Lateral Pelvic Tilt and its Resolution

April 13, 2012

in Fixing Your Body, Fixing Your Hips

Since July, I’ve been struggling with a condition called lateral pelvic tilt. I get more in depth about LPT in this post.

It’s hard to know the exact sequence of events, because my lateral tilt only became known to me after experiencing debilitating backs spasms. They were so bad that I couldn’t stand up straight for over 48 hours. After the spasms had subsided, I was left crooked. My whole upper body leaned to one side.

Clearly my quadratus lumborum had been tight and was causing much of the tilt; once I effectively stretched it the majority of the tilt disappeared. I was still perplexed about the remaining tilt, though.

Lateral Pelvic TIlt

Lateral Pelvic Tilt. Click on picture ot enlarge

For the rest of the summer I had intermittent pain. In the beginning of my episode, after the acute pain had subsided, I went searching for the offending muscles. I instinctively knew what was probably occurring–tight trunk muscles on the high side of my pelvis–but for some reason I kept getting distracted by the possibility of a tight hamstring on the lower side of my pelvis. I was distracted because I didn’t feel any tightness in my trunk muscles but I did feel tight in my right hamstring.

In the meantime I had rid myself of any pain by inserting an extra insole into the shoe of my low side pelvis to effectively level it out. But I still had to find why my pelvis was tilting.

What I Got Wrong

It is a phenomena of human psychology that leads us to believe that the experts might not know what they are talking about. In my case, a tight hamstring was never mentioned in any of my physical therapy texts as a cause of lateral pelvic tilt, yet I was still obsessing over it! I was making a connection that didn’t exist.

I felt back pain, primarily in my SI Joint, and I knew that a tight hamstring can cause SI joint pain, especially in men. So I imagined that the tight hamstring was causing both the tilt and the resultant SI joint pain. Yet the hamstring wasn’t causing the tilt that was causing my SI joint pain. Something else was.

My psoas.

The Psoas

Psoas major

Psoas and other hip musculature


The psoas is a hip flexor muscle that originates on the lower lumbar vertebrae and inserts on the upper leg. As it passes down the front of the pelvis, it merges with another hip flexor muscle called the illiacus and they then insert via a common tendon into the femur (upper leg bone). These two muscles are often found to be tight both among the general and exercising public. While they are normally implicated in anterior pelvic tilt, they can often be implicated in lateral tilt, too. To be complete, there is some debate as to the exact roles that the psoas plays, rather, how many roles the psoas plays. Not only that, about half the population has a psoas minor, too.

Addressing a tight muscle is all well and good, but why the heck was my psoas tight?

The Root Cause of the Pelvic Tilt, My Car

The foot rest for my left foot sits closer than the gas pedal does. That’s why my psoas was tight.

This meant that I was sitting in a position which effectively tilted my pelvis in the exact position that I saw it tilted in the mirror. I had been sitting like this for seven years, day after day. Eventually it adds up.

I tried to address the psoas tightness through stretching, but it just wasn’t working. So I headed to the massage therapist and gave her instructions to focus on my quadratus lumborum and psoas. I didn’t feel anything when she pressed on my QL, but when she pressed on the psoas, I knew we had found the culprit.

At the end of the massage, my pelvis was completely straight and I’ve been good ever since. I still feel some residual tightness in my psoas which I try to address by rolling on a medicine ball or self massage. In addition, I often feel tension in my glutes, although this is easily addressed by foam rolling. Perhaps the tightness in the glutes is caused by the semi-tight psoas and/or quadratus lumborum still exerting an upward pull. Tightness is most often felt after arising in the morning but is relieved after foam rolling.

Lessons

1. If no acute injury has occurred, bodily pain is often caused by our daily habits. The way we sit, sleep, or stand for example. Tissues get stressed from repetitive use, muscles can weaken from being repetitively stretched, and muscles can tighten due to static positions. Often, it’s a combination of all three.

2. When pain is being experienced, you need to look above and below the painful area. For instance, if the lower back is hurting, you need to examine your upper back posture, pelvic alignment, and hip range of motion. The body works as a system, also conceptualized as “you’re only as strong as your weakest link”. If one area of the body isn’t working correctly, the body can only cover up for this inefficiency for so long until it breaks down.

3. Although I didn’t cover this aspect, your training needs to be examined so that you don’t make things worse. For example, if someone is experiencing rotator cuff pain, they should refrain from doing a lot of pressing movements, whether they be overhead or horizontal (as in the bench press). If someone is experiencing SI Joint pain, they should likely refrain from squatting and deadlifting due the shear forces exerted on the spine. In general, if something hurts, don’t do it.

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