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How To Correct Lateral Pelvic Tilt & Leg Length Discrepancy

Written by: Nick Jack
Category: 2014
on 25 February 2021
Hits: 5141

One of the most difficult forms of muscle imbalance to correct is the lateral pelvic tilt which is often associated with a leg length discrepancy. When the pelvis is not maintained in a square and level position the body compensates by shifting the hip of the supporting leg out to the side, rotating the lower limb inwards,  forcing the opposing side of the shoulder to collapse. The body will be always want to maintain an erect head position with eyes level and will sacrifice anything in order to achieve this. This is often where many people are diagnosed as having one leg longer than the other (leg length discrepancy), as this is what appears to be the case upon examination of their posture. However, in most cases the bones of the legs are the same length and it is the muscular imbalance at the hips creating the appearance of one leg being longer than the other. Apart from the immediate problems felt at the hips and loss of function with walking and running, this poor pelvic position places tremendous pressure on the spine, and can lead to development of scoliosis and even shoulder pain. Failure to correct this condition will eventually lead to a lifetime of chronic pain that severely impacts daily activities. In this article we will take a look at what causes this problem and the exercises you can use to prevent or correct this condition.

There Are Two Types of Leg Length Discrepancy

This is a very complex problem and I must state that there is no magical exercise that will make it go away. You will need a series of exercises to correct this dysfunction and restore the imbalance back to its ideal position.

The first thing you need to determine is if this is something you can change via exercise.

Leg length difference as a condition comes in two types.

  1. The anatomical type
  2. The functional type

The anatomical type is quite rare, for while some of us may have a small difference in leg length it is uncommon for legs to be so different in length that it makes the hips uneven. According to the American Academy of Orthopaedic Surgeons, a difference of about 4cm can cause walking difficulties or a limp.

In these cases the cause of the problem may be due to things like:

  • Injury to the growth plate of the leg during childhood or adolescence
  • Broken leg bone or severe infection that did not heal correctly during childhood
  • Bone diseases, such as neurofibromatosis or juvenile arthritis

Exercise intervention is very limited in these cases as this is a structural problem with the skeletal system.

The functional type however is a different story. This is the more common way a leg length imbalance is created which is linked to postural muscle imbalances. And these imbalances can be traced back to repetitive movement strategies.

I personally suffered with this problem on my left leg 20 years ago, after I repeatedly injured my ankle playing basketball and failed to rehabilitate the injury properly. Like many athletes, I went back to playing competitively too soon and my body was forced to compensate and I eventually created a left hip and right shoulder problem that I still suffer with today. Unfortunately, I was not provided with any exercises to correct this problem and was told all I needed was to have orthotics to raise the pelvis on the side that was collapsing. All this ended up doing was causing even more trouble to my hips and a stack of other problems. It wasn’t until many years later working on my own problems as a PT that I eventually developed the correct plan to fix my problem.

Uneven Hips Affect Everything

The most common immediate sense of pain from this imbalance is usually felt in the hips and spine. This imbalance is regularly seen with piriformis syndrome and SIJ dysfunction where the gluteal muscles are weakened and the body is relying on stiffness in the hips to stabilize the leg. However, it is not just the hips that are exposed to problems for your pelvis is connected to your shoulders and upper back by your spine. As a result the effects of uneven hips can sometimes be seen in these areas:

