Back pain, hip pain, and knee pain can creep into your daily life and interrupt even the most simple of activities. But what is the culprit of your achy ailments?

Believe it or not, you may have a twisted pelvis. And it could be caused by nothing more than going through your day-to-day life (no obvious injuries needed).

Often referred to as a tilted pelvis, pelvic misalignment can create a dramatic chain reaction through your body - causing pain and tightness to arise in surprising places. It is easy to attribute pain in your lower back or even hip pain to things like arthritis, but there is a far more common reason that can be easy to overlook: muscle tightness that leads to pelvic tilt.

When you think about all the movements your hip region is responsible for, it’s not surprising that they may be feeling overworked.

Your hip flexor muscles are even engaged while you are sitting as they stabilize your core! And when these muscles are allowed to remain tight, they add strain to neighboring joints, muscles, tendons, and ligaments.

Over time, this muscle tightness has the potential to cause your pelvis to be pulled out of alignment. This leaves you with a twisted pelvis and a tight core.

The anatomy of your pelvic region

Before we jump into defining what a twisted pelvis is, and how to identify some possible twisted pelvis symptoms, it’s important to know how all the parts of your pelvic region interact together.

The bones and joints that are the main players in your pelvis include your femur (thigh bone), pelvic bone, and spine (vertebrae). Your thigh bone is what connects to the pelvic bone, making up your hip joint.

Your pelvis then is made up of three separate bones that connect: the ilium bones that join in front to make your pubic joint, and then one in back called the sacrum that connects to the ilium. This connection in the back is your sacroiliac joint. You’ve probably heard the sacrum referred to as the “tailbone.”

Now, to set the anatomical stage for your pelvis, let’s think of your bones as puppets.

Without your muscles, your bones would not be able to move around. The muscles grab hold of the bones at their connection points and pull on them like strings in a puppet show. Essentially, without your muscles (and ligaments or tendons), your bones are inanimate.

There are 19 different muscles that cross through your hip region. All of the muscles in your pelvis region play important roles and cross joints at different angles. Some of your muscles are very long, extending all the way from your pelvis to your knee joint, while others are only a few inches in length.

Two of the primary muscles are the iliacus and the psoas muscles. All of your muscles have their own specific job when it comes to movement, but they all work in conjunction with your iliopsoas.

They’re either working with your hip flexors or in opposition to them.

The iliopsoas muscles have two primary roles: they help your hip flex or move forward, and they hold the spine in place relative to your pelvis.

Essentially they are what keep you upright, whether in motion or sitting/standing still.

Your iliacus crosses over your hip joint and attaches to your pelvis which is why it affects your sacroiliac joint as well. Then, your psoas muscle crosses over your hip joint and the pelvis all the way to your lower spine.

These two muscles are also commonly known as your hip flexors or the iliopsoas muscles. And when not properly taken care of, they can be the culprit of your hip pain, back pain, and a whole other slew of issues. These muscles are NOT quiet about expressing their unhappiness!

There are other major muscle actors that help with hip flexion, including the pectineus, rectus femoris, tensor fasciae latae (connects to your IT band), and part of your gluteus medius on the outside of your hip. All of these muscles help the iliopsoas perform hip flexion, but there are also many muscles that pull in the opposite direction.

These opposing muscles are in a sort of tug-of-war, working to keep the bones in the proper alignment.

Most of the muscles that help with hip flexion and forward leg movement are on the front of your body, and the opposing muscles are on the back of your body. Your glute muscles are the primary muscles that help pull your leg backward (called hip extension), but these opposing muscles also include your quadratus lumborum, hamstring muscles, and the piriformis muscle.

Your body is at its optimal alignment when your spine, pelvis, and hip are all lined up and held together properly. But when your iliacus and psoas are too tight, they begin to pull too much in one direction or on one side, causing other aspects of your hip region to topple out of place.

For instance, when your iliacus is constantly pulling and tightening, it can pull your pelvis forward - adding tension to your piriformis muscle and SI joint. This can cause hip pain and even change your posture as the iliacus pulls on the hip and spine bones.

Once your bones are out of alignment, it can start to cause knee pain as your posture is compromised more and more. That effect will start to trickle down your whole leg and can manifest as knee or leg pain. It can even change your walking stride.

It’s clear to see that, without healthy hip flexors, you don’t have a strong foundation. And you are likely set up for a domino effect of issues - including a twisted pelvis.

What is a twisted pelvis?

It is good to know how your muscles and bones are working together, and that tight muscles can cause a twisted pelvis, but what exactly does that mean?

The short definition of a twisted pelvis or pelvic tilt is an abnormal positioning of your pelvic bone.

When your pelvis is in a neutral position, your ilium (the large, flared portion of your pelvic bone) forms a joint with your lower spine (the tailbone or sacrum). As I mentioned above, this junction is known as the sacroiliac (SI) joint.

There is also a socket that forms at the base of your pelvic bone which is where your hip joint ball and socket junction with your thigh bone.

A neutral pelvis position is when the hip points and your pubic bone are aligned and in the same plane. This means that they are vertical when standing - and horizontal when you are lying down - and that both sides of your hip points are also aligned in the same plane.

A twisted pelvis occurs when there’s a misalignment of the pelvic bone itself, which is why a twisted pelvis is often referred to as pelvic misalignment.

There are several causes of a pelvic misalignment, but they are usually either structural or functional problems within your legs, hips, or spine. The most common causes of pelvic tilt include:

• Muscle imbalances
• Uneven leg lengths
• Spinal scoliosis
• Tight iliopsoas muscles

The primary cause of your pelvic tilt is also a determining factor in the exact type of pelvic misalignment you have. There are three main types:

1. Anterior pelvic tilt: Anterior pelvic tilt is when your hip bones are pushed or pulled forward. This occurs when the bottom of your pelvic bone tips back and up. This type of pelvic tilt is the most common one associated with tight hip flexor muscles. It is also a common issue during pregnancy.
2. Lateral tilted pelvis: A lateral pelvic tilt (or pelvic upslip) is when the pelvis is misaligned side to side. This means that one side of your hip is sitting slightly higher than the other, causing a tilt. This type of pelvic tilt is most often caused by uneven leg lengths or spinal scoliosis.
3. Posterior tilted pelvis: Posterior pelvic tilt is the opposite of an anterior pelvic tilt. It happens when your pelvic bone scoops under the body towards the front. This type of misalignment pushes your hip bones backward and stretches your lower back muscles, flattening the natural curvature of your lower spine. A common cause of posterior pelvic tilt is tight hamstring muscles.

Since there are varying causes for each type of pelvic tilt, the culprit of your own issue can sometimes be difficult to identify. But, more often than not, you will start off with an innocent sensation, like tight hip flexor muscles. As the pelvic tilt worsens over time due to poor posture, excessive sitting, or general muscle weakness and imbalances your symptoms may become more noticeable.

8 clues or twisted pelvis symptoms

The first step toward a twisted pelvis correction is identifying if you have a pelvic misalignment to begin with. This can get tricky because not everyone that has a pelvic tilt can visually see it. In fact, they may not have any obvious symptoms!

The symptoms of pelvic misalignment often begin to occur in patients with severe pelvic tilts, whereas minor tilts may not have any pain or discomfort associated with the issue.

If your twisted pelvis does cause symptoms, they will often occur in a variety of places in your body, not just the pelvic region. For example, if...

1. You are experiencing hip pain, lower back pain, or leg pain
2. Your gait is uneven or you are having trouble walking normally
3. You are experiencing SI joint irritation and inflammation
4. You have pain in your buttocks
5. You feel numbness, tingling, or weakness of your legs
6. The height of your hip bones is uneven
7. You are experiencing pelvic floor muscle weakness
8. You have an extreme lower back arch or lack of an arch

...then you may be experiencing twisted pelvis symptoms.

Identifying a pelvic tilt can be difficult when basing it solely on symptoms because it can mirror several other issues, including sciatica pain. Consulting a medical professional or doing an at-home pelvic tilt test can help you narrow down the possible causes of these symptoms.

To properly and officially diagnose a twisted pelvis, your doctor will likely perform a physical exam and measure the angle of your pelvis to determine the type and severity of the tilt. The physical examination will usually be accompanied by various questions to help determine the best course of treatment.

Remember, there is no replacement for an official diagnosis. It’s always important to work with a licensed professional before beginning any treatment program.

Twisted pelvis treatment options

A twisted pelvis can cause several issues, including pain that interrupts your daily life. But I have good news for you: It can be corrected relatively easily - and without surgery in almost all cases.

Once the cause of your pelvic tilt has been determined, then you and your doctor can decide the best type of treatment for your specific needs.

For instance, if you have a twisted pelvis that is caused by muscle problems like tight hip flexors, then treatment will involve extended pressure release of the psoas and iliacus muscles, hip flexor stretches, and the appropriate strengthening of the hips, glutes, and core.

Keep in mind that although this is likely to treat anterior pelvic tilt, tight hip flexors can also pull on and tighten muscles on the back of your hip like your piriformis. So, stretching, strengthening, and pressure release should occur on both sides.

When working on how to fix a rotated pelvis, it can be beneficial to work with a physical therapist to target specific needs. We can teach you how to do exercises and stretch properly to avoid creating more issues and avoid pain.

A physical therapist can also perform pressure release of your muscles for you. This is often the easiest and only way to target your iliacus and psoas muscles responsible for an anterior pelvic tilt.

That’s because it’s nearly impossible to find the right angle and apply the right amount of pressure needed to release these muscles on your own.

But I have more good news for you.

With the help of the Hip Hook, you can perform this much-needed muscle release at home. This is a great supplement between your appointments, making treatment more accessible and effective.

If you experience severe pain due to a twisted pelvis, some doctors may recommend certain injections to alleviate pain as you begin treatment. Although surgery is uncommon, if the pelvic tilt is due to a structural problem of some kind, it may be necessary.

Frequently asked questions about having a twisted pelvis

Is a tilted pelvis painful?

One tilted pelvis symptom can be pain or tightness in the muscles and areas around your hips. The level of discomfort you feel often depends on the severity of the tilt or misalignment.

If you are experiencing pain in your hips, lower back, and knees you may want to discuss the possibility of having a tight iliopsoas and/or pelvic tilt with your doctor or physical therapist.

Can a tilted pelvis cause bladder issues?

Yes, a severely tilted pelvis can cause some incontinence, if left untreated. When your pelvis is misaligned, it can impact the strength of your pelvic floor muscles which can make it more difficult for you to control your bladder. This is a normal symptom that can be managed or may even go away with an effective treatment plan.

Should I see a chiropractor for my twisted pelvis?

A chiropractor can be a helpful resource during your treatment of a pelvic tilt but they should not be the sole treatment provider. A combination of chiropractic work, physical therapy, and consistent at-home exercise can help move your pelvis back into alignment over time.

But remember, to keep your pelvis and hip muscles happy, you’ll need to make some changes to your daily habits, posture, and stretching routine.