Lateral Pelvic Tilt and Lower Back Pain: The Connection

Lateral Pelvic Tilt is a position that finds one side of the pelvis higher than the other. In the picture below, you’ll notice my left side is higher than the right. This picture was taken about four years ago when I was trying to figure out what was causing all my back pain.

this is a picture of a lateral pelvic tilt with the left side higher

this picture shows a neutral pelvis that no longer has lateral pelvic tilt

A more neutral pelvis

My understanding of lateral pelvic tilt, it’s causes and how it produces back pain, comes from the work of the Postural Restoration Institute.  It’s been over 3 years of study, attending intensive weekend seminars in NYC, CT, and Boston, considerable financial investment, and lots of practice on myself and clients.

More experientally, I have felt the effects of lower back pain for most of my adult life, from the age of 20-35. I know first hand the misery, depression, and hopelessness that chronic pain can cause.

Everything PRI has taught matches my experience as a back pain sufferer and I have used this information to relieve many other people of back pain stemming from a prominent underlying issue which can often cause lateral pelvic tilt.

note: It’s important to realize that what I am going to discuss is not the only reason you can end up with a tilt. Anything that causes certain muscles to spasm or be hypertonic can cause a tilt. Herniated disks and hip joint damage can contribute to lateral tilts as well.

Postural Restoration Institute’s Two Body Philosophy

Before I begin, I must explain that PRI teaches that humans are inherently asymmetrical beings and that we have two bodies, a left side and a right side. Here is one example of our internal asymmetry. A right diaphragm that is much bigger, stronger, and more favorably positioned and supported for breathing than the left side. The view is from the top looking down. You see the spine behind the dome-shaped diaphragms.

Human diaphragms

It’s a bit complicated, but this diaphragmatic asymmetry plays a role in lateral pelvic tilt because of how the diaphragms attach to the spine. Over time, and approximately 20,000 breaths a day, the left diaphragm is overpowered by the right, and the right diaphragm starts to pull our spine and center of gravity over to the right. I won’t get too detailed in this diaphragmatic activity because it’s just one part of an overall bodily system that favors the right side of the body, but it is an important part.

For more discussion about our inherent human asymmetry, you can read this page I put together.

The Pelvis

Female pelvis showing the sacrum, right illium, and left illium and SI jointsOn the right I have a picture of the female pelvis. It is facing you. The three bones I have labeled, the right illium, the sacrum, and the left illium, are three different bones.

The right illium joins the sacrum to form the right SI joint. The left illium joins the sacrum to form the left SI joint.

The sacrum is the base, or the foundation, of the spine, which then runs upwards and ends at the base of your skull.

The importance and precarious nature of the SI joints can’t be overstated. These two joints connect the upper body and the lower body. That’s a big responsibility when you consider all the activities that the human body engages in. Jumping, sprinting, lifting. That’s a whole lot of force being transferred through these joints, and the pain that can result from a dysfunctional SI joint is often debilitating.

In addition, all three bones move upon each other. What I mean is that the illium can move on the sacrum and the sacrum can move on the illium. We often think of one bone moving on another, like the femur (upper leg) moving on the acetabulum (the acetabulum being the part of the pelvis that the leg “sits” in.) What is less appreciated is that the acetabulum also moves on the femur.

To visualize this, think of when you are doing a single leg Romanian deadlift. Your foot and leg are fixed on the ground and not moving. As you perform the movement, your pelvis is rotating on your leg. This might seem obvious, but rarely is this movement, pelvis on leg, ever considered at great length.

Yet its implications are huge because this duality in movement, two bones moving on each other at the same time, is happening all the time throughout your body. But standard approaches to resolving musculo-skeletal pain rarely even consider it.

So the fact that the femur moves inside the acetabulum is a given. But the fact that the acetabulum, and thus the pelvis itself, moves on the femur, is huge. It means that using the proper muscles, we can reposition our pelvis. Why would we want to reposition the pelvis?

More on that coming up.

Pelvic Motion

distracted SI joint, a common source of low back painIn my little drawing, I’ve flipped the view on you. Now you are looking at the pelvis from the back.

What my diagram shows is a left pelvis, also known as a left hemi-pelvis or left innominate, that has forwardly rotated.

The arrow for the left hemi-pelvis is showing a forward, or anterior, rotation. It’s running back to front. The arrow for the spine shows that the sacrum and lower spine “go” with the left hemi-pelvis and turn, or orient, to the right.

Here is a video I made further explaining how this pelvic position can cause right SI joint pain.

Weight Shifting, Walking, and Running

Now, this left hemi-pelvis rotating forward and orienting right is perfectly normal. It’s what happens when you walk as your left leg moves forward through the air and your weight shifts to your right foot.

To try and visualize or feel this, you can try this exercise.

Stand with your feet slightly apart and your weight evenly balanced. You can place on your fingers on the front of your hips to help feel what is happening.

First, shift most of your weight on to your right foot. This shift of your weight into “right stance” should result in the left pelvis coming forward and the right pelvis moving back.

The position of the pelvis in right stance

Return to an evenly balanced stance.

Now shift your weight to the left. This shift of weight into “left stance” should move your left pelvis back and your right pelvis forward.

position of the pelvis in left stance

This is the natural movement of the pelvis when you shift your weight in standing position, walking, or running.

However, what happens if you were to shift your weight to the left foot but the left pelvis doesn’t move back? Normal mechanics dictate that the left pelvis should move back when you shift to the left.

Can this happen?

Yes. All the time. And this is the origin of many of our problems. A left pelvis that doesn’t move back. In other words, a left pelvis that is stuck forward.

In this case, the left hemi-pelvis, the sacrum and lower spine stay oriented to the right. The directions never switch. You are stuck in “right stance”, meaning a forwardly rotated left pelvis, even when you are ostensibly standing on with your weight on the left leg. And you stay in this position during all activities: sleeping, swimming, running, squating, deadlifting, bench pressing, or whatever.

If that left pelvis never moves back, you have lost normal human pelvic mechanics. You are living on your right leg with a pelvis and lower spine oriented right. Here is what right stance looks like:

Neal Hallinan of Novus Fitness stuck in right stance and lower back pain

Me stuck in right stance circa 2012.

The picture shows me clearly stuck in right stance. Of course, in 2012 I had no idea that this was so. To me, standing with my weight shifted over to my right leg was “normal”. In fact, I didn’t even know my weight was shifted to the right.

I was simply standing.

All I knew was that my left pelvis was higher than my right (your left pelvis doesn’t have to be higher than the right, mine was because of the tilt). But look at the accompanying postural distortions. You can click on the picture for a closer look. They all stem from a left pelvis that was stuck in a forward position, oriented to the right, and a subsequent shift of my center of gravity to the right.

Look at this picture of a pelvis facing you. Notice the left pelvis higher than the right? Although this isn’t my pelvis, that’s what I probably would have looked like underneath.

a pelvis with the left side higher

SI Joint Pain

distracted SI jointBack to my drawing. As I mentioned, if the left pelvis tips forward and stays there, the sacrum and the lower spine will have to go with the left pelvis. So now the left pelvis, sacrum, and lower spine are oriented to the right.

Look what happens to the right SI joint. It gets pulled apart. This was the source of my skeletal pain. A right SI joint that was under constant stress because my left pelvis, sacrum and lower spine were stuck orientated to the right. The sacrum and right illium were pulling away from each other.

Keep in mind that the pain can also occur in the left SI joint, but I’m not getting into that in this post. It’s still caused by the forwardly rotated left pelvis but the mechanics are more complicated.

a pelvis with a distracted right SI joint but an intact left SI jointHere is a picture of the real thing. Notice the areas directly above my labels. The right SI joint is pulled apart. The left SI joint is intact.

Lateral Pelvic Tilt

What this means is that sometimes (but not always) a lateral pelvic tilt is just a visible and exaggerated manifestation of the underlying issue, a left pelvis that is stuck in a forwardly rotated position. This position and its impact on muscle function causes some muscles to become overactive, and some of these muscles, particularly the hip flexors (psoas, illiacus, and TFL)  and quadratus lumburom (QL) can cause the tilt.

In my long battle with lateral pelvic tilt, I was actually able to get rid of the majority of the visible tilt through massage. While the pain lessened to a degree, it didn’t get rid of it completely.

When I discovered PRI, I finally understood why the pain was occurring, and that to get rid of the pain I had to get my left pelvis out of the forwardly rotated position.

So that’s what I did, and I haven’t had any significant SI joint or lower back pain since. Coming from someone who would get knocked out for weeks at a time due to SI joint pain, this is amazing.

Repositioning of the pelvis is at the core of everything PRI does. It’s what I do with clients all the time. Lots of pain–knee, hip, lower back, and shoulder–has cleared up by pulling the left pelvis back into a better position, and restoring tri-planar motion of the pelvis.

An important thing to realize is that I don’t touch anyone, except to test the position of their pelvis and rib cage.

I teach people to use their own breathing, muscles, power, and ultimately their own brain, to pull the left pelvis backwards (in the saggital plane) to establish true movement of the pelvis, instead of living with a restricted and stuck pelvis.

Here is what a typical pelvis repositioning technique looks like.

A pelvis that can move in all three planes of motion is better than a pelvis that can’t.

Important note: while this post addresses what is going on at the pelvis, there is another critically important aspect: what goes on at the rib cage. The pelvis and rib cage connect via the internal obliques.

Since the body is an integrated system, what happens at the pelvis effects the ribs and what happens at the ribs effects the pelvis. In PRI, this region of pelvis/oblique/rib cage connection is called the Zone of Apposition. This post addresses this very critical junction: Do You Have A Zone of Appostion?

Proof?

So how do you know all I’m saying is true?

There is a test for it.

A forwardly rotated pelvis won’t permit the leg to same-side leg to adduct. Because of how the bones are lined up when the left pelvis is forward, the leg hits the pelvis, and can’t go down.

In the first picture, you are seeing a left leg that will not adduct. It won’t go down to the bench. I am not holding it up. Actually, I’m pressing down.

positive test anteriorly rotated pelvis Postural Restoration Institute

Positive test for forwardly rotated pelvis.

 

negative Postural Restoration Test for a forwardly rotated pelvis

Negative test for forwardly rotated pelvis.

The second picture is after a pelvic repositioning technique. She now has full adduction of the leg because we pulled her left pelvis back, which then provided space for her left leg to adduct.

Why Me?

If everyone is stuck with a forwardly rotated left pelvis, why doesn’t everyone get back pain from it?

