Hip Clicks and Pelvic Asymmetry: A Comprehensive Guide

Body asymmetry may indicate issues such as anterior pelvic tilt or hip joint problems?

A few years ago, I suddenly noticed a "clicking" sound in my right hip when putting on and taking off my pants.
Later, I researched online and found that it might be due to hip snapping, but it didn't cause any physical discomfort.
I initially thought it was related to my right foot being misaligned, which I believed was caused by pelvic tilt.
When wearing shorts, the right pant leg is always higher than the left, and the waistband on the right side is also higher than on the left.
Therefore, I felt that my right pelvis was higher.
I later visited a traditional Chinese medicine practitioner who examined the bones around my hip and confirmed that my right pelvis was indeed higher.
I underwent several adjustments, but there was no improvement.
During this time, I searched for pelvic exercises and glute muscle videos to do, but I didn't notice any changes in my before-and-after photos.
Eventually, I consulted a relative who is a physical therapist.
I told him that the traditional Chinese medicine practitioner said my right pelvis was high, but he said my left pelvis was higher instead.
He based his judgment on my heels.
Since I had been exercising and losing weight, I took full-body photos and realized that my waistlines on both sides were also uneven.
Recently, I discovered that my shoulders are also uneven (the right side is lower).
A while ago, I had a lumbar strain and visited an orthopedic doctor for an X-ray, one of which was a KUB.
I asked the doctor if my pelvis was uneven, and he said it wasn't.
I then asked him about the clicking sound in my hip, and he said it was due to hip abduction and advised me to strengthen my glute muscles.
Later, while reviewing the KUB image, I noticed that the right pelvis is noticeably larger than the left.
Although it was a supine KUB image, I wonder if this is due to pelvic tilt or anterior pelvic tilt, which might make the right side appear particularly prominent.
In terms of posture, the right pelvis is significantly more protruded laterally compared to the left pelvis.
This issue has been troubling me for a long time, and I hope to realign my bones.
Thank you for reviewing the KUB and CXR images.

Hong Dou, 30~39 year old female. Ask Date: 2023/07/08

Dr. Shi Guozheng reply Orthopedics

To determine whether there is an issue with pelvic anterior tilt, it is necessary to obtain both frontal and lateral X-rays for accurate assessment.
It is advisable to consult an orthopedic physician for diagnosis, as sometimes scoliosis can also present with this condition.

Reply Date: 2023/07/08

More Info

Understanding hip clicks and pelvic asymmetry can be quite complex, especially when considering the interplay of various anatomical structures and potential underlying conditions. From your description, it seems you have been experiencing a persistent hip click, particularly when performing certain movements, such as putting on or taking off pants. This clicking sound, often referred to as "snapping hip," can occur due to several reasons, including the movement of tendons over bony prominences or the presence of tight muscles around the hip joint.

Hip Clicks (Snapping Hip Syndrome)
Snapping hip syndrome is characterized by a noticeable sound or sensation when the hip moves. This can be caused by:
1. Iliopsoas Tendon: The iliopsoas muscle, which is responsible for hip flexion, can snap over the femoral head or other structures in the hip joint, producing a clicking sound.

2. IT Band: The iliotibial band can also snap over the greater trochanter of the femur, leading to a similar sensation.

3. Labral Tears: In some cases, a tear in the labrum (the cartilage that surrounds the hip joint) can cause clicking, often accompanied by pain or discomfort.

If the clicking is not associated with pain or discomfort, it is generally considered benign. However, if you experience pain, it may warrant further investigation.

Pelvic Asymmetry
Pelvic asymmetry can manifest as one side of the pelvis appearing higher or lower than the other. This can be due to several factors:
1. Muscle Imbalances: Tightness or weakness in certain muscle groups can lead to an uneven pull on the pelvis, causing one side to elevate or drop.

2. Structural Differences: Anatomical variations, such as differences in leg length or hip joint structure, can contribute to perceived asymmetry.

3. Postural Habits: Long-term postural habits, such as favoring one leg over the other, can lead to adaptations in muscle length and strength, resulting in asymmetry.

Diagnosis and Treatment
Given your experiences and the conflicting assessments from different practitioners, it may be beneficial to pursue a comprehensive evaluation. Here are some steps you can take:
1. Consult a Specialist: A visit to an orthopedic specialist or a physical therapist with expertise in biomechanics can provide a more thorough assessment of your hip and pelvic alignment.

2. Imaging Studies: While X-rays (like the KUB you mentioned) can provide valuable information about bone structure, MRI may be more effective in assessing soft tissue structures, such as muscles, tendons, and cartilage.

3. Physical Therapy: A tailored physical therapy program focusing on strengthening weak muscles and stretching tight ones can help address muscle imbalances. Exercises targeting the hip abductors, adductors, and core stability can be particularly beneficial.

4. Postural Training: Awareness and correction of postural habits can also play a significant role in addressing pelvic asymmetry. Engaging in activities that promote balanced muscle use, such as yoga or Pilates, may be helpful.

Conclusion
In summary, while hip clicks can often be benign, persistent clicking accompanied by asymmetry warrants a closer look. Understanding the underlying causes of your symptoms is crucial for effective treatment. A multidisciplinary approach involving orthopedic evaluation, physical therapy, and possibly imaging studies can provide clarity and guide you toward a resolution. Remember, maintaining open communication with your healthcare providers and advocating for your health is essential in navigating these concerns.

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