Pelvic Tilt: When Your Body Is Out of Sync

1. Prevalence, Symptoms, and Consequences: A Basic Understanding of Pelvic Tilt

If you have not yet received a diagnosis or have only recently encountered a pelvic tilt, there are sure to be many questions floating around in your head. Therefore, we will begin by offering a brief overview of how your pelvis is constructed and what function it performs. This will explain why some very different symptoms can occur when the pelvis is misaligned, what causes them, and where our treatment begins.

1.1 The Pelvic Link in the Middle of the Body

The pelvis is located at a central point in your body and acts both as a connecting link and secure support. It connects the legs with the upper body, plays a crucial role in your spine’s health, and keeps you both stable and flexible via the hip joint.

Your pelvis’s excellent mobility is due not only to the hip joint and its muscles but above all to your fasciae in the pelvic floor.¹⁾. Fasciae – the soft tissue components of your connective tissue – permeate the body like a three-dimensional spider web, surrounding your muscles so that everything stays in its intended place. When we move, the fasciae automatically follow these movements and quickly adapt to our frequently performed actions. Thus our everyday movement patterns significantly shape the structure and flexibility of our fasciae.

1.2 Pelvic Tilt = Symptoms?

Numerous studies have shown that not every pelvic tilt will immediately cause problems. On the contrary: a straight pelvis tends to be the exception. It’s estimated that around 70 percent of all people in the western industrialized nations have a slight pelvic tilt.²⁾ Such minimal inaccuracies are not significant for our body, which can quickly compensate without those affected ever even noticing.

Differences in leg length are not uncommon
The same applies if one leg is a few millimeters shorter or longer than the other – the most common reason for a tilted pelvis. In most cases, any difference in leg length is only three to nine millimeters. Such differences are also quite normal in growth phases. Human bones don’t grow at the same rate, so one leg can be temporarily longer than the other. This usually rights itself during puberty.

However, if these differences are greater, and if they occur in adulthood, pelvic tilt can become more significant and cause numerous symptoms.

1.3 Does Pelvic Tilt Have Any Typical Symptoms?

Even if some tilted-pelvis symptoms are more common than others, there is no one classic symptom. More often, the pelvis’s central location sometimes leads to “a whole-body reaction from top to bottom.”³⁾

• Back pain, muscular imbalances, and tension in the lumbar and cervical spine can appear upstream of the pelvis. Pain in the buttocks, shoulder, and neck may occur, as well as headaches and tooth and jaw pain. Even teeth grinding (bruxism) can be associated with pelvic tilt.
• Downstream, your pelvis may become a suspect if joints are wearing out and becoming stiff. This can manifest itself as pain in the hip, knee, or foot.⁴⁾

Because the joint head and acetabular cup in the hip joint do not sit on top of one another as intended, the cartilage can also wear unevenly, increasing the risk of arthritis of the hip. Furthermore, a seemingly longer leg, resulting from a pelvic tilt, has to make a lateral compensating movement when walking, triggering pain outside and inside the thigh. Also, a shortening limp and a “compensatory pointed foot position” on the shorter side is often observed in patients with a pelvic tilt.⁵⁾

Further consequences: scoliosis and SI joint block
The greater the imbalance and differences in leg length, the more negative the consequences for the pelvis and spine. When the pelvis is misaligned, the back will try to balance it. The spine also tries to keep your body upright, despite the tilt in the middle. To succeed, it must bend strongly when there is a pronounced pelvic tilt. This lateral bending of the spine is termed scoliosis. It starts from the lumbar spine, but the thoracic and cervical spine can also be affected. Although congenital scoliosis can also cause pelvic tilt – the reverse is more common. The same applies to a so-called block of the sacroiliac joint.

2. Causes of Pelvic Tilt

To better understand the causes of a pelvic tilt, we can consider them in two distinct categories:
• a functional pelvic tilt,
• a structural misalignment.

Since over 90 percent of cases involve a functional pelvic tilt, we will focus on this variant first.

2.1 Functional Pelvic Tilt

Here, your tilted pelvic girdle has no anatomical cause but is the result of certain restricted functions. Your bodily structures – i.e., your bones – are intact, and the functional disorder affects the “soft tissue” around the hips and pelvis. In essence, this means your muscles, fasciae, ligaments, and tendons.

“Shortened” muscles through one-sided movement

If you spend a lot of time sitting, or if some repetitive movements permanently overload the muscles around your pelvis, certain regions are “neglected,” while others become overused. This can leave one half of your body stronger or weaker than the other.

