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November 26, 2025

Correcting an Asymmetrical Weight Shift (Lateral Pelvic Shift or Tilt)

An asymmetrical weight shift (AWS) is a movement impairment (a.k.a. postural dysfunction) characterized by a consistent, observable lateral shift or frontal-plane tilt of the pelvis (one iliac crest higher than the other), during bilateral lower-body movement patterns such as the squat or deadlift

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

Asymmetrical weight shift (Lateral Pelvic Shift) during a squat.

How to Correct an Asymmetrical Weight Shift (AWS)

This article pulls from several courses (with systematic reviews) and is intended to be a short, practical read to address a common movement impairment/postural dysfunction :

Definition:

An asymmetrical weight shift (AWS) is a movement impairment (a.k.a. postural dysfunction) characterized by a consistent, observable lateral shift or frontal-plane tilt of the pelvis (one iliac crest higher than the other), during bilateral lower-body movement patterns such as the squat or deadlift. It is most reliably identified during standardized assessments, particularly the Overhead Squat Assessment (OHSA) . Note that an AWS may also be described as a hip shift, lateral pelvic tilt, pelvic elevates on one side, pelvic drops on one side, or favoring one side/leg.

Introduction

Numerous online recommendations claim to address AWS, but most are suboptimal. This is largely due to a few correctable issues. First, many approaches fail to distinguish between ankle dysfunction and lumbo-pelvic-hip complex dysfunction (LPHCD), despite both being common drivers of this observable sign. Second, the associated impairments are frequently inaccurately or incompletely described, for example, addressing the problem as excessive hip adduction or abduction rather than hip internal and external rotation. Third, most recommendations do not present an integrated strategy that accounts for the cluster of correlated impairments typically underlying an AWS. The result is recommendations with low expected value. That is, they are likely to have low reliability (the percentage of time an intervention works) and small effect sizes (the amount of improvement made). As stated in prior Brookbush Institute articles and courses, we are not interested in what works; we are interested in what works best.

This article explains how to assess and correct AWS, often within a single session (note that a targeted home exercise program should reinforce all interventions). Three tiers of solutions are provided: a “quick and dirty” approach, a more complete corrective sequence, and a comprehensive plan derived from a movement assessment and a predictive model of correlated impairments. Although we are willing to bet that our simplest approach has a higher expected value than other recommendations online, the highest expected value will result from the comprehensive plan. We are so confident in this solution that we use this as the case study at the end of our Corrective Exercise Lab and Integrate Manual Therapy workshops. So many professionals struggle to understand and correct this dysfunction that our complete or near-complete resolution in a single session would elicit impressed gasps. It honestly is not magic. It is just a combination of thoughtful assessment, careful analysis, and an integrated approach, refined by research—more math than magic.

Quick and Dirty Solution:

Question 1: Which way do they shift?

Although this seems straightforward, it is easy to get turned around when performing additional assessments, especially as clients or patients move from standing to prone to supine, and as you transition from assessment to program creation. Because we are addressing an asymmetrical dysfunction, the corrective strategy will include techniques performed on only one side, and the side on which you intervene matters. You cannot correct an asymmetrical dysfunction with a symmetrical solution, and applying a technique to the wrong side may reinforce or exacerbate the impairment. Make sure you document which side the individual shifts toward, and keep referencing your notes throughout the assessment and programming process to confirm you are still addressing the correct side.

  • Common question: What if I only see one side of the pelvis elevate, but I do not see an obvious shift to the right or left?
    • Treat this as an AWS that shifts to the side of the higher iliac crest.

Question 2: Is the shift originating from ankle dysfunction, lumbo-pelvic-hip complex dysfunction, or both?

Determining where the dysfunction originates is straightforward with the Overhead Squat Assessment (OHSA) . If you identify an asymmetrical weight shift from the posterior view during the OHSA, your next step is to repeat the OHSA with the modification, "heels elevated" (OHSA with Heel Rise).

Heel Rise Rationale: Adding a heel rise places the ankle in relative plantar flexion at the start of the assessment, which effectively increases the available dorsiflexion range of motion during the OHSA. By minimizing the influence of dorsiflexion restriction, the ankle is “removed” as a primary contributor to the movement impairment. We generally use a half-foam roll to elevate the heels because it is inexpensive, convenient, and an appropriate height. If the height of the heel rise is insufficient, you will not adequately reduce the influence of the ankle on the assessment, and your results may be confounded.

