Lateral Pelvic Tilt and Back Pain

Edit. Since I last wrote this post, which is almost four years ago, I have gained a ton of knowledge and experience in dealing with Lateral Pelvic Tilt.

Lateral Pelvic Tilt and Lower Back Pain

I urge you to read my updated post as it reflects four years of education acquired through the Postural Restoration Institute and finally understanding where the tilt and the lower back pain was coming from.

Lateral Pelvic Tilt and Lower Back Pain

lateral pelvic tilt

My lateral tilt: left side higher than the right

neutral pelvis

A more neutral pelvis

Lateral Pelvic Tilt

I had the intention of using my “Summer of Back Pain 2011” as a way to conceptually explain:

1. What can go wrong in the human body without anyone noticing.

2. The source of pain is often difficult to discover.

3. Why you, or your doctor, must think globally instead of locally. Basically, if I had treated my SI joint pain as SI joint dysfunction (or simply “lower back pain”), I never would have fixed myself. Rest and anti-inflammatory might relieve you of the pain temporarily, but unless you address the underlying issue, the treatment only serves as an temporary bandage.

I’m going to skip most of that stuff and get straight to the physical problem.

lateral pelvic tilt

Lateral pelvic tilt is a common source of lower back pain.

Looking at the diagram above, I’ve documented what is often associated with a lateral pelvic tilt.

1. Tight abductors (glute medius, TFL, glue max) on the low side that could be exerting a downward pull.
2. Lengthened and perhaps weak abductors (especially glute medius) on the high side.

note: This is a typical situation found everywhere in the body. When one side is short and tight, the other side is often lengthened and weak. It’s so common and widespread that it should be taught in high school (insurance companies would save a lot of money on needless doctors visits).

3. Tight lower back muscles on the high side of the pelvis
4. Possibly tight inner thigh (adductors) on the high side. Just another example of the short and tight/lengthened and weak pattern. This one centers on the high side hip joint.

In my case, the only thing I could definitely feel was a tightness in my lower back muscles which often felt like a spasm. Other times it was more of sharp pain. I was also having generalized lower back pain–more of a dull ache–and acute SI joint pain. Life was miserable.

All this is unsurprising because the pelvic tilt caused the back muscles to be overactive and my spine to curve as a compensation (as seen in the diagram) so that I could remain up straight. This curved spine put extra compression forces on my vertebrae.

Getting My Pelvis More Neutral

At this point, I’m done speculating on how I ended up with a pelvic tilt. It was probably the way I stand or sit in the car. Adaptive postural distortions are one of the main sources of non-acute injury pain; in other words, the type of pain that just sneaks up on you. And don’t think that just because you lift weights and stay in shape means that pelvic shifts–lateral or anterior– won’t happen to you. It’s quite common in both sedentary and more athletically minded people.

What I did to fix the tilt was very high-tech: I put the insole of my Nike Frees into my Chuck Taylors. This raised the low side of my pelvis so that my pelvis is now neutral. The relief was virtually instantaneous and I can happily say that today is the first time I lifted weights since July 12!

From now on, I’ll be careful to make sure I do my foam rolling, dynamic warmups, and stretches so that I am balanced on both sides of my body. It’s hard to notice that muscles might be getting a little out of whack until the pain lets you know. This is why a well balanced program is so important.

Update: As this post seems to get a lot of traffic and questions, here is my most recent post on the subject.
My twisted pelvis
It discusses how the real root of my problem was a twisted pelvis and provides a resource that may be helpful.

PS. I drew the diagram at the top of the page by myself. Took me hours. Hope it’s helps illustrate the problem.

Comments

  1. xra says

    if i understand you correctly, you inserted the insole into one of your shoes to raise that side? do you plan to do this indefinitely or is it a temporary measure? I’m curious as to what kind of stretches/exercises one could to to work on something like this, as well. You mention the abductors, lower back, and adductors; what targets these, and should I do only one side or train both while working the weaker side more? I’d appreciate any response ou can give me, thanks

    -f

    • Administrator says

      Yes, I inserted another insole into my sneaker, so that the sneaker on my right foot has two insoles. It leveled my pelvis. I plan on wearing it for at least a month and then I’ll check my pelvic alignment again without the extra insole.
      All my physical therapy resources say that Just wearing the insole and making sure that I stand with my weight evenly distributed should take care of the problem. Beyond that, I’m just continuing with my normal workout routine which involves dynamic warmups and regular static stretching (although I’m making it more well rounded as I’ve been neglecting some things). I’m also doing a lot of foam rolling on my legs and hips. I’ll try to do a post on what I am doing and shoot some videos.

