What are Uneven Hips?

what are uneven hips image

Definition of Uneven Hips

Uneven hips, also called "hip hike" or "lateral pelvic tilt," characterize a posture where one hip sits higher than the other. While individuals with leg-length disparities naturally present with uneven hips, in many cases, the imbalance emerges due to asymmetrical use or dominance of one side. Factors like past injuries, consistent, one-sided physical activities, or other habitual actions further contribute to this misalignment. The resulting unevenness affects whole-body posture, disrupts normal gait patterns, and significantly impacts the overall biomechanics of the body, potentially leading to pain, diminished balance, and a range of other physical complications.

Do I Have a Lateral Pelvic Tilt?

are your hips level

Wondering if you might have uneven hips? Here's a simple way to perform a preliminary self-assessment:

  1. Mirror Test: Stand barefoot in front of a full-length mirror, far enough back to view your whole body alignment.
  2. Hand Placement: Place the heels of your hands on the top of each hip bone. These are your iliac crests, and they'll serve as markers.
  3. Assess Height Difference: Observe the level of your hands in the mirror. If you were to imagine a string stretched between your hands, it should be parallel to the ground. A noticeable tilt in this imaginary line indicates a potential lateral pelvic tilt.
  4. Foot Symmetry: Look down at your feet. Are they pointing straight ahead and symmetrical, or does one foot angle out more than the other? Foot orientation offers clues about hip imbalances.
  5. Balance Test: Close your eyes and bring your attention to the weight distribution between your feet. Do you feel more pressure on one foot? A significant difference is indicative of an uneven weight distribution due to hip imbalance.

If you observe any of these signs but want some help in assessing your posture, we've got you covered. We offer a free consultation and postural assessment that you can schedule here.

Anatomy Overview

hip elevation or lateral pelvic tilt anatomy

Our hips serve as a fundamental junction in our body, enabling movement, providing stability, and connecting the upper and lower body. Understanding the anatomy involved is useful in grasping how uneven hips affect various functions.

  1. Bones: At the core of the hip structure is the pelvis, composed of three bones: the ilium, ischium, and pubis, which converge to form the acetabulum, a socket that accommodates the head of the femur or thigh bone. The relative positions of the iliac crests (top edges of the pelvis), indicate whether the hips are level or not when viewed from the front or back. With a high hip on one side, the sacrum that connects the pelvis and effectively serves as the keystone supporting the spine is no longer level either.
  2. Muscles: Surrounding the bones is a complex group of muscles that ensure the hips' mobility and strength. Primary players include the adductorsgluteus medius, minimus, and gluteus maximus (the glutes collectively abduct the thigh), the hip flexors (like the iliacus and psoas), and the quadratus lumborum, which connects the pelvis to the spine. Muscle imbalances between the right and left sides produce prolonged tension in these areas that contribute to and result from uneven hips.
  3. Ligaments and Myofascial Lines: Connecting the bones and providing joint stability are ligaments like the iliofemoral and ischiofemoral ligaments. Moreover, the fascial tissue, which encapsulates muscles and extends throughout the body, plays a role in maintaining posture. For instance, the "lateral line" of fascia runs from the foot, up the side of the leg, across the pelvis, and continues upward, integrating with the torso and upper extremity. Dysfunction or tightness in this myofascial line contributes to lateral pelvic tilts, though all fascial slings are affected as they cross the uneven pelvic position.

In essence, the interplay between these structures determines hip alignment. When one element is out of sync due to injury, habitual patterns, or other factors, the resulting postural change can manifest as uneven hips.

Synonymous Posture Terms

  • Lateral pelvic tilt
  • Hip hike
  • Hip drop
  • Elevated hip
  • Hip elevation
  • Hip disparity
  • Hip asymmetry (Asymmetrical hips)
  • Leg-length disparity or discrepancy
  • Scoliosis

The Biomechanics of Uneven Hips

risk of falls goes up with uneven hips

Skeletal and Muscular Structures

The hips are major crossroads of the body, where many muscles converge to orchestrate the coordination needed for bipedal movement. The spinal and abdominal muscles, and any others that attach from the upper body to the pelvis (like quadratus lumborum or latissimus dorsi via the thoracolumbar fascia) are rendered uneven between the right and left. The hip flexors that determine how high we can lift our legs are now unbalanced, and the glutes (gluteus medius, minimus, and maximus) which laterally stabilize our gait, are all thrown off-balance.

