If the pelvis is inclined, the pelvis is not in its natural, horizontal position, but is inclined to one side of the body. An inclined position of the pelvis can lead to severe discomfort and, over time, damage your posture. Depending on the severity of the deformity, conservative or surgical therapies offer good prospects of recovery.
What is pelvic obliquity?
The pelvis is the link between the spine and the legs and is therefore of great anatomical importance for the human body. It is usually in a horizontal position and thereby stabilizes and regulates the body posture. If the pelvis is not horizontal, but rather tilted towards one side of the body, this is referred to in medicine as pelvic inclination.
Depending on the severity, this can lead to serious orthopedic problems and damage the entire postural and musculoskeletal system. The spine, in particular, is usually gradually deformed by a pelvic inclination, and those affected suffer from increasing symptoms. Basically, two forms can be distinguished in medicine: the structural and the functional pelvic inclination.
Structural pelvic obliquity is usually caused by a difference in leg length. If one leg is much shorter than the other, the pelvis tilts to one side when standing upright. This form of pelvic inclination is caused by anatomical conditions and leads to severe stress on the spine of those affected.
A functional pelvic inclination, on the other hand, has no anatomical causes. Here it is mostly muscular imbalances or tension that trigger the misalignment. The tense muscle cords shorten and pull the pelvis from its originally horizontal position into a tilted position.
It is estimated that around two thirds of all people in western industrialized nations suffer from pelvic obliquity, but in many cases it goes unnoticed by those affected for years or even decades. Young people are particularly often affected by the deformity, here it is caused by irregular growth spurts and is therefore usually only temporary.
The causes of a pelvic inclination can either be congenital or arise from poor posture and strain in the course of life. One of the main causes of a crooked pelvis is uneven distribution in the muscle system. Naturally, the right half of the body is different from the left half of the body in every person, usually the muscles on one are better developed than on the other. However, this can be aggravated by incorrect or insufficient stress in everyday life.
If, for example, one half of the body is stressed during sport, the result is an uneven distribution in the body’s own muscle system. The same is the case with a lack of exercise due to a lot of sitting or lying down. Over time, these so-called muscle imbalances lead to poor posture and can promote the formation of a pelvic oblique position.
In addition, muscle tension in combination with a lack of exercise lead to poor posture. Especially people who spend a lot of time sitting (for example in front of the computer or in the car) often suffer from tense back muscles. The tension causes the muscle to shorten – if this occurs predominantly on one side of the body, the long-term result can be pelvic inclination.
Another cause of pelvic inclination can be congenital differences in leg length. If one leg is significantly shorter than the other (about a few centimeters), this results in a pelvic inclination. This has a negative effect on the spine – scoliosis forms. However, this can also be congenital and in turn cause the pelvic obliquity.
Symptoms, ailments & signs
If the pelvis is inclined, the back tries to compensate for it so that there are no restrictions on movement. A slight pelvic inclination can usually be effortlessly compensated for by the spine and leads to little or no discomfort for the person concerned. With a massive pelvic inclination, however, there is a strong curvature of the spine, which is also known as scoliosis.
Scoliosis usually only causes symptoms after a long period of time and with increasing age, these then occur mainly after standing, lying or sitting for long periods of time. The typical symptoms primarily include back pain, which those affected perceive as stinging, tearing or cramping.
In addition, in most cases the pelvic inclination leads to pain in the shoulder and neck area, as the incorrect posture here triggers cramping of the muscles. Also headaches are part of the clinical picture, in some cases the pain radiates also made on knees or ankles. Due to the oblique position of the pelvis, the spine permanently curves to one side and shows signs of premature wear and tear. This in turn leads to an intensification of the symptoms, in particular the back pain usually increases steadily with age.
A very pronounced and untreated pelvic inclination leads to a curvature of the spine in the course of life, a so-called scoliosis. This in turn can cause massive posture damage and severely limit the mobility of those affected. The curvature leads to one-sided overloading and premature signs of wear. These are accompanied by tension in the shoulder and neck area and can sometimes be very painful for the patient.
