Tilted Pelvis

Medically Reviewed By William C. Lloyd III, MD, FACS

What is a tilted pelvis?

A tilted pelvis is an abnormal position of the pelvic bone. Normally, the pelvic bone sits levelly or neutrally within the pelvis. The large flared sides of the pelvic bone—the ilium—form a joint with the bottom portion of the spine—or sacrum on either side. This is the sacroiliac (SI) joint. At the bottom of the pelvic bone, there is a socket that forms the hip joint with the ball of the thigh bone (femur). Various muscles connect to the pelvic bone and its joints to allow leg movement and stabilize the pelvis and lower back. A tilted pelvis occurs when there is a problem with the alignment of the pelvic bone within the pelvis. Pelvic misalignment is the medical term for this condition.

Structural or functional problems in the legs, hips or spine can cause a tilted pelvis. The most common causes are uneven leg lengths, spinal scoliosis, and muscle imbalances or contractures. These problems often occur in combination. Depending on the structural or functional issue, three main types of tilted pelvis problems are possible:

  • Anterior tilted pelvis occurs when the bottom of the pelvic bone tips back and up, pushing the hip bones forward. This exaggerates the curve in the small of the back. It is often due to tightness in the hip flexor muscles. These are the muscles at the front of the hip that contract when you lift your leg or bend at the waist. This tilt is also common in pregnancy and with extra weight in the belly.
  • Lateral tilted pelvis is a side-to-side misalignment. One hip sits higher than the other. If the right side is higher, it is a left lateral tilt and vice versa. The pelvis has been described as a bowl of water, and whatever side the water will spill out of is the name of the tilt. A tilted pelvis lateral in either direction is usually a result of uneven leg lengths or scoliosis. Pelvic obliquity is the medical name for this problem.
  • Posterior tilted pelvis happens when the bottom of the pelvic bone scoops under the body to the front. This pushes the hip bones backward and stretches the muscles in the lower back, flattening it. Tight hamstring muscles are often to blame for a posterior tilt. These muscles run down the back of the leg between the hips and knees.

Excessive sitting, poor posture, and muscle weakness can increase the risk of developing a tilted pelvis.

A tilted pelvis may or may not cause symptoms. When symptoms occur, they commonly include lower back pain, hip pain, leg pain, and gait problems. A tilted pelvis can also irritate the SI joint, causing inflammation. This may cause additional symptoms, including pain radiating to the buttocks, leg weakness, and numbness or tingling.

Treatment of a tilted pelvis depends on the underlying structural or functional issue. Sometimes, tilted pelvis exercises can help loosen overly tight muscles and strengthen supporting ones. Physical therapy, anti-inflammatory drugs or injections, bracing and surgery are other options for some causes.

Left untreated, a tilted pelvis can cause problems with the pelvic floor, interrupt sleep, and decrease your quality of life. See your doctor if you notice changes in your hips, pelvis or walking gait, or if you have unexplained lower back or leg pain. Seek prompt medical care for sudden lower back pain with fever or sudden weakness, numbness or tingling.

What are the symptoms of a tilted pelvis?

A tilted pelvis does not always cause symptoms. Mild misalignments may never cause any problems. When symptoms are present, they can affect several different areas of the body.

Common tilted pelvis symptoms

Common tilted pelvis symptoms include:

  • Leg weakness or numbness, tingling or pins-and-needles sensations
  • Lower back, hip or leg pain
  • Uneven hip height

Tilted pelvic symptoms can resemble several other problems. This includes other causes of lower back pain, such as herniated discs, muscle spasms, and sciatica. Seek medical care for lower back pain that persists for more than a week or two despite home treatment. If back pain develops suddenly, seek prompt medical attention.

What causes a tilted pelvis?

A tilted pelvis is the result of a structural or functional problem with the legs, hips or spine. Anterior and posterior tilts are usually due to functional problems with muscles. This includes muscle tightness—or contracture—and imbalances. Imbalances occur when one set of muscles is weaker than another set with opposing actions. The stronger muscles pull the pelvic bone away from the weaker set. Problems with an anterior tilt are more common than a posterior tilt.

A lateral tilted pelvis—or pelvic obliquity—can be due to either functional or structural issues. The most common structural causes are scoliosis and uneven leg lengths.