  • If the shift disappears with a heel rise, the dysfunction is likely originating from the most restricted ankle.
  • If the dysfunction does not improve, it is likely originating from lumbo-pelvic-hip complex dysfunction (LPHCD).
  • If the dysfunction improves but does not completely resolve, it likely originates from both.

Answering this question will prevent attempts to address an AWS originating from the ankle with a corrective exercise or manual therapy program designed for the hip or sacroiliac joint, and vice versa. Although no research is currently available to quantify the prevalence of AWS originating from the hip versus the ankle, our clinical experience suggests it may be close to a 50/50 split, and may even lean toward unilateral ankle restriction as the more common cause of an asymmetrical weight shift.

Question 3: "What is going on with hip and ankle range of motion (ROM)?"

If the OHSA with Heel Rise indicates that dysfunction originates from the LPHC, you can likely make significant improvements for most individuals without hip ROM goniometry , although it is preferred for developing a more detailed intervention plan (discussed below). Generally, the only two goniometric assessments needed to refine recommendations for addressing an AWS are hip internal rotation (supine 90/90; optimal 40–50° passive ROM) and hip external rotation (supine 90/90; optimal 40–50° passive ROM) . The reason this shortcut works is that changes in hip ROM and sacroiliac joint stiffness tend to match the side of the shift more reliably. That is, the recommended solution for a shift originating from the LPHC will likely be similar for the gross majority of individuals, perhaps 80%. Further, the solution recommended below is unlikely to make someone worse, even if it is not perfectly individualized.

However, the relationship between the side of the shift and which ankle is restricted tends to be less reliable. Further, addressing the wrong ankle could worsen a client's dysfunction. The best way to identify restricted ROM is goniometry . Dorsiflexion goniometry is not hard, but if you have not done goniometry or could use a refresher on terms like "active-assisted ROM" or the potential restricting structures, here is our video on dorsiflexion goniometry . You might be able to identify the most restricted side by having someone lie down in supine, ask them to dorsiflex as far as they can, and while adding a little over-pressure, attempt to identify which side is more restricted. The problem with this crude test is that it tends to be reliable only if there is a pretty significant discrepancy between the two sides. Performing goniometry (as described in the video) will force you to be more careful with your assessment and improve your accuracy.

  • Common question: What if both sides are restricted, but one side is restricted more?
    • You will only treat the more restricted side until the two sides are even. Then you can resume addressing both sides.

Quick Summary

Assessment: At this point, you should be able to answer at least 3 questions:

  1. Shift to which side?
  2. Ankle, LPHC, or both?
  3. If the ankle, which side is most restricted?

Simplest Solutions: These strategies are best used by practitioners who are new to corrective exercise, as a home exercise program, or when time is very limited.

Asymmetrical weight shift (lateral pelvic shift) during a squat.
Caption: Asymmetrical weight shift (lateral pelvic shift) during a squat.

More Comprehensive Solutions for Asymmetrical Weight Shift Right (Originating from LPHC)

If you and your client or patient are willing to add just a few techniques, the reliability and efficacy of your interventions can take another significant leap. This step involves addressing more structures that are likely to exhibit altered activity, length, or stiffness, and adding a couple of additional techniques to help regain optimal motion. Note that all of this is based on the predictive model of dysfunction described below. The techniques selected are those that research and clinical experience suggest are doing the “heavy lifting,” accounting for the majority of the improvement from the intervention. Prioritizing interventions based on expected value (reliability × effect size) is an important step in optimizing practice. If short on time, prioritize release, mobilization, and isolated activation techniques (similar to the "Simplest Solutions" described above).

Another important lesson: Assess–address–reassess. If your solution was effective, you should see a significant improvement in assessment results immediately following the intervention. If the intervention does not result in a meaningful improvement in outcomes, attempt to determine what was missed during assessment and which additional techniques may be necessary. Understanding the more complete analysis below may be necessary to determine a more effective solution for cases that do not respond adequately to the above approach.

Assessments:

Assessment Results

At this point, you should be able to answer at least 3 questions:

  1. Shift to which side?
  2. Ankle, LPHCD, or both?
  3. If the ankle, which side is most restricted?

LPHCD: Asymmetrical Weight Shift Right

These solutions assume that the AWS is to the right. If the shift is to the left simply reverse the lefts and rights.

Self-administered Corrective Exercise Intervention

Manual Therapy Intervention (Licensed Manual Therapists Only)

Ankle: Asymmetrical Weight Shift Right

This solution assumes that the more restricted ankle was the one on the side opposite the shift (the left ankle). Carefully assess to determine which ankle is more restricted. You may notice this is nothing more than a great general solution for ankle dysfunction.