I can’t say for certainty, but these are thoughts I have had:

  1.  The human body has many ways of compensating for lack of movement. Some people are master compensators. Since there is a huge neurological and nervous system component to all this, and people’s consciousness and sensory experiences are unique to them, different outcomes are experienced.
  2.  Since this phenomena is pretty universal, there could be a built in neurological degree of acceptability, but once you stray outside this range of acceptability, the body starts to react angrily.
  3.  Modern life may exacerbate these underlying asymmetries and push them to the extremes where the body can no longer compensate comfortably. Sedentary life styles, sitting, and a general lack of movement could all contribute.

What Can You Do About It?

If you live somewhere that there is a PRI trained physical therapist, you could see one of them. Unfortunately, as yet, there aren’t a whole lot of them, although the ranks are growing. There is a directory on the website, however.

NOTE: I get a lot of e-mails about this issue from all around the world, and I do my best to help in any way I can. Everything I know and do comes from Postural Restoration. If you are in the United States, please try to find a PRI provider. They can help you much better than I can through e-mail.

Find a PRI provider.

Another possibility is that you’ll respond well to traditional treatment which can treat the pain, though not necessarily the underlying issue, which is the forwardly rotated left pelvis.

Or you can try this technique that is shown in the video below. The therapist is Ron Hruska, the founder of PRI.

A couple notes about the video.

  1. You don’t have to use a balloon and don’t have to position your right arm above your head. The reason the right arm is above the head is in order to facilitate air flow into the upper right chest area. This area often becomes shut down as a result of compensations stemming from the forwardly stuck left pelvis.
  2. In this version of the exercise, the patient has both her feet on the wall and is engaging both of her hamstrings. Most likely she has both sides of her pelvis rotated forward and has to bring both sides back. There is no way that you will know if you are forward on both sides, or just the left side, without being tested. If you have a visible tilt, I would probably have you do the single leg version. This means only using the left hamstring. In order to modify the exercise, once you are in the correct position, you simply take your weight off your right foot so that only your left leg is weight bearing.
  3. If you can feel your left hamstring engage, and you can follow his instructions for breathing (with or without the balloon) you have a good shot at success.
  4. If you feel your left quad (front of the thigh) you are doing it wrong. Most likely you are pushing your foot into the wall instead of pulling down. You should think of performing a left hamstring curl by “pulling” your left foot down. Have your weight distributed mostly from your mid foot to heal. You don’t want your weight on your forefoot and toes.
  5. If you are currently in a lot of pain, you might want to hold off on doing this technique. Just getting into the correct position can be painful. Depends on the person.
  6. Without the supervision of someone well versed in PRI technique, this stuff is hard. There are a number of places that someone can mess up with the result being a repositioning exercise that doesn’t reposition.  Also, pelvic repositioning is just the first step of any program. There is more that has to be done. However, I’ve had many clients who feel results and pain relief from just the repositioning techniques.

Here is another video showing the single leg version of the exercise. I use this one with people who are only in the Left AIC pattern, which means only their left pelvis is forward. For these people, which is the majority of us, this technique probably works better than the two legged technique above. As I mentioned, only PRI testing can determine which pattern you are in.

Due to the highly individualized nature of bodily pain, there is no way for me to know exactly what is going on in your particular situation. The more research you can do on your own, the better it will be. In the PRI view, pain not attributed to sickness, arthritis, or injury is often the result of an underlying pattern of muscular activity that has reduced your ability to move efficiently.

Remember, PRI does not treat pain. It addresses the position of your pelvis, ribcage, and neck.

Here is some other content that I have created to help you understand what is going on. People who read and research find resolution to life’s problems much more effectively than those who don’t.

The Left AIC Pattern. This post is a more detailed discussion of the underlying “pelvis rotated forward” pattern that was the basis of my pain. The vast majority of humans are in this pattern. It’s completely normal. When this pattern gets too extreme is when the problems start.

The Right BC Pattern. This post is a more detailed discussion of the compensation that occurs in your upper body in response to what is happening at the pelvis, in particular the ribs around the ribs and spine.

These two patterns, the Left AIC and Right BC, almost always occur in tandem to one degree or another. Both patterns must be addressed.

How to Conceptualize PRI

PRI is really difficult to understand. It’s difficult to understand for trainers, physical therapists, massage therapists, and doctors. The reason is simple: PRI presents a different way to view the function of the human body.

PRI starts with this fact: the human body is asymmetrical. Asymmetry is the starting point.

We have not been taught to view the body as asymmetrical. Symmetry was always assumed, not considered at all, or believed to be desirable.

Until you can buy into the fact that the human body is, and always will be, asymmetrical, it’s hard to understand how PRI works.

Comments

  1. Brandon says

    I’ve been fighting this exact same issue for 4 years now. I’ve been to multiple chiropractors who all seem to think it’s not the cause of my pain. I have all the same symptoms you did and on the same side. Low right shoulder, high left hip. My leg won’t adduct during the test shown above either.

    My question is this. If you got this fixed, was it through a manipulation to move your inominate posterior? If so, who did you go see to get it done. I can’t not for the life of me get a chiropractor in my area to take this seriously despite having all the same symptoms you describe as well as x rays that look basically identical to yours.

    I’m desperate to get this fixed.

    • Holly says

      I haven’t gotten people to take it seriously either! Going on 2 years. Thousands of dollars and hours at doctors’ offices. I say my right hip is poking out more than my left, and it’s like they don’t hear me.

