Lateral Pelvic Tilt – Causes and Treatment

250px-Gray342There are three types of pelvic tilt : anterior, posterior and lateral. Often the pelvis can become tilted forward (anterior pelvic tilt), backward (posterior pelvic tilt), or rotated so that one of the pelvic bones is tilted forward while the other is not (lateral pelvic tilt.)

Lateral pelvic tilt describes tilting toward either right or left and is associated with scoliosis or people who have legs of different length. The lateral pelvic tilt is a postural deviation in which one side of your pelvis is tilted to your left or right, causing one side of your hip to appear higher than the opposite side.

Proper diagnosis requires close attention to not only lateral pelvic tilt but also lateral pelvic shift (measurable together as hip adduction angle), trunk position, arm position, and position of the non-weightbearing leg.

Diagnosis

There is a direct association between asymmetrical pelvic tilt and hip instability. To check if you have any degree of pelvic tilt, your doctor will palpate the ASIS (anterior superior iliac spine) and the PSIS (posterior superior iliac spine), seeing if it’s compensated or uncompensated.

An ‘uncompensated’ positive test result is described as pelvic tilt occurring towards the non-weightbearing side and a ‘compensated’ positive test as trunk lateral flexion towards the weightbearing side during single leg stance.

What you could typically expect to see from a loaded weak hip would be either excessive internal rotation of the hip and/or relative hip adduction. From there, the domino effect takes over. Lateral pelvic shift toward the weak hip (actual hip adduction), elevation of the pelvis on the weak side, and lateral torso flexion towards the contra lateral side are all deviations that usually accompany a weak hip.

Causes

Physical therapists commonly associate lateral pelvic tilt (LPT) with a variety of musculoskeletal adaptations, syndromes and altered function.

Lateral tilt is often caused by scoliosis while anterior tilt can be caused by shortening of the hip flexors and lenghtening of the hip extensors. Lateral tilt refers to the slight shift of the pelvic joints when the leg is flexed. When the leg is fully extended and the quadricep muscles are relaxed there is no shift. It is common to see in ACL injuries and after a dislocation.

Rarely, the person has a lateral pelvic tilt because one leg is longer than the other. This results in a functional leg length discrepancy, and in the physical therapist texts is referred to as a hip joint lateral asymmetry or a lateral pelvic tilt. It is not uncommon for someone with a 1/8 of an inch leg length discrepancy to have a much greater difference in that lateral pelvic tilt because of the compensations over time.

Although muscle weakness is a potential cause of a lateral pelvic tilt, there are also several other causes.

A direct cause of the lateral (left-right) tilt is the forward pelvic tilt; apparently a pelvis can not just drop on one side, it has to rotate in the perpendicular (front/back) plane at the same time. 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.

Correction

Lateral pelvic tilt can best be described as simultaneously involving two motions: hip hiking and hip dropping. Correction of lateral pelvic tilt associated with a lateral curvature can be helped by proper heel lifts. It would make sense to initially correct the lateral pelvic tilt if it is not due to a leg length discrepancy.

Lateral band steps will also help dynamically strengthen your lateral pelvic stabilizers.

It is possible to do some physical therapy exercise to try and build up some of the muscle around the hip to compensate for the slight tilt, but that will only work if it is a slight tilt. Without seeing the MRI scan it is difficult to say the extent of the tilt. Posterior pelvic tilt hip thrusts, American deadlifts, and other exercises that strengthen the posterior pelvic tilt movement pattern and weak muscle groups (especially glutes and abdominals) may work under the guidance of a physical therapist.

In some situation if you do have a lateral pelvic tilt (ie leaning to one side) you may initially need chiropratic treatment to get you straight, followed by a programme of treatment.

What Other Exercises Can I Do?

Hopefully the orthopedist that is working with you will recommend that you see a physical therapist for this problem. It is possible that through some exercises and perhaps some biofeedback the problem could go away.

Also try this exercise to see if it helps:

1.) Get a 2×4 and stand on it. The foot will be on it lengthwise.
2.) Place the good foot on the board or a book of about equal size and keep the other foot on the floor.
3.) Now straighten out the knee that is on the board.
4.) Do this fifteen times and then rest for one minute and repeat that cycle twice more.
5.) After a one minute rest switch legs and try the injured hip if there is any pain back away from doing that movement until the leg is able to do it without pain.

Will I Need Surgery?

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If you are experiencing pain, then it is a possibility that you could need to have it corrected. Most likely it would be done arthroscopically (jut a few little poke holes, no open incision) and just correct the tendon to re-align the hip joints. This would probably not be too bad of a procedure and would not put you out for too long.

A lateral tilt means the sacroiliac joint is rotated away from the neutral position that it should have. This is not that unusual the only thing is that you are having pain I would imagine. Surgery is not something that would be recommended for this unless the angulation or rotation of the sacroiliac joint was so severe that it was going to cause significant problems.

Do I Need to Worry?

It just means that your sacroiliac joints has a lateral tilt (your pelvis is tilted to the outside of your leg). Lateral refers to the outside of the leg, where as medial refers to the inside of the leg. It is probably just your normal anatomy, and as long as it is not causing you any pain, or is not tilting to a point where it is rubbing up against any other bone or ligament, cartilage or tendon, then it should be ok.