Scoliosis is the primary cause of uneven hips, but it can also be caused by a difference in leg length. Treatment options include exercise and surgery.
The hip joint is part of the pelvis. When your hips are uneven, with one hip higher than the other, your pelvis is tilted.
This is also called a lateral pelvic tilt.
Symptoms and treatments depend on what has caused your hips to be uneven.
The main reasons for uneven hips are:
- scoliosis, which may be mild to severe and can change as a young person grows
- a difference in leg length that comes from posture and stance (this difference is functional rather than physical)
- a physical or structural difference in the lengths of your legs
There are a few possible reasons why your hips are uneven. Uneven hips might be the result of a developmental issue that happened before you were born or a problem with your posture.
Scoliosis is the most common cause of uneven hips.
In this condition, the spine has a sideways “S”- or “C”-shaped curve and may be slightly rotated.
Most people experience their first symptoms between the ages of 10 and 15. Although people of any sex can develop scoliosis, girls are more likely to develop the condition and to have a more pronounced curve that requires treatment.
The curve is more likely to get worse if it’s “S”-shaped, large, or in the middle of the spine. It’ll usually stop progressing once the bones stop growing.
Scoliosis may occur because of an issue with the way the spine develops before birth. It can also be the result of a nerve or muscle problem, such as:
Scoliosis can run in families.
Functional leg length discrepancy
A functional leg length discrepancy is when one leg looks and feels longer than the other, but it’s the same length when measured. This discrepancy is caused by poor posture, which leads to tension and imbalances in muscle strength.
When poor 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, while other muscles become weaker. This leads to imbalances that may make one hip appear longer or shorter than the other.
Another cause of functional leg length discrepancy is staying in one position with one hip higher than the other for a long time. This can happen if you always lean to the same side when sitting or standing.
Structural leg length discrepancy
Structural leg length discrepancy is when one leg measures longer than the other.
Most people’s legs are slightly different lengths, but it’s uncommon for the legs to be so different in length that they make the hips uneven. A difference of only 2 centimeters (cm) can cause problems such as walking difficulties or a limp.
Sometimes the difference in leg length is congenital, which means you’re born with it. The reason for it may not be known.
In other cases, the discrepancy is caused by:
- a short or missing bone in the leg at birth
- a congenital abnormality in which the upper part of the thigh bone has not formed properly or is missing
- a severe infection in a leg bone during infancy or childhood
- a broken leg bone that heals badly during childhood
- an injury to the growth plate of the leg during childhood or adolescence, which is called a Salter-Harris fracture
- Blount’s disease, which affects the growth plates in the knee joint
- conditions that affect growth on one side of the body, such as clubfoot or developmental dysplasia of the hip
- conditions that make the joints swollen and inflamed, such as juvenile rheumatoid arthritis
- conditions that cause tumors to form on the bone, such as hereditary multiple exostoses (HME), neurofibromatosis, and Ollier’s disease
- nervous system disorders such as cerebral palsy or polio
- Legg-Perthes disease, in which loss of blood flow to the ball of the hip joint causes the bone to die
- hyperemia, which is increased blood flow into an area (such as the leg)
The symptoms of scoliosis vary based on the cause and severity. Mild scoliosis often has no symptoms. Symptoms of more severe scoliosis as well as other causes of uneven hips, include:
- difficulty walking
- unusual gait
- knee pain
- back pain
- hip pain
Your clothes might not fit well when your hips are uneven.
Differences in the way you walk or look can also cause emotional problems such as:
Other effects on your bones
Your pelvis is connected to your shoulders and upper back by your spine. It’s also connected to your legs. The effects of uneven hips can sometimes be seen in these areas:
- Uneven shoulders: Your shoulders may look uneven. The side with the 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: If scoliosis has caused your uneven hips, your spine might look like it’s curved into the shape of an “S” or “C.”
- Rib cage that sticks out on one side: If you have severe scoliosis, your rib cage might be twisted. This makes the ribs on the side with the higher hip stick out further than the other ribs.
- Difference in leg length: The leg on the side with the higher hip might look and feel longer than the other leg, even though they’re really the same length.
Treatment for uneven hips depends on its cause.
Mild cases may only need to be monitored. Surgery can be an option for more severe cases.
It may help kids to know that they didn’t cause their scoliosis and there isn’t anything they could have done to prevent it. Scoliosis isn’t caused by poor posture, using heavy weights, or carrying a heavy backpack.
Scoliosis usually isn’t treated unless the curve is severe.
Kids with mild spinal curves may need back X-rays once every 6 months to monitor changes.
A doctor may recommend a back brace for larger curves in kids who are still growing. A brace won’t correct the spinal curve, but it stops it from getting worse. Kids usually have to wear the brace throughout the day and night, except when it interferes with their participation in sports and other activities.
