Check for and Correct Unequal Leg Lengths
If your pelvis is tilted to one side when standing, it can create a shearing force in your deep gluteal muscles. The piriformis muscle connects your sacrum (the triangular bone just below your spine in between your pelvic bones) to your hip joint (proximal femur), so if your pelvic bowl tilts to the left or right, it will strain one or the other piriformis muscle.
You can identify which side your pelvis is tilting by observation (you will need a full body mirror). For example, when wearing pants with a belt, does your belt tilt to the left or right? Does one of your pant legs appear more crumpled as it rests on top of your foot? When you pinch the tops of your pelvic bones with your fingertips and look in the mirror, is one hand lower than the other?
Confirm your findings by doing a leg length check. Lie on your back or stomach and make your body straight as possible, feet together hands to your sides. Have someone ensure you are lying down straight (not angled) and your observe your heels. If you have a tilted pelvis (or anatomically short leg– rarer case) your heels will not line up; one will appear shorter:
Once you have the “short leg” identified, buy an adjustable heel lift and place it in the shoe on the short leg side. I recommend starting with a 1/8″ heel lift, wearing it for two weeks, and then increasing by 1/8″ until you notice which heel lift thickness gives you the most relief.
Alternatively, try buying some shoe comfort inserts, and placing just one in the shoe of the short leg. The one I recommend due to its quality construction and durability is the Physix Full Length Orthotic Inserts.
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