Self-administered Intervention

Manual Therapy Intervention (Licensed Manual Therapists Only)

Comprehensive Analysis

A comprehensive analysis, from which the previous approaches were derived, is where many institutions and gurus fail. Although the most accurate analysis will make sense to most fitness, performance, and clinical professionals, there are several common pitfalls. Examples include treating every AWS as a problem originating in the pelvis or hip, trying to manage AWS as a purely frontal-plane issue involving the adductors and abductors rather than, when originating from the LPHC, a problem that correlates more strongly with changes in hip rotation ROM and knee valgus and varus mechanics, and failing to recognize that sacroiliac joint dysfunction can significantly influence hip muscle recruitment. As mentioned above, these errors result in solutions that do not reliably produce improvement or that fail to achieve complete resolution. The following is the most precise model of an AWS we can presently support with the available research and our outcomes in practice.

Modeling the Asymmetrical Weight Shift (AWS):

An AWS is an asymmetrical presentation of a portion, or a combination of the following impairments:

  • Knee valgus on the side of the shift
  • Knee varus on the side opposite the shift
  • Sacroiliac joint dysfunction

Additionally, it is important to define what each of these impairments implies about motion.

  • Knee Valgus (Knees Bow In) = Excessive tibial external rotation and femoral internal rotation (and potentially a lack of dorsiflexion)
  • Knees Varus (Knees Bow Out) = Excessive ankle eversion and femoral external rotation (and potentially a lack of dorsiflexion)
  • Sacroiliac Joint Dysfunction = Asymmetrical stiffness (generally, stiffer on the side opposite the shift)

Modeling Dysfunction:

Once each movement impairment/postural dysfunction has been defined, changes in muscle recruitment can be modeled (and refined with research). The following are the Brookbush Institute models/solutions tables for each impairment.

Side of Shift: Knees Bow In (Knee Valgus) = Excessive tibial external rotation and femoral internal rotation (and potentially a lack of dorsiflexion)

Short/Over-active

Long/Under-active

Side Opposite of Shift: Knees Bow Out (Knee Varus) = Excessive ankle eversion and femoral external rotation (and potentially a lack of dorsiflexion)

Short/Over-active

Short/Under-active

Long/Under-active

Joints Likely to Exhibit Altered Stiffness:

  • Sacroiliac Joint (Generally stiffer on the side opposite the shift)
  • Hip
  • Knee
  • Ankle
  • Proximal and Distal Tibular Fibular Joints
  • Transverse Tarsal Joints
  • Metatarsophalangeal Joints

Movement Assessment

This comprehensive AWS model is not intended to be a comprehensive treatment approach, but rather a list of all potential changes. Modeling may be the first step in developing a comprehensive approach; however, movement assessment determines which techniques are appropriate.