  • Poor hip mobility. This can be a huge problem to the spine and how you bend over. Poor bending mechanics that use the spine to flex is the common cause of bulging disc injuries in the lower back. Loss of hip mobility prevents the gluteal muscles from positioning correctly and eventually they lose muscular strength and your lateral pelvic tilt is exacerbated.
  • Uneven shoulders. Your shoulders may look uneven too, but the side with lower hip will usually have the higher shoulder. The side with the lower shoulder will be exposed to shoulder impingement and rotator cuff injuries as it loses its ability to centre the humeral head within the socket. This is referred to as a depressed shoulder and many treatments for these shoulder injuries will be ineffective if the pelvic dysfunction is not addressed.
  • Scapula Winging. Your shoulder blade might stick out more on the side with the lower hip and once again this will create a series of problems for the shoulder and neck as the stability is compromised. See the article about winged scapula exercises for more detail on this.
  • Curved spine. Your spine may look like it’s curved into the shape of an S or C as seen with scoliosis. In some cases the scoliosis could be the cause behind the lateral pelvic tilt but for most people it is the lateral pelvic tilt that came first. A functional leg length difference is not always accompanied by scoliosis. Some reports state that up to 87% of people with leg length differences also have scoliosis.
  • Prominent rib cage on one side. Uneven hips can make your rib cage twist, so the ribs on the side with the higher hip stick out further than the other. Once again shoulder and neck problems are inevitable, along with altered breathing mechanics affecting stabilization and posture.

Many of these problems are associated with oblique dysfunction and you will find great detail about this in the article – To strengthen the obliques you must understand their purpose


Before we discuss the various corrective exercise strategies it is important to discuss scoliosis in more detail. This is where your spine has a sideways “S”- or “C”-shaped curve and may be slightly rotated. People with a functional leg length difference may present with some mild form of scoliosis however, this type of scoliosis is considered functional, not anatomical.

Anatomical scoliosis is a much more complex topic and beyond the scope of this article. It can be caused by improper formation of the spine before birth, usually for unknown reasons or neuromuscular causes such as:

Scoliosis affects girls more often than boys and can run in families. The curve usually stops progressing when the bones stop growing. The curve is more likely to worsen when:

  • The curve is large
  • The curve is “S”-shaped rather than “C”-shaped
  • The curve is in the middle of the spine rather than the top or bottom

I have worked with two clients with extreme scoliosis and both had developed this for unknown reasons during childhood. They were able to move quite efficiently with most movements, although they both had repeated periods of back pain and shoulder problems due to the poor skeletal structure. Both had extreme scapula winging on one side of the body and found it difficult to strengthen the shoulders with overhead movement. Interestingly one of these clients a male in his mid-40’s was able to complete heavy deadlifts and squats with minimal pain!

Nothing I could do was able to change them significantly as this needed a much more specialized approach that was above my realm of knowledge and experience. All I could do was help them to manage their problem and identify movements with high risk to the spine so they could avoid aggravating their condition.

These extreme cases are quite rare and exercise correction will do little to change the skeletal structure without specialist advice. However, the functional scoliosis person there is many things you can do and you can reverse this condition with corrective exercise. But before we discuss this, we must identify the cause of the problem.

Recognizing and avoiding the pain mechanism is critical to the success of any rehabilitation program. By understanding your pain trigger you can begin to understand how to get rid of it for good or even avoiding more damage to begin with. But how do you find your trigger?

What Causes Functional Leg Length Discrepancy?

We know that even though one leg looks and feels longer than the other, it really is the same length when measured. This illusion is caused by poor posture and repeated habits that leads to unbalanced muscle strength and tension.

Poor Postures and Habits

Functional leg length differences, and especially the pelvic imbalances that drives them, usually come from the day in and day out way you perform common activities (sitting, standing, walking, housework, playing sports, etc.). When bad posture becomes a habit and you sit or stand in the same position daily for months or years, your muscles compensate. Some muscles become shorter and tighter and pull the hip up, and the muscles attached to the lower hip become weaker, longer and looser.

Another way this can happen is if you stay in one position with one hip higher than the other for a long time. This can happen if you always sleep on one side, arch your back while sitting for a long time, or always lean to the same side when sitting or standing.

Try to identify the repeated positions you use during the day and notice if you are standing or sitting unevenly.

Unilateral Sports

Many sports that require a one sided dominance such as a tennis player who serves thousands of times on one side or a fast bowler in cricket who bowls with only one hand. This repeated motion forces one side of the body to become stronger than the other and can easily create a multitude of problems for the pelvis and spine if a corrective program is not used early on to prevent this dysfunction.


