Pelvic Drop and Running Injuries: the Cause, Effect, and Fixes

If you’ve ever Googled what the most optimal running form is, you probably know how many blog articles, conflicting opinions, and quick fixes exist on the internet — but the good news is that behind all the noise, biomechanics and science have answers.

That being said, figuring out what to work on can still be a bit overwhelming. A safe and focused place to start is with the four most common running form errors, and then a biomechanics expert can provide direction on the smaller, more nuanced aspects of running form. (Plus, it makes sense to start with the major issues first, as correcting these will impact a bunch of other movement deficiencies in the long run.)

While four is a much more digestible number to tackle, there’s still quite a bit of detail that goes into each form error — and that’s exactly what we’re here for.

This blog will break down the definition, identification, and solutions for the notorious form error known as “pelvic drop.” Let’s get started, shall we?

What is Pelvic Drop in Running?

The term “pelvic drop” (also commonly referred to as hip drop) identifies moments when your pelvis lacks proper leveling, causing one side of your hip to drop lower than the other. Pelvic drop can occur with any activity that requires single-leg support, even if it’s only for a brief period of time (i.e., walking, running, using the stairs, etc.). And, as long as you know what you’re looking for, it’s actually not all that difficult to spot pelvic drop from behind.

Pelvic Drop

That being said, the technical process for identifying it goes beyond simply trying to assess your hip levels from behind. The official test for pelvic drop is called the “Trendelenburg Test,” which basically assesses whether or not your hip drops during a static, single-leg stance. If your pelvis drops on the side opposite of your stance leg, then it’s confirmed that you have pelvic drop.

In the grand scheme of things, that’s all it is — just one hip dropping lower than the other. But with something as repetitive as running biomechanics, just a few degrees can have a major impact on your overall performance (especially when it’s at the hips). 

So let’s find out just how much that little drop matters for your running form…

What Causes Pelvic Drop?

If you didn’t already know, your hips are a vital piece of the puzzle for proper and efficient running. To put it into perspective, think of your body as a car, and your pelvis is the frame or chassis. Ideally, you’d want to avoid any excessive motion or wear and tear, otherwise you may jeopardize the car’s structural stability. On top of that, you’ll also want to maintain the suspension, tires, and alignment to ensure everything is working in proper order.

Hip Muscles

The same applies to your pelvis: your hip region is imperative for maintaining stability and alignment, generating power, absorbing shock — the whole shebang. 

Proper body alignment is determined by a mix of both motor control and muscular strength; in the case of your pelvis, this means you’ll need ample core stability, strong gluteal muscles, and other hip stabilizers to help keep your body well-aligned. If one (or more) of these muscles are weaker or feel fatigued while running, you’re prone to experience pelvic drop.

But, that doesn’t mean each of these muscles are equally responsible. In fact, excessive pelvic drop is primarily a result of weakness in the gluteus medius (which is the primary muscle stabilizer that prevents pelvic drop). As you can see in the image here, this muscle attaches to the ilium (the top of your hip bone) and the greater trochanter of the femur (the top end of your thigh bone). Due to its attachment points on your bones, the gluteus medius controls both the amount of pelvic drop and hip abduction (motion away from the center of your body) in your movement, making it an incredibly important muscle for support during any of those single-leg activities. 

Single Leg Activity

When the pelvis is unable to maintain its position, your other structures end up overcompensating for the lack of stability. If your pelvis drops, your center of mass gets pulled to that side, so your body will naturally lean towards the higher side to prevent falling over. In order to maintain balance and stability, the body most commonly responds by increasing its trunk lean towards the affected side and causing your knee to move towards the center and rotate inwards. You can observe both the trunk lean and knee adduction in these images. You may also experience some internal rotation of your femur, which is your body’s attempt to keep the center of mass over your leg.

Several studies have shown how fatigue or weakness in your hip muscles is directly correlated to an increased displacement of center of pressure (otherwise causing a lack of stability and balance) as seen in this image:

Hip Strength

So, if the body is only able to maintain balance by deviating from proper alignment, you can imagine how much increased stress is placed on other areas of the body — and that’s the biggest factor connecting pelvic drop to injury.

Pelvic Drop and Injury Risk

Now that you have a better understanding of what role your hips play in stability, you can imagine why pelvic drop can be a major obstacle in maintaining proper form.

Many studies have found that weakness or dysfunction of the gluteus medius can be linked to a plethora of lower extremity pathologies, particularly involving a wide range of knee and ankle injuries.

But since we can’t cover every potential injury in depth, let’s focus on two of the most common injuries linked to pelvic drop: patellofemoral pain syndrome and ilio-tibial band syndrome.

Who’s ready?

Patellofemoral Pain Syndrome (PFPS)

If you haven’t heard of this injury before (or you have, but don’t know exactly what it is), it’s essentially used as an umbrella term to describe injury within your knee cap joint or in the soft tissue of the front of your knee. Although PFPS can be a result of a trauma to the patella, it’s most commonly caused by a combination of factors involving overuse or excessive stress on the joint.

With ideal alignment, your patella should have a significant amount of contact with the bottom of your thigh bone, which is what allows for proper dispersal of force around your joint. However, when any part of your alignment changes (as it does with pelvic drop and knee adduction), that surface area decreases, and the peak forces at your knees only increase in intensity. 

Some studies have found that even a 10-degree change in your hips and knees can increase peak pressure by 45% — and with all that repetitive, extra force, your knees will definitely let you know when it gets to be too much. This can ultimately lead to pain over time, especially for runners, since they put in a bunch of miles in any given week (and all that excess force adds up fast). 

Iliotibial Band Syndrome (ITBS)

Now for the second most common injury to come from pelvic drop: iliotibial band syndrome.

Iliotibial Band

As you can see in this image, your iliotibial band attaches to the pelvis, runs down the side of your thigh bone, and attaches to the top of your shin bone. With ample alignment, your IT band doesn’t experience any excessive pulling or overstretching. However, you can imagine how that might change if you stand on one leg with pelvic drop.

Think of it this way: if you stand on one leg and your hip drops on the opposite side, your stance leg requires the IT band to lengthen, creating strain. Additionally, if your hip or knee adducts (moves closer to your midline), it’ll end up pulling the bottom end of your IT band as well — meaning that poor band of tissue is undergoing excessive stress with every single-leg motion you do. 

As your IT band gets pulled in both directions, some of your other muscles also undergo excess strain; for example, this will also pull at your tensor fascia latae muscle (as shown in the image) as well as compress some of the tissues in your quadriceps muscles. Plus, the pulling of the IT band will naturally cause some pain at the insertion site on the tibia (your shin bone).

The most common solution here is to simply use a foam roll on your IT band, which will alleviate the pain temporarily. In a pinch, this can help make your pain feel more manageable, but it usually won’t address the issue enough to provide long-term relief.

Realistically, the only way to truly fix ITBS is by adjusting your biomechanics to ensure stability at your pelvis and prevent adduction at your hips and knees.

How to Improve Pelvic Drop

Alright, here’s the part you were probably waiting for: how to actually fix pelvic drop, or avoid it altogether. And the good news is that fixing pelvic drop is almost as easy as noticing it (almost). 

Based on the previous sections, you now know that the gluteus medius is key for hip stability. And since that’s the primary muscle that controls pelvic drop and hip adduction, the answer is pretty straightforward — focus on THAT muscle. 

More specifically, you’ll want to focus on strengthening the gluteus medius, that way it has enough strength and control to actually fulfill its stabilizing role.

So. How do you go about that, you may ask?

Well, as you may already know, there’s a wide range of possibilities when it comes to strengthening exercises for your glutes. But that doesn’t mean you should spend your time trying to get through all of them; there’s plenty of research that’s helped narrow down which exercises are actually the most beneficial for your gluteus medius.

Fortunately, electromyography (EMG) technology gives researchers a huge advantage in identifying which exercises are best for activating your gluteus medius muscle. Studies have indicated that the highest level of gluteus medius activation was found in single-leg squatting and sideplanks. Some other exercises that promote higher levels of EMG activation include the following: single-leg bridges, single-leg Romanian deadlifts, lateral step-ups, and forward step-ups.

And if you’re wondering if there’s a pattern here, you’d be on the right track — each of these exercises practice that vital single-leg support. Emphasizing those single-leg workouts will elicit the most gluteus medius stability, which is ultimately what’ll help to fix that primary issue of pelvic drop.

But, fixing it is much more than just developing enough muscle strength; it’s also just as important to develop proper motor control, positional awareness, and speed of activation to further enhance your control over the pelvis. Once you’ve mastered each of these elements with gradual training progressions, you’ll also want to practice applying all of these aspects to your actual, specific physical activity (particularly with walking and running). After all, isolated practice will only get you so far if you can’t apply these improvements to your actual biomechanics.

Let’s take a look at this concept in practice. Here, we have two images of our very own Dr. Lindberg performing a single-leg squat while replicating pelvic drop:

Single-Leg Squat Demonstration

Using our EMG, we confirmed that his gluteus medius was thoroughly activated in both images — but there’s a big difference between the two. If you pay attention to his belt, you’ll notice two pieces of tape that land just above his hips. This is to help call attention to pelvic drop, as it makes it easier to observe if one hip is dropping lower than the other. 

As you can see, Dr. Lindberg is replicating pelvic drop in both images, but the left-hand image has a much more prominent drop than the right. This is because the left-hand image is an example of practicing single-leg squats while still allowing pelvic drop and knee/hip adduction to continue. Conversely, in the right-hand image, there is a noticeable difference in his overall form; his pelvic drop is minimal, and his knee and hip are both aligned more properly.

This is all to emphasize that, in order to actually fix pelvic drop, you need to be more particular about your training and form — you need to practice activity-specific movements. It’s imperative that you find a practitioner who will help you address any biomechanical issues; because even if you know what exercises to practice, it takes an expert to walk you through the motor control/positional awareness to make sure your exercises are sufficiently corrective. Plus, they’ll be able to better help you put all your hard work into practice within your walking or running gait, or your specific sport! 

Final Thoughts

If ever there was a time you once thought “What’s the big deal?” about those few degrees of pelvic drop, now you know.

On top of the two main injuries we covered in this blog, there are countless other pathologies that can stem from pelvic drop, including a wide variety of other knee and ankle injuries. So, make sure you take the time to address pelvic drop from the beginning; you can even assess it at home yourself by putting tape around your hips, just like Dr. Lindberg did above. (Practice those same single-leg squats and take a recording of yourself from behind, and you’ll be primed for catching that notorious pelvic drop in no time.)

All About Pelvic Drop

By Dr. Josh Tatsuno DPT

Dr. Tatsuno is passionate about high-level sports training and rehabilitation and is dedicated to educating his clients of proper maintenance and care for their bodies. After graduating from the Chapman University Doctorate of Physical Therapy Program, Josh explored his passion for developing and implementing vertical jump, strength and conditioning, and speed and agility programs for all levels of athletes. Josh stays active through his personal passions of backpacking or playing a variety of sports, though he also enjoys traveling, photography, and being a foodie in his spare time.

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