  2. Melissa says

    Please let us know how you go after a month, I have the same issue and am wearing the heal insert but only had it in for a few weeks. Also doing the foam rolling and appropriate exercise, it’d be good to know if it actually works!

    • Administrator says

      I have had a mixed experience. When I put the insert in, I felt immediate relief, for obvious reasons. After wearing it for about two weeks, I took it out. I felt fine for a couple days, but then it started to hurt again. So I’ve been back and forth a few times- with the insert and without it. My back feels better with it in. In fact, I have no problems when I have the insert in.
      What I do notice is that my right hamstring and calf are consistently tighter than the left side. I think that is the root of the problem.
      I talked to a physical therapist and she pointed out that I’ll probably have to wear the insert for quite some time. I think that’s probably true because a situation that takes years to build up isn’t going to fix overnight.
      For the near future, I’m going to continue foam rolling, stretching, and keeping the insole in.
      Hope that helps.
      Neal

  3. Melissa says

    I agree it’ll probably take some time. I’m not sure what to think about the long term effects though as once you take out the insert surely the pelvis will drop again, no matter how long you wear the insert. Kind of like wearing braces on your teeth, if you don’t keep the retainer in afterwards then they tend to move out of alignment again. I’m willing to give it a go as exercise alone wasn’t really helping. I’ve also had a mixed experience, the latest being that my big toes have gone numb on the top! I suppose there must be pressure on a nerve somewhere through the changes in my posture, not sure if it’s good or bad though. Hope you get sorted soon!

    • Administrator says

      I don’t think I”m qualified to talk about nerve issues, so I’d get that checked out if possible.
      In regards to exercise, I’m taking more care to:
      Stretch the abductors (outside of the hip) on the low side of the pelvis since they’re probably tight. (going to post a video for this soon)
      Strengthen the abductors on the high side (since they’ve probably been stretched and weakened).
      Stretching my hamstrings, especially on the low side of my pelvis.
      I’ve been doing more static stretching overall, in conjunction with mobility drills. I’m feeling pretty good.

      Neal

  4. Olli Paukkeri says

    Hi. How is wearing an additional insole going to solve the problem? The problem probably has to do with imbalances in your body and putting in an outside fix will not solve the imbalances. In fact it will probably make them worse. Try the egoscue method. It has helped me.

  5. Mark Beckworth says

    Adding an insole to one side but not the other merely maintains the pelvic inequality. You may not feel as much pain with it because the short leg isn’t having to travel all the way to the ground now as you step. Look at the picture and imagine what is happening when you place added material under the foot of the short leg. Do you see what you are doing? You are re-enforcing/supporting the problem! As long as you do this, the problem will not go away.

    If you take 3 2×4 piece of wood of equal length – stand two of those pieces vertically (like your legs) then place the other 2X4 on top of them (your pelvis) the board representing your pelvis will be level. Now, place that extra insole under one to the 2×4’s representing one of your legs. The 2×4 representing your pelvis will now be tilted and remain that way.

    You need to address the muscle imbalances you have without throwing a permanent tilt into your hips.

    • Administrator says

      The insole is used to even out the pelvis and relieve the pain. It is not meant, nor did I mean to imply, that it would address the underlying imbalances. The source of the problem was the way I was seated in my car (which I had speculated) that tilted my pelvis up higher on one side.

  6. Jimmy says

    Hi Neal,
    I stumbled upon your blog after searching around for information on how to correct a lateral pelvic tilt (I have one too). I wanted to know how you’ve been doing with the insoles? Any luck or have you moved on to a different approach? If you’ve written a follow up article to this topic, just point me to it. Otherwise, look forward to hearing from you. Thanks!

    • Administrator says

      Hey Jimmy,
      I’ve actually resolved the issue. The insoles relieved the pain by straightening my pelvis but it didn’t address whatever was causing it. I recently was writing a post about how I resolved the problem, but it got convoluted and I scrapped it. I’m in the process of re-writing in a more concise manner. Long story short, the culprit was how I was sitting in my car (as I suspected) and the position caused my psoas and my QL to tighten, which pulled my pelvis up. I was able to stretch the QL effectively, but I needed a massage therapist to get my psoas to relax. She pressed on it for about 1 minute- felt much different than the other side psoas, so I knew we found the correct muscle. After the massage my pelvis was completely level. There are some after effects, but nothing horrible. I’ll address that in the post.
      Thanks for reading!
      Neal