What are the risk factors for a tilted pelvis?

A number of factors play a role in the risk of developing a tilted pelvis. However, not all people with risk factors will have problems. Risk factors for a tilted pelvis include:

  • Genetics and heredity
  • Inactivity, excessive sitting, and muscular weakness
  • Neuromuscular conditions, such as cerebral palsy and muscular dystrophy
  • Poor posture and incorrect body mechanics
  • Pregnancy and extra weight in the belly
  • Scoliosis

Reducing your risk of a tilted pelvis

It is not always possible to prevent a tilted pelvis. You can’t control things like genetics and medical conditions. However, you can control factors such as posture and body mechanics. You may be able to lower your risk of a tilted pelvis by:

  • Avoiding sitting for long periods by taking breaks to walk or stretch
  • Getting regular physical activity with both stretching and strengthening exercises to keep muscles loose and balanced
  • Practicing proper posture, especially when sitting by keeping both feet on the floor and maintaining all three curves in the back
  • Using the correct body mechanics for such activities as lifting objects and changing body positions

Working with a physical or occupational therapist can help you learn the right posture and ergonomics tips for healthy muscles and alignment.

How do doctors diagnose a tilted pelvis?

To diagnose your condition, your doctor will perform a physical exam. This will involve looking for signs, such as uneven hips from the front view, an overly curved small of the back, or an absent curve in the low back. Your doctor may also feel for muscle tightness and look for other functional issues.

Your doctor may take measurements of different landmarks on your pelvis. For example, comparing the location of two protrusions on the pelvic bone can give your doctor information about the tilt of your pelvis.

There are also specific movements your doctor may ask you to make. Examples include the Thomas test and Trendelenburg test. Observing your body during these two movement tests can give your doctor information about muscle imbalances involving your hips.

Imaging exams, such as X-rays, can reveal structural problems with your hips or legs. Your doctor may or may not need these exams to make a diagnosis. If surgery is an option, imaging exams can help your doctor plan the procedure.

Your doctor may also ask you several questions including:

  • Do you notice a tilt in your pelvis?
  • What symptoms, if any, are you having, such as back pain or pain with walking?
  • What, if anything, makes your symptoms better or worse?
  • What medical conditions do you have?
  • Have you ever injured your back, hips or legs?
  • How active are you and what do you do for exercise?

How is a tilted pelvis treated?

Treating a tilted pelvis depends on the underlying cause. When muscle problems are to blame, treatment may only involve strengthening and stretching exercises. For an anterior pelvic tilt, this means stretching the hip flexors to make them more flexible and strengthening the glute, hamstring and core muscles. For a posterior tilt, you will stretch the hamstrings to lengthen them and strengthen the hip flexors, core, and lumbar back. There are also exercises for a lateral tilt to strengthen the weaker side and release the other.

Working with a physical therapist (PT) is often beneficial. A PT can teach you the exact exercises you need and show you how to stretch your muscles safely. PTs also use joint mobilization and manipulation to help restore proper joint function. Research shows mobilization can improve pelvic tilt in as little as a day.

When a tilted pelvis causes pain and joint irritation, doctors may recommend other add-on treatments. This may include NSAIDs (nonsteroidal anti-inflammatory drugs) and joint injections.

If a structural problem is causing a pelvic tilt, surgery may be an option. However, for uneven leg lengths, the solution can be as simple as a shoe insert or shoe lift. Bracing may help people with scoliosis.

Alternative treatments for a tilted pelvis

Chiropractic therapy and massage therapy may be helpful for treating a tilted pelvis. Chiropractors use manual therapy and joint manipulations to improve joint alignment and function. Massage therapists use different massage techniques to relax tight muscles and release other soft tissues. Mind-body exercises, such as yoga and Pilates, that focus on posture, flexibility and strength may also help.

What are the potential complications of a tilted pelvis?

A tilted pelvis does not always cause symptoms or lead to complications. However, complications are possible, including pelvic floor dysfunction. Problems with the pelvic floor can lead to urinary incontinence and pelvic organ prolapse.

A tilted pelvis can also affect your quality of life when it causes pain. Pain can disrupt your sleep and cause absenteeism, depression and disability. The best way to avoid complications is to see your doctor for an accurate diagnosis.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Apr 14
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