Do you ever wonder why:
- One hip always seems to be tighter than the other?
- One leg tends to rotate out when you sit, stand, walk, or run?
- You just can’t seem to shake that stubborn foot, knee, or hip pain?
The answer could be that your pelvis is rotated.
Correcting this isn’t about more hip stretches. It’s instead about stretching your pelvis into a neutral, balanced alignment. In this article, we introduce a new tool to make it happen.
This article is the first in a two-part series meant to help identify and correct pelvic rotations. In part two, next month, we’ll look at how to strengthen into a neutral, balanced pelvis by identifying running-specific pelvic and hip strength strategies.
The Rotated Pelvis: What Is It?
In a previous article covering all things pelvis, we reviewed the bones of the pelvis, how it should move, and what may happen if we lose motion.
Specific to a rotated pelvis, this occurs when at least one — but often both — bones are rotated out of neutral in the frontal plane. Anatomically, this refers to the internal and external rotation of the pelvis bones. Visually, this means the pelvis bones, when viewed from the front are either excessively open (external rotation) or closed (internal rotation).
What’s most common is when the two interconnected bones are in a paired rotation: one bone is internally rotated, and the other is externally rotated. Known as a torsion, this often happens as a result of a major restriction on one side of the body. To adapt, the opposite side of the pelvis pairs by doing the opposite motion.
While this maintains joint continuity in the bowl of the pelvis, it results in a stubborn and troublesome net rotation to one direction.
Imagine driving a car. You want to go straight, but both rims of your front tires are pointed left. This is what it can be like to run with a left pelvic rotation or torsion. This isn’t a habit: the bones, and often, surrounding soft tissues, are stuck in this alignment.
Runners who have a pelvic rotation often feel twisted. Indeed, when a pelvis gets rotated, the rest of the body usually compensates, creating stiffness — usually a counter-rotation in the ribcage — and a whole lot of stiffness, aches and pains, and other issues in the legs.
The Rotated Pelvis: Problems It Causes
Stiffness and Imbalances
At the very least, a rotated pelvis causes significant alignment and mobility imbalances. One leg is often rotated more than the other. Since we notice outward rotations more, we tend to identify an externally rotated leg more easily. But with paired rotations, the out leg looks more extreme, because the opposite leg is subtly internally rotated as well.
Some examples include, which are pictured in the numbered images below:
- A rotated leg in a standing position
- Imbalanced cross-legged sitting in a chair
- Imbalanced cross-legged sitting on the ground
- Paired rotation imbalances while sitting
1. A rotated right leg in a standing position. All photos: iRunFar/Joe Uhan
2. The left leg has increased external rotation, and the right has decreased external rotation.
3. The butterfly stretch position shows the right leg with increased external rotation.
4. When both legs are more mobile going in one direction, this is a paired pelvic rotation. Here, the pelvis is rotated left: the left hip has more external (than internal) and the right hip has more internal (than external).
And while running, you might see:
- A heel whip, which indicates an internally rotated leg
- A toe out, which indicates an externally rotated leg
These are also demonstrated in the numbered images below.
1. The author demonstrates a heel whip. This occurs when the hip and pelvis have excessive internal rotation: the femur rotates in, thrusting the shin and foot, outward.
2. The author demonstrates a toe-out swing phase. This often occurs when the hip and sometimes tibia have excessive external rotation.
Chronic Aches, Pains, and Injuries Caused by Pelvic Rotation
As we mentioned before, imagine trying to drive your car straight down the road, yet the wheels are stuck, pointed left! Now consider the strain on the legs when the pelvis is stuck rotated to one side.
A rotated pelvis causes excessive and imbalanced landing forces on the legs. This might manifest as excessive pronation on one leg with excessive supination on the other. This is a major factor in foot, lower leg, and knee pain.
Pelvic rotations change how the hip muscles pull on the femur. Chronic hip flexor, adductor, and hamstring strains, as well as gluteal tendinopathy and hip impingement, are common issues stemming from pelvic rotation.