  2. admin says

    Hi Brandon,
    No, it wasn’t through manipulation to move the inominate posterior. I re-positioned my left inominate posteriorly in pretty much the same way you see it done in the video, except that all my weight was being supported by the left leg.
    By performing a posterior pelvic tilt, while keeping your lower back in contact with the ground, and pulling down through your left heel, you are positioning yourself to activate your left hamstring. The left hamstring is what is being used to pull the left inominate posteriorly.
    If breathing correctly, which means exhaling all the air out so that your left obliques and TA engage to bring the left ribs down, you will also be turning off your hip flexors via relaxation of the left diaphragm (which connects to the psoas).
    I repositioned myself after my first Postural Restoration Home study course. Have you checked to see if there are any PRI providers in your area?

    Neal

    • Brandon says

      I’ve checked and no. I’m in Ohio, so the nearest is some distance away. I’ll look into making a trip to see one. Thanks for the reply Neal. I’ll try the video too and see what that does.

      • John says

        Hi Brandon,

        I’m also in Ohio and have the exact same issue from you stemming from maladaptive gait and movement pattern due to a severe ankle sprain 7 years ago. Were you ever able to find anyone who was able to tackle your problem? How did you get it resolved? I’ve seen osteopathic manipulation DO doctors who have been able to get me feeling way better BUT only for like a day before I revert back to my old postural alignment/movement form. I’m having one hell of a time so hoping maybe I could pick your brain. If so, please reply or shoot me an email.

        Thanks so much,

        John

  3. Tom says

    Hi there Neal – thanks for your blog which has been fascinating as I have suffered from almost identical problems over the years with regards to x-rays proving the pelvic tilt (right side low), the resulting curve in my spine, and the symptoms and pain which have followed. My tilt is also the right side being lower and issues have been pain and severe restriction in my right leg (primarily the high hamstring area) and plantar fasciitis in my right foot. The left side has been quite clear other than ongoing calf muscle problems (which I don’t know are related or not).

    The thing is however that I don’t think I have a forwardly rotated pelvis as both my legs right and left are able to adduct, which means I assume (based on the test you refer to) that the left pelvis cannot be forward.

    Is there any other advice you can provide on attempting to identify what may be causing the pelvic tilt? Thank you!!

  4. admin says

    HI Tom,
    If you are self testing your legs ability to adduct, you are probably getting a false result. The problem is that as you try to adduct your leg, you must be sure that it stays in a neutral position, ie. it doesn’t flex at all or internally rotate. Someone must position the leg carefully, hold the joint steady, and then move it down for you. If not, it’s almost a certainty that the leg will flex and internally rotate, since the left pelvis is oriented in a flexed and internally rotated position.
    I hate to use absolutes in anything, but if you are human and have never been repositioned, your left pelvis will be rotated forward.
    Your issue is one that is seen all the time. Essentially, your right leg/hamstring/lower back is holding you up as your left leg is not in a biomechanical position to hold and support your gravity over the left leg, even when you are standing on your left leg. It’s crazy, but I’ve seen this with numerous people who suffer from right side pain.
    It’s likely that your left calf is being overused due to weak glutes and/or your foot is being pushed into a poor position by the position of your left leg, and the calf is working too hard for one reason or another.
    If I were you, I’d try to find a PRI therapist in your area. They’ll be able to help.
    Neal

  5. Tom Stephens says

    Thanks for this. My questions are duration and frequency for preforming the technique shown in the video. Should you perform just one cycle as shown in the video, or more? How often should this be done? Thanks again.

  6. admin says

    If I am using the exercise to re-position the left pelvis, I’ll have someone do it for three sets of five breaths. Then I would re-test to see if their leg can adduct. If it adducts, the exercise worked and the pelvis has re-positioned. If the leg doesn’t adduct, the left pelvis is still forward.

    This particular movement is just the first step for a basic “left-pelvis forward” client. It’s usually just used to re-position the pelvis in the sagittal plane. Then you address frontal and transverse plane pelvis/femur relationships.

    Keep in mind that the upper body (rib cage and neck) are a huge part of PRI, as are teeth and vision. If someone doesn’t re-position with this exercise, it could be a mistake in technique, or more commonly, people not fully exhaling (although that’s what the balloon helps with). Less frequently a vision or teeth issue could be hampering progress, but it does happen.

  7. Suki says

    Hi, I have had back and hip issues for quite a few years now, but all my issues are on the right side. I have worked in aged care for years and done a lot of uneven lifting using my right arm and shoulder. I have also given birth to 4 children quite close together and this is when A lot of my problems started.

    Its my right hip, that is higher and it juts out to the right side also when lying on my back my right leg rotates outward more. My body posture is very similar to your photograph only on the reversed side. 

    I have seen chiropractors and ostyopath’s which have helped greatly but never eliminated the problem or pain completely and it always returned.

    I have been doing a lot of yoga and trying to stretch out my right side, hip and surrounding muscles in hopes of correcting my uneven pelvis/hips.

    By your article it was my understanding that people are more likely to have a rotated left hip, but I have always thought mine was on the right. Do you think this could be the case or do you think it is more likely a rotated left hip is causing all my right side problems?

    Thanks so much for your time.  Any advice would be so greatly appreciated. I really don’t know where else to turn.

    • admin says

      Hi, thanks for writing. Right sided pain is very common. The tilt can be on either side and, although the visual can be striking, it doesn’t really tell you a whole lot about what is going on underneath.

