Potential glute imbalance

@soph77 Welcome to Mayo Connect, where patients and caregivers support one another on our journeys through various medical conditions and life in general.

This is one of the most interesting questions I have seen here in a while. Let's begin by saying nobody has a perfectly symmetrical or balance body, so that in itself is not unusual. And also that you have probably hit on the actual diagnosis, which is pelvic rotation. And I am assuming that by seeing the sports doc you have ruled out any major cause that might require medical intervention.

Pelvic rotation can happen for many reasons, some anatomical, and some environmental. Here is a concise explanation:
"Pelvic rotation is a postural problem in which one side of the pelvis is further forward than the other. It’s important to note that this means that one hip is further forward, not necessarily higher or lower than the other (this is pelvic obliquity although the two conditions often go hand-in-hand).
In this diagram, the right ASIS is further forward than the left. This is called left pelvic rotation.
You can assess the position of a person’s pelvis by feeling for their ASIS (anterior superior iliac spine) points. These are the bonier bits at the front of the person’s hips, and once you have found both, you can judge their pelvic positioning.
If you find that the person’s left ASIS is further forward, this is referred to as right pelvic rotation. Conversely, if the person’s right ASIS is further forward, this is called left pelvic rotation.
What causes pelvic rotation?
Pelvic rotation can be a sign of many things including asymmetrical leg length, hip flexion, or hip adduction. These can all cause the pelvis to twist to compensate for the positioning.
It is important to note that as with all postural problems, pelvic rotation is not a linear chain of cause and effect.
The problem is more a continuous circle of cause and effect, where if a combination of factors are present these cause issues which then further the problem if they are left unchecked, and thus the cycle continues.
This self-fuelling ‘vicious circle’ can be reversed by removing the root causes ..."
(I am not promoting this site, I just liked their way of explaining
https://www.vivid.care/insights/advice-tips/how-can-specialist-seating-correct-pelvic-rotation/

Knowing this, all of your symptoms point also to this imbalance, which can be dealt with, but it is not a simple "tweak" and all is good. When you have lived with it for a while (some doctors in the past called it "Mommy hip" - where you worked and walked with a child perched on a thrust forward hip) it can be a puzzle to realign.

I had this issue for many years, along with uneven shoulders. An excellent chiropractor figured it out, and got my spine aligned, which has helped both. In addition, I was given a series of exercises to perform EVERY DAY by my PT - this covers most of them:
https://paininjuryrelief.com/rotated-pelvis-symptoms-causes-fixes/
In addition, I do a rotational stretch designed by my awesome PT, every morning before getting out of bed - I will try to explain it - it stretches both pelvis and shoulders/chest (important for hours at a keyboard) Follow these directions:
https://www.youtube.com/watch?v=XGZCOEptqNA
BUT, add a lower body rotation at the same time: knees bent & together, rotate your lower body in the opposite direction of your neck.
Return to neutral & rotate the opposite way.
The eventual goal is to be able to rest your knees on the bed with your head turned in the opposite direction.

Here are additional steps you might consider:
Get up from your desk every 30 minutes and stretch - many of the pelvic stretches can be done then, even in the office (at first I had to set a buzz reminder on my phone for every 30 minutes to do it.) Standing and even pacing while working is also good. I do it during online meetings.
I have added anatomical memory foam cushions to the chairs where I sit most, and to my car seat. They keep me sitting evenly & make it somewhat uncomfortable to cross my legs.
Finally, look at your day-to-day footwear. Flip-flops, crocs, slides and the like don't promote or support good posture or proper gait when walking. Yes, we got by with them for a long time in our youth, but now... Fortunately, there is plenty of attractive and supportive footwear to choose from.

I'm not sure you need a doctor, just a commitment to on-going self-care. Remember, we see the doctor, PT or chiro for maybe 20 minutes - following through is the rest of the job, and that's on each of us.

Do you think any of these might be helpful?
Sue

Hello, I had a bad foot surgery 4o+ yrs ago, which left me with a fused foot. The fused foot brought on a gait disturbance and then an SI/pelvic floor rotation. After being in PT for decades, I finally found a PT who specializes in Pelvic Floor dysfunction. She had been specializing for 30+ yrs and told me exactly how my rotation was occurring, then gave me correction exercises. There is a gal , Stephanie Pendergast. in California who specializes. She also has clinics all over the country. Blair Green in Atlanta also specializes. Barbara Green in Charlotte is who I saw. The wrong PT can do damage, and forget about chiropractors! There is a procedure called Prolo therapy where they inject sugar water into the ligaments/tendons to scar the rotating SI into place. It works for some, and not for others. I'm in the process of researching doctors recommended who have helped others with this procedure. Good luck to you! Sandy

Spent a bunch of money on prolotherapy with a reputable practitioner. Sad to say it didn't help. Wishing you better luck.