A higher hip completely changes the length-tension relationship, leverage, and power roles the muscles play in the position and function of our hips and lower extremeties. A discrepancy or imbalance in any of these structures, whether from muscle tightness, weakness, or anatomical differences such as leg length discrepancy, will shift the pelvis to one side. If it’s the right hip that’s higher, for example, this will put more loading onto the left leg. And with the left side bearing the brunt, this can lead to tightness, decreased range of motion, and eventually symptoms like low back pain, hip bursitis, SI joint disorder, and other problems that differ on each side of the body.

Pelvic Floor Effects

When the hips are uneven, the harmony between muscles that stabilize and coordinate both sides of the body is disrupted. While this directly impacts the hips, its effects ripple upwards to the spinal and abdominal muscles and downwards to the muscles and joints of the legs. A critical yet frequently neglected player in this scenario is the pelvic floor. This network of muscles forms the foundation of the pelvis, providing support to pelvic organs and playing a pivotal role in core stabilization. Any dysfunction or weakening of the pelvic floor can contribute to the misalignment of the hips, and postural deviations like a hip hike can contribute to pelvic floor weakening.

Joint Movements

Movement in the hips doesn't just affect the immediate area. The sacroiliac joint, where the spine and pelvis meet, is intricately tied to hip mechanics. When one hip hikes or drops, the sacroiliac joint and the lumbar spine compensate by adjusting their positions. Compensating strategies can include rotation, anterior and posterior tilting, lateral movements, or excessive flexion or extension to adapt to the imbalance. Such compensations reverberate upwards, leading to potential lower- and mid-back, shoulder, and even neck issues as the body strives to keep the head centered above the feet.

Below the pelvis, the femur, which nests into the hip socket, has to adjust its angle, often leading to hip, knee, ankle, and foot issues. These cascades of misalignments introduce stresses and strains on ligaments, tendons, and muscles unprepared for the altered demands, increasing the risk of injury.

Gait and Balance Implications

Our gait, including walking and running, is a complex interplay of muscle coordination and skeletal movement. Uneven hips quickly disrupt this symphony, leading to an asymmetrical stride. Always striving for efficiency, the body will compensate with larger steps on one side, excessive pelvic or spine rotation, an outward turning foot, or even a habitual limp.

These gait alterations wear down joints (and shoes) prematurely and throw off our balance. With uneven hips, our body's center of gravity shifts, making tasks like standing on one foot, quickly changing directions, or navigating uneven terrains more challenging. Over time, this can lead to increased fatigue, a higher risk of trips and falls, and even a decline in athletic or physical performance.

In essence, the positioning and health of the hips are foundational. They bear our body weight, influence our posture, and play a fundamental role in every step. Addressing uneven hips is not just about alleviating hip discomfort—it's about restoring balance and harmony to the body's entire biomechanical system.

How Fixing Uneven Hips Can Help Prevent Falls for Seniors

fix the posture before strength training

Clients like Carol can make great strides by combining the power of posture therapy with their balance classes and strength training.

Consider the story of Carol, a 72-year-old retiree. She began noticing that she felt unsteady when standing or walking and had even experienced a few near-falls recently. Her family, concerned about her safety, encouraged her to participate in a balance program at a local gym. While she experienced some improvement with the balance exercises, the underlying issue of her uneven hips wasn't being addressed.

1. The Problem with Uneven Hips in Older Individuals

For Carol, her uneven hips meant her body weight was not distributed evenly. The left hip elevation led to an elongation of the glute muscles on one side, causing them to work harder (without the necessary leverage) than those on the opposite side. This muscular disparity, along with the lean of her trunk onto her right leg (away from the weakness), added a degree of instability to walking, getting up, and moving in general. With age already contributing to decreased muscle strength and flexibility, this postural imbalance further heightened her fall risk.