The hip flexor “corrodes”
Let’s say you neglect the front of your pelvic area on the right. Then muscular “shortening” can develop there, and at the same time, the fasciae can become “matted.” The entire motor system here becomes inflexible and feels almost corroded. When you go to stretch your right hip flexor, over time, you will notice increasing resistance.

But something else also applies: the more your musculature “shortens” on one side of the body, the harder the opposite side has to exert itself so you can perform specific movements. With a shortened right hip flexor, this will affect the muscles in your right buttock and lower back. A vicious circle of tension and counter tension develops, which subjects your hip joint to enormous tensile forces.

These forces can exert such a strong pull on your hip joint that the right joint head moves ever higher into its socket. Your right leg attached to your hip is pulled up, causing the entire pelvis to tip to the left.

The result is a functional difference in leg length. In other words: due to your tilted pelvis, your right-side leg appears to be shortened. But in most cases – apart from natural deviations – both your right and left legs are the same length.

Where do pelvic tilt pains come from?
As we see it – to restate what we have already said – your hip and back pain are not the direct result of a shortened leg or a tilted posture. We believe the excessive tension in muscles and fasciae also play a part.

Signal pain as a warning
How can this be possible? Everywhere in the periosteum (tissue surrounding your bones), there are special receptors (interstitial receptors) which your body uses to allow your brain to monitor tension and tensile forces. Once the registered values exceed a certain level, your body intervenes, responding to the overload by sending pain to the exact location where the joints are threatened. This pain warns you something is wrong in a particular part of your body. That’s why we at Liebscher & Bracht refer to this as a “signal pain.”

2.2 A Structural Pelvic Tilt

In rare cases, a pelvic tilt has an anatomical cause. Here, the body’s structure – its shape and dimensions – holds the pelvis in a tilted position where it won’t automatically return to its proper alignment. Most often, this is because of a genuine difference in leg length. This can originate in the thigh or lower leg and be a congenital disorder or develops throughout a lifetime. Basically, one leg is either too long or too short.

Possible causes of growth inhibition:

• a genuine genetic predisposition which results in a shorter leg,
• early damage to highly active growth plates (epiphyseal plates) in the knee area (the joint mentioned indicates the area of a bone in which growth takes place),
• accidents or operations: especially after a severe and complex fracture, subsequent bone growth can cause a shortening.

Possible causes of growth stimulation:

• vascular tumors or infections which trigger growth in neighboring joints⁶⁾,
• fractures of the middle section of a bone (bone shaft), where malpositions persist for longer and the growing together (remodeling) is thus delayed.

If there is a “real” difference in leg length, insoles, or sole elevations can prove a valuable means of securing a correct posture. Surgical procedures are also justified here. However, if your pelvic tilt is functional, we advise against artificial aids or surgical interventions. Liebscher & Bracht therapy offers you an effective alternative to medication, inserts, and surgery.

3. Treatment of Pelvic Tilt

Let’s remind ourselves once again: it’s not your tilted pelvis, a “shortened” leg, scoliosis, an SI joint blockage, or the intervertebral discs that hurt you. On the contrary, in more than 90 percent of all cases, your accumulating symptoms of pelvic tilt are based on muscular-fascial tensions and signal pain.

Muscle-fasciae stretching exercises
If your leg is too short because your muscles are pulling too much, you will have to make it longer again. In other words, the position of the joint head in your hip joint must be normalized, so the apparent shortening of the leg disappears, and your pelvis is once again horizontally aligned! Our stretching exercises will help you achieve precisely that. They provide the means to help you pursue a pathway towards long-term freedom from painful symptoms.

Foam rolling massages
Foam rolling massages are a smart addition to our exercise programs. Targeted self-massage helps kickstart your fascia tissue metabolism and relieve muscle tension in your thighs, buttocks, and lumbar spine in a thoroughly natural way. The guiding principle is simple: you displace unwanted metabolic products, which can then be removed faster. This actively promotes the repair process. Furthermore, fibroblast cilia (which weave new fascia 24 hours a day) can break down matted fascia threads, which relieves tension. This causes the tensile forces on your hip joints to decrease even further.

4. Exercises to Combat Pelvic Tilt — How to Bring Yourself Back Into Balance

All theory is gray. So we now present some practical exercises designed to have an immediate impact and help you restore your pelvis to its correct alignment. They can help you balance one-sided movement patterns and bring all possible hip joint angles into regular use. And thus, by addressing your muscle tension, you can eliminate the real triggers of your pelvic tilt over the longer term. One round of exercises is often enough to extend your “short” leg by one to two centimeters.

There are a large number of muscles surrounding your hip joint. But two of them deserve special attention because any “shortening” here can quickly lead to a pelvic tilt.