The Best Resource On The Internet For Fixing Lateral Pelvic Tilt (asymmetrical hips)Jun 23, 2023
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.
In this article I will address:
- The best way to think about lateral pelvic tilt
- The two 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:
Redefining Lateral Pelvic Tilt
Instead of thinking about lateral pelvic tilt as an isolated issue at the hips and lower body, I want you to think about it as a "total body compensation pattern".
And we can make sense of it more easily by considering what it represents, which is when we shift our bodyweight to one side in the gait cycle.
Lower Body Position
Imagine when you are walking, when you are fully on one side of your body, you are in mid-stance phase of gait. This means that your other leg is off the ground in "swing" phase:
During this phase of gait, we are in mid-stance on the weight-bearing side, which is a position of internal rotation. The hip on this side is raised subtly at this point.
On the side that is in swing, we are in external rotation.
This is a very good representation of what is happening when we have asymmetrical hips, or lateral tilt of our pelvis.
We are essentially lateralized to one side of our body.
The side we are lateralized in will have more internal rotation-based measurements of the hip and the side we are shifted away from will have more external rotation based measurements of the hip.
As for the feet, if you were to stand with your feet parallel and hip width apart and lean to one side, your foot arch will naturally raise on the side you are leaning on and it will drop on the side you are leaning away from:
So the side you are lateralized to will likely have a higher foot arch in most (but not all) cases.
Upper Body Position
As for the upper body, there are predictable positions that are associated with this.
When we are lateralized to one side, we will also be representing that in our trunk and shoulders.
As we enter mid-stance phase of gait on one side, the shoulder will also drop subtly on that side.
Our shoulder internal rotation will be better on the side we are shifted away from and our shoulder external rotation will be better on the side we are shifted towards. You can imagine it as if you were to turn like this:
The takeaway point of all this is that lateral pelvic tilt is simply a representation of one side of your body being in mid-stance and the other in later stance/swing.
Measuring and Assessing Lateral Pelvic Tilt
If you want to determine which side you are more lateralized to, it's important to first get accurate measurements.
We know based on the above description of lateralization, we will have predictable asymmetrical measurements on one side of the lower and upper body relative to the other.
Here are the seven assessments to use:
Hip Internal and External Rotation
Hip internal rotation is often better on the side you are lateralized towards. Hip external rotation is often better on the side you are shifted away from.
Straight Leg Raise
A straight leg raise is a representation of hip internal rotation beyond about 45 degrees. Therefore, the side you are lateralized towards will often have a better straight leg raise.
Hip flexion is a representation of external rotation. The side you are shifted away from will often have better hip flexion.
Shoulder Internal Rotation
Shoulder internal rotation will often be better on the side you are shifted away from.
Shoulder External Rotation
Shoulder external rotation will often be better on the side you are lateralized towards.
Shoulder abduction will often be better on the side you are lateralized towards because it is a measurement of how well your trunk can turn towards that side.
Based on above, you will have asymmetries from side-to-side. One side will be relatively better than the other. You can plot them on this chart:
Because we have 7 different tests, you will ultimately have at least 4/7 in one column. That means you are very likely lateralized towards that side.
And yes, the foot is included in there as well, but it's more of a subjective assessment so it should be more of a confirming tool.
An example of this would be this:
While they do have two in the left column, they still have 5/7 in the right, so that person is right lateralized and we would approach their situation as such.
There can be more complex cases where some people will present with upper bodies clearly going in one direction and a lower body oriented in the other direction like this:
This is an additional layer of compensation built on top of the baseline lateralization pattern. I will discuss this later in the article.
Most people are going to present with a right lateralization pattern because humans are naturally and inherently asymmetrical.
Addressing Lateral Pelvic Tilt
Based on your asymmetries, you will present lateralized to one side and shifted away from the other.
Therefore, the goal would be to improve the ability to "push out" of the side you are lateralized towards and "shift into" the side you are shifted away from.