There is a dominance of right handed people in society, and many daily activities and postural positions predispose people to problems of muscle imbalance as one side of the body is used more than the other. This is referred to as handedness. This tends to happen less with left handed people as they are constantly having to conform to many activities and positions designed for right handed use.

Foot Instability

This is another big factor is FOOT STABILITY and I have discussed this many times in articles relating to knee and hip injuries.

Our feet are designed to do 2 critical things.

  1. ABSORB shock and then.
  2. Provide the ability to stabilize and PUSH off the ground when we walk, run or jump.

The foot needs to act like a spring being soft flexible foot to cushion the stress of each step we make, and then instantly become stiff enough to provide enough power to move us forwards or upwards. This is also known as being able to lock the foot at one point and then being able to unlock the foot at the very next part of the movement. Problems arise if we lose either one of these two things, and ultimately lose our spring.

The person with functional leg length discrepancy will often exhibit over pronation of the foot on the leg that appears to be shorter. Over pronation is a very common problem today and is easily seen when a person is standing barefoot. If one arch is lower than the foot of the other side and the foot is slightly splayed outwards you can safely assume they are over-pronating. Sometimes both feet may do this but usually one side is worse than the other.

This foot is basically very unstable, has become over stretched along the bottom of the foot that now makes it almost impossible to become a rigid lever to create the "spring" and release energy.

A person who over-pronates may have had problems in the past like ACL tears, Achilles pain, patella-tracking knee pain, plantar fasciitis, and shin splints for they are unable to align the lower limb correctly as it constantly collapses inwards. These previous injuries are another sure sign they over-pronate.

Foot instability will always result in gluteal weakness, due to the inability of the glutes to fire from the dysfunctional positioning and alignment. The glute medius in particular is vital for maintaining stability in the single leg stance but it will be severely impaired by compensation of other muscles like the adductors. And when this happens is when the gait cycle is disrupted.

Lower Leg Discrepancy Affecting How You Walk

If our hips are uneven when we walk the shorter leg will feel like it is stepping down from a step, and the longer leg will feel like it is being used as a pole vault type motion. This is very much like stepping into a series of potholes with every step you take over the day. Once the body has completed thousands or even millions of repetitions of this compensatory pattern it begins to encode it into the nervous system as the preferred way to walk. This becomes a real problem with the corrective exercise program for you MUST include dynamic walking based exercises for you to have any chance of succeeding.

This is where many rehabilitation programs fail for they try to fix everything at the muscular level only and fail to reprogram the faulty software program the body developed. You will see in the exercises shown later that the last few movements integrate the body into walking patterns. I highly suggest to read the article – 6 ways to improve walking for more detail on this.

In the picture above you can see the pelvis drops on one side and this faulty stabilisation pattern is called a Trendelenburg gait. This altered pattern shows weakness on the right glute medius as it is held in a lengthened position with the hips move laterally to the right dropping the pelvis on the left side. This is a list of the various things you will see at the pelvis alone from this position.

  • As the pelvis sways sideways the pelvis is higher on the right side
  • The right side is adducted
  • The left hip joint is abducted
  • The right hip abductors are stretched and weakened
  • The left hip abductors and TFL are held in a shortened position

This does not even look at the valgus knee position or collapsed foot and poor Achilles alignment. Okay, so what can you do about it?

Best Exercises to Treat Leg Length Discrepancy

Like many other injuries in the body there is a paradox that confronts you with correcting this problem and that is:

The very movement that will fix your problem is the same one that is likely to aggravate it!

This means your end goal is to learn how to control the single leg stance but you must have a strategic plan of getting to that stage. If you rush this process you will go backwards and cause more problems. I like to use a step by step approach of using basic floor exercises that gradually progress to more challenging exercises that eventually place you in the single leg stance.

By spending the time to develop control and strength with simple movements you will have a greater chance to correct the pelvic imbalance when you stand. Bilateral squats and lunges can be useful but will have little effect on changing the lateral shift.

Here is how I would approach correcting leg length discrepancy.

