Lateral Pelvic Tilt and its Resolution

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

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Old, outdated post:

Since July, I’ve been struggling with a condition called lateral pelvic tilt. I get more in depth about Lateral Pelvic Tilt in this post about LPT

It’s hard to know the exact sequence of events, because my lateral tilt only became known to me after experiencing debilitating backs spasms. They were so bad that I couldn’t stand up straight for over 48 hours. After the spasms had subsided, I was left crooked. My whole upper body leaned to one side.

Clearly my quadratus lumborum had been tight and was causing much of the tilt; once I effectively stretched it the majority of the tilt disappeared. I was still perplexed about the remaining tilt, though.

For the rest of the summer I had intermittent pain. In the beginning of my episode, after the acute pain had subsided, I went searching for the offending muscles. I instinctively knew what was probably occurring–tight trunk muscles on the high side of my pelvis–but for some reason I kept getting distracted by the possibility of a tight hamstring on the lower side of my pelvis. I was distracted because I didn’t feel any tightness in my trunk muscles but I did feel tight in my right hamstring.

In the meantime I had rid myself of any pain by inserting an extra insole into the shoe of my low side pelvis to effectively level it out. But I still had to find why my pelvis was tilting.

What I Got Wrong

It is a phenomena of human psychology that leads us to believe that the experts might not know what they are talking about. In my case, a tight hamstring was never mentioned in any of my physical therapy texts as a cause of lateral pelvic tilt, yet I was still obsessing over it! I was making a connection that didn’t exist.

I felt back pain, primarily in my SI Joint, and I knew that a tight hamstring can cause SI joint pain, especially in men. So I imagined that the tight hamstring was causing both the tilt and the resultant SI joint pain. Yet the hamstring wasn’t causing the tilt that was causing my SI joint pain. Something else was.

My psoas.

The Psoas

psoas major muscle

The psoas major is a powerful hip flexor muscle

The psoas is a hip flexor muscle that originates on the lower lumbar vertebrae and inserts on the upper leg. As it passes down the front of the pelvis, it merges with another hip flexor muscle called the illiacus and they then insert via a common tendon into the femur (upper leg bone). These two muscles are often found to be tight both among the general and exercising public. While they are normally implicated in anterior pelvic tilt, they can often be implicated in lateral tilt, too. To be complete, there is some debate as to the exact roles that the psoas plays, rather, how many roles the psoas plays. Not only that, about half the population has a psoas minor, too.

Addressing a tight muscle is all well and good, but why the heck was my psoas tight?

The Root Cause of the Pelvic Tilt, My Car

The foot rest for my left foot sits closer than the gas pedal does. That’s why my psoas was tight.

This meant that I was sitting in a position which effectively tilted my pelvis in the exact position that I saw it tilted in the mirror. I had been sitting like this for seven years, day after day. Eventually it adds up.

I tried to address the psoas tightness through stretching, but it just wasn’t working. So I headed to the massage therapist and gave her instructions to focus on my quadratus lumborum and psoas. I didn’t feel anything when she pressed on my QL, but when she pressed on the psoas, I knew we had found the culprit.

At the end of the massage, my pelvis was completely straight and I’ve been good ever since. I still feel some residual tightness in my psoas which I try to address by rolling on a medicine ball or self massage. In addition, I often feel tension in my glutes, although this is easily addressed by foam rolling. Perhaps the tightness in the glutes is caused by the semi-tight psoas and/or quadratus lumborum still exerting an upward pull. Tightness is most often felt after arising in the morning but is relieved after foam rolling.

Lessons

1. If no acute injury has occurred, bodily pain is often caused by our daily habits. The way we sit, sleep, or stand for example. Tissues get stressed from repetitive use, muscles can weaken from being repetitively stretched, and muscles can tighten due to static positions. Often, it’s a combination of all three.

2. When pain is being experienced, you need to look above and below the painful area. For instance, if the lower back is hurting, you need to examine your upper back posture, pelvic alignment, and hip range of motion. The body works as a system, also conceptualized as “you’re only as strong as your weakest link”. If one area of the body isn’t working correctly, the body can only cover up for this inefficiency for so long until it breaks down.

