Nine out of ten patients who come into our office present with some degree of pelvic tilt or shift. Low back or radicular pain may not even be the complaint… yet. Something we see a lot of is what is termed pelvic unleveling. This occurs when an individual repeatedly gravitates to one side more so than the other when standing, or sitting, or lying down. This can result in what appears as a short leg but is actually just a shifting of the pelvis that can lead to low back pain, and even radiating pain into the glute and down the leg.
Repeated postural pelvic imbalances can cause the muscles to elongate, or shorten unilaterally which can ultimately lead to postural deviations and pain.
This is achieved while standing when an individual stands for long periods, often while at work, but can also occur during events where standing for long periods is required, and they shift their weight over to one leg. Most people have a favorite side. For many, this has become such a habit that it’s not even something they are conscious of. In fact, when asked to shift their weight to the opposite leg some will say that it feels weird. Another cause while standing occurs in mothers, or caregivers of small children who form a habit of carrying the child on their hip, usually on the side opposite their dominant hand. This too can eventually lead to pelvic unleveling.
The same can occur when sitting. While driving, or riding as a passenger some have a tendency to either lean on the console or an armrest. If you tend to sit on your billfold, or phone this can have a similar effect. I once bought a recliner for my office from a patient who was unloading it because it clashed with the rest of her furniture. She had bought it used. Whoever owned it before her was right-side dominant and leaned to the right while sitting… IN A RECLINER! It was not possible to sit in this chair without leaning to the right. It eventually made it to a dumpster. Other problems causing sitting positions can be sitting repeatedly with the same leg crossed, or sitting with one foot tucked under you. I often ask patients during their initial exam to cross one leg over the other while seated, and then do the opposite. Fifty percent of the time they’ll say that crossing the opposite leg doesn’t feel right.
We can also tweak our hips while sleeping. This occurs mostly in individuals who sleep on their side with their top leg flexed at the hip and knee. This position can cause a tilt and rotation of the pelvis that can over time lead to back or hip pain. Especially if they always sleep on the same side.
So what is the solution to this? We have to start by retraining the muscles. Stretching and doing the opposite is a good place to start. A patient once shared that they always sit on the far right side of their couch leaning against the armrest while watching their favorite shows. I told them to go home and do the opposite for a while. Of course, we were stretching their back and hip muscles, and adjusting their pelvis during this retraining period, but doing the opposite is a good place to start. Whether it’s putting your weight on your left leg instead of your right while standing, crossing your right leg instead of your left while sitting, or sleeping while facing the other side and flexing the opposite leg training your body to tolerate the opposite will help. In the case of side sleeping, it’s helpful to place a pillow under the thigh and knee of that leg that is flexed. This will help to decrease the amount of strain and tilt on your pelvis.
After a while, you’ll begin to notice when you’re favoring one side and it will become natural to counter it and to gravitate toward a more neutral position.
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