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The Elevated Hip and Gait
There are been a number of visitors to the forum who show up with questions after reading the What is an Elevated Hip? post of a last year. The most common question isn’t as much what to do about it, it’s figuring out which side is out of normal alignment. Here are a couple of hints to help you sort things out.
What we loosely call an elevated hip is actually an asymmetry of the iliac crests, the top part of the pelvic bowl on one side is higher than the other. This results in a functional leg length discrepancy, and in the physical therapist texts is referred to as a hip joint lateral asymmetry or a lateral pelvic tilt. The top of the pelvis on the high side is flexing toward the spine; the hip socket is high, the pelvis is elevated and probably rotated forward toward the opposite side, and usually the spine will move in a convex arc, toward the opposite side.
This has a big affect on walking. There are three parts of gait representing movement in all three planes of motion, sagittal, frontal and transverse. Optimal gait involves an equal amount of each, and when parts are limited, we see other aspects taking over, creating a compensating gait. For example, picture Frankenstein for a dominant sagittal-plane walk, a runway model’s sway representing the frontal, or a John Wayne swagger as the transverse image.
With a lateral pelvic tilt, the hip joint isn’t able to move well. During walking the pelvis needs to move into posterior tilt during the stride forward; both sides need to move equally. Of course, this can’t happen if one is sluggish, somewhat stuck in an abnormal position.
The glute on that side won’t fire optimally with the pelvis out of neutral; the abductors are weak or not firing and are unable to stabilize the pelvis and move the leg. Instead, the QL lifts the leg around, creating a pelvic flexion toward the spine, rather than true transverse plane action.
This takes longer, meaning the normal-side foot will be on the ground longer as it waits for the elevated side to come around. You can see this if you sit at a mall coffee shop people-watching, and you can feel it in yourself if you find a quiet place where you can pay attention to your footsteps. In fact, attention to your foot pattern is a real good way to sniff out a hip problem.
The high-side hip is in adduction, and the normal side is in abduction. This generally means more weight rests on the outside of the high-side foot. When that happens, there will be less weight on the opposite foot, which will usually drop in, so the high-side foot will be supinated and the normal side foot will be pronated.
The tight areas are the outside hip area of the low side, and the side, glutes and low back area of the high side, including the QL, which will be tight from doing all the work during hip hitching. These you’ll foam roll or roll using a small myo ball.
The weaknesses will be primarily the abductor musculature of the high side. Working the abductors – the outside of the hip region – means fairly isolated work like side-lying leg raises, clamshells or some kind of propped donkey kicks, isolated so the lumbar area stays stable and the leg is only moving from the hip socket.
The psoas will probably need stretching, and the IT band will need rolling. The IT bands always need rolling.
There will probably also be a low shoulder on the side of the elevated pelvis — the length of the waist will be shorter on that side. Those of us who are novices at this will often go after correcting an obvious high shoulder, but it’s usually a factor of the opposite-side hip elevation and will correct itself when the hips level out.
With all our discussion of imbalances and movement patterns, we need to remember there are always exceptions to the rule. Some compensations are common to most people, but we can easily compensate in unique ways. Enforce a little caution on yourself; don’t just assume you’ve “got that†when you read about a functional problem that sort of matches your symptoms.
Test yourself, read a little more and test again. Otherwise, you’re likely to be stretching an area that needs strengthening or working an area that needs soft tissue therapy. You’ll have yourself tottering around in circles, and that’s almost as frustrating as being entirely clueless. Actually, it’s more frustrating.
on December 10th, 2009 at 5:43 pm
HI, MR Draper, I just sign up to receive your weekly news.I got to say i just receive my first one today. Iam 46 and i respect you guys of the golden era.I have been a fan of yours as of now .I respect you for your honestly and not building a physique with roids . their seems to be no time for hard work in building a awesome body .well i got to say your in a class buy yourself . the way you word things especially the hoildays is right on the money. I well be buying your book [ brother steel sister iron] .write you soon keep up the good fight.
on December 28th, 2009 at 5:06 pm
Dave – very interesting article. I have been training for 30 years and am a 44 year old Royal Marines Commando who is still managing to keep in reasonable shape and do the things we do in the Corps despite many injuries and much wear & tear along the way. Weight training is key to keeping an old body in shape. I have a hip imbalance which sounds remarkably similar to the description above. It causes me daily grief but with stretching, mobility and strength work and by replacing the traditional road pounding for miles every day with a mix of various other endurance work it has been manageable for some years now. I am looking for a cure rather than constant management. We have good rehab teams supporting us nowadays and I am hopeful for improvement.