Mobility Breathing & Basic Pelvic Stability

Before I do any strength work I will spend considerable time learning basic stability and correct breathing patterns to ensure my body can hold a neutral pelvis. Remember, strengthening is of no use to you if your stability is compromised.

This is the easiest place to start and really ensures that you know how to create stability at the pelvis using your abdominal muscles and not your hips. The video below gives a great explanation of how to activate your inner unit stabilizers in a series of very simple floor based drills. This is a fantastic video to watch as I explain exactly how to find neutral, how to brace your core correctly, and then how to ensure it remains in neutral during simple movements that you will need later on.

It is also very important to make sure you have completed a basic mobility assessment and are working on releasing stiffness in areas of the hips and thoracic region. Mobility must precede any stability or strength work for the tight muscles will inhibit weak muscles from firing.

You will find some great ideas of how to address mobility in these specific areas by checking out the articles below that feature several videos and explanations of various drills to use.

Now that you have your breathing sorted out and you are working on your mobility you need to address the multiple weaknesses within the body. The first place to start is with the feet. 

1: Foot Stability Correction

Firstly I would advise against using orthotics to correct this problem. I can speak first hand in saying that this course of action created many more problems that ended up being bigger than the original one. It can be a short-cut to correcting the problem as it helps to artificially lift the dropped side back into alignment.

The problem with this is it assumes your body is able to generate the correct firing mechanisms and movement function of the muscles immediately. I found that I had severe cases of hip clicking, and weakness from wearing the orthotics, and it did little to change the muscle function of the hip. In some cases people have such weak feet that this is the best option, however it is always wise to try and correct these problems with strengthening drills first, in particular with young kids.

The key to correcting the weak foot is with improved stability strategies and STRENGTHENING! Remember this foot type problem is all to do with instability and weakness and like any muscle or joint it needs work.

The first set of exercises I would use are foot based and you will find some great ideas in this videos below.

2: Hip Extension Test

This exercise is a great test to use and is one I use in my standard assessments with all new clients. It provides great information as to the stabilisation strategy the client uses with the glutes and pelvis. You will very easily see the lateral pelvic tilt if there is a weakness in the gluteal and obliques on the opposite side.

You should feel a strong contraction in the glute area in combination with your core bracing the just prior to your lifting the foot off the ground. This is where you often see the person shift to one side before they even lift the foot. This indicates poor stability. It is hard to confirm that it is only the glutes at fault here for it could be several reasons for this. But one thing is for certain is if that happens on this exercise it will be much worse on the more complex standing ones about to come. Do not progress any further until you pass this test.

The glutes are obviously a huge factor with this problem and there is a lot of things you may need to work through to regain control of this muscle group. There is a FREE checklist you can download below that will help you work through these various factors. Click here or on the image below to get your free copy.

3: Horse stance

Another floor based movement you can use to build tremendous strength into the gluteal region but still have an emphasis on pelvic stability. I prefer this exercise over the clams and other glute exercises for that very reason.

The main benefit to this exercise is its ability to target the gluteus maximus muscle that can be very difficult to engage with many other exercises. Quite often the glute med will steal work from the glute max and this can cause pain into the lower back and SIJ. This exercise overcomes this as you can find the perfect position to lengthen the spine and avoid the compression of the SIJ and glute med.

Adding resistance to this helps a lot as seen in the video below

4: Clams and Side Planks

These can be useful but you have to be careful of over-strengthening the shortened side and making it worse. I have found it is not wise to only strengthen one side as it creates problems within the nervous system and screws up the timing of the muscles that should function together. For some people these exercises can be useful, but treat these with caution.

My personal preferences are the closed clam and the kneeling side plank which are both very simple regressions of the more intense exercises most people know.

5: Inline Stability Lunge

This is quite a unique exercise and this is a great way to transition to a standing position with a focus more on stability than strength. This will highlight the stiffness on one side and its inability to maintain an upright trunk position. The reflex timing it demands will help the person learn how to activate the core muscles during a position similar to a lunge. If you use this exercise in combination with hip mobility or stretching of the tight side you will yield great results.