  7. Brandon says

    Hey Neal,
    My left pelvic/hip tilts higher than my right which is causing stress on my lower back and sometimes down to my left leg. I’ve gone to chiros, sports therapist, and accunpunturist but still no resolution, only temporary. In the morning the tilt is there but gets worse through the day and even worse at night, I’m guessing due to fatigue of muscles. I have to minimize my walking or it will get really sore along the left buttox and hip area. I try to stretch my hamstrings and hang from pull up bars as much as possible. I try not to take any medication but can’t help it sometimes. Sometimes I wear a sole in the lower side to balance out but no resolution with that either. Any suggestions on what I can do? The sports therapist seem to be most affective but costly and painful because the therapist is stretching the muscles that are shortened that’s causing the tilt. Your thoughts and suggestions would be appreciated. By the way, I’ve had this tilt for about one year now and started when I tweaked my lower back from lifting a box and tossing it across the room, I know it was dumb of me. My back doesn’t really hurt but I do feel the left side of back pulling sometimes (raised side of pelvic) The pain comes from the hip/buttox area, most likely the sciatic nerve caused by all the tightness and mis-alignment of that side of my body.
    Thanks for your response!
    Brandon

  8. Joe Ryan says

    Hi Neal , if you are still checking this post it would be great to email you personally with a question or two. My symptoms were pretty spot on from yours, but I’ve yet to resolve my problem. I’ve heard so many mixed views from people who aren’t in the same situation so it would be great to talk with someone who has struggled with the same problems. I’ve tried nearly everything up to this point and I’m not joking. Hope to hear from you with some ideas and I’ll email you personally my exact symptoms.

    Hope to hear from you

    Joe

  9. Matt says

    Hey Neal,

    I found out almost two years ago that I had a pelvic tilt from an xray at my chiro office. He said that after a few adjustment it should work itself out. The pain never went away… throughout those two years, I have gone to PT, and a sports PT, nothing changed. The majority of my pain is first thing in the morning, I am really stiff and sore when I get up. To get loosened up,I take a hot shower and do a little bit of stretching, all my back does is pop. (my muscles, not my bones)
    I had another xray done about two weeks ago…. surprise surprise, I still have a pelvic tilt. So my chiro gave me a little pad to put under my right heal. Its helped a little, but I still wake up with the pain. However, I realize it won’t fix itself over night. I just want some relief. What are your thoughts?

    Matt

  10. - K says

    Hi there – appreciate reading about symptoms very similar to mine. Tilted pelvis is my diagnosis too.
    I almost wonder if my symptoms originated while pregnant. I have the
    same lower back pain now as when I was carrying my baby. Except now it flares up for no apparent
    reason, and I really don’t know how to fix this. If you have alternate ideas
    to share, I’m listening!

    • Administrator says

      Hi, Karlene. I’ll e-mail you. I was abroad on vacation for the last two weeks and had no access to the blog.

      Neal

  11. Jesse says

    Hi Neal,

    I have the same problem as you. My left hip is higher than my right. I’ve had my legs measured and it’s not a Leg Lenght Discrepancy. I suffer the most when when I drive and at night (I sleep on my stomach).

    I am wondering what exercise did you do to stretch your QL and PSOAS? Were both your QL and PSOAS tight on the same side (longer)?

    Thanks,

    Jessee

    • Administrator says

      Hey Jesse,

      Sorry for the delay but I live in New Jersey and Hurricane Sandy has wreaked havoc on electricity, so this is the first time I’ve been able to go online.

      You could try this one: it hits the psoas and potentially also hit the QL a bit: http://nealhallinan.com/blog/fixyourbody/my-favorite-stretch-hip-flexor-lat-stretch-combo/. You can also do this one standing. Put one foot in front of the other and reach to the side of the front leg, as I’m doing in the picture.

      You can also try: lie face up. Bend your knees. Let your legs fall to one side while you keep your upper body flat on the floor. You should feel something in your hip and hopefully the QL

      There are many different stretches you can try. I would look on Youtube for examples. Sometimes one stretch will work well while another won’t do anything for you.
      Pretty good video on the QL. This guy is actually demonstrating a ball version of what I’m doing in my first video.
      http://endyourbackpainnow.com/blog/how-to-get-a-quadratus-lumborum-stretch-2/

      From my recollection, both my psoas and QL were both tight. I felt my QL release when I did the second stretch where I let my legs fall to the side. The psoas was still tight, though, and no amount of stretching helped it. A massage therapist got my psoas to release. You may have to try different things. There doesn’t seem to be one perfect answer for everybody.

