A twisted pelvis, also known as pelvic torsion, is an extremely common distortion pattern but often remains undiagnosed. The result can be significant chronic pain that seems to have no clear explanation.
Without understanding this phenomenon, it's impossible to see the cascading muscular effects that can result.
Back pain, hip pain, knee pain, shoulder pain, neck pain, and more can potentially be traced back to this primary root cause.
To help us understand what we mean by a twisted pelvis or pelvic torsion it’s helpful to have a clear sense of the bony anatomy of the pelvis.
The pelvis is composed three bones:
To understand what we mean by torsion, let’s look to Miriam-Webster:
1: the twisting or wrenching of a body by the exertion of forces tending to turn one end or part about a longitudinal axis while the other is held fast or turned in the opposite direction also : the state of being twisted
2: the twisting of a bodily organ or part on its own axis
3: the reactive torque that an elastic solid exerts by reason of being under torsion
Pelvic Torsion, then, is a condition in which the two pelvic bones are twisting in opposite directions.
In the example below, the arrows indicate the rotational direction of this twisting motion.
Here, the torsion is an anterior (or forward) rotation of the right pelvic bone, with the left pelvic bone in an oppositional rotation.
A NOTE ABOUT THE IMAGES - The images don't show the actual twisting motion of the pelvic bones because the imaging I’m using doesn’t have this flexibility.
Therefore the bones, here, are in a neutral position. The red arrows are meant to imply the twisting direction of the torsion pattern.
When half of the pelvis rotates in one direction, and the other half rotates in the opposite direction we call that a twisted pelvis or pelvic torsion.
This puts the hip joints at a different height from one another.
In other words, the hip joints are no longer level with one another. One hip joint is higher and the other is lower.
The result is a functional leg-length difference.
When a pelvis is balanced, the hip joints are level and the legs are more or less equal in length.
However, as we've said, when there’s a torsion, one hip joint is pulled up higher than the other causing a functional leg-length difference.
In this example, a right anterior (forward) rotation has the effect of pulling the right hip joint upwards.
If you look closely at the right hip joint perhaps you can visualize how this happens.
Can you see how a right rotation around the longitudinal axis would elevate the right hip joint? And how that would result in the entire right leg being pulled up shorter?
The overall result is that the entire right leg becomes functionally short.
This does not mean that one leg is actually shorter than the other.
This is an example of a functional leg-length difference, as distinct from a congenital leg-length difference.
A congenital leg-length difference is one we're born with and in which the leg bones themselves are a different length.
A congenital leg-length difference is routinely and appropriately addressed with a shoe lift of some kind.
This strategy should not be used, however, in addressing a functional leg-length difference as this would fix the imbalance, the torsion, in place.
As we will see, a functional leg-length difference can be corrected — i.e. brought back into balance — while a congenital leg-length difference can only be compensated for.
When the legs are a different length, we have a balance problem whenever we’re upright in gravity.
This is one of the root causes for an array of potential problems because the body is knocked off its center of gravity and loses what we call equipoise, or overall balance.
When equipoise is lost, the body shifts from being in a neutral relationship with gravity to being in a struggle with gravity.
Our muscular system automatically strives to bring us upright, contracting certain muscles to counter the force of gravity.
But over time this can develop into a series of muscular contractions that become entrenched, resulting in chronic pain.
Certain muscles become locked short -- fixed, stuck, adhered -- while other muscles become locked long -- strained, overstretched, weakened.
Over time, these compensations can become the source of significant pain and dysfunction in the body.
The short answer is hip flexor dysfunction.
Our primary hip flexors are the iliacus muscle and the psoas muscle.
While these are two distinct muscles, they share a common attachment at the upper inner thigh and are commonly referred to as one muscle: the iliopsoas.
Hip flexor (or iliopsoas) dysfunction means that one or more of these paired muscles -- right iliacus, right psoas, left iliacus, left psoas -- has adapted into a shortened position.
When these adaptations occur in a non-uniform manner, the result can be a twisted pelvis, also known as pelvic torsion.
Once pelvic torsion is present, a whole cascade of additional muscular adaptations can result which serve to reinforce the torsion pattern.
But what causes hip flexor dysfunction in the first place? What causes the imbalance between the right and left iliopsoas muscles?
The causes of hip flexor/iliopsoas dysfunction include:
For more on iliopsoas dysfunction please see:
I used to think the answer to this question was, yes. I used to think there were a variety of patterns.
But after thirty years of evaluating and treating this problem, I no longer hold that view.
I now believe that in the industrialized world -- in which sitting in chairs and on standard toilets, with the legs at a right angle to the body -- there is strong evidence of a single dominant pelvic torsion pattern.
This torsion pattern is characterized by an anterior rotation of the right ilium (as is indicated in the example above), and a fixing or bracing of the muscles of left pelvic region and hip.
I call this pattern the Right Anterior, Left Fixed Pelvic Torsion Pattern, or The RALF Pattern for short.
While there are some variations from person to person, this is the twisted pelvis torsion pattern I have seen again and again in clinical practice.
Sensory Motor Amnesia is a term coined by Thomas Hanna who developed the movement re-education system called Somatics. Sensory Motor Amnesia means that we have lost sensory motor awareness and control of certain muscles in our body.
One result of Sensory Motor Amnesia is that certain muscles can remain chronically contracted and we don’t have the ability to relax them. If we can’t sense a contracted muscle, then we can't change its state.
A twisted pelvis is often characterized by loss of sensory motor awareness and control in the muscles of pelvis, hips, waist and low back. Therefore key Somatic Movements are essential for resolving a twisted pelvis.
Since a twisted pelvis is characterized by a torsion in the pelvis, we must counter-rotate that torsion in order to correct the problem.
Coaxing the pelvis out of its torsion pattern and back into proper alignment is accomplished using a lunge position that counters the torsion.
By setting up in what I call the Lunge Position of Correction which opposes the imbalance, then performing both stretching and antagonist activation, we are literally able to re-pattern the pelvis back into a balanced position.
In a twisted pelvis, certain muscles tend to adapt into a shortened position while other muscles get pulled into a strained, or locked long, position.
The adapted locked short muscles must be regularly lengthened in order to correct the torsion, and also relieve the strain on the locked long muscles.
This is most successfully accomplished using the gentle but powerful method of Active Isolated Stretching.
Locked short muscles will often have weak or non-firing antagonist muscles. Activation and toning of these antagonists has a compound effect:
Hip flexor dysfunction is central to the development of pelvic torsion, and a significant contributor to hip flexor dysfunction is the lack of squatting competence.
In the industrialized world we don’t regularly perform deep squatting many times a day as is routinely done in the non-industrialized world to go to the bathroom. Thus we lose both flexibility and strength in several dimensions of the pelvis, hips and legs.
Therefore restoring deep squatting competence is essential for lasting correction of a twisted pelvis and maintenance of pelvic balance.
Activation and maintenance of excellent tone in the deep core muscles, especially the transverse abdominus, helps prevent overuse of the hip flexors and thus is essential for lasting correction of a twisted pelvis.
I have been developing strategies for resolving this problem for many years.
In 2013, I released my online course, Healing the Hidden Root of Pain: Self-Treatment for Iliopsoas Syndrome, which specifically targets hip flexor dysfunction.
In 2020, I followed up with the Stretching Blueprint for Pain Relief and Better Flexibility, which widens the focus to resolve pain and dysfunction in the whole body.
The two above courses can also be obtained for a bundled price using this link: Discounted 2-Course Bundle