The inclined position of the pelvis also results in uneven strain when walking and running, which can lead to premature wear and tear on the knee or ankle.
A pelvic inclination caused by a difference in leg length can also lead to poorly developed gait and gait disorders in children. Even if the therapy of pelvic obliquity is mostly successful, complications can arise, especially with the operative leg lengthening. In the worst case, the bone growth expected by the attending physician can only take place very slowly or not at all. In this case, there are usually other underlying diseases.
When should you go to the doctor?
Pelvic obliquity often does not cause any symptoms at a young age and is therefore often not even noticed by those affected. In some cases, the deformity is diagnosed at an early stage by a doctor, but due to its minimal severity it is classified as not worthy of treatment. A slight pelvic inclination can remain unchanged and therefore harmless for a lifetime, but the risk of the diagnosis worsening increases, especially with increasing age.
At the latest when the pelvic inclination causes discomfort when walking, standing or lying down, a doctor should be consulted immediately. The same applies if the person affected perceives diffuse pain in the knees, back or shoulders and cannot precisely identify them.
You should be particularly quick if the spine is already beginning to curve due to the misalignment. Even this is rarely noticed by the patient in the initial stage, but over time severe back pain develops, especially when sitting or standing upright. Since a curvature of the spine (scoliosis) can lead to serious postural damage, the orthopedic surgeon should be consulted as soon as the first signs appear.
In order to diagnose pelvic obliquity, the doctor usually does not need any elaborate procedures. A pronounced inclination can usually be determined by simply palpating the spine and pelvic bones. With the patient standing upright, the doctor examines the pelvis from behind and checks whether the outer pelvic bones are at the same height. If this is not the case, there is an inconsistency.
An X-ray examination can also be carried out to obtain a more detailed diagnosis. Here it can also be assessed whether a leg length difference is the cause of the pelvic obliquity. A 3D spine measurement is also one of the common diagnostic procedures for suspected pelvic inclination and can provide further information about the misalignment.
Here, the person’s body is measured with light rays, with the help of which a three-dimensional image of the spine and pelvis can be generated on the computer. Since no X-rays are used here, the measurement can be repeated several times if necessary and is therefore particularly suitable as a diagnostic method for children.
Treatment & Therapy
If the pelvic inclination is only minimal (a few millimeters), therapy is usually unnecessary, as the body can compensate for this small irregularity itself. If there is a pronounced inclination of the pelvis (several centimeters), therapy is medically indicated.
Treatment essentially depends on the cause that caused the pelvic obliquity. The age of the patient and the extent of the inconsistency also play a significant role in choosing the right therapy.
If muscle imbalances or muscle tension are the cause of the misalignment, physiotherapeutic measures such as targeted strengthening exercises or special massages are often sufficient.
Treatment is much more difficult if a leg length difference causes the pelvic obliquity. If the difference between the leg lengths is only small (about one centimeter), the person affected is usually prescribed special shoe insoles that increase the soles of the feet and thus compensate for the difference in length.
However, shoe insoles are now considered out of date if there are minor differences. Today, orthopedic exercises are recommended that can correct a slight inclination of the pelvis or a slight difference in leg length.
However, this orthopedic measure can only be used to a certain extent – if the leg length difference is more than three centimeters, it must be corrected surgically. In this case, the significantly shorter leg is artificially lengthened through several surgical interventions – this form of therapy is very tedious and, depending on the findings, can take several years.
Here, the bone of the affected leg is drilled and an artificial growth plate is created. A frame is then attached to the leg, which gently and steadily stretches the bone. This stimulates the growth of the bone until it is the desired length.
Outlook & forecast
The prognosis essentially depends on the extent of the pelvic inclination and, above all, on its cause. The age of the patient also plays a role and can have a positive or negative influence on the healing process.
If the person’s body is still growing (children or adolescents), the deformity can often regulate itself. Since most people’s bones grow at different speeds, minimal differences in leg length can occur until the end of the growth phase, which will compensate for themselves over time.