The Rotated Pelvis: What Causes It?
As discussed in the runner’s pelvis article, the most common causes of pelvic dysfunction include:
- Trauma
- Surgery
- Pregnancy and childbirth
- Visceral dysfunction, where abdominal illness or food sensitivity causes gut mobility loss
All these factors can directly cause a pelvis to lose its efficient alignment and motion. The pelvis gets stuck, so it can’t move or align correctly.
But there’s another factor that can cause chronic pelvic torsion: upstream factors. Head, neck, or thoracic cage injury can cause fascial tension compensations that can pull the pelvis into rotation.
Pelvic Rotation Treatment, Part 1: 360-Degree Mobilization
Directly addressing pelvic rotational deficits requires approaches that are specific to the pelvis. Most hip stretches mobilize the hip, meaning the femur-on-pelvis joint, only.
Pelvic rotations originate in the pelvis’s articulation with the trunk. This includes at least three articulations, listed and shown in images below:
- Sacroiliac joints — where the pelvis connects to the sacrum in the back
- Pubic joint — where the pelvis connects to one another in the front
- Trunk’s soft tissues — the belly in the front and sides, and abdominal musculature around the full circumference
1 and 2. The sacroiliac and pubic joints on the pelvis. Image is a modified Shutterstock image.
3. Lateral trunk musculature and the pelvis. Image is a modified Shutterstock image.
In order to restore balanced motion and alignment, the pelvis must first be freed from soft tissue restrictions.
To do so:
- Mobilize the front and sides of the belly, just above the pelvis, using a soft ball.
- Mobilize the muscle and fascia on the sides and back of the pelvis, above the bony rim, targeting muscles like the internal and external obliques and the quadratus lumborum, using a firmer ball.
Once that soft tissue is free, the Roll-and-Reach Exercise can address the bony pelvic joints.
Pelvic Rotation Treatment, Part 2: The Roll-and-Reach Exercise
The main tool to improve rotation is the Roll-and-Reach Exercise. This requires a foam roller or ball, upon which one leg rolls, and reaches, on the other. I first observed this exercise from Conor Harris, a personal trainer with advanced biomechanical expertise who focuses on novel ways to optimize movement efficiency.
To perform the Roll-and-Reach Exercise:
- Position yourself in a side-lying position, with your legs flexed to about 100 degrees of hip flexion. This can be adjusted based on the hip angle at which you feel the most restriction.
- Place a foam roller between your knees.
- Move the top leg, first, by reaching forward as far as possible, and then, retracting the leg as far as possible. The top leg rolls atop the foam roller, while the bottom leg stays stable.
- The pelvis and lower back should move, and the ribcage and shoulders should remain stable.
- Hold the end of each range for a full second.
- Experiment with different hip angles to identify the stiffest areas.
This video demonstrates the Roll-and-Reach Exercise:
How the Roll-and-Reach Exercise Works
Pelvic rotation is very difficult to isolate. This exercise achieves that by focusing the motion at the sacroiliac joint — the articulation between the pelvis and sacrum bones. The hips also rotate during the Roll-and-Reach Exercise, though to a lesser extent.
When reaching forward, the top leg — both the hip and sacroiliac joints — go into external rotation, opening relative to the sacrum. The bottom leg, though not moving, is pushed into internal rotation. When retracting backward, the motions reverse.
Conclusion
Pelvic mobility and alignment are subtle but substantial factors in how fast, far, and pain-free we can run. Check in with pelvic mobility if you have any stubborn aches and pains, or alignment, mobility, or strength imbalances.
Next month, in part two of this short series, we will outline how to strengthen into a neutral, balanced pelvis by identifying running-specific pelvic and hip strength strategies! Stay tuned.
Call for Comments
- Do you have any hip rotation issues?
- If so, how have they affected you and what have you done about them?