      In regards to the pelvic rotation, PRI teaches that either the left side will be forward compared to the right, or both sides will be forward. I would say a greater percentage of people I have worked with have had just the left side forward, but I’ve also worked with a number of people with both sides rotated forward.
      If you have ever heard of anterior pelvic tilt, this is really the same thing. However, most people (and I was one of those people until I discovered PRI) believe you can stretch your way out of anterior pelvic tilt. But you really can’t. So stretching your right side will probably have limited benefits.

      https://www.posturalrestoration.com/find-provider

      I highly advise that you look at the PRI website’s “Find a Provider” page and see if there is a provider in your state, region. Also, if you tell me what city and state you live in, I could e-mail the private PRI google group where PRI talk about PRI related stuff and ask if anyone knows someone with PRI experience in your area. Not everyone that knows PRI has gone through the certification process since it’s rather lengthy and time consuming.

      If I had discovered PRI earlier I could have saved myself years of pain and frustration.

      Any other questions, e-mail me at info@novusfitnesstraining.com

      Good luck!

      Neal

  8. Peter says

    Hello Neal,
    I am writing from China My main issue is very similar to yours:
    higher left pelvis, also higher left should, left rib cage lower edge has been raised since 1981; also left hip forward and my left crest is also outward,but right backward (I feel by my hand from both front and back); left hip muscle (most likely gluteus Maximus ) is loose , but harder and very strong rectus formoris ( most hard muscle in my body when I surprised to find out, and quards have some knots or hard stripe muscle) ;

    In addition , it seems my left body is tight and inward.My left lower abs is harder. I guess it is my lower left external oblique as I can feel a hard stripe close to iliac crest parallelly; also my left external oblique between my rib cage and pelvis is tight . However my right (maybe whole right chain) is so loose that I can’t kick the water properly (actually right leg stretches outward widely when kicking and right ankle is not flatten as left one).My left shoulder is forward and inward, too.Since I do some lats strecth, and use left lat pull water, my left lat is activiated but sometimes slight pain and burnig.My left foot is a bit supination, so big toe is not working well to support me standing,left inner heel is painful.

    My pain is on the left hip to left foot and particularly around inner thigh and groin area. My left inner thigh will be in a feeling of burning and pain if I sit more than one hour, so I prefer to stand when I use computer. However, my right hip,leg and abs and lats are fine, no pain and muscle’s tone is hard to surprise me.
    I had tried 90-90 hip lift from youtube befor I read your blog and had felt my left hamstring and hip was engaged.However, left pelvis is still high although some changes have taken place. I thought I had to continue doing until it become even.So I have done it for more than month. Now, just know 3 sets of 5 breath will restore pelvis position.

    Please help me and give me some advice. Thanks a lot in advance.

  9. April says

    Hi,

    I have a very strange story to share, and I’m hoping to get some answers. In elementary school, the people who came to screen for scoliosis thought that my shoulder blades didn’t line up (when I bent forward), but when a specialist came to the school to check, he didn’t find anything. But I knew there was something wrong in high school because whenever I wore an unzipped jacket underneath my backpack, the jacket would slowly shift to the left until it had fully receded into the space between my backpack and my back (annoying as heck!).

    Two years ago, while serving a mission for my church, I noticed that my upper body and hips had a tendency to angle toward the left when I planted my feet straight on the floor, hip distance apart. Later, I realized that the bigger problem is that my pelvis is extremely tilted. When I find my iliac crests, the right one is much higher than the left one–worse than lots of the pictures I have found online. Sitting is uncomfortable because I consistently get a dull pain in my right hip (groin and sometimes front of the hip) and I never feel like I’m sitting straight. It always feels like my body is out of whack.

    Yes, I’ve been to my primary care physician. She told me that this is purely postural and tested for leg length discrepancy in a quick, inaccurate way on the examination bed (which wasn’t even flat!), proclaiming that I didn’t have any discrepancy; then she offered me the option of having my hips x-rayed (which I haven’t yet done). I don’t know what to do at this point because I’m still living at home and my parents don’t believe me that there is anything wrong. But this really reduces my self esteem and quality of life. I went to the chiropractor and he told me to stretch more. But stretching doesn’t seem to help. Nothing seems to help.

    I would be happy to receive any help or advice you can give me. By the way, I’m 24 and I eat really well (all organic, lots of fruits, vegetables, and healthy grains). I also try to exercise regularly.

    • admin says

      Hi April,
      Stretching doesn’t generally help these types of things. If you could cut and paste your comment into an e-mail and send it to nealhallinan@gmail.com, I could respond more easily. I don’t check the blog every day, but I do check e-mail. And let me know where you live so I can try and find out if there is a therapist in your area that could help.
      thanks!
      Neal

  10. Michelle says

    Hi
    I was adjusted by a chiropractor 8 years ago. He adjusted my pelvis, the last time he did it, there was a loud pop and I was not able to walk for 4 months because a disc severely herniated. I have been having back pain since then. I went to a doctor a while ago only to find out I know have adult onset scoliosis, my pelvis is tilted, one hip higher than the other, left shoulder higher than the other, causing serious pain. I have been getting depressed and trying to figure out what kind of doctor or physical therapist can help fix the problem. It was the first time having my hips adjusted and I’m thinking that is all the cause of the problems that have started. Any info would be great. Thank you