Think about this as if you want to improve more early to mid-stance mechanics on the side you're shifted away from and more later stance on the side you are shifted into.
This means improving:
- The ability to turn your hips away from the side you are shifted towards (external rotation)
- The ability to turn your hips away towards the side you are shifted towards (internal rotation)
- The ability to turn the trunk to the side you are shifted away from
- The ability to turn the trunk to the side you are shifted away from
In order to do this, we need to consider the relevant biomechanical positions that will accomplish this:
To improve the ability to shift out of this side, we want to encourage the foot contacts of the arch of the foot, specifically the inner heel and first metatarsal head under your big toe:
This is because these foot contacts represent the transition from mid stance to late stance where we being to turn our bodies to the other side.
If we can feel these foot contacts, we will help get a "push" from that side back to the other.
These foot contacts also help us engage our external rotators like our:
- Outer hips
Example of starting exercises like this can be:
Do these lying on the side you are shifted away from, using glute on side you are shifted towards.
Side Shifted Away From
To improve the ability to shift into this side, we want to encourage the foot contacts of the heel:
When we strike the ground with our heel, we are beginning the transition of turning our bodies to that side and initiating our transition to mid-stance.
The heel will also help us engage muscles that help pull the pelvis back on that side and create more internal rotation like our:
- Abs (specifically obliques)
Example exercises for this can be things like below. If you want a more comprehensive approach to shifting side to side while addressing common movement limitations, check out my Beginner Body Restoration program:
Do this one reaching overhead on the side you are shifted towards.
Do these on the side you are shifted away from:
I recommend doing these exercises every day for two weeks. 2 sets in both the morning and night for 5-10 breath cycles.
For some of you, you will present as I mentioned before with your lower body lateralized one way and your upper body shifted the opposite direction:
If this is the case, you have an additional layer of compensation. You have created an additional "twist" at your lower or upper body. This can happen for so many different reasons. Examples of this could be:
- Heavy rotational demands on your body (job, training, sport)
- Previous or present injury creating compensatory patterns
- Visual or vestibular asymmetries
If you do have this contrast between your lower and upper body, it should be clear. Do not do the following exercises if you don't see consistency. Basically, all three upper body measurements should be in one column and 3-4 of the lower body should be in the other.
The goal of this approach would be to get you entirely lateralized to one side again. This is usually the right side because we as humans are all naturally biased towards the right side initially.
So by "resetting you" back to the right side, we can better then shift you left.
For example, if your lower body is going left and upper body is going right, we want to get your entire body lateralized back to the right side again.
This means getting your lower body to turn right without focusing too much on taking your lower body because it's already going right.
Examples of these exercises would be very similar to ones above, but with slightly different variations:
Eventually we want to integrate these qualities of "pushing out of one" side and "shifting into the other" together.
And we want to do it in a way that mimics that gait cycle so that we give our body "context" for how it can better shift from side-to-side. This would be how we progress.
It's important that progressions are slow and steady. If you progress too quickly to upright exercises you will not be able to handle it and you will minimize your progress.
Only progress to upright exercises once you can master the other exercises, which realistically takes about 3-4 weeks of doing the more ground-based exercises every day.
Here are some more upright progressions.
This is an example of how you could progress the Sidelying Abduct & Shift. For example, if you were right lateralized, you would do this with your right leg in abduction (external rotation) and the left leg the one you are shifting towards (internal rotation)
This is an example of how you could improve "stance" on the side you are shifted away from. If I was right lateralized, I would do this shifting left:
Here is a really easy way you can work on integrating shifting from side-to-side better in the gait cycle. If I was right lateralized, I would do this with my left left forward:
Same principle here, but this one is teaching you how to stay "shifted" into one side and not move out of it too early in the gait cycle, which is something we will tend to do on the side we are shifted away from. If I was right lateralized, I would do this with my left left back:
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