Having one hip appear higher than the other is a visible sign of pelvic asymmetry, often called a functional or structural leg length discrepancy. This imbalance means the pelvis is not level, causing one side to sit higher than the opposing side. This unevenness frequently leads to discomfort, postural issues, and compensatory strain throughout the body. Understanding the precise root cause is the first step toward implementing an effective treatment plan.
Identifying the Underlying Cause of Hip Height Difference
Determining the reason behind uneven hips is important because the treatment approach depends entirely on the underlying mechanism. The disparity is categorized into two types: structural and functional discrepancies.
A structural difference indicates a true variation in the bone length of the femur or tibia, meaning one leg is physically shorter than the other. These differences may originate from congenital conditions, previous trauma affecting a growth plate, or developmental issues. Specialized X-rays, such as a scanogram, are required to accurately diagnose and measure a structural discrepancy. This precise measurement is needed because the degree of correction is directly linked to the finding. If the issue is bone-based, the body struggles to maintain a level posture, leading to a tilted pelvis.
In contrast, a functional discrepancy occurs when the legs are the same length, but the pelvis is tilted due to soft tissue imbalances, muscle tightness, or poor movement patterns. This is an acquired issue where the apparent difference is not skeletal but relates to how the body holds itself. For example, tightness in the hip flexors or weakness in the gluteal muscles and core stabilizers can pull the pelvis into an uneven position. Compensatory patterns from issues like a pronated foot or ankle instability can also cause the pelvis to tilt. Treating a functional discrepancy requires addressing the muscle imbalances and postural habits creating the tilt.
Recognizing the Secondary Symptoms
The uneven load distribution caused by a tilted pelvis forces the rest of the body to compensate, resulting in secondary symptoms. Chronic low back pain is common, often presenting as unilateral discomfort or pain that shifts sides. This strain arises from the constant need to stabilize the torso over an uneven base.
Changes in walking patterns, known as an altered gait, are also common. An individual might develop a subtle limp or an uneven stride length while managing the difference in leg length or pelvic position. This uneven movement transmits stress down the kinetic chain, leading to discomfort or soreness in the knees and ankles.
The body’s attempt to level the head and eyes can lead to compensatory curves higher up the spine, sometimes manifesting as mild, functional scoliosis. This chain reaction may also result in a noticeable shoulder height discrepancy, where the shoulder on the side of the higher hip appears lower. Muscle soreness or fatigue often concentrates in one leg or hip, as those muscles are overworked maintaining balance and posture.
Non-Surgical Solutions for Pelvic Alignment
The approach to correcting the higher hip depends entirely on whether the cause is structural or functional.
For individuals with a structural leg length discrepancy, management focuses on externally correcting the height difference to level the pelvis. This is achieved through shoe lifts, heel inserts, or custom orthotics prescribed by a specialist, such as a physical therapist or podiatrist. The goal of this external correction is to physically bridge the gap between the shorter leg and the floor.
The prescribed correction is rarely the full measured difference; instead, it is often a partial lift introduced gradually. This allows the body to adjust without causing new strains.
For functional discrepancies, the solution lies in internal realignment through manual therapy and corrective exercises. A physical therapist performs an assessment to identify the specific tight and weak muscles contributing to the pelvic tilt.
Treatment for functional issues involves a targeted program of stretching and strengthening. Stretching focuses on releasing muscles that pull the pelvis out of alignment, such as tight hip flexors, hamstrings, or the piriformis muscle. Strengthening exercises focus on stabilizing the pelvis by activating weak muscles like the deep core stabilizers and the gluteus medius and maximus.
Postural awareness and ergonomic adjustments are also components of correcting a functional tilt. Simple changes, such as avoiding crossing the legs while sitting or ensuring proper support while driving, can prevent the re-establishment of detrimental muscle memory. Consulting with a healthcare professional ensures the chosen solution is safe, appropriate, and directly addresses the specific cause of the pelvic asymmetry.