Without a doubt one of the most confusing and difficult conditions to work with is lateral pelvic tilt or lower leg discrepancy. It is also a very common problem affecting many people of all ages and in some cases the person does not even know they have a hip problem for their injury or pain is located at a different joint. Finding ways to correct this condition is very challenging and requires a lot of different exercises and strategies along with a considerable amount of patience. In recent times I have great success in using two exercises that strengthen many of the muscles that are responsible for weakness in the hip and pelvic region. In this article, I discuss why this works so well and how you can use them in your program to correct any dysfunction you may have in your hips.

What Is Lateral Pelvic Tilt?

Before we discuss the two exercises it is important to define what lateral pelvic tilt is and the various factors that contribute to creating this postural dysfunction.

In the picture above you can see a perfect example of lateral pelvic tilt and lower leg discrepancy and the various joints affected by this type of posture.

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.

The reasons for this are often broken into 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, which is far more common is a much different story. This is created by the way we move and the type of postures we use to complete many daily activities. Weakness and compensation create postural imbalances and these are often formed during repetitive movement strategies seen from inactivity, in sports, or various occupations. It can be quite difficult to narrow this down to one thing as even the way you sleep, sit, and stand can all play a part in this.

I don’t want to get stuck talking about these potential causes in too much detail as I want to discuss the two exercises but you will find more information about the various causes of lateral pelvic tilt and where to look for the source of the problem in the articles below.

• 5 daily habits that could ruin your spinal health
• What causes lateral pelvic tilt?

Now that you have a better understanding of what lateral pelvic tilt is let’s look at the two exercises I use to correct this dysfunction.

Before You Do Anything You Must Know How to Do the Romanian Deadlift

The two exercises I am about to discuss are both variations of the popular exercise for hip and back pain called the Romanian Deadlift. This means you need to have a great understanding of how to do the basic version of this exercise before you can attempt the two more advanced versions that include more advanced skills and technique.

The RDL is a fantastic exercise in its basic form for it helps to realign the femoral head (thigh bone) back deep into the hip socket by releasing stiffness in the hip simultaneously strengthening the hamstrings and glutes. This position allow the glutes to generate their full capacity for strength but also protect the hip and spine from damage. The best part about this exercise is that it mimics the action of bending in daily life and any quality training learned can change this pattern permanently leading to great long term results.

You can watch the video below to see an example of how to do this exercise correctly and why it works so well for restoring hip control and strength.

Instructions:

1. Position the kettlebell on the floor between your legs so that you cannot see your shins in a mirror from the side.
2. Standing with feet a comfortable width apart. Reach down keeping the natural arch in your low back, and neck tucked and grab the kettlebell maintaining good posture.
3. Inhale and engage your core before you begin to stand to the top position, exhaling when at the top and gently rolling your shoulder down and scapula apart.
4. At the top repeat the inhaling process before lowering to the ground.

The only problem with this exercise is it may not target the weakened side enough. This is where logically you would assume that the single leg version would be the better choice, and you would be right in thinking this way. Unfortunately, the weakness is often so pronounced that this is too difficult to do and can really aggravate the problem.

This means you have an exercise that is not hard enough and one that is a bit too hard. You need something that falls somewhere between the two. This is where the two exercises I am about to discuss come in as they do exactly that!

One of them targets the obliques and QL more intensely while the other version targets more the glutes and muscles around the hip more effectively. This means you can activate both weakened areas within this bending action and create a much more aligned and stabilized hip.  

Exercise 1: The Uneven Deadlift

This particular exercise is called the uneven deadlift for it uses a barbell that is weighted on only one side. This asymmetrical loading forces the body to apply a corrective strengthening strategy to maintain the horizontal alignment of the bar. By combining the hip hinge bending action it has a great effect on strengthening the abdominal muscles in combination with the glutes to allow the body to move without falling over to one side.

This exercise focuses more on the core and muscles of the obliques and core.

Watch the video below to see how it works.

The theory behind this exercise is very similar to the concept used with the suitcase carry and where you see greater activation of the muscles used in the lateral sling that is responsible for maintaining pelvic alignment.

The lateral 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.

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

Here is a great video to watch of the suitcase carry in action with a client of mine who had severe hip trouble.

You will find a ton of other exercises to target the oblique muscles used in this exercise in the article – To strengthen the obliques you must understand their purpose

Let’s look at the second exercise.

Exercise 2: The Band Distracted Deadlift

This is very similar to the uneven deadlift but instead of using a load that tries to compress the hip joint by using gravity to fall to the ground we use a band to try and pull the hip laterally! Basically, we try to apply a force that tries to make the hip fall even further to the side than it already is. It sounds crazy I know as it appears that we are trying to make the problem worse, but in reality it does the exact opposite.

This type of training method is known as reactive neuromuscular training where a small amount of resistance is applied to a faulty movement that “feed the mistake” and therefor forces the body to make a correction.

With lateral pelvic tilt there is a shift of the body towards one side. Sometimes it is due to weakness, other times it is due to a loss of mobility and the body has no choice but to find another way. By applying an excessive amount of compensation it forces the body out of its first line of thinking and recruit other muscles to counter the abnormal position.

You do have to be very careful and take your time with this type of training as the weakened muscles may fatigue quickly and make many mistakes as they are not used to working like this. However, if you are patient and work slowly the person can begin to experience what it is like to use these weakened muscles in an integrated movement that they would normally compensate in.

This is far more effective than using a stack of isolated exercises to strengthen the weak muscles but have no relevance to changing a functional movement pattern. Using reactive neuromuscular training allows to train the weak muscles within the functional movement. This is very powerful stuff if used wisely.

Don’t Forget To Use Other Exercises In Combination

While the Romanian Deadlift, Suitcase carry, and these two advanced deadlift variations are great at correcting lateral pelvic tilt you will still need to use a lot of other exercises in combination to ensure your technique is adequate. Just using these exercises on their own will not be enough.

Addressing hip mobility, foot stability, basic core function, and glute strength will all require a number of exercises to ensure the body can handle the demands of different movements that force the pelvis to re-align itself.

Exercises like horse-stance, side planks, hip extensions and various hip stretches and mobility drills should all be included in a rehabilitation program for hip and pelvic dysfunction.

Also you must not forget that the single leg exercises are much better at producing greater strength gains than the uneven deadlift or band distracted deadlift and the only reason you are using these is because the single leg exercises are too hard at this point in time.

This means that these exercises are merely stepping stones to much harder variations. I would argue the suitcase carry is much more difficult than these exercises as well for it is far more complicated due to its dynamic nature and combination of more joints and muscles. Using the uneven deadlift and band distracted deadlift may help you to gain more control over the suitcase carry.

You will find a ton of additional information on these other areas in the articles in the links below.

• Exercise solutions for weak feet
• How to improve hip mobility
• Best exercises for hip and pelvic stability
• How to strengthen weak glutes
• How to identify mobility restrictions affecting how you move

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.

Summary

There is no doubting that trying to correct a hip and pelvic problem like lateral pelvic tilt is extremely difficult so it is great having exercises like these in your toolbox to fall back on as it can help to navigate around difficult parts of the rehabilitation process. The best part about using concepts like this is that it changes the way you move really fast. The sooner you begin to move more efficiently the easier it is to regain strength and stability of weakened muscles and unstable joints.

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 300 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 18 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.

References:

• Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
• Muscle testing & function - By Kendall, McCreary, Provance, Rogers, Romani
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek
• Twist Conditioning Sports Strength - By Peter Twist
• Twist Conditioning Sports Movement - By Peter Twist