3. Although I didn’t cover this aspect, your training needs to be examined so that you don’t make things worse. For example, if someone is experiencing rotator cuff pain, they should refrain from doing a lot of pressing movements, whether they be overhead or horizontal (as in the bench press). If someone is experiencing SI Joint pain, they should likely refrain from squatting and deadlifting due the shear forces exerted on the spine. In general, if something hurts, don’t do it.

Comments

  1. Lynn says

    Great post. Neal I have been having the same issue as you, tilted pelvis along with hip pain, tight psoas, SI pain, etc….and I have always thought that it attributed to the fact that I drive with a clutch. The tight shortened psoas is on my left side. The only problem is when ever I get it massaged, it tightens back up and wont hold its length. I realize I need to get a new car but its not really an option for me right now. What self massage techniques do you use to lengthen your tight psoas? Thanks again!

    • Administrator says

      Hi Lynn, thanks for the comment and question. Even though I do feel some residual tightness in the psoas, I’m lucky that it has maintained its length. Eliminating the root cause is essential (the car) but in the meantime I can offer a few suggestions. I try to start each morning with a heat pack. I throw it in the microwave for about a minute and then put it on my lower back in the area of the psoas during my morning commute. I have found that it helps relieve some of the possible lower back tightness. Second, once I’m in the gym, I get on the foam roller and roll my glutes, hip flexors, hamstrings, calves, and quads using the hardest foam roller the gym has. Then I’ll take a small 4 pound green medicine ball and lie on it. I try to position myself the same way the massage therapist gets at my psoas- on a 40 degree angle just above my pelvis and below the rib cage. I have also figure out a stretch that I think is helping. There is no way to describe it, so I’ll have to take a picture of me doing it.
      In regards to foam rolling, I found that if I neglect my hamstrings it doesn’t work as effectively. Never underestimate the roll other muscles play in the dysfunction, pain, or tightness experienced in another muscles
      Hope that helps.
      Neal

  2. Peter says

    Hi Neal,

    My first thought was, “how does a guy who foam rolls like mad, does dynamic exercises for the core and hips regularly and lifts lots of weight to stay strong in those areas, get back spasms from tight muscles, from sitting in a car?”

    lol … it was a long thought.

    My reasoning is that the average person doesn’t do any of that good stuff, and they do sit in cars or offices all day and don’t have back spasms (although some do).

    Also, if you are doing dynamic exercises like spiderman regularly to increase mobility in the hip joint, why didn’t that exercise keep the psoas lengthened even though you had your left leg in a shortened position in the car?

    One more thing. If stretching didn’t help then does it have a role to play in lengthening our muscles if they have knots in them? I am finding foam rolling to have more lasting effects than static stretching.

    Thanks for a great blog again Neal.

    • Administrator says

      In response to your first though–I’ve thought the same thing! I’m doing everything I can to avoid these types of situations, yet it still happened. I look at in a couple different ways:
      1. Each day, I sit in the car longer than I actively stretch (about 70 minutes compared to 5-10 minutes). Plus I only started stretching on non-workout days in response to what happened.
      2. Things just go wrong. The body has so many nerves, muscles, ligaments, fascia, cells etc… things are bound to go wrong as some point.
      3. Some people are injury prone, some aren’t. A football player can prepare his body for 6 months leading up the season and blow out his ACL in the first quarter when he tries to change direction. It’s unlucky I guess.

      In regards to stretching knotted muscles, I recall someone comparing the stretching of knotted muscles to pulling a rubber band that has a knot tied in it. Stretching the rubber band just makes the knot tighter, it doesn’t remove it. I can’t claim to know if the comparison is applicable, but it does seem logical. I consider foam rolling and stretching as playing synergistic roles in improving both muscle and fascial tissue quality–though I feel foam rolling has more of an impact on how I feel.

  3. Lynn says

    Hi Neal, Thanks for the information re: tight psoas, foam rolling, etc…with regard to your lateral pelvic tilt blog. I do foam roll on a regular basis and I find it helps tremendously.
    In regard to your comment “I try to position myself the same way the massage therapist gets at my psoas- on a 40 degree angle just above my pelvis and below the rib cage. I have also figure out a stretch that I think is helping. There is no way to describe it, so I’ll have to take a picture of me doing it”; if you happen to take a photo of both the ball release and the stretch for your psoas, I would love to see it. Its so great to see someone writing about this subject. Thanks again Neal!

