It depends on why they are uneven. When one hip sits higher because of tight or weak muscles, the position of the pelvis or the way your feet carry you, hands-on care, exercise and foot support can change it. A true difference in bone length cannot be adjusted away. Knutson’s review divides leg-length inequality into anatomic and functional, and the exam tells you which you have.
What makes one hip sit higher than the other?
Your hip bones are part of the pelvis, so anything that tilts or rotates the pelvis shows up as one hip higher than the other. Knutson divides leg-length inequality into two groups, anatomic and functional, and says the functional kind is more accurately called “unloaded leg-length alignment asymmetry”: the legs measure the same but sit differently. Knutson’s review found some anatomic inequality in about 90% of people, with a mean of 5.2 mm, and OrthoInfo puts it at more than 50% of people with a subtle difference that usually causes no problems.
- Overactive muscles around the pelvis: functional. Knutson’s second review says this kind of asymmetry “may be due to suprapelvic muscle hypertonicity” and recommends dealing with it before any treatment of a true length difference. Hands-on care and exercise can change it.
- Pelvic tilt or rotation: functional, or a response to a short leg. Knutson found that the most common effect of anatomic inequality is rotation of the pelvis, often called pelvic torsion, so a tilted pelvis can be the cause of the uneven look or its result.
- Flat feet, or feet that roll inward: functional. As our arm and leg pain page puts it, when the foot is an unstable foundation, stress can travel up into the knees and hips, which is where foot support comes in.
- A curve in the spine. Gurney’s review lists scoliosis among the problems leg-length discrepancy has been implicated in, which is one reason the exam looks at the curves of the spine as well as the hips.
- A leg bone that is shorter: structural, or anatomic. OrthoInfo notes that some children are born with legs of different lengths, and that an illness or injury such as a fracture can create a difference over time. Bone length does not change with an adjustment; a minor difference is often well tolerated or evened out with a small lift in one shoe.
How much of a difference matters?
For most people, not much. Knutson concluded that anatomic inequality does not appear to be clinically significant until it reaches about 20 mm. OrthoInfo draws a similar line: a difference greater than 2 cm can affect well-being and quality of life, while a difference under 2 cm with no angular deformity is usually treated without surgery.
The link to back pain is unsettled. In the data Knutson reviewed, people with symptoms had a mean inequality of 5.1 mm and people without symptoms 5.2 mm, which suggests the average difference is not correlated with low back pain. OrthoInfo says some studies suggest a link to low back pain and others do not, and Gurney notes that authors disagree on the extent, if any, to which the discrepancy causes these problems and on how large it needs to be.
What happens when you come in with uneven hips?
We start with questions: when you noticed it, whether anything hurts, what makes it better or worse, and any X-rays or records you already have. Then Dr. Kalay checks your posture, standing and moving: shoulder height, pelvic tilt, knees, feet, the way you walk and the curves of your spine, with X-rays if your case needs them. The exam looks past the hips on purpose, because Knutson warns that the side and amount of a leg-length difference cannot be reliably read from the level of the pelvic crests.
If the exam finds segments that are stuck, you lie on a padded table while Dr. Kalay makes gentle, targeted adjustments to those segments, the pelvis included. You also leave with advice on how to sit, stand, walk and set up your desk, plus a few stretches for home, because the muscles and habits holding the old position have to change too; our older post on how chiropractors approach poor posture lists muscle imbalance and a weak midsection among those habits. Where the feet are the unstable foundation, the evaluation decides whether Pedics sensorimotor orthotics make sense for you: custom insoles made from a scan of your feet, designed to guide how they move. Our chiropractic care page sets out the full first visit.
When should uneven hips be checked by a medical doctor first?
After an injury, if the hip looks misshapen or out of place or the leg seems shorter than usual, you cannot move the leg or hip, you cannot put weight on it, or there is intense pain, sudden swelling, fever or chills, Mayo Clinic’s advice is to seek medical care right away. In a child, a limp is usually from a minor injury and gets better on its own, but OrthoInfo flags a limp that lasts longer than a week, and a limp with a fever, which raises concern about a bone or joint infection. As with any arm or leg pain, weakness that keeps getting worse, numbness that spreads, or any change in bladder or bowel control needs a medical doctor first.
Can a chiropractor do a hip adjustment?
Yes, when the exam finds a reason for one. Adjustments go to the segments the posture check found stuck, and that can include the pelvis and the joints at the base of the spine. The posture check comes first, so an adjustment goes where your exam says it is needed.
Can uneven hips cause lower back pain?
The evidence is mixed. Knutson found the same average leg-length difference in people with and without symptoms, OrthoInfo says some studies suggest a link to low back pain while others do not, and Gurney notes that authors disagree on how large a difference it takes. That is why the exam measures rather than assumes.
Do orthotics help with uneven hips?
It depends on the cause, and the exam decides. For a minor difference in bone length, OrthoInfo says a small lift in one shoe can even it out and may help back pain from a smaller discrepancy; lifts are inexpensive and easily removed if they do not help, though Knutson found the evidence “seems to preclude the need for heel lifts in most cases.” Pedics sensorimotor orthotics are a different tool: they are made for how the foot works, for when an unstable foot sends stress up into the knees and hips, not to add length to a short leg.
How do I know if my legs are different lengths?
Have them measured rather than judging by how your hips look. OrthoInfo describes the clinic method: measured wooden blocks are placed under the shorter leg until the hips are level, and the blocks give the difference. Knutson warns that the side and size of a difference cannot be reliably read from the pelvic crests alone, which is why we check your whole posture and take X-rays if your case needs them. More on back pain and posture is on the blog.
Sources
- Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy, 2005. pmc.ncbi.nlm.nih.gov/articles/PMC1232860
- Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry. Chiropractic & Osteopathy, 2005. pubmed.ncbi.nlm.nih.gov/16080787
- Gurney B. Leg length discrepancy. Gait & Posture, 2002. pubmed.ncbi.nlm.nih.gov/11869914
- Limb Length Discrepancy. American Academy of Orthopaedic Surgeons, OrthoInfo, accessed November 2026. orthoinfo.org/en/diseases--conditions/limb-length-discrepancy
- The Limping Child. American Academy of Orