Your hip bones are part of your pelvis. When your hips are uneven, with one hip higher than the other, it means your pelvis is tilted.

This is also called a lateral pelvic tilt, and only a few things cause it. The symptoms and treatment depend on the reason your hips are uneven.

The main reasons for uneven hips are:

  • scoliosis, which can be mild to severe and change over time
  • a difference in leg length that comes from posture and stance, which is functional rather than physical
  • a physical, or structural, difference in the lengths of your legs

Scoliosis

  • A mild spinal curve in children is usually followed with back X-rays every four to six months. It’s not treated unless the curve gets worse. Only about 10 percent of people with scoliosis have a severe enough disease to need treatment.
  • Doctors may recommend a back brace for children older than 10 while their bones are still growing. It won’t correct the spinal curve, but it will stop it from progressing. It’s usually worn all day and night, except when it interferes with participating in sports and other activities.
  • In cases of severe or rapidly worsening scoliosis, doctors may recommend surgery to fuse the vertebrae together with a rod or artificial bone to stop progression of the curve.

Functional leg length discrepancy

You can do several things to correct uneven hips when the measured length of your legs is equal:

  • Massage can help remove any knots and relax your muscles.
  • Exercises that stretch the side with the tight muscles can improve the mobility and range of motion of your legs and hips. These are the main treatment for uneven hips.
  • Exercises that strengthen your muscles are also helpful.
  • It’s also important to correct any bad posture, so the problem doesn’t come back.

Structural leg length discrepancy

Correcting uneven hips when the measured length of your legs is unequal is more difficult. According to the Pediatric Orthopaedic Society of North America, treatment is based on the difference in leg length:

  • Young children and adolescents who are still growing may just be observed until bone growth has stopped.
  • Wearing a lift in the shoe worn on the shorter leg can help reduce back pain and improve the ability to walk with a normal gait. This is the usual treatment for mild leg length discrepancy (less than 2 centimeters).
  • In more severe cases, surgery to even out the leg length might be considered. If the length difference is 2 to 5 centimeters, a surgical procedure to stop or slow bone growth in the longer leg is usually done. For a difference over 5 centimeters, a more complicated procedure that makes the shorter leg longer is usually done.

Uneven hips and scoliosis

Scoliosis isn’t caused by carrying heavy weights or back packs in school, or by bad posture. For kids, it may help them to know they didn’t cause it, and there isn’t anything they could do to prevent it.

If a child receives a scoliosis diagnosis and it seems to be getting worse, a back brace or surgery may help prevent the condition from progressing.

In scoliosis, the spine usually begins to curve right before puberty, when children have a growth spurt. This can be a difficult time in life because of all the physical and hormonal changes occurring.

A child who has scoliosis at that age may feel angry, embarrassed, insecure, or self-conscious because of their appearance or having to wear a back brace.

It’s important that children talk about their negative feelings and have someone to confide in.

Finding a support group for a child with scoliosis allows them to meet others like them who are having the same experience. It also gives them a place to talk about how they feel and find out how others deal with it.

Stretching exercises to loosen and lengthen muscles are used to correct functional leg length discrepancy. They also help improve back pain and other symptoms.

The main muscle to stretch is called the quadratus lumborum. This muscle connects the pelvis and backbone.

Any stretch that increases the distance between your hip and shoulder on the side with the higher hip is good. Here are five stretches that can help.

The 90/90 stretch

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  1. If your right side is tight, sit on the floor with your right leg in front of you bent at a 90-degree angle, with your knee and ankle on the floor. Align your knee with your hip.
  2. Your left leg should be out to your left side, bent at the knee into a 90-degree angle. This may be uncomfortable.
  3. Reach forward with your right hand, pushing your right hip away from it.

Leg split with quadratus lumborum stretch

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  1. Sit on the floor with your legs open as wide as possible.
  2. Reach your right hand over, trying to touch your left foot. You don’t actually need to touch your foot.
  3. Then reach your left hand over to your right foot. This stretches the quadratus lumborum on both sides.

Child’s pose with hand reach

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  1. To get into child’s pose, start on your hands and knees, then sit back onto your heels and bring your forehead towards the floor to keep your head low.
  2. From child’s pose, where you are seated on the ground folded over your thighs or lap, lift one arm and reach out as far in front of you as possible. Repeat using the other arm.
  3. With arms still outstretched, walk your hands over to one side. This will stretch your lower back and hip on the opposite side.
  4. Stay in this position, and breathe in and out as you stretch.