6: Swissball Hip-Hike Exercise

This next exercise is quite strange but a great way to transition to standing exercises that demand you maintain a neutral pelvic alignment. Without a doubt the single leg exercises are the best ones to correct the problem once and for all as they demand a high degree of strength from the gluteus medius to maintain alignment of the pelvis. The problem these exercises have is that they are also quite difficult to do and require a lot of stability.

This is where you need to use exercises that plug the gap between floor based movements and bilateral exercises to single leg movement. And this is where I regularly use exercises like the ones shown in this video. This exercise actually tries to place you in lateral pelvic tilt as seen below and force you to get out of it using your glute medius.

7: Deadlifts

We are now at the point where I would introduce the standing exercises and this is where you will make the biggest difference. One of the best ways to do this is with the deadlift exercise, in particular, the Romanian deadlift where the hips are predominately used. The deadlift is by far the most effective exercise for correcting all types of hip and lower back dysfunction and it has a lot to do with HOW you complete the movement.

The only problem with this exercise is it is unlikely to correct the lateral pelvic tilt by itself so you must be very careful about loading this too heavily. Your goal with this is to learn how to master the basic form to get to the next stage which involves the single leg stance.

You can read more about all the deadlift technique and various other versions to try by reading the article - How to find the best deadlift version for your body.

8: Toe Touch Drill

This is a fantastic exercise to use for correcting lower limb injuries and pelvic imbalances. The purpose of this exercise is to teach you how to effectively stabilize the foot, knee, and hip all at the same time with minimal strength  required to complete it. This is important as the minimal risk of aggravating the injured area allows you to learn the skills needed to stabilize the pelvis in this position. For this reason this is usually this is the first drill I use with clients when I am trying to teach them how to stabilize the hip and pelvis in the frontal plane.

This exercise is NOT to be confused with strengthening of the muscles. The specific purpose of this is to improve your single leg stability to help you progress to the strengthening stage shown in the next step. You will not be able to safely progress to step 9 if you do not master this exercise first.

You can read more about the benefits and technique of the toe touch drill by reading this article - Why I rate the Toe Touch Drill as the best stability exercise for the lower limb

9: Single Leg Deadlifts

Out of all the exercises you could use to correct leg length discrepancy this would be the best!

This exercise demands foot stability, high levels of coordination, knee stability, gluteal strength, hip mobility and core control all at the same time. Unfortunately, I also recognize that this exercise may be too difficult for many people to complete straight away so I must be cautious and have a high emphasis on quality of moving over trying to fatigue the glutes with excessive volume.

The problem with many exercises used to target the glutes is that they only use one part of the glutes role. When in fact there are three distinct heads of the gluteus medius muscle that perform a unique role as the body moves:

  1. The posterior fibres - These fibres contract at early stance phase to lock the ball into the hip socket. The posterior fibres therefore essentially perform a stabilising or compressing function for the hip joint.
  2. The middle/anterior fibres - These run in a vertical direction, help to initiate hip abduction, this is where the clam comes in which is then completed by a hip flexor muscle known as the TFL. The glutes work in tandem with TFL in stabilising the pelvis on the femur, to prevent the other side dropping down.
  3. The anterior fibres - These allow the femur to internally rotate in relation to the hip joint at mid-to-end stance phase. This is essential for pelvic rotation, so that the opposite side leg can swing forward during gait. The anterior fibres perform this role with TFL.

The single leg deadlift performs these three key function all at once! The exercise needs to stabilize the hip, act as a hip rotator, and lock the head of the femur into the socket, creating a very tight and stable hip joint during the single leg stance. This prevents the ball and socket joint from rattling around during walking and running and it prevents the lateral pelvic tilt causing all of the problems.

The next two exercises begin to incorporate the upper body into the mix and utilize the lateral sling and posterior sling to help engage the trunk muscles to maintain optimal shoulder alignment.

