Uneven Hips: Why Does One Hip Sit Higher Than the Other?
Uneven hips, sometimes called a lateral pelvic tilt, means one side of your pelvis sits higher or further forward than the other. This can come from a leg-length difference, muscle imbalance, spinal curvature or a combination of all three. Because the pelvis connects your spine to your legs, a tilt here often causes pain or stiffness in areas you would not expect.
Key takeaways
- Uneven hips are common and can be structural (bone-related) or functional (muscle and habit-related).
- Pain from a pelvic tilt often appears in the lower back, knee or even the opposite hip, not at the tilt itself.
- Lying-down scans relax the muscles and can hide the tilt. A standing, weight-bearing image shows how your pelvis actually sits when you are upright.
- Knowing whether the cause is structural or functional changes the approach entirely.
- An EOS whole-body standing scan captures your alignment from head to feet in a single image with about 90% less radiation than a standard X-ray.
How do you know if your hips are uneven?
Many people notice uneven hips when clothes fit oddly, a waistband sits at an angle, or one hip sticks out more than the other. But the signs often go beyond what you can see in a mirror.
Standing in front of a mirror, one side of your pelvis or shoulder appears noticeably higher than the other.
A lateral pelvic tilt forces your spine to curve to compensate, often creating one-sided lower back ache.
When the pelvis tilts, one leg effectively works harder. This can lead to knee strain, IT band tightness or hip bursitis.
You may wear out one shoe faster, or people comment that your walk looks uneven.
What causes uneven hips?
Uneven hips fall into two broad categories: structural and functional. A structural cause involves a genuine difference in bone length or joint shape. A functional cause means the bones are normal but muscles, habits or compensation patterns pull the pelvis out of line.
Even a small difference in leg length tilts the pelvis when you stand. This may be in the bone itself or from a joint issue like hip arthritis.
A sideways curve in the spine can shift the pelvis. It can also work the other way: a pelvic tilt creates a compensatory spinal curve.
Tight hip flexors on one side, or a weak gluteal muscle, can pull the pelvis into a tilt without any bony cause at all.
Years of standing on one leg, sitting cross-legged or carrying weight on one side can train the pelvis into an off-centre position.
In many cases, the cause is a mixture. A small structural leg-length difference may be made worse by tight muscles and a long-standing postural habit. That is why imaging the whole body together, while you are standing, gives a much clearer answer than looking at the hip alone.
Why does a pelvic tilt cause pain somewhere else?
Your body is a connected chain from your feet to your head. When the pelvis tilts, everything above and below has to adapt. The spine curves to keep your head level. One knee takes more load. Muscles on one side work harder than on the other.
This compensation is what catches people off guard. You might have your knee scanned because it aches, and the scan looks normal. Or your lower back is investigated in isolation and nothing obvious shows up. The real driver, a tilted pelvis, is only visible when you look at the full chain in a standing position.
Lying-down imaging, whether X-ray, CT or MRI, relaxes the muscles and lets gravity flatten out the tilt. The misalignment that causes your symptoms when you are on your feet can simply disappear on the scan table. That is not a fault with those scans. They are designed for other things. It just means they can miss alignment problems that only show up under load.
How is a pelvic tilt assessed with a standing scan?
An EOS scan captures your skeleton from head to feet in a single upright image while you stand naturally. Because you are weight-bearing, your pelvis, spine and legs are shown exactly as they function in daily life. The scan uses about 90% less radiation than a standard X-ray, around ten times less.
From this one image, a specialist radiographer can see whether one hip truly sits higher, whether a leg-length difference is contributing, and how much your spine is curving to compensate. It replaces the guesswork of piecing together separate scans of different body parts.
Not sure whether a standing scan is right for you? We offer a free, no-obligation video consultation to talk through your symptoms first.
Book a free video consultationWhen MRI is the better choice: EOS shows bones, joints and alignment. If your clinician suspects a soft-tissue problem such as a labral tear, disc issue or nerve irritation, MRI is usually the better tool. The two types of imaging answer different questions and often complement each other.
What helps with uneven hips?
The right approach depends entirely on the cause. That is why accurate diagnosis comes first. Without knowing whether the tilt is structural, functional or a combination, any exercise programme or intervention is based on guesswork.
For a functional tilt driven by muscle imbalance, targeted stretching and strengthening, guided by a physiotherapist, is often effective. For a structural leg-length difference, a heel raise or orthotics may be considered. In some cases, further specialist input is needed.
ScanAlign is a diagnostic imaging clinic. We do not provide treatment, but we give you and your clinician the detailed alignment information needed to choose the right path forward. If you do not already have a specialist, we can point you in the right direction after your scan.
Frequently asked questions about uneven hips
If the cause is purely functional, such as tight muscles on one side, targeted exercises and stretches can make a real difference. But if there is a structural cause like a leg-length difference, exercises alone will not change the bony anatomy. That is why finding out the cause first matters so much.
Stand in front of a mirror in underwear and place your hands on the top of your hip bones (the iliac crests). If one hand sits noticeably higher, your pelvis may be tilted. This is a rough guide. It cannot tell you whether the cause is in the hip, the leg or the spine.
Yes, they describe the same thing. "Lateral pelvic tilt" is the clinical term for a pelvis that is higher on one side when viewed from the front. "Uneven hips" or "one hip higher" is how most people describe it in everyday language.
Yes. When the pelvis tilts, one leg bears more weight and the angle of the thigh bone into the knee changes. Over time, this extra stress can lead to knee pain, IT band tightness or even early joint wear. You can read more about how alignment affects the knee on our knee alignment page.
Most X-rays are taken lying down. In that position, gravity and muscle relaxation can flatten the tilt, making the pelvis look more level than it really is. A standing X-ray or EOS scan captures the pelvis under your full body weight, the way it actually sits when you walk and stand.
No. ScanAlign is a private, self-pay clinic and you can refer yourself. We recommend starting with a free video consultation so we can check that a standing scan is the right next step for your symptoms.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more details about safety and what to expect on our FAQs page.
Pricing information is available on our FAQs and cost page. We are happy to talk through options during your free video consultation.
Absolutely. The lumbar spine sits directly on top of the pelvis. When the pelvis tilts, the spine compensates with a curve, placing extra strain on the muscles and joints on one side. This is one of the most common reasons for persistent one-sided lower back pain. Our spine alignment page covers this in more detail.
Your images are reviewed by a specialist radiographer and a detailed report is produced. This report shows how your pelvis, spine and legs are aligned and highlights any areas of concern. You receive the report and can share it with your GP, physiotherapist or consultant to guide your next steps.
Ready to see the full picture?
A free video consultation lets us understand your symptoms and check whether a standing scan is the right next step. No referral needed, no obligation.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Khamis, S. and Yizhar, Z. (2007). Effect of feet hyperpronation on pelvic alignment in a standing position. Gait & Posture, 25(1), pp.127-134.
- NHS. (2024). Hip pain in adults. Available at: nhs.uk [Accessed 2024].
- Gurney, B. (2002). Leg length discrepancy. Gait & Posture, 15(2), pp.195-206.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.