I have found your website a great source of inspiration over the years and have used many of the routines and nutrition advice along the way. I have never been a bodybuilder, it’s not my thing, but the weight training has kept me in business through several serious injuries and the long road of rehab. Thanks and keep it up.
on January 19th, 2010 at 8:49 pm
Boy, that really describes my gait. The cerebral palsy set this up…wished you lived close enough to be my P.T. Most therapists around my digs are clueless.
on January 20th, 2010 at 8:25 pm
Laree:
You’ve hit the nail on the head. I, too, have had this problem – and at a time long before functional training modalities emerged. First obvious symptoms made bench pressing nearly impossible, standing presses ackward, by 1978. Fortunately, Jean Houston about that time published her Listening to the Body, a synthesis of Feldenkreis and Alexander technique. Moshie Feldenkreis lived for at least six months with Houston and her husband, the late Bob Masters, at their estate in Ithaca. Her speciality, consciousness research, bore well on the technique she developed – detailed instructions to be recorded and played back to pace and lead movement exercises, addressing both conscious and unconscious mind. What I learned and did there had me back bench pressing without pain in six short weeks. Since then it’s been an ongoing exercise in learning, finally understanding issues systemically arising from hips. Why not? All we did in those days was sagittal plane training. Adding to it, I’d started out as an Olympic lifter doing the old style split lifts – great for creating a functional imbalance if underlying problems weren’t already present.
Your short article will hopefully reach a wide audience to help alleviate needless pain and suffering in this world.
on March 23rd, 2010 at 5:59 am
Sue
Laree, it’s like you’ve seem me walk. I have a torn ACL and MCL (had since ’01, never had them repaired) and have had a very slight foot drag on that side since. With my hip now elevated on that side it is more pronounced in farm boots but not in street shoes. I knew something was really wrong when I had to use such effort just to lift my foot off the ground.
I have learned more from your articles than all the rehab books I’ve bought in the last year. Thank you, you have done an invaluable service to those who know something’s wrong but can’t get a handle on it. Thank you for setting me on the correct path (Now I just need to remember which muscles are which, been a looooooooooong time since my lifting days. I can barely remember what I did yesterday :).
on May 6th, 2010 at 12:12 pm
I have been very interetsed in reading the information and comments about an elavated hip as for many years I have felt that i was out of alignment, mainly due to my trouser zip sitting over to the right and my right trouser leg being shorter – it was putting in a search about this that brought up this information. About 5 weeks ago I bent over to pull a light weight a tray out from a rack and something happened to my back. I put up with it for a few weeks thinking it would get better but did’nt and was eventually referred for physio. The exercises seem to help the lower back pain but made the pulling sensations I was having a lot worse. i returned to my GP explaining that I think it may be an elavted hip (after reading this information) and i am now waiting for an MRI scan and have made an appointment to see a chirpractor. On driving our Rover to my work on Tue I was in horrendous pain by the time i got there due to pushing down the heavy clutch with my left foot and the pain never subsided even after 3 Tramadol so I had to return home and lie down. I cannot walk straight and if i do too much on my feet eg. making dinner i have to lie down to relieve the pain and pulling, sitting or standing doesn’t work. I feel something must have moved when my back went as I am unable to stand straight or walk straight which I could do before although i was not aligned properly. I wonder if anyone has any comments on this and also I am starting to feel quite down and frustrated with it and would like to know if everything can be put back in the correct place and how long this may take? Also what causes an elavated hip?
on May 7th, 2010 at 8:08 am
Hi, Sue,
Sorry you’re having so much trouble! Did you see the thread below? It talks more of hip problems and there are a few links in it to help you get started fixing it.
http://davedraper.com/blog/2008/09/10/what-is-an-elevated-hip/