So sorry to hear it did not help you. I'm told a big difference in success rate is whether you were in "proper position" prior to the injections. Here in Charlotte, those I've consulted with told me it wasn't necessary to be in proper position. . . but they only had at most 50% success rate. A doctor in Atlanta has a 98% success rate, but he is adamant about a PT being present to assure proper SI joint positioning prior to injecting.

@soph77 Welcome to Mayo Connect, where patients and caregivers support one another on our journeys through various medical conditions and life in general.

This is one of the most interesting questions I have seen here in a while. Let's begin by saying nobody has a perfectly symmetrical or balance body, so that in itself is not unusual. And also that you have probably hit on the actual diagnosis, which is pelvic rotation. And I am assuming that by seeing the sports doc you have ruled out any major cause that might require medical intervention.

Pelvic rotation can happen for many reasons, some anatomical, and some environmental. Here is a concise explanation:
"Pelvic rotation is a postural problem in which one side of the pelvis is further forward than the other. It’s important to note that this means that one hip is further forward, not necessarily higher or lower than the other (this is pelvic obliquity although the two conditions often go hand-in-hand).
In this diagram, the right ASIS is further forward than the left. This is called left pelvic rotation.
You can assess the position of a person’s pelvis by feeling for their ASIS (anterior superior iliac spine) points. These are the bonier bits at the front of the person’s hips, and once you have found both, you can judge their pelvic positioning.
If you find that the person’s left ASIS is further forward, this is referred to as right pelvic rotation. Conversely, if the person’s right ASIS is further forward, this is called left pelvic rotation.
What causes pelvic rotation?
Pelvic rotation can be a sign of many things including asymmetrical leg length, hip flexion, or hip adduction. These can all cause the pelvis to twist to compensate for the positioning.
It is important to note that as with all postural problems, pelvic rotation is not a linear chain of cause and effect.
The problem is more a continuous circle of cause and effect, where if a combination of factors are present these cause issues which then further the problem if they are left unchecked, and thus the cycle continues.
This self-fuelling ‘vicious circle’ can be reversed by removing the root causes ..."
(I am not promoting this site, I just liked their way of explaining
https://www.vivid.care/insights/advice-tips/how-can-specialist-seating-correct-pelvic-rotation/

Knowing this, all of your symptoms point also to this imbalance, which can be dealt with, but it is not a simple "tweak" and all is good. When you have lived with it for a while (some doctors in the past called it "Mommy hip" - where you worked and walked with a child perched on a thrust forward hip) it can be a puzzle to realign.

I had this issue for many years, along with uneven shoulders. An excellent chiropractor figured it out, and got my spine aligned, which has helped both. In addition, I was given a series of exercises to perform EVERY DAY by my PT - this covers most of them:
https://paininjuryrelief.com/rotated-pelvis-symptoms-causes-fixes/
In addition, I do a rotational stretch designed by my awesome PT, every morning before getting out of bed - I will try to explain it - it stretches both pelvis and shoulders/chest (important for hours at a keyboard) Follow these directions:
https://www.youtube.com/watch?v=XGZCOEptqNA
BUT, add a lower body rotation at the same time: knees bent & together, rotate your lower body in the opposite direction of your neck.
Return to neutral & rotate the opposite way.
The eventual goal is to be able to rest your knees on the bed with your head turned in the opposite direction.

Here are additional steps you might consider:
Get up from your desk every 30 minutes and stretch - many of the pelvic stretches can be done then, even in the office (at first I had to set a buzz reminder on my phone for every 30 minutes to do it.) Standing and even pacing while working is also good. I do it during online meetings.
I have added anatomical memory foam cushions to the chairs where I sit most, and to my car seat. They keep me sitting evenly & make it somewhat uncomfortable to cross my legs.
Finally, look at your day-to-day footwear. Flip-flops, crocs, slides and the like don't promote or support good posture or proper gait when walking. Yes, we got by with them for a long time in our youth, but now... Fortunately, there is plenty of attractive and supportive footwear to choose from.

I'm not sure you need a doctor, just a commitment to on-going self-care. Remember, we see the doctor, PT or chiro for maybe 20 minutes - following through is the rest of the job, and that's on each of us.

Do you think any of these might be helpful?
Sue

@sueinmn Which anatomical memory foam cushion do you use, and would you recommend? Thank you

I love my cushion - in fact, I have a second one in my other house, and a third in my living room chair. It is the Cushion Lab Pressure Relief Seat Cushion. They are kind of pricy, but mine are over 2 years old and still work perfectly. It was recommended by my PT, and I just looked for the best price I could find - it wasn't Amazon, but I don't know where I found it. I probably just Googled for it.
It looks kind of ugly on my furniture, but it makes so much difference to my achy body that I don't care.
Sue
PS My daughter trued to take one of mine home with her after trying it.