    • Administrator says

      Lynn, I’ll try to get a picture of it soon. Some days I feel like my psoas is agitated, some days I don’t notice it at all. The heating pad definitely helps, too.
      Thanks for commenting!

  4. Peter says

    Thanks for the reply Neal.

    I understand what you mean. The human body reacts differently for different people and there isn’t always a reason for it. Some people can smoke for a year and die of lung cancer while others smoke 2 packs a day for 50 years and have no big lung issues??? Who knows why.

    One more question if you don’t mind. There’s been lots of talk online and many articles written about static stretching and how it’s not considered effective anymore. Almost every trainer’s blog or website I visit has come to believe this and incorporate this belief into their training systems. If this is the case then how do ballerinas and yoga enthusiasts get so flexible and have such great mobility? I’m pretty sure they didn’t use a foam roller pre-2000.

    Thanks again.

    • Administrator says

      I’ve actually moved the other way on stretching. At first I wasn’t a big believer in static stretching because it didn’t work for me. Dynamic warmups were what worked for me and helped me fix my anterior pelvic tilt. However, at that time I didn’t really know what I was doing back then, and had no understanding of functional anatomy, so perhaps that was the reason static stretching didn’t help me. Now I use it after every workout, especially on my hamstrings and calves. I feel a difference.

      On the other hand, I too have read articles that say it’s not that effective, but I can’t recall why that is. It’s never been something I have had too much interest in but I should probably revisit the issue.

      I also have a thought about tight muscles: perhaps we describe muscles as feeling “tight” because we have no other word for it. My psoas is an example. I don’t think it’s tight at this point because my pelvis is straight, but it does get a weird feeling from time to time. It’s almost like I have no other way to describe it, so I say it’s tight. Many women think there hamstrings are tight, yet they have tremendous hamstring flexibility. I believe I’ve seen it attributed to some sort of neural sensation due to inactive glutes and overactive hamstrings. I have to double check that, though.

      As for ballerinas and yoga: sometimes in sport, or certain sport-like activities, you’ll have people who seem to be “built” for a certain sport. I’ve read that body measurements and body typing are used as guides by many countries to select athletes for their Olympic training programs. Perhaps the most successful ballerinas and yoga enthusiasts tend to be “built” for those activities, with genetic predisposition for flexibility, and thus thrive, while everyone else eventually drops out. That is mere speculation on my part, but worth considering.

  5. says

    This a great post – very well written and highly informative. I also have a lateral tilt, when seems to have accumulated from several things (1. sitting on a faulty chair at my work desk and developing pour postural habits and 2. an emotionally traumatic life event which caused my psoas muscle to contract – this article has helped me to understand a lot about how my body has responded to trauma http://massagefloat.com.au/index.php?option=com_content&view=article&id=83:trauma-recovery-therapy&catid=50:trauma&Itemid=156).
    I look forward to the day when I’m back in alignment.

    • Administrator says

      Thanks for the compliment, Bobbi. And thanks for the link to the trauma article. Interesting how they specifically mention the psoas. Understanding the link between the human brain and our physical well being is unbelievable important. I highly recommend “Social Intelligence” by Daniel Goleman, “Why Zebras Don’t Get Ulcers” by Robert Sapolsky and “Anatomy Trains” by Thomas Meyers. They kind of tied everything together for me.
      Very nice blog, by the way.

      Neal

  6. Peter says

    Thanks Neal … everything seems to go back to having strong active glutes LOL (half joke). I appretiate you taking the time to respond.

    Thanks also to Bobbi for the link. I also have muscles that are tight due to trauma and that is by far the biggest hurdle to having them be relaxed and mobile. I only wish they talked more about how to specifically release it.