Only those with a severe curve of 45 to 50 degrees or higher will need surgery to treat scoliosis. During this procedure, the vertebrae are fused together with a rod or artificial bone to stop the curve from progressing.
Support for scoliosis
Scoliosis often starts just before puberty. This can be a difficult time for kids due to all of the physical and hormonal changes they’re going through.
A kid who has scoliosis at that age may feel angry, insecure, or self-conscious about their appearance or having to wear a back brace.
Consider having your kid join a support group for kids with scoliosis. This gives them a place to meet others like them. They can talk about how they feel and find out how others deal with scoliosis.
Functional leg length discrepancy
If your legs are of equal length, there are several things you can do to correct uneven hips.
- Get a massage to help remove any knots and relax your muscles.
- Perform exercises that stretch the side with the tight muscles to improve the mobility and range of motion in your legs and hips. Exercises that strengthen your muscles are also helpful.
- Correct poor posture so that the problem doesn’t return. Here are a few actions you can try:
- When you sit, put a rolled towel between your shoulders to keep your back straight and prevent slouching.
- When you stand, hold your neck straight and keep your shoulders even with your hips.
- Perform exercises like planks to strengthen the core muscles that support your spine.
Structural leg length discrepancy
Correcting uneven hips when the measured length of your legs is unequal is more difficult. Treatment is based on the difference in leg length and your age.
Young children and adolescents who are still growing may just be checked regularly until their bones have stopped growing.
Treatment for a mild leg length discrepancy (less than 2 cm) is usually nonsurgical. A doctor might recommend putting a lift in the shoe on the shorter leg to reduce back pain and make walking easier.
Surgery to even out the leg length is an option in more severe cases.
In young people who are still growing, a procedure called epiphysiodesis can be performed on the growth plates to slow or stop bone growth in the longer leg. Teens and adults who have stopped growing can have surgery to shorten the longer leg.
There are also procedures to lengthen the shorter leg, but these are more complex to perform.
The best stretches for uneven hips increase the distance between your pelvis and rib cage on the side with the higher hip.
One of the main muscles to stretch is the quadratus lumborum, which connects the pelvis and backbone.
Stretching exercises to loosen and lengthen the muscles are used to correct functional leg length discrepancy. They also help improve other symptoms, such as back pain.
Here are five exercises that can help if you have uneven hips.
The 90/90 stretch
- If your right side is tight, sit on the floor with your right leg in front of you bent at a 90-degree angle and your knee and ankle on the floor. Align your knee with your hip.
- Your left leg should be out to your left side, bent at the knee into a 90-degree angle. Adjust the angle slightly if it feels uncomfortable.
- Reach forward with your right hand while pushing your right hip away from your hand.
Learn more about the 90/90 stretch.
Leg split with quadratus lumborum stretch
- Sit on the floor with your legs open as wide as possible.
- Reach your right hand over to the left side and try to touch your left foot. (You don’t need to touch your foot.)
- Then reach your left hand over toward your right foot. This stretches the quadratus lumborum on both sides.
Discover other stretches for the quadratus lumborum.
Child’s Pose with hand reach
- To get into Child’s Pose, start on your hands and knees, and then sit back onto your heels and bring your forehead toward the floor.
- From Child’s Pose, lift one arm and reach it out as far in front of you as possible. Repeat with the other arm.
- With both arms still outstretched, walk your hands over to one side. This will stretch your lower back and hip on the opposite side.
- Stay in this position, and breathe in and out as you stretch.
- Repeat on the other side.
- Lie on the floor on your side with one leg stacked on top of the other. Push up until you’re propped up on one hand with your arm straight. Keep your elbow right underneath your shoulder.
- Pull in your abdominal muscles, and lift your hips until your body is in a straight line.
- Hold this position for 15 seconds at first. You may be able to work your way up to a few minutes over time.
- Repeat on the other side.
- Lie on your stomach.
- Extend your arms straight out in front of you and your legs out behind you.
- Lift your arms and legs about 6 inches off the floor.
- Pull in your abdominal muscles and reach your arms and legs as far as possible. Hold the position for 2 to 3 seconds.
- Relax your arms and legs back down to the floor.
Uneven hips have many causes, from scoliosis to conditions that lead to differences in leg lengths. Many of these underlying issues are diagnosed during childhood.
Treatments for uneven hips will depend on the severity of the issue and the person’s age. Treatments are available to correct or even stop the progression of uneven hips.
Some mild issues may require no treatment or be addressed with exercise or other lifestyle changes.
If a child has uneven hips, it’s important that they have follow-up appointments with a doctor as they grow. The doctor can monitor for any changes.