      Any other questions, let me know.
      Neal

  12. Jo says

    Hi Neal,

    I was just reading the posts above… And the one written by Brandon is identical to everything I am experiencing. I feel exactly the same problems on left glute area/sciatic region and tight left lower back muscles that spasm, getting worse at night with a left sided hip hike. Can you please send me the information you sent to him. Ive seen multiple osteo’s and physios and had no long lasting resolution. Thanks, Jo

  13. Jo says

    Hi Neal,
    I was just reading the posts above… And the one written by Brandon is identical to everything I am experiencing. I feel exactly the same problems on left glute area/sciatic region and tight left lower back muscles that spasm, getting worse at night with a left sided hip hike. Can you please send me the information you sent to him. Ive seen multiple osteo’s and physios and had no long lasting resolution. Thanks, Jo

  14. says

    I keep coming back to this post because I continue to work on this issue with my PT. I’m feeling the tilt in my hip flexors at my hip crease (where they are stretched/lengthened and have to work extra hard to contract and thus feel chronically achy/fatigued). The latest revelation from my PT….my breathing patterns. I favor the lobes in my right lung (why wouldn’t I, as I have three lobes in my right lung but only two in my left, as we all do) and my PT believes my rib cage is orienting in such a way that it causes my pelvis to tilt. So…we’re working on my breathing and getting my para sympathetic nervous system to activate by neutralizing my lumbar spine which requires core engagement. Isn’t this stuff fascinating? I imagine I’ll be sharing these revelations on my own blog when I make more progress in PT (still figuring it all out at this point).

    • Administrator says

      Hi Bobbi,
      I put up a new post last night about this back pain issue. Unfortunately, it’s not always just a matter of a tight muscle here or a weak muscle here. I will be sure to follow your progress and please share anything you discover. I’ve gotten a ton of emails about this exact issue and, unfortunately, I don’t have all the answers.

      Neal

  15. Mathias says

    Hey neal please give me some advice

    Im only 18 years old and i have a bad pelvic tilt i can see it when i take pictures that i lean against the left i tried stretching my muscles every day for a month but i still have dull pain on my right lower back i feel like my spine is weak and cant b standing or walking for more than an hour! I cant work anymore when i walk i feel like i cant walk straight i feel like im 60 years old with this pain . Im going to physical therapy but its not doing much and i dont have insurance or much money i ordered some 1/2 inch shoe lift from amazon but it wont do anything.

    Im so tired of living like this . Its really taking the joy out life i cant have fun with my friends anymore please please email me i beg you

  16. Nikki says

    Hi Neal

    I have lower back pain (right hand side of pelvis area in my lower back) and have read your posts with interest and hope. However, although i have had these issues for a few years, they havent bothered me until I have started exercising recently. I am very new to this and basically wanted to know how do you know whether it is lateral or anterior issues?
    Also, how do you know which side is the problem area for instance i feel pain on my right hand back side, does that mean that the muscles on the left are the problem and causing the pain, or does it mean the ones on the right?
    many thanks for your time, i look forward to hearing from you :)
    kind regards

    • Administrator says

      Hi Nikki,
      If it’s lateral, your pelvis will be higher on one side than the other. If it’s anterior, your pelvis will tilt down in front. Keep in mind, however, that some amount of anterior tilt is normal. From my experience, and from what I’ve seen in physical therapy texts, the pain can occur pretty much anywhere. I’d get checked by a PT and have them check your alignment.
      Hope that helps.
      Neal

  17. Joe says

    Hey Neal, Seem to have the same symptoms. I didnt see anything about you glute on the high hip side. I feel that my glute on this side is very weak. I assume it has something to do with the ql pulling upward constantly and the glute isnt strong enough to pull back. Also, did you seek a certain type of massage therapist?

    Thanks,
    Joe

  18. Chris says

    Hello I am very interested in finding a solution for my lateral pelvic tilt. My right side is about an inch higher and it has limited me from making progress in getting back in shape. I would really like your rehab plan to overcome this problem. My email is chris.beckham@wildblue.net

    • Administrator says

      Jordan,
      I’m not sure there is anything specific that you should avoid. Many people have a tilt and don’t even know it. Apparently it’s not causing them any pain, they are completely asymptomatic.
      If you do have one, though, and you have pain, you’ll want to find a professional who can help straighten you out.

  19. shavice says

    I have this problem and the back pain have me in tears it have been months and I feel really uncomfortable walking in front of people n I want to try exercises to get this corrected fast have any suggestions on the most effective ones that I could try

  20. Helen says

    dear neal, I am 78 yrs, and fell on the right side of my body. The doc said I had some fluid on my hip. Not to worry the fluid would dissipate throughout my body. This happened 8-12-12. I have been to orthopedics chiros, and taken therapy. No one can identify the problem, Due to some back surgeries, I am fused L-1 to S-1 and unable to do some exercises, but, I am willing to try anything I am able to do. I will appreciate anything you can advise me on.
    Thank you very much

  21. Joan says

    Right sided pelvic tilt after a fall, You name a treatment, including Prolotherapy…..Zillow have had it all. Pain in SI joint and piriformis is so bad. Worsening for two years. All X-rays confirm diagnosis. Please offer any suggestions

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