push Left - This means using the right glute and external rotators to "push" the right side over the left to help create a more neutral pelvis.

Left Sidelying Right Propulsion

Exercise credit: Bill Hartman. https://billhartmanpt.com/ 

Right Glute Max Facilitation in Left Sidelying

2. Pull the Left Side Back - Now that there is more leverage for the adductors and hamstrings to control the tilt of the left pelvis, using the left hamstrings and adductors can be helpful to secure that left side down and back.

PRI Right Sidelying Left Adductor Pullback

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com  

Supine Cross Connect with Compensation Bias: This will passively turn their trunk left via the mat to allow the pelvis to actively do the same via the foot reference on the wall.

 

3. Dynamic Right Foot Forward Activities - Promotes the ability to push from right to left to push the right hip forward & up and left hip down & back

Front Foot Elevated Split Squat with Right Foot Forward and Ipsilateral Load: This will hip bring the right hip higher so we can create more symmetry. The ipsilateral load will also further help us push the right hip forward and left hip back:

Front Foot Elevated Split Squat with Right Foot Forward and Contralateral Load: We can then progress this to a contralateral load. Because with single-arm loads, the body will want to "turn away" from the load, the contralateral load will faciliate more of a challenge to keep the right hip forward. This is a progression from the last exercise:

Lateral Cable Chop in Staggered Stance

Exercise credit: Bill Hartman. https://billhartmanpt.com/ 

Summary

Identify your limitations via objective assessments, choose the right exercises, and always test and re-test. A massively important note: Execution is key to these drills for optimal success. If you are not feeling the right things as described in the videos, or not breathing properly through them, you won’t see nearly as much success as you could.

These exercises are a bit complex for a reason – we are respecting so many different things in the body:

  • Skeletal position
  • Muscular recruitment
  • Foot references as they relate to gait so that you can achieve these positions in upright, dynamic movement (i.e. walking and running)
  • The nervous system via breathing to allow your body to feel safe & accept these new positions

That’s the (slightly) bad news – these require real effort. The good news is, for most people, they will work better than anything else you’ve tried before.

Thank you for reading!

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