  1. Overhead Squat Assessment (OHSA) : Does the client/patient exhibit an AWS during the OHSA? Additional lower-extremity signs may help determine which joints should be prioritized for treatment.
  2. OHSA with Heels Elevated : Does the AWS remain, resolve, or improve? Does the AWS originate from LPHCD, ankle dysfunction, or both? Only treat the segment exhibiting dysfunction, and then re-assess.
    1. If the shift disappears with a heel rise, the dysfunction is likely originating from the most restricted ankle.
    2. If the dysfunction does not improve, it is likely originating from the lumbo-pelvic-hip complex (LPHC).
    3. If the dysfunction improves but does not completely resolve, it likely originates from both.
  3. Goniometry : From a decision-theoretic perspective, after completing the OHSA with Heels Elevated , the goniometric assessments recommended below refine your intervention selection more than any other assessments. You only need to include mobility techniques for ROM that is assessed as restricted with goniometry, and only structures on the most restricted side (until symmetrical). It is worth taking a moment to review the Goniometry Course  and/or the videos below to review the potential restricting structures for each ROM.
    • Ankle dorsiflexion  (optimal 15 - 20° active-assisted ROM): This assessment more accurately identifies the most restricted side, especially in cases in which the restricted ankle is not the side anticipated by the direction of shift, or in cases where both sides are restricted, but one side is restricted more.
    • Hip internal rotation (Supine 90/90)  (optimal 40-50° passive ROM)
    • Hip external rotation (Supine 90/90)  (optimal 40-50° passive ROM)
      • These assessments more accurately identify which hip is more restricted, and in which direction. For example, for those exhibiting an AWS originating from LPHCD, we recommend releasing the synergists of hip external rotation on the side opposite the shift. However, it is possible that the hip on the side opposite the shift exhibits normal mobility, and the hip on the side of the shift exhibits restricted internal rotation. In this case, you would only perform mobility techniques for the hip internal rotators on the side of the shift, targeting the structures identified with goniometry.
        • Special Note about Hip Goniometry: For some reason, the restricting structures for hip internal and external rotation in supine 90/90 are not intuitive; however, we continue to use these assessments because we have found that when optimal ROM is achieved in these positions, other hip ROMs tend to return to optimal as well. Make note that the hip internal rotators, especially the TFL and gluteus minimus, have a propensity to restrict hip internal rotation. Further, the hip external rotators, especially the piriformis and adductor magnus, have a propensity to restrict external rotation. If you do not believe me, try it. I can only hypothesize about the cause (perhaps altered arthrokinematics), but the outcomes do not lie.
  4. Brookbush/Grieve SIJ Motion Cluster : Although the gross majority of individuals exhibit excessive stiffness on the side opposite the shift. This cluster may be beneficial when a more "complex" case presents itself. The additional movement assessments can highlight uncommon findings, for example, excessive stiffness on the side of the shift, bilateral stiffness, or lack of SIJ stiffness asymmetry (while presenting with an AWS). Generally uncommon cases will present with a posteriorly titlted innominate and less motion on during the Gillet Test on the side of the shift.
    • Overhead Squat Assessment  (OHSA): Stiff SIJ on the side opposite of an asymmetrical shift with "heel rise"
      • "Top-tier exam" used to identify asymmetry and imply further SIJ assessment
    • Unilateral Pelvic Tilt: Posterior tilted innominate (ASIS higher and PSIS lower than the opposite side) correlated with the stiffer side.
    • Gillet Test : Less motion on the stiffer side
    • Hip Rotation Range of Motion : Note, this test was already performed above, but the hip tends to exhibit less rotation ROM (expecially external rotation) on on side of the stiffer SIJ.
  5. Passive Accessory Motion Exams for Additional Joints (For licensed Manual Therapists)
    • These are manual therapy-specific exams intended for licensed manual therapists only. In practice, they should be performed after a dysfunctional segment has been identified with the prior assessments, while the therapist is preparing to apply manual techniques. Remember, a joint that demonstrates normal or hypermobile ROM during goniometry cannot be exhibiting excessive stiffness. However, it remains important to assess passive accessory motion of all joints that could be related to an assessed restriction. For example, even excessive stiffness of the proximal tibiofibular joint can significantly influence vastus lateralis and TFL activity, which may contribute to hip internal rotation restriction and an AWS.

Additional Assessments: Could additional assessments be necessary? Of course. This is where your experience and continued education become important. If the “Quick and Dirty Solution” addresses roughly 80% of clients or patients well, and the “Comprehensive Solution” addresses 90-95% of dysfunction with complete or near-complete resolution, then about 1 in 20 individuals will still need additional help. It is also likely that the information required to halve the number of patients again, who did not exhibit an ideal outcome, would require roughly twice as much information. Although it is difficult to know the exact exponential rate of increase in information required to continue halving the population missed, it is fair to say that no solution is 100%. We are confident our solution is the most accurate, effective, and reliable approach published, but we still see patients who require more than what is described above. Keep learning. Our patients need us to keep learning. 

Case Study: Comprehensive Approach to an Asymmetrical Weight Shift

  • Assessment findings that imply an intervention different from the simpler solutions recommended above.

Assessments:

  1. Overhead Squat Assessment (OHSA) : AWS Right
  2. OHSA with Heels Elevated : AWS right improves, but does not resolve
  3. Goniometry :
  4. Brookbush/Grieve SIJ Motion Cluster :
  5. Passive Accessory Motion Exams for Additional Joints (For licensed Manual Therapists)
    • Excessive stiffness identified at the:
      • Left SIJ
      • Right hip
      • Right tibiotalar joint
      • Right distal tibiofibular joint
      • Right tarsal joints

Hypothesized Changes in Activity and Stiffness

Special Note: In this case we can see that the side of opposite the shift does not exhibit significant dysfunction, except for SIJ stiffness. However, the hip and ankle on the side of the shift exhibit restriction. To addres this dysfunction we would only treat the assessed asymmetrical restrictions (right side hip internal rotation and dorsiflexion restriction).