2. The Limitations of Traditional Balance Programs

The balance program Carol initially tried gave her strength training, which is essential and beneficial for seniors. Still, it didn't cater to her specific poor posture issues as she continued to work around the left hip elevation. The group exercises improved her muscle tone, but they inadvertently reinforced the muscle imbalances and the weight distribution to her right side caused by her uneven hips. Without addressing the root of her instability, she was undeniably stronger, but still at risk.

3. The Advantage of Posture Therapy in Preventing Falls

Upon consulting a posture therapist at Activ8 Posture, Carol’s situation began to turn around. Not only did her therapist identify the uneven hips as the main culprit, but they also noticed secondary postural deviations, such as a trunk lean, uneven shoulders, a flatter foot arch on the elevated hip side, and her right knee caving inwards. The holistic approach of Activ8’s posture therapy worked on correcting her uneven hips and the associated postural misalignments. The individualized treatment plan ensured Carol’s body was more symmetrically aligned and balanced. Over time, as her hips leveled, her sense of balance improved, and her risk of falls significantly decreased.

Through her journey, Carol exemplifies the importance of treating the root cause of postural deviations. While traditional balance programs have their merits, addressing the foundational imbalances through posture therapy offers a more holistic and lasting solution, ensuring safer mobility and improved quality of life. As Carol’s body became more centered, she was able to feel new muscles working along with her better balance during her balance classes at the gym.

Postural Deviations Commonly Found with Uneven Hips

When the foundation of our structure (the hips) is off-kilter, it's almost like a domino effect across the body's biomechanics. Misalignments instigate a reaction of compensatory adjustments throughout our musculoskeletal system. While uneven hips might be the primary issue, it typically doesn't stop there. Accompanying postural deviations often include:

  • Uneven Shoulders: One shoulder might appear higher or more forward than the other. This is the body's attempt to keep the head centered over the feet, despite the misalignment below.
  • Spinal Curvatures: The spine may exhibit lateral curves (scoliosis) as it tries to adjust and keep the body upright. These can be temporary, muscular-based curves or more long-term structural changes.
  • Offset Trunk and Shifted Head Posture: The spine and head can tilt or rotate to compensate for lower body imbalances. This can lead to issues like neck pain, dizziness, or tension headaches.
  • Knee and Ankle Adjustments: The knees might bow inwards (genu valgum) or outwards (genu varum) as a result of the changed hip position. One knee will often rotate in or out more than the other. Similarly, the ankles might pronate or supinate, leading to foot and arch pain.
  • Altered Weight Distribution: Individuals might habitually put more weight on one leg (usually the lower side), leading to overuse syndromes and further reinforcing muscular imbalances.
  • Pronounced Foot Flare: One foot usually points outward more than the other, a compensatory adjustment to hip changes.
  • Changes in Arch Height: The foot under the elevated hip might experience a higher arch, while the opposite foot might have a flatter arch due to the uneven weight distribution.

It's essential to understand that these postural deviations are interconnected. Addressing the root issue, in this case, uneven hips, can alleviate or even correct many of these secondary postural changes, restoring balance and symmetry to the body.

What are the Symptoms of Uneven Hips Posture?

low back pain and sciatica from uneven hips

A number of pain symptoms ranging from sciatica and lower back pain, to neck and shoulder pain, are often related to uneven hips seen as a hip elevation.

Common Pains and Limitations

  • Joint Pain: Misalignment stresses the knees, ankles, and the feet.
  • Gait Abnormalities: A tilted hip disrupts the walking pattern, leading to compensatory mechanisms.
  • Lower Back Pain: Uneven hips place strain or exert pressure on one side, causing discomfort in the lumbar region.
  • Sciatica (or Piriformis Syndrome): Misalignment of the hips may result in nerve impingement, leading to sharp pain that radiates from the lower back through the buttock and down the leg.
  • S-I Joint Pain: Uneven hips exert undue stress on the sacroiliac joint, leading to pain in the region where the spine and pelvis meet.
  • Knee Pain: A misaligned hip can alter leg alignment, placing stress on the knee joints.
  • Hip Pain: The side with the raised hip often experiences pain due to muscle and joint stress.
  • Hamstring Pulls: The uneven hip position compromises the pull of the hamstrings, hip, and leg muscles.
  • Groin Pulls (adductor strains): The elevated hip side’s adductors are short and weak while the down side adductors are compromised.
  • IT Band Syndrome: Uneven hips can create tension in the iliotibial band, a ligament that runs along the outside of the thigh, leading to pain especially near the knee.
  • Foot Pain and Plantar Fasciitis: Misalignment can affect foot posture, leading to pain or inflammation of the plantar fascia, the thick band of tissue at the bottom of the foot.
  • Bunions: The pressure on one foot can cause the big toe to lean towards the second toe, forming a bunion.
  • Ankle Pain: Altered gait due to uneven hips often puts extra stress on the ankle joints.
  • Shoulder Pain: To compensate for the hip tilt, the opposite shoulder may elevate, causing shoulder pain or discomfort.
  • Trap Tension: Tension can build up in the trapezius muscle, especially on the side opposite the elevated hip, as it tries to balance the body's alignment.
  • Neck Pain: The domino effect of uneven hips can extend to the cervical spine, leading to neck pain and stiffness.
  • Headaches: Misalignment of the spine and neck muscles, as a result of uneven hips, can trigger tension headaches.
  • Gait Abnormalities: One of the most noticeable symptoms, a tilted hip, can disrupt an individual's walking pattern, forcing the body to develop compensatory movements.

By recognizing and addressing these symptoms early, you can prevent further complications and improve your overall posture and muscle balance.

Long-Term Risks and Issues

Uneven hips, when left unaddressed, can lead to a cascade of both physiological and musculoskeletal complications. These aren't just limited to the immediate area of the hips but can reverberate throughout the body. Here are some of the potential risks and issues that can arise:

  • Chronic Pain: Persistent misalignment of the hips can result in prolonged discomfort, not just in the hips but in areas like the lower back, knees, and even the neck.
  • Degenerative Joint Issues: Over time, the increased pressure on one side can accelerate wear and tear in the joints. This can lead to conditions like osteoarthritis in the affected hip or degenerative knee disorders.
  • Collapsed Arch: Continuous weight bearing on one foot can lead to a breakdown in its arch, causing flatfoot or other related foot disorders.
  • Trochanteric or Hip Bursitis: The bursa, a fluid-filled sac near the outside of the hip, can become inflamed due to uneven pressure distribution, leading to pain and swelling.
  • Pelvic Floor Weakness: An uneven pelvis can compromise the strength and function of the pelvic floor muscles, potentially leading to incontinence or other related issues.
  • Coccyx Pain: Misalignment can place undue stress on the tailbone, resulting in persistent discomfort.
  • Balance Disorders: Uneven distribution of body weight can disrupt an individual's center of gravity, leading to balance issues and an increased risk of falls.
  • Vertigo/Dizziness: While less common, persistent postural deviations can sometimes affect inner ear balance mechanisms, resulting in symptoms like dizziness or vertigo.
  • Decreased Athletic or Daily Functional Performance: An individual's ability to perform at their peak, whether in sports or daily activities, can be hampered due to the body's compensatory mechanisms trying to adjust for the uneven hips.
  • Muscle Imbalances: Continuous overuse of one side and underuse of the other can lead to certain muscles becoming overworked while others weaken, creating a cycle of imbalance and potential for injury.

Recognizing these risks and addressing the root cause help you prevent further complications and improve your quality of movement. Consistency in doing your customized exercises and regular check-ins help optimize progress in reversing these conditions and sustaining the changes.

What Causes Uneven Hips?

one-sided sports, activities, hobbies and lifestyle all can lead to uneven hips

Muscle Imbalances and Postural Deviations: The Silent Culprits Behind Uneven Hips

Muscle imbalances and the resultant postural deviations are among the primary reasons behind uneven hips. However, it's not just about the hips. A misalignment or imbalance in any part of the body can ripple effects that eventually impact hip position and function.