A great article to read with more detail single leg stability – How to use the single leg squat as an assessment tool

10: Suitcase Carry

This exercise differs to the single leg stance in that is in motion and on the move. As the name suggests this is basically holding a single dumbbell or kettlebell in one hand. This is a highly complex exercise and stresses areas that are known to be very weak in most people, being the glutes and QL (quadratus lumborum).

This exercise activates what is known as the Lateral sling. This sling connects the glute medius and glute minimus of the stance leg to the adductors and with the contralateral Quadratus Lumborum (QL). This sling plays a critical role in stabilizing the spine and hip joint in everyday activities like walking upstairs which the person with lateral pelvic tilt has all sorts of trouble with. This has obvious weakness with almost all back pain sufferers and a program to develop the integration of the inner unit and outer unit is crucial for long term success in getting rid of their pain.

There is a great lecture by Dr McGill found out about the suitcase carry where he states.

"I learned such a valuable lesson. When an athlete picks up a heavy load, the force comes up the leg, but in order to allow leg swing, the force has to shear across the pelvis and up the spine. We measured the winning strongman. Believe it or not, he had 500 Newton Meters of strength of hip abduction. I could lie on his leg on the side and he would just pop me up into the air. His strength was mind-blowing. Then we measured him with the Super Yoke. Remember, he had 500 Newton Meters of strength to hold his hip there and hold his pelvis up through hip abduction to allow a leg swing. When we measured World Class level, we showed that he needed 750 Newton Meters. He did something that was impossible—he did something he did not have the strength to do.

Where did the strength come from?

It came from the quadratus lumborum on the other side. The obliques assisted in lifting and keeping the pelvic platform level to allow a leg swing. That’s the type of information we learn when we work with the world’s best. Now let’s go to the world’s worst. Let’s consider a child who has a paralysed QL. What’s the gait pattern? Would you see the paralysed QL on this side? The hips can’t keep up. That’s just a little demonstration of the lessons you learn. For a football player, the ability to do the job is not limited by pull or press strength—it’s limited by being able to hold the pelvic platform up on one leg, plant, externally rotate and go.

The best way to enhance that is a suitcase carry.

How many people have you seen do that in the weight room? The suitcase carry is the number one way to do it. It’s a unilateral exercise.

Don’t do too much. Do perfect quality." - Dr Stuart McGill

We filmed a quick video of a version we use going upstairs. The load is greatly reduced as the complexity of the movement is much greater. The goal is to prevent any shoulder sway and maintain a straight line up the stairs with no deviation. Easier said than done.

You can read more about this in the article – Why farmer’s walks and suitcase carries are the ultimate functional exercise

11: Single Leg Squat with Single Arm Pull

This last exercise exposes weakness with the posterior sling and where you see the shoulder drop. This system is also seen most commonly in again in walking where it provides the propulsion for the body to move forwards. This is where the glute max of one hip works with the latissimus dorsi of the opposing side to create tension in the lower back region called the thoracolumbar fascia. The action of these muscles along with the fascial system is to prevent rotation of the pelvis when we walk and enable you to store energy to create more efficient movement.

You can read more about the slings of the body in this article – How to train the myofascial slings and improve core strength

Do You Need More Help?

Before jumping straight into a corrective program make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self-diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors, and Physiotherapists before implementing our program to know exactly what we are dealing with. Being certain on where to start is crucial to the success of the program.

If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program for both back pain and hip problems associated with piriformis syndrome. These include a 85 page PDF report 60-90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process!

Click here or on the image below to get a copy.



As you can see this is a very complex dysfunction to correct and there is no is no rulebook that is 100% certain on how to approach these cases, just a stack of possibilities to explore and rule out. If you can treat the exercises shown in this article as assessments it helps to narrow down your exercise selection to the drills that you need the most.

Some people it will require more stability and strength exercises whereas others it will have more to do with mobility and even coordination of movement.

Lastly, always remember that you must find the repetitive habit that is the underlying trigger behind this being created in the first place. Failure to identify and change this will mean your program has little chance of succeeding and you will remain in constant pain.

I hope this article gives you a better idea of how to correct this problem if you already have it, and prevent it if you don't.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.


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