    • admin says

      Hi Michelle, where do you live?
      If I were you, I’d check the Postural Restoration Institute website and click on “Find a Provider”. A PRI trained therapist could help you with the tilt. Left shoulder higher than the right shoulder is a typical visual pattern when a left pelvis is rotated forward compared to the right. It occurs because your torso rotates back to the left as a compensation. This torso rotation could also potentially explain the adult onset scoliosis. Right now I am just speculating. A PRI therapist has tests that show you what position your pelvis and ribcage are in.
      Any other questions, e-mail me at Nealhallinan@gmail.com

    • Jane says

      I appreciate your writing about chiropractic-caused injury. All it takes is one time. I should have learned my lesson when my boss went to a chiropractor and he adjusted her without due medical history and examination. Turned out, she had bone cancer and he further fractured her bones. Pain leads to fear that the internet increasingly aides and abets, but that is an important anecdote.

      Meanwhile, I found a gentle “network” chiropractor – they’ve changed the name of the style now, but moved far from any. Went to a local chiropractor here, who adjusted my neck so severely, first visit, without any prior massage, or … that, ten years later, I continue to suffer the effects and pain.

      I have had lower back and other pain – mostly right-sided, but primarily from feet to head for three weeks, and I almost contacted a chiropractor. Thanks to your comment, and this website, I won’t, and I am very grateful.

      • Jane says

        PS There is also not a physical therapist in the area where I live that I would go to for a million bucks, not even – perhaps, especially – the one associated with the hospital. Been there. Dangerous. And stupid. A very bad combination. Thank you.

        • Jane says

          PPS And yet chiropractic is covered by Medicare and other insurances…even gentle massage is not. They must have a hell of a government lobby.

  11. Cindy says

    After a year of different PT and doctors, a chiropractor was finally able to diagnose my anterior tilt on my right side and now I see a great PT person who has me on an alternating exercise routine to try and keep this from continuously happening. Instant relief after I see him. I can now tell when I am “out of whack” immediately. The problem is we cannot figure out why I keep going out of whack every few weeks. Working on the right glute to activate better. I am still a work in progress, but I am optimistic.

    • admin says

      Cindy, I would check the Postural Restoration Institute website and see if there is a PRI provider in your area. The foundation of all PRI treatment is getting a pelvis into “neutral” and keeping it there.

  12. BG says

    Stumbled across this blog in my never ending search for what may be the cause of my chronic back pain. I’ve noticed a lot of the things in myself that you discussed in this post dealing with hip alignment. I tried the exercise in the video and it seemed to target the exact location of where my pain in stemming from. Is that typical with the patients you’ve seen who have had success? Also, my hips begin to “bounce” almost like an uncontrollable twitch while holding the position. I’ll definitely be looking into a PRI provider for further guidance.

    • admin says

      Hello BG,
      The exercise in the video moves the left side of your pelvis backwards (and can also move the right side forward depending on how the exercise is done). So if your pain is coming at the SI joint area or right in the middle of your back, you could feel the exercise directly. However, if it hurts, there are other ways of repositioning the pelvis without this exercise. Some people can’t do this exercise for one reason or another (generally if they are in acute pain, getting into the position alone could be painful).
      In regards to the hips “bounce”, that could just be fatigue, or the fact that your left hamstring is working hard to support you.
      I would definitely encourage you to find a PRI provider to help you in the process.
      Neal

  13. Eloy says

    I have my right pelvis tilted forward. Will these exercises work for me? Or do I have a different condition just because it’s right pelvis forward.

    • admin says

      Eloy, although it may seem that you have a right pelvis tilted forward compared to the left, it is unlikely that that is what is happening. Only the testing can tell you for sure, but the way that the human body is put together results in a left pelvis forward compared to the right (although sometimes both sides are forward, but the left would still be more forward than the right). In regards to the exercises, yes, they could work, but they are easy to do incorrectly.

  14. Amanda says

    Hi! I’m really glad I found this information. It’s 4:00am in the morning and I am awake in bed from pain, desparelty seaching for comfort! Ugh. All of these same symptoms… Left hip visibly higher etc. Extremely hard to function normally.. Even walking and standing are painful most of the day. I’ve searched for PRI near me but unfortunately there are none in my area. (BC, Canada). I was seeing a Chiropractor for a few months ago charged me a lot of money to use a heat laser machine on my lumbar spine and a few minor manual manipulations.. But no help from this at all. I guess my question for you is… What is my next course of action? Try seeing another Chiropractor, a Physical Therapist, a Doctor, or search around for online exercises and try to correct this on my own?

    I’m a 24 year old female and I used to be able to hike and run and now I’m just in pain 24/7 and desparate for change!

    • admin says

      Hi Amanda,
      If you can travel a bit, there are a number of PRI providers in the Seattle, Washington area. I wish I could recommend another course of action that wouldn’t require travel, but unfortunately I can’t. PRI is the only method that I am aware of that addresses the underlying asymmetry of the pelvis. And from my experience, that asymmetry has to be addressed first, and then maybe other treatments can help.

    • Tab says

      I feel your pain! I’m 27 and out of nowhere I’ve had massive pain I have 4 children and can’t walk or take care of my home… thankfully it’s been less than 2 weeks I plan to drive 2 1/2 hrs next week to see a pri special and hope it work

  15. vicki says

    I have been tilting to the right for years and can feel it in my abdomen and spine. It is a gnawing feeling. I thought it was muscles and had an x-ray. I was told that it is in bad shape and shows no space in it for movement. The weird thing is that I don’t feel so much pain like ‘bone on bone’ but more in my groin and legs going down.
    I am wondering if anyone knows if there is anything that could make an xray look like the joint is bad off but really it is muscles or something else doing it. My whole body even up to my neck going diagonally from my hip feels so out of sorts.

    • admin says

      Vicki, I understand how confusing these things can be.

      But always keep in mind that muscles move bones. Bones don’t just move on their own.

      So yes, it is a muscular issue. What I describe is a neuro-muscular “pattern” (your brain is coordinating your muscular activity) that puts you in a particular position. So the position of your joints are a reflection of muscular activity. Your X-Ray is showing your bones and joints that are in the position that they are because of muscular activity. To change the situation, you need to turn off the over-active muscles that are putting you in that position. That’s what PRI does.

  16. Elliot Eichelmann says

    Besides surgery, what is the treatment for a bony pelvic discrepancy, where one innominate is vertically taller? I have a pad on the short side and it’s the only thing that helps. I had surgery that fixed the problem (Millis-Hall pelvic osteotomy for a small hemipelvis) but I had complications and failed hardware and still have the issue. I feel like I have to sit on a pad under my left ischium for the rest of my life if I don’t want to be in pin and constant discomfort. I’m 26.. this has been the bane of my existence.
    -Elliot

    • admin says

      Hi Elliot,
      I’m sorry to hear about your struggle. I know what that’s like. To be honest, I have never dealt with that issue and am not sure what to advise. I’d check the Postural Restoration Institute website to see if they have any providers in your state.

      Neal

  17. Erik says

    hello, about a year ago I fell out of a truck onto my right knee and injured my right hip, couldn’t walk normaly for about 4 months. I let it heal and thought it was ok. I continued with running,lifting weights,skateboarding until one day I landed funny on my left foot and felt something in my back.still continued to do activities until one day I was working and couldn’t stand the pain and just felt twisted.i went to a chiropractor a few times and then started getting sciatica down the right leg.i stopped almost all activity. but even having worse burning pain in right s.i. joint.went to see pt and he had said I herniated a disc most likely and that my pelvis is tilted forward.the right side is having all of the pain and when I sit I can feel the butt bone on the right is higher and crunching my back.do you think this would be the left pelvis tilted forward? or the right? would appreciate any input thanks.

    • admin says

      Hi Erik,
      The asymmetrical pelvis position with a left pelvis rotated forward can certainly produce a pelvis appearing higher on the right side. This is usually due to a tight lower back muscle on the right side (such as the right QL) that is always “on” due to the position of the pelvis.

      It’s rare that a right pelvis will be rotated forward compared to the left.

      Check the Postural Restoration website and see if there are any PRI trained therapists in your area.

      Neal

  18. William Sumner says

    After experiencing L sciatic pain for about 1 month, I stepped out of the shower one morning and was surprised to see L pelvic tilt in the mirror. My L leg felt longer than the R and I could not put = weight on both feet when standing straight. Went to my doctor who observed the tilt and sent me for x-rays of the pelvis and lumbar. Awaiting results, however, after reading your article, I will be surprised if the diagnosis is other than you have described. I live in the CA Central Valley region and have several PRI providers within 150 miles. I’ll contact one in a few days and give the treatment a try.
    Thanks for the information.

  19. Patricia says

    Hi…..thank you for this information. I am currently receiving myofacial treatment for this exact issue. The difference being, my left hip is high and my right hip is rotated forward. What exercise would you suggest for this?
    Thank you again as you really opened my eyes to what the culprut is to most of my rib cage issues.
    I look forward to hearing from you.
    ~Tricia~

  20. Scott says

    I would like more info On this condition because I do believe I have this and would like more information to give my physical therapist I live in Idaho

  21. Nicky says

    Hi, I have forwardly rotated right inominate. And lateral pelvic tilt with left hip higher than right. My left ribs flares up. Exercise shown here will work for my condition?? ‘am living outside US . Can you pls help??

    Thanks…

    • admin says

      Hi. Yes, the exercise here (as long as it’s done correctly) can help. Every detail about the exercise is important (foot placement, lower back position, breathing etc..) Where do you live?

      • Nicky says

        Hi…..Thank you for the answer….I have lateral pelvic tilt with right side of pelvis forwardly rotated. My right shoulder sits lower than left one. Also, I have my left hip higher than right. My left ribs esp. near sternum flares out….I also have anterior pelvic tilt and patellar tilt. I am from India and doing requied exercises… but right pelvis always slides back to its forwardly rotated position. I realised after reading your article that I first need to correct breathing pattern. I was extremely happy when I found your article. Excellent information and very well explained! I did few exercises as shown here. I was confused though when I realised that this exercise is for left pelvis forwardly rotated.

        I understand that I can perform exercise shown here (single leg version)… with one modification only…i.e. with right hamstring activation and same breathing pattern.

        Thanks again for your reply…

        • admin says

          Nicky, sometimes people think that their right pelvis is forward, but that is very, very rare. I’m not saying yours isn’t forward, but again, it’s very, very rare. If you can have someone do the abduction drop test on you, it would help determine what is going on.

