Charting a course for correcting pelvic obliquity seems like a task for a Chiropractic 101 class when considering its simplest definition: “A postural abnormality occurring when the pelvis tilts to one side.”
The reality is it can be more complex and require we use our full set of tools. Furthermore, while this may be a common presentation in your office, the chiropractic perspective on this and other neuromusculoskeletal issues is rarely the first to reach the public. The competing information a potential patient is exposed to when researching subjects like pelvic obliquity will likely add roadblocks to their path to chiropractic care. Therefore, your care plan needs to address all clinical components and be well-supported by patient education.
As the immediate base of support for the spine, the pelvis directly influences the effectiveness of your chiropractic care. The most common postural distortion of the pelvis is anterior translation. Often this distortion is caused by overpronation; when the arches collapse, the weight falls to the midline, the feet flare out and the body’s weight is pushed forward. This phenomenon presents itself overwhelmingly as asymmetrical — contributing to obliquity in the pelvis — and the margins are so small they may go unnoticed. A healthy population typically has a normal pelvic obliquity angle of 0–5.6°. Slight pelvic obliquity may be common and normal. This can also cause a bilateral stretch-weakness of the iliopsoas muscle bilaterally. Pelvic obliquity can cause abnormal posturing, which can increase stress on the spine, sacroiliac joint and hips. It can also cause pain in the buttock region, hip region, lower back or into the lower extremities.
A common chiropractic approach to correction would be to clear spinal subluxation before addressing any related areas like the hips and lower extremities as needed. This may take place within a visit or over the course of multiple visits. While getting through these clinical steps requires taking a position, the gold standard is to scan the patient’s feet on the first visit to further evaluate the status of the plantar vault. This investigative approach powered by our technique-indicator systems allows us to address what may be multiple causes. Prioritizing care around the spine and nervous system might be our first instinct, but most do not share this integrated view of the body. Unfortunately, the traditional linear approach to examination and diagnostics can create a funnel overly focused on symptoms.
Viewed from the public’s perspective, I believe you’ll find the world is hungry for chiropractic. A quick search yields the following possible causes for pelvic obliquity:
- Muscle imbalance
- Unsuitable seating
- Leg length inequality
- Scoliosis
- Hip contracture
- Gait abnormalities
- Spine surgery
- Trauma
The traditional approach people have been taught through conventional medicine is to follow each of these leads individually, but a chiropractic assessment and treatment plan has a pathway to address all of them. Let’s unpack some of the components of pelvic obliquity with a chiropractic solution in mind.
Muscle imbalance
Tight or weak muscles in the front or back of the pelvis, can cause misalignment. In the chiropractic model, the vertebral subluxation complex is the first consideration and explains functional muscle imbalance from nervous system interference. Muscle coordination is based on timing that’s measured in milliseconds. Even a partial loss of reception can disrupt muscle action timing, leading to a tug-of-war between muscles struggling to maintain balance. Psoas reactions are common to protect against SI joint instability, particularly involving the SI ligament, which is also vulnerable to dysfunction of the arches. In our exam, look at individual ranges of motion as well as symmetry of motion, a big part of our indicator systems that guide specific adjustments. This approach is critical in assessing spinal and pelvic dynamics.
Leg length inequality
Leg length inequality can cause pelvic obliquity. While planning how to correct asymmetrical pelvic tilt, there may be complicating factors, such as naturally occurring leg length discrepancies, which make compensatory misalignments a functional necessity. One of the most common findings that can introduce asymmetry to the legs and pelvis is excessive foot pronation (hyperpronation). In addition to occurring bilaterally, it usually presents asymmetrically. Extremity adjusting and custom flexible orthotics can balance the pedal foundation and minimize serial distortion, so your adjustments hold longer and better.
Hip contractures
Hip contractures can develop when the normally elastic connective tissues in the hip or knee are replaced by inelastic fiber-like tissue, which can prevent normal movement. Additionally, connective tissue contracture can affect neutral positioning, further compromising posture. The care plan may need to include ways to influence connective and soft tissues to hold and provide stability. By correlating the spine with hip and lower extremity fixation and misalignment, we can identify the whole-body patterns that cause pelvic obliquity and simultaneously map out areas that need support to recover.
Unsuitable seating, including an ill-fitting chair
Sitting down should offer a chance to recover from activity, but unfortunately, many people have to perform from an office/desk environment, and the choice is more of a necessity. Whatever postural abnormalities you bring to the chair can quickly be magnified if the chair can’t provide support and promote balance. After corrective chiropractic adjustments are given, holding adjustments will require expert guidance on posture in all common positions, such as sitting (proper chair selection and use), standing (flexible orthotics and shoes) and sleeping (positioning and pillow use).
Final thoughts
Each of these mechanisms involves the dynamic relationship between the spine and extremities through the pelvis. You can likely trace the pattern leading throughout the lower extremity. In these cases, we need to be resourceful and get as much support and function from the entire kinetic chain as possible. We can teach movement efficiency and build on posture-based behavior to help people manage these common abnormalities, even complex cases like pelvic obliquity.
ANISH BAJAJ, DC, is a 2000 graduate of Life University in Atlanta, Georgia, and the owner of Bajaj Chiropractic in New York, New York. Bajaj serves on the executive board of the New York Chiropractic Council and was the recipient of their Chiropractor of the Year Award in 2022. As a member of the Foot Levelers Speakers Bureau, he travels extensively, sharing his chiropractic knowledge and expertise with audiences around the U.S.
