Proper biomechanics demand a lot of things, one of which is a person's ability to maintain proper muscular length-tension relationships. As is the case with any joint, a postural abnormality and pain can develop when a muscle is tight while its antagonist is lengthened and weak. The pelvis involves a number of muscles that allow it to tilt anteriorly, posteriorly, and laterally. If a sizable disparity in those length-tension relationships emerge, then pain ranging from nagging low back pain to something more severe, such as piercing or radiating pain in the buttocks and legs can result. In this article, I'm going to be specifically exploring how the pelvis can become fixed in a lateral tilt and what can be done to both identify and correct the problem.
So what is lateral pelvic tilt and how is it best identified? Lateral pelvic tilt can best be described as simultaneously involving two motions: hip hiking and hip dropping. When compared to a neutral pelvic position, where the iliac crests appear level, hip hiking requires that the hip on one side is raised above a neutral position, while the other iliac crest must drop below a neutral level. When standing as evenly as possible, one should be able to determine with a mirror or another set of eyes whether or not their iliac crests appear level. But where are these iliac crests, you ask? The iliac crest is a term used to describe the pelvic border that stretches from the anterior superior iliac spine to the posterior superior iliac spine. Part of the anterior portion can be felt as the bony point of the pelvis situated beneath the oblique while the posterior portion is laterally offset from the base of the spine. If necessary, practice tilting the pelvis forwards and backwards with your hands on your hips to determine their respective locations.
Another important, albeit indirect, screening method requires scrutinizing the walking gait. If there is weakness in the gluteus medius or the tensor fasciae latae, then the gait is characterized by a lateral shift of the trunk when the opposite leg swings forward. A similar conclusion could be reached by standing on one leg with the opposite leg flexed to 90 degrees at the knee and the hip and then assessing the opposite hip's position. If the hip drops then the abductors are likely weak. Let's now take a closer look at some of the common dysfunctions that accompany hip hiking and hip dropping.
First and foremost, for hip hiking to take place one most likely has a tight quadratus lumborum, which is a muscle that connects the lumbar vertebrae to the iliac crest and is primarily used in extension and lateral flexion of the lumbar spine. As a result, the hiked side must create adduction in the hip, which likely means that the adductors are tight as well. Consequently, the hip abductors, namely the gluteus medius, are likely to be in a lengthened and possibly weakened position.
On the other side, the dropped hip is likely to have a lengthened quadratus lumborum and a tight gluteus medius, which connects the ilium to the top of the femur. Due to this position, the dropped hip must therefore be in abduction. This then places the hip adductors in a lengthened and possibly weakened position. Another potential contributor to the hip drop could be a tight tensor fasciae latae muscle, which connects the iliac crest to the iliotibial band. Now that the typical dysfunctions have been clarified, what is recommended in terms of treatment?
Before proceeding, I advise everyone with marked pain to consult a physician before initiating any self-treatment program. With that said, the simplest fix for those with only a slight impairment might only require a subtle alteration in posture and walking mechanics. In other words, practice standing with the weight evenly distributed over the feet and with the pelvis in a neutral position. This may seem painfully obvious, but too many people are unaware that they stand in "postural adduction" which is when the hips are shifted outward and the weight bearing leg sits underneath the hiked and shifted hip. If symptoms are a little more pronounced, then some other provisions that include stretching and strengthening will be necessary. When walking, one should use a walking stick or a cane in an effort to support the weak gluteus medius. This should only be necessary in the beginning stages of treatment so as to better manage the pain. If sleeping in an adducted position is painful, then a pillow between the knees might be appropriate. On the side of the dropped hip, one should stretch the tensor fasciae latae by standing on one foot on a sturdy platform 2-4 inches thick and with the other foot on the floor. Be sure that the knees and feet are facing forward. Next, posteriorly tilt the pelvis and hold for 20-30 seconds. Corrective exercise is certainly a vital component to eliminating any movement impairment. Those who have experienced some pronounced pain would be advised to start conservatively in their corrective exercise. Hip abduction exercises from a prone or supine position are recommended initially. Progress to a side-lying position once 20 pain-free repetitions with a full range of motion can be performed in the introductory positions. Eventually, one should move to standing exercises where one places a leg on a 2-4 inch platform to practice dropping the hip so the foot touches the floor and then hiking it back up to a neutral position by recruiting the gluteus medius.
Hopefully, this article has helped clarify the ways to identify and understand lateral pelvic tilt and what can best be done to correct it. I'm confident that with a little diligence and patience your lateral pelvic tilt will soon become a thing of the past.