          • Nicky says

            I really don’t have anyone here … who can test my condition. Though, after reading your reply, I did perform the exercise shown here exactly. To much of my surprise, my pelvis was leveled. I just can’t believe it :)

            I have an exact same condition like yours…described here in this article. Logically, it make sense to establish left zoa as my left ribs flare out.

            After performing 90 90 with hip shift exactly as shown here… I have been able to correct my pelvis alignment. I understand that… in order to keep my pelvis leveled I have to do this exercise 2/3 times per day until mind muscle connection is established.

            I can’t thank you enough… your one reply has saved my much precious effort and time towards correcting my pelvis alignment. Thank you very much…

  22. jason says

    Heyy..I have noticed that my left leg looks relatively longer than right and I am getting pain in lower left back…could you please tell me how to get rid of it and do tell me which side is not proper??
    Thank you …hoping for your reply

  23. liviutza7 says

    first of all, thank you for your blog! I would have a question for you, if you could find the time to answer. I do have a rotated left pelvis( in that my left tight is forward compared to the other side ). I also have the left shoulder higher then the right one ( the right one is internaly rotated, quite visible ). Now, my problem come from the fact that my right hip is actualy higher then the left one. In compensation, my left leg feels shorter, my femur is more internaly rotated and my femur externaly rotated. What do Y do in this case? Do I still do the same wall exercise or do I need do to a variation? Thank you!!

    • admin says

      Hi. The right hip can end up higher than the left in many cases (often due to a tight right QL). The underlying pattern, left pelvis rotated forward compared to the right side, is still the underlying issue, but on some people this pelvic position causes the right QL to be tight and pull the right pelvis higher. In this case you would still do the same exercise and really concentrate on exhaling all your air. You may also need to try and stretch your right QL to help the process. Unfortunately without seeing you and testing you in person I really can’t be of more help.
      Neal

  24. Dejo Olateru says

    Hello, about 3 years ago I was running and felt a little pull in my lower back area (L4/L5) area, but it wasn’t too bad and overtime it’s gotten worse. I can’t stay standing for over 30 minutes without pain. The region gets very tight and almost feels like something has to be pulled apart.The pain has also started radiating towards my left hip. Also, in the last year I started feeling sensations up the left side of my mid to upper back area. That area is actually more pronounced than the right side. There’s a clear difference when I take off my shirt. Usually if I bend over, or standing for a while or even if I carry a backpack on my right, i’ll feel it on my left. I’ve gotten an MRI of my lumbar spine, as well as a CT Scan and the images show that my spine is fine, no discs out of place or anything like that. The doctor wants me to get an MRI of my pelvis and abdomen, reading this and the other questions, I’m thinking it must have to do with my pelvis. For background, I’m 28, in good shape, played soccer in college and a bit after. Thanks in advance for your response.

    • admin says

      Dejo, if you live in the United States, I would suggest seeing a PRI certified PT. Check the Postural Restoration website. Left sided pain can be a very stubborn thing and from my experience more difficult to address than right sided pain. If it is a pelvis/spine/muscular issue, PRI can help.

      Neal

  25. Mohit Kumar says

    sir,
    In mirror my right side is lower than left side same as your’s in the very first picture.
    I want know which side pelvis is forward rotated?

      • admin says

        Mohit, which side is higher doesn’t matter. It’s still the underlying pattern of left pelvis forward/right pelvis back, that causes muscular tension. Either side can be high. Only perform the exercise with the left leg to activate the left hamstring and left abdominals.

  26. Ankur Vashishtha says

    Hi Neal,
    First of all, thank you very much for sharing such a detailed blog. I have had back pain for last 8 years and I am just 28. My doctors had no clue as to what is wrong and I started accepting the pain as a part of my life. But it had side effects. The pain was excruciating and I remained irritated all the time. But then, I saw the blog. i started doing the exercises and my 90 percent of my pain has gone. Thanks a lot.

    But I have some doubts.
    My symptoms are as of left AIC but pelvic tilt for me is on the left side i.e my right hip is higher than left. Is it normal. Is it still left AIC only.

    My symptoms are as;
    Left leg forward.
    Right leg backward.
    Right Hamstring very tight
    Left Quads very tight
    Right QL pain.
    Right Shoulder pain.(right shoulder tilts down)
    Right side of the spinal erectors are very tight compared to left.

    Second doubt is I have pain on the back side of left ribcage sometimes while breathing.

    And third doubt is I do exercises as shown and it addresses the rotation of the pelvis as well but in the morning it returns.
    Exercises I do are as;
    Hooklying Right Rectus Femoris and Sartorius
    Right Sidelying Left Adductor Pullback
    Sidelying left hip internal rotation
    All Four Right Glute Max

    I sleep on the ground on a thin mattress.
    Do I need to do something else or am I doing something wrong here.

  27. Kurt says

    Can’t thank you enough for your post. It is very informative.
    I have serious anterior pelvic tilt and my right pelvis is slightly forward and also elevated. I’ve been exercising and stretching to fix APT for a month now. It seems like my posture has been improved when I’m standing but I found another issue I have.

    When I walk, my pelvis twists side to side. I step forward with my left leg and taking the whole left side of my pelvis forward too and vice verse with the right leg. I twist my pelvis constantly when you see from the back.
    Also my posture collapse especially when I walk. I videotaped my walking and my belly sticks out and my lower back is arched.

    I can’t find any information about this walking issue. Is it also a cause of APT?

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