Unlevelled Pelvis in the Child Or Teen

The unlevelled pelvis is a common finding in the pediatric and teenaged athlete and if not detected, will often cause a lifetime of musculoskeletal issues. Any parent or doctor who doesn’t look for this common finding is missing critical information.

An unleveled pelvis is defined as a pelvis that has one hip bone higher than the other. This type of finding is typically seen on a low back examination. When a doctor places their hands at the top of both hip bones their hands should be level, if they are not level,  a standing x-ray can help confirm how unleveled the pelvis is.

For the athletic or physically active child or teen, an unleveled pelvis increases the likelihood of injuries and has the ability to decrease performance. Like a car with a misaligned front end, there will be loss of function during movement and more degenerative wear and tear over time. The longer misalignment is there, the more likely it is to have permanent degenerative change.

Short term, an unlevelled pelvis has an increased likelihood of injury. When there is an imbalance between the right and left hip, the ligaments, tendons, muscles, cartilage or bone of the pelvis, spine and legs, can all be placed under abnormal mechanical stress. This type of abnormal biomechanics sets these tissues up for failure especially if the athlete is fatigued or repeating a specific activity repetitively. When the same sports motions and positions are repeated over a long enough period of time, the altered biomechanics result in premature tissue breakdown, injury and pain.

Long term, the effect of this type of biomechanical imbalance will result in degeneration of joints that are dealing with abnormal biomechanical loading. As adults, these active children will be faced with the likelihood of osteoarthritis in the affected joints making detection of the unleveled pelvis critical, even in the absence of symptoms.

There are multiple causes for unleveling of the pelvis. Detecting the exact cause is critical in making the proper treatment recommendation.

  1. Muscular imbalance: Repetitive motions, like pitching which require the extension of one leg, while thowing, have specific demands that get placed on muscles of one side of the body that are different to the demands placed on the other side of the body. These imbalances can lead to contracture of back muscles or leg muscles that attach to the hip, creating a hip imbalance.

2.Anatomically short leg : The hip may be low when the leg long bones on that side are shorter than on the other side.  (A lift may be placed in the shoe to level the legs.)

  1. Physiologically short leg: The hip may be low when the muscles, ligaments or tendons of one leg are tighter than they should be, creating a functionally short leg.
  2. Increased Pronation: A dropped foot arch can occur on the low pelvis side. In this case, orthotics should be recommended. Often, if an x-ray of the pelvis was taken before the orthotics were implemented, a re-X-ray of the pelvis will show how the pelvis levels out substantially.

Once pelvic unleveling has been found in a patient, it is necessary to establish the cause of the pelvic unleveling so an effective treatment can be planned. The first step is to differentiate whether the source of the imbalance is in the pelvis and low back or in the lower extremities. This may require accurate, standing x-rays.

Once it is established whether the unleveling is structural (a function of a short leg bone, or bone deformity) or functional (correctable by repairing muscles, tendons and ligaments to normal function) appropriate chiropractic treatment and therapeutic exercise can be established.

Our Doctors can evaluate any child or teen for pelvic unleveling or any other joint complaint. Please contact us at (636)928-5588 if you would like your child assessed