  • Asymmetrical Posture Deviations: When other parts of our body deviate from their optimal alignment, it can indirectly lead to uneven hips. For instance, someone with a forward head posture might lean their upper body backward to compensate, which can then put an uneven strain on the pelvis.
  • Elevated Side Dynamics: On the side where the hip appears elevated, certain muscles tend to become hypertonic (overly tight) while others become weakened. The hip flexors, notably the iliopsoas, can become tightened and shortened, pulling the front of the pelvis down. Simultaneously, the gluteus medius, which should be stabilizing the pelvis, may weaken, exacerbating the elevation.
  • Lowered Side Dynamics: Conversely, on the lowered hip side, the gluteus maximus can become inhibited and weak, failing to counteract the pull of the tight flexors on the opposite side. The quadratus lumborum, a muscle connecting the lumbar spine to the pelvis, may become overly tight in an attempt to stabilize and balance the pelvis, but this can further accentuate the uneven hips.
  • Lumbar Spine Impacts: The lumbar spine is intimately connected to the pelvis, and deviations here can influence hip position. For example, if there's a lateral curvature (scoliosis) in the spine, it might cause one side of the pelvis to lift.
  • Everyday Habits and Their Effects: The postures we assume daily, such as consistently crossing the same leg, leaning to one side while sitting, or even carrying a bag on one shoulder, can create and exacerbate muscle imbalances. Over time, these seemingly minor habits can lead to significant deviations in hip alignment.

In an age where sedentary routines dominate, the propensity to develop these imbalances has magnified. It becomes vital to recognize these asymmetries and address them promptly to ensure optimal alignment and function of the hips and the body as a whole.

Additional Factors Behind Uneven Hips

Uneven hips are a result of various factors, often intertwining and compounding. Beyond the evident muscle imbalances and poor posture, a myriad of life habits, past experiences, and even subtle personality traits play a role.

  • Past Injuries: An old injury, whether from sports, accidents, or random incidents, can have lasting impacts. The body's natural response to injury is often to compensate, leading to overuse or underuse of certain muscle groups. Over time, these compensations can contribute to uneven hips.
  • Avoidance of Past Pains: Sometimes, after experiencing pain on one side, people might unconsciously favor the other side to avoid potential discomfort. This subconscious favoring can gradually lead to uneven hips.
  • Dominance of One Side: Many of us have a dominant side, be it right or left. Activities like writing, throwing, or even the way we stand can lead to the overdevelopment and overuse of one side, contributing to the disparity.
  • Sports and Activities: Athletes or individuals who engage in specific sports may develop muscle imbalances due to the repetitive nature of their chosen activity. For instance, a tennis player or pickle-baller might have stronger muscles on their racket-holding side.
  • Habitual Behaviors: Simple daily habits, often overlooked, can influence our hip alignment. Consistently crossing one leg over the other, leaning to one side when sitting, or even the way we sleep can play a part.
  • Occupational Factors: Jobs that require repetitive motions or standing for extended periods can contribute. For instance, someone who always carries their bag on one shoulder or workers who lean to one side regularly.
  • Personality Traits: Surprisingly, our personalities can indirectly contribute. A more reserved person might habitually cross their legs, while someone more dominant might stand with weight predominantly on one leg.

In today's world, where sedentary lifestyles are commonplace, the risk of developing uneven hips has grown. Tightened hip flexors on one side due to prolonged sitting, combined with weakened glute muscles from lack of use, create a perfect storm for hip imbalances. Recognizing and adjusting these subtle habits can make a significant difference in preventing and correcting uneven hip alignment.

Posture Terms Related to Uneven Hips

  • Anterior Pelvic Tilt: This refers to a forward tilt of the pelvis, which is often associated with tight hip flexors and can exaggerate the appearance of a protruding abdomen and arched lower back.
  • Leg Length Discrepancy: When one leg is shorter or longer than the other, it can cause or contribute to a hip elevation on one side, leading to uneven hips.
  • Scoliosis: This is a sideways curvature of the spine that can either give the illusion of uneven hips or directly contribute to the condition.
  • Pelvic Tilt Disparity: A situation where one side of the pelvis is tilted more anteriorly (forward) or posteriorly (backward) compared to the other side, often causing asymmetry.
  • Knock Knees: This is when the knees touch or come close together while the ankles remain apart. It's especially common on the side with the lower hip.
  • Hyperextended Knee: The knee joint extends beyond its typical range. This can be due to weakness on the elevated hip side, or the heavily loaded side may cause the knee to overextend to compensate for imbalances.
  • Lateral Flexion (of the spine): A sideways bending of the spine. When it happens persistently to one side, it can contribute to uneven hips.
  • Trunk Offset (Trunk Lean): A condition where the upper body or torso leans to one side, often as a compensatory mechanism for uneven hips.
  • Pelvic Rotation: This refers to the pelvis turning or twisting to one side more than the other, which can alter hip alignment.
  • Trunk Rotation (Torso Rotation): A situation where the upper body or torso rotates or twists to one side, potentially stemming from or leading to pelvic rotation.
  • Uneven Shoulders: When one shoulder is higher or more forward than the other, it can be an indicator of larger postural imbalances, including those in the hip region.
  • Head Offset (and Head Tilt): This refers to the head being positioned off-center or tilted to one side. It's often a compensatory adjustment in response to other postural deviations down the chain, such as uneven hips or shoulders.

Don't Let Uneven Hips Throw You Off Your Game!

Balance issues, chronic pain, mobility issues all can stem from imbalances in the hips. Let's talk about how to get you back into alignment with our FREE Consultation and Posture Assessment.


Uneven hips represent more than just an aesthetic concern; they signify a multifaceted interaction of muscular imbalances, structural deviations, and ingrained habits. Addressing this requires a comprehensive understanding of interconnected postural deviations and the physiological and musculoskeletal implications that accompany them. Integrative approaches, such as posture therapy offered at Activ8 Posture, not only address the immediate concerns but also target the root causes, paving the way for optimal alignment and enhanced biomechanical efficiency. If you’re experiencing symptoms related to uneven hips, or if you’re unsure, a free consultation and posture assessment will help assess your situation. This proactive step is a game-changer on the path to restoring equilibrium, enhancing mobility, and ensuring your long-term health and wellness.

Frequently Asked Questions

What is a lateral pelvic tilt?

A lateral pelvic tilt is a postural deviation where one side of the pelvis rests higher than the other. This can result from a combination of muscular imbalances, skeletal misalignments, habitual patterns, and even past injuries or dominant side use.

What are the symptoms of a lateral pelvic tilt?

Symptoms can vary widely but often include hip pain, lower back discomfort, joint issues, S-I joint pain, knee pain, gait abnormalities, sciatica, IT band syndrome, foot pain, and disturbances in balance.

How can you find out if you have a lateral pelvic tilt?

To perform a preliminary self-assessment, you can stand barefoot in front of a full-length mirror and observe the level of your hips. Another method involves noting the orientation of your feet and weight distribution. However, for a comprehensive evaluation, it's best to consult with a healthcare or posture professional.

What’s the outlook for a lateral pelvic tilt?

With the right interventions, which may include posture therapy, targeted exercises, and conscious postural adjustments, individuals can address the underlying causes and symptoms of a lateral pelvic tilt, enhancing their overall well-being and biomechanical function.

How can I fix my uneven hips?

Many traditional therapies often perceive uneven hips as a genetic, insurmountable issue, frequently resorting to orthotics or heel lifts as a primary solution. When symptoms related to uneven hips, such as sciatica, manifest, conventional physical therapy might typically focus on actions like hamstring stretches and core-strengthening exercises, missing the root cause— the elevated hip itself. In contrast, postural therapy adopts a more holistic approach. It addresses the underlying cause of the symptoms, aiming to return the body to its natural, optimal alignment. By working with the body and its unique biomechanics, posture alignment specialists seek to correct imbalances at their source. Always remember, though, that every individual's body is different. It's paramount to pursue a tailored strategy, grounded in a thorough understanding of one's specific alignment and needs.

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