  7. says

    Hi Neal,
    Thanks for the reply and the book recommendations. I’m definitely on a journey to understand my body and the mind-body connection. The term “muscle memory” has a whole new meaning to me now. I’m reading “Yoga and the Quest for the True Self” by Stephen Cope. He provides a lot of interesting and insightful information about fascia and explains how our bodies contract as a protective mechanism, a fight or flight instinct, and get stuck in this holding pattern. A lot of the tightness many of us feel in our bodies has a direct connection to our emotional histories. But…as I am learning through physical therapy a sensation that we might equate as tightness might also be a weak muscle from our body imbalances and misalignments.
    I look forward to reading more of your blog. Your knowledge of the body and the discovering you are making about body mechanics and the mind-body connection are impressive.
    And to Peter…I too would like to know more about trauma release. Myofascial release is one method, but it is my hope that I can learn how to release my muscles on my own. I am learning that perhaps the most effective method is through breathing exercises and meditation. Best wishes to you on your journey.
    Bobbi

  8. says

    Hi Neal,

    I’m back! I just wrote my own version of the effects of a lateral pelvic tilt (for me this stems from a weak gluteus medius). I weave my story of emotional trauma into my piece, because that is the source of my hip and leg issues. I still have much to learn an uncover. Since you mentioned it, I have heard from others about the book “Why Zebras Don’t Get Ulcers” and my massage therapist and yoga teacher has recommended that I read Peter Levine’s work, “Waking the Tiger.” I wanted to share my story with you and whatever of your readers might want to check it out. My piece is entitled “Body Talk” and can be found here: http://myinnermystic.wordpress.com/2012/05/30/body-talk/

    Thank you,

    Bobbi

  9. says

    Oh man this is a great post. I dearly hope you write about the resolution of your issues. I have been dealing with this since the birth of my #2 son. I have bent and stretched my body in so many ways to relieve this problem. I think mine is mostly from carrying children for years on my left hip causing my QL to become tight and short. I probably also have to work on my pelvic floor muscles as well.

    Anyway, hope to read more about this. Added you to my reader.

    • Administrator says

      Hello Meredith,
      Like I mentioned in the post, my tilt is resolved, but I still have some residual stiffness in my left hip upon waking in the morning. It goes away as I become more active during the course of the day. It also goes away with a couple advil. I’m thinking I have some inflammation that I never get rid of. I don’t know, but it’s not a big deal.
      Is you pelvis tilted?

      Neal

  10. Nathan says

    Neal-
    Thank you so much for this. You literally just changed my life. I am laying on my stomach with the my foam roller on my psoas and it is such a liberating feeling! I am a recreational body builder and this has been tormenting me off and on for a while now. My waist measures 41 inches (I fit in 36 jeans cause we americans love to lie to ourselves) and I have very large and strong core muscles. I always thought that the problem was my core being too loose because I would go months at a time with no issue and then after a day of hard work my back would go out on me. That’s obviously not the problem. It’s the tightness in my right psoas. I also had the pulled hamstring delusion you speak of and a lot of sciatica problems. Now I am going to make an appointment for a massage. Thanks again.

  11. says

    My left hip is hiked and so is my left shoulder. So I am tight in my left QL, and right upper trap. I do right hip hikes to balance it out and Stretches for my tight QL. also stretches for my trap

  12. Terry says

    So glad that I found this this series of postings. Not sure if I am too late to catch up with you guys or Neal? But I also drive a stick and at 6’4″ the small GMC Sonoma cab is definitely an issue for me. Newer vehicle on the way but not until sometime next year. I would be grateful for your thoughts on my taking up Pilates or Yoga to help with both strengthening and flexibility of my core and lower body?

    My background: The X-ray at the chiropractor clearly showed a lateral tilt or rotation of my pelvis. Chiropractic treatments offered fairly immediate relief of the acute pain so that I could remain functional at work where I do physical labor.

    But still the lower level pain has remained constant. And I still deal with daily flexibility issues, like I can put a sock on my right foot and tie my shoe with no problem, but it is super difficult to get a sock on my left foot and tie my shoe. I can bend my right leg and flex my right side hip to bend down and pet my dog or pick up an item off of the floor, but the pain and tightness is too much in my left side for it to be functionally flexible.

    Because of this constant pain, lack of flexibility, and lack of mobility I know that I have been losing strength in basically my entire lower body and I have experienced weight gain due to a reduction in physical activity. So the chronic condition of lateral pelvic tilt is becoming a growing concern for my overall physical health. I have even begun to feel a numbness / tingling up the length of my right quad muscle on the outside of my leg, which I believe is related to the lateral pelvic tilt condition.