In adults, self-regulation of the pelvic inclination can no longer take place. Here the chances of recovery depend heavily on the cause. If the misalignment is caused by a slight difference in leg length, conservative therapy with special heel inserts can usually provide relief. Often with this form of treatment, however, symptoms arise when walking / running, as the body only slowly gets used to the foreign body in the shoe and the new type of stress.
The patient usually has to be a little patient here, and the orthopedic surgeon often has to readjust the insoles several times. If it is a very pronounced misalignment, a surgical intervention is usually necessary. Here, the patient has to plan a lengthy treatment, which, however, is uncomplicated in many cases.
The chances of recovery are usually very good if the pelvic obliquity is caused by muscular imbalances or tension, as this is only a temporary deformity. As soon as the muscle imbalances or cramps are balanced or resolved through targeted physiotherapeutic exercises, massages and sport, the pelvis moves back to its original position.
Since a pelvic inclination can be triggered by congenital anatomical irregularities such as a leg length difference, this can only be prevented to a limited extent. Sports and a healthy lifestyle are only suitable as preventive measures if the pelvis is inclined due to poor posture and improper strain.
In particular, people who spend a lot of time sitting should specifically train their muscles and integrate sufficient exercise in the fresh air into their everyday life. It is often sufficient to make the daily commute by bike instead of the car and to use the stairs more often instead of the elevator.
A long walk during the lunch break also ensures sufficient oxygen supply and relieves tension in the back and shoulder muscles. Endurance sports such as swimming or jogging are particularly recommended, as all muscle groups are moved here.
In addition, pelvic inclination can also be prevented by taking sufficient rest. In particular, people who are heavily stressed at work suffer more quickly from muscle tension, back pain and postural damage, which in the long term can, in the worst case, lead to a pelvic tilt.
Depending on the cause, a pelvic inclination is compensated differently. Follow-up care adapts to the method used to compensate for the pelvic obliquity.
Surgical measures require more intensive aftercare than manual therapies. With compensatory measures, insoles, heel cushions or raised heels can eliminate the pelvic inclination. When the leg joints and pelvis receive adequate treatment, the pelvic obliqueness, the leg length discrepancy that caused them, and the pelvic blade tilt disappear.
Still, aftercare is important. After an operative leg length compensation, a pelvic obliquity often occurs again. The therapy-related pelvic inclination can occur immediately after the end of therapy or later. If there is no regular follow-up after the treatment, the new pelvic obliquity will go unnoticed.
As part of the follow-up care, it is examined whether unilateral tense gluteal muscles are the cause of the new pelvic obliquity. Untreated pelvic inclination ensures that the spine cannot straighten up. Scoliosis can result. With the timely compensation of the inconsistency with insoles or a temporary increase in sales, the problem can be resolved in the aftercare. The gluteal muscles can relax again and the pelvic obliquity disappears. The doctor will determine how long this will take in further follow-up examinations.
You can do that yourself
If the cause of the pelvic obliquity is not innate, but results from the consequences of postural damage, incorrect strain and lack of exercise, the person affected can strengthen his back muscles himself through sport and specific exercises and thus counteract a deformity. Muscle imbalances can be balanced and an upright and healthy posture can be promoted.
It is important not only to train the back, but also the abdominal, buttock and thigh muscles. Sports such as yoga or Pilates are particularly suitable for this, as they also contain many stretching elements and thereby loosen and stretch tense and shortened muscles.
If there is already a misalignment, sports such as jogging, soccer, etc. should be avoided, as this puts a lot of strain on the back and pelvis. Swimming or aqua aerobics are more suitable, as is light walking or walking.
In addition, if you have an existing pelvic inclination, you should pay more attention to your own body weight – if this is too high, the spine is unnecessarily stressed. A healthy and balanced diet is advisable here, and any excess weight should be reduced.
In addition, those affected should not sleep on mattresses that are too soft. During the night these give way under the body weight, the spine is unnecessarily bent while sleeping and thus stressed. Many patients therefore experience severe back pain during the night or the next morning. High-quality mattresses with firm material, which additionally stabilizes the back, are more suitable.