Strengthening the weak, loose muscles, including the quadratus lumborum, of the lower hip can also help. Exercises that help this include:

Side plank

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  1. Lie on the floor on your side with your feet together and prop yourself up with your forearm below you on the floor. Align, or stack, your elbow underneath your shoulder.
  2. Contract your abdominal muscles and lift your hips, so your body makes a straight line.
  3. Hold this position for 15 seconds at first. You could work your way up to 4 minutes over time.
  4. Repeat on your other side.

Superman

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  1. Lie on the floor on your stomach.
  2. Extend your arms straight out in front of you and your legs out behind you.
  3. Lift your arms and legs about 6 inches off the floor.
  4. Contract your abdominal muscles and reach out as far as possible. Hold for two to three seconds.
  5. Relax your arms and legs back down to the floor.

Your pelvis is connected to your shoulders and upper back by your spine. It’s also connected to your legs. So, the effects of uneven hips can sometimes be seen in these areas:

  • Uneven shoulders. Your shoulders may look uneven too, but the side with lower hip will usually have the higher shoulder.
  • Prominent shoulder blade. Your shoulder blade might stick out more on the side with the lower hip.
  • Curved spine. Your spine may look like it’s curved into the shape of an S or C if the cause of your uneven hips is scoliosis.
  • Difference in leg length. Uneven hips can make the leg on the side with the higher hip look and feel longer than the other, even though they’re really the same length. Having one leg that really is longer than the other can cause uneven hips.
  • Prominent rib cage on one side. Uneven hips caused by severe scoliosis can make your rib cage twist, so the ribs on the side with the higher hip stick out further than the other.

Scoliosis effects

The symptoms of uneven hips vary based on its cause and severity. Early, mild scoliosis often has no symptoms. Symptoms of more severe scoliosis and other causes of uneven hips include:

  • back pain
  • hip pain
  • knee pain
  • difficulty walking
  • unusual gait

Sometimes fitted clothes don’t fit comfortably when your hips are uneven. This, in addition to looking or walking differently, can make people become self-conscious and develop low self-esteem, anxiety, or depression.

Scoliosis

In this condition, your spine has a sideways “S”- or “C”-shaped curve and may be slightly rotated. It’s the most common cause of uneven hips.

Scoliosis can be caused by improper formation of the spine before birth, usually for unknown reasons. It can also have a neuromuscular cause, such as:

Scoliosis affects girls more often than boys and can run in families. The curve usually stops progressing when the bones stop growing. The curve is more likely to worsen when:

  • the curve is large
  • the curve is “S”-shaped rather than “C”-shaped
  • the curve is in the middle of the spine rather than the top or bottom

Functional leg length discrepancy

In this condition, one leg looks and feels longer than the other, but is the same length when measured. It’s caused by poor posture that leads to unbalanced muscle strength and tension.

When bad posture becomes a habit and you sit or stand in the same position daily for months or years, your muscles compensate. Some muscles become shorter and tighter and pull the hip up, and the muscles attached to the lower hip become weaker, longer and looser.

Another way this can happen is if you stay in one position with one hip higher than the other for a long time. This can happen if you always sleep on one side, arch your back while sitting for a long time, or always lean to the same side when sitting or standing.

Structural leg length discrepancy

In this condition, one leg is longer than the other when measured. Most people have legs that are slightly different in length, but it’s uncommon for legs to be so different in length that it makes the hips uneven.

According to the American Academy of Orthopaedic Surgeons, a difference of about 4 centimeters can cause walking difficulties or a limp.

Sometimes it’s congenital, which means a person is born with it. In that case, the cause is usually unknown. In other cases, it’s caused by:

Your doctor might notice you or your child has uneven hips during a routine physical exam, or you may notice it yourself, and see your doctor about it.

Scoliosis is frequently diagnosed during screenings done at school or during sports physicals.

Your doctor will ask you about your symptoms and perform an examination, including checking for scoliosis by looking at your back while you’re standing and when you’re bent at the waist with your arms hanging down.

Your doctor will also assess your hips and shoulders to see if they’re even or not. Other tests your doctor might do to help determine the cause of your uneven hips include:

  • evaluating the way you walk
  • measuring each leg and the difference in length between them
  • X-rays to look for abnormalities in the bones or take more leg measurements
  • scanogram, which is a special X-ray that gives a more accurate measurement of leg length
  • CT scan to look for abnormalities in the leg bones or tissue

In a child who is still growing, the same test first used to measure leg length is usually repeated every 6 to 12 months to see if the difference in length changes.

Regardless of what’s causing uneven hips or pelvic tilt, there are things you can do on a day-to-day basis to help. It’s also important to follow up with medical professionals over time.

Checking in regularly with your doctor or healthcare provider can help you get a proper diagnosis. It can also help you correct or stop the progression of certain conditions that may be causing uneven hips.