    I am hoping to learn how to treat this pelvic tilt myself by putting together a regimen of stretching and flexibility work along with some strengthening work as well. I am an old-school jock who knows some basic static stretches that help the hamstrings and groin area, but I am not familiar with the foam roller that you mentioned. I will have access to the local LA Fitness gym soon and maybe they have the foam roller that you have talked about. Can you please tell me what this piece of equipment looks like?

    Thank you sir!

  13. Tom Wheatley says

    Yes, the psoas is responsible–pelvis will always tilt to the side the psoas has been shortened.

    However, in my case, both the psoas and rectus femoris have been shortened–both contributing to the tilt

  14. Romana says

    There’s no question that contractures within the iliopsoas group are the most likely factor causing both anterior and lateral pelvic the tilt, primarily because of the horizontal (side-by-side) and forward components of the force created by the shortening of these muscles–this is attributed to the the angle between the psoas’ attachment at the spine (and the iliacus’ attachment at the hip) and the femur. Using basic trigonometry, it’s easy to see that even small contractures in either the psoas and iliacus will yield a drastic tilt toward the side with the shortened muscles.

    However, it’s important to remember that any muscle attached to the pelvis–notably those attached on the left/right or anterior (front) sides can induce a lateral and/or anterior tilt if they’re sufficiently shortened.

    The challenge is in locating the exact sites of the contractures–referred to as “trigger points” in myofascial therapy. Although they can be felt as localized pain spots where pain tends to be centered in a muscle, if a sufficient number of muscles surrounding the contractured flexor muscles are also lesioned, it’s extremely difficult to determine the location of the trigger points via sensation alone.

    MRIs have proven nearly useless in diagnosis of this condition, because their resolution and water-based imaging do not provide sufficient contrast to differentiate between the tiny regions of scar tissue (trigger points) that are locally warping the muscles (much like spacetime around a black hole) and normal tissue.

    MRE, magnetic resonance elastography, is showing some promise in this area, given its ability to identify abnormal tension in various muscle groups, but merely identifying stretched muscles is insufficient; the CAUSE of the tension, i. e. the specific trigger points, still need to be identified.

  15. Darin Bowman says

    Hey Neil – thanks for your article. I’m currently seeing doctors and physiotherapists for my low back pain. I broke my ankle and wore a cam walking boot for 6 weeks which basically jacked my left hip up about half an inch higher than the other. This left my lumbar spine tilted slightly. So, I have lateral pelvic tilt because the muscles took on a new shape while wearing the boot. Also I have anterior pelvic tilt but I’m sure I’ve had this for years, surely from sitting at a desk for….well ever.

    Any recommendations? My Chiro has also told me my Psoas are really tight. I’ve been working on them some but apparently not enough.

    Thanks!

  16. Emmet says

    Great post Neal. Thanks for sharing. I’ve had really bad lower back pain and periformis pain for months. Turns out it was related to tightness on one side, the QL mainly and my psoas muscles. Google to the rescue as nobody actually pointed out what the cause was. Mine was due to bad posture whilst training.

  17. Sam Douglas says

    All,

    This information is online gold! I love staying active, but I’ve been experiencing back/hip/right leg pain for sometime now and I simply alter things i am doing in the gym to stay active. I am VERY good with foam rolling, mobility circuits & strength training form which is so helpful, but I still have issues. I got an X-Ray about a week ago and sure enough, I have lateral hip tilt (I am getting the X-rays on a CD tomorrow so i can clarify with which side it is, but I have a feeling its left hip high and right hip low as my right foot generally sits more forward than my left when standing…make sense?) It’s interesting Lynn mentioned her clutch as a culprit as I also drive a heavy/deep clutch and have been speculating whether that could be assisting in creating my dysfunction? I get consistent massages and recently my therapist recommended working on my right psoas because she was seeing the same thing the X-Ray showed (but she saw it prior to the X-Ray which was impressive!). When i came into a recent massage visit, I had tightness in my right hip, and R leg, which i do most of the time. She did 2 deep passes on my R psoas, which by the way if you want a massage therapist to do this, i recommend going in with an empty stomach (no food and no water) because her/his elbow goes deep into the stomach to get to the psoas. I instantly felt way better afterwards and had a great training session days later…BUT since then i have been thinking about and unsure whether this is the correct approach because if my R hip is dropped, wouldn’t releasing the R psoas tightness make it worse, just resolve pain in the moment? It may be tight for a reason as it is trying to pull the R hip up into place? This is simply me speculating a lot. I am no expert, just an engineer by day and a guy trying to resolve his pain by night. Anyways, I am very appreciative of the information here and wanted to drop a line! if anyone has any recommendations/thoughts, please add!

    • admin says

      Hello Sam.
      The underlying neuromuscular pattern that PRI identifies is one of a left pelvis rotated forward compared to the right side. It will almost always be this way due to how the human body is put together (particularly the bigger and stronger right diaphragm’s influence on spinal rotation). Over time our center of mass shifts over to the right and our left pelvis (left ilium, really) falls forward.

      After that, the body can react, or compensate in various ways. There are typical patterns that are observed, but then there are variations of the typical compensation patterns that we see. A right psoas can be tight due to this pattern, do doubt. It may be attempting to direct our center of mass back to the left. It could also be tight because the right diaphragm tends to be tight, as does the right QL, in the typical pattern that I described in the blog post. I believe all three of these muscles have fibers that blend together. So any tightness in one can affect the others.
      From my experience, the only thing that addresses the underlying issue (which is the forwardly rotated left pelvis) is pelvic repositioning, but you would need either a personal trainer or physical therapist who has a good understanding of PRI.

      Neal

  18. Peaches says

    Hello I have been experiencing pain in my right hip going down through my knee for almost a year now the pain was so bad that I couldn’t move my leg an inch without horrible shooting pain. My doctor diagnosed me with frozen hip and put me under anesthesia to manipulate my hip to get it moving again. Unfortunately I do not think the frozen hip was the underlying cause for my hip pain my first ever symptom was that my right leg was longer than my left leg and the leg length discrepancy would get longer the more I would walk on my right leg. Did you have a leg length discrepancy with your pelvic tilt? My muscles in my back are so tight it feels like they are ripping apart when I go to stand up straight or lay down straight. I’ve been trying to stretch my muscles but it doesnt seem to be enough because my leg length problem keeps popping up.

    • admin says

      Hi Peaches,
      A longer right leg is very common in the pelvic position that I described in the blog post. Although I have never helped anyone with frozen hip, I have helped someone with the diagnoses of frozen shoulder. It was not frozen, it just couldn’t move correctly because of the position of the ribcage that sat underneath it.
      There is a strong possibility that your pelvic position is causing the issue as a lack of traditional range of motion, leg and back pain are both common when the resting position of your pelvis becomes too asymmetrical.
      Where do you live?

      Neal

    • John Rodgers says

      How is it? I had debilitating pain down my theigh ( I.t. band ) , I was given a pelvic excersize and it went away within days. The I.t. band was rubbing somewhere.

  19. Deepak Sharma says

    Hey Neal
    Its always great to read when someone write on the issue you are suffering from. Great article and also very logical.
    I am also suffering from lateral tilt, functional scoliosis, left shoulder high and right leg short. All indicating that the pelvis is upward on my right side. This shit happened in 2008 and initially suppressed by massage but comes back always once in a year and guess what i dont know why. Recently one year back i came to know the reason that when ever i sit on hard or bend forward or left i feel pain and functional scoliosis but doing certain stretching and rest i feel ok.
    Guess what brother the CULPRIT was my own car and finally just 2 months back I sell my car. Now sitting on hard surface for long time only give scoliosis symptoms. Happy most of the times.
    Thanks again.

  20. Deepak Sharma says

    And most important think which I do 1 hour two times a week is
    1. Yoga
    2. Foam rolling
    Rest i do just simple stretching 15 min per day.

  21. John Rodgers says

    Hello , thanks for the article. I started with back pain then , had weak glute and my hip slowly collapsed over a couple of months , now noticeably leaning to the right. Tight q.l. and glute on that side not Firing. Yes did a lot of driving for work , lot of physio seems to be helping but very slow.

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