Right side (side of the shift):

  • Over-active/Short: Tensor of fascia latae, gluteus minimus, anterior adductors (pectineus, adductor brevis, adductor longus, adductor magnus, gracilis), vastus lateralis, and biceps femoris (short head)
  • Under-active/Long: Gluteus maximus, gluteus medius, gracilis, semitendinosus, semimembranosus, popliteus, medial gastrocnemius
  • Stiff Joints: hip joint, distal tibiofibular joint, tarsal joints

Left side (side opposite the shift):

  • Excessively Stiff Joints: Sacroiliac joint

Mobility Routine

Notes: It is recommended that a manual mobility routine or a self-administered mobility routine be performed during a session, but not both. Self-administered mobility routines should be a priority to ensure a client can self-manage issues, perform techniques between sessions, and ideally incorporate techniques into a personalized warm-up/movement prep routine.

  • Release Techniques: Hold on to the most tender spot for 30-120 seconds (or until a release or significant reduction in pain is felt). If time allows, multiple tender points may be addressed.
  • Mobilization Techniques: Small amplitude (1 - 3 inches), 1-2 oscillations/second, for 15-30 sec (20-50 reps)
    • A passive accessory motion exam is recommended to determine whether a mobilization/manipulation technique is necessary (the joint exhibits excessive stiffness)
  • Lengthening Techniques: Hold the stretch for 30-120 seconds (or until a significant reduction in discomfort or increase in mobility)

Manual Mobility Techniques (Licensed Manual Therapists Only)

Note: The goal of mobilization and manipulation techniques is to restore optimal mobility. Most often, it is not necessary to do both a manipulation and a mobilization technique for the same joint. What is important is choosing an effective technique for each joint exhibiting stiffness. All techniques are listed to provide options to therapists who may or may not be able to perform certain techniques.

Self-administered Mobility Techniques

Activation and Integration Routine

Activation Circuit Acute Variables:

  • Load: Light to Moderate (60 - 85% of 1-RM), focus on form and range of motion (ROM)
  • Reps/set: 12 - 20 reps-to-failure/set
  • Sets/exercise (circuits): 1-2 sets
  • Tempo: 2-4: 2-4: Maximum velocity or explosive
  • Rest between exercises: Circuit training, 0-60 seconds rest between exercises.
  • Training Time: 10 - 15 minutes (excluding mobility interventions)

Isolated Activation

Core Integration

Subsystem Integration

Taping

Home Exercise Program:

Note that the home exercise program should consist of the 2–6 exercises that produced the greatest improvement. Reassessing between interventions will usually clarify which techniques deserve priority. The example home program below is simply one way to assemble a routine from commonly effective techniques.

Bibliography: Research Correlating Asymmetrical Impairments with Pain and Dysfunction

  1. Kiesel, K. B., Butler, R. J., & Plisky, P. J. (2014). Prediction of injury by limited and asymmetrical fundamental movement patterns in American football players. Journal of sport rehabilitation, 23(2), 88-94.
  2. Adhia, D. B., Milosavljevic, S., Tumilty, S., & Bussey, M. D. (2016). Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin. Manual therapy, 21, 100-108.
  3. Buyruk, H. M., Stam, H. J., Snijders, C. J., Laméris, J. S., Holland, W. P., & Stijnen, T. H. (1999). Measurement of sacroiliac joint stiffness in peripartum pelvic pain patients with Doppler imaging of vibrations (DIV). European Journal of Obstetrics and Gynecology and Reproductive Biology, 83(2), 159-163.
  4. Damen, L., Buyruk, H. M., Güler-Uysal, F., Lotgering, F. K., Snijders, C. J., & Stam, H. J. (2002). The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine, 27(24), 2820-2824.
  5. Cibulka, M. T., Sinacore, D. R., Cromer, G. S., & Delitto, A. (1998). Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine, 23(9), 1009-1015.
  6. Van Dillen, L. R., Bloom, N. J., Gombatto, S. P., & Susco, T. M. (2008). Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Physical Therapy in Sport, 9(2), 72-81.
  7. Dyal CM, Feder J, Deland JT, Thompson FM. Pes planus in patients with posterior  tibial tendon insufficiency: asymptomatic versus symptomatic foot. Foot Ankle Int 1997;18: 85-8.
  8. Nadler, S. F., Malanga, G. A., Feinberg, J. H., Prybicien, M., Stitik, T. P., & DePrince, M. (2001). Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. American journal of physical medicine & rehabilitation, 80(8), 572-577.
  9. Ellison, JB., Rose, S., Sahrmann, S. (1990). Patterns of Hip Rotation Range of Motion: A Comparison Between Healthy Subjects and Patients with Low Back Pain. Phys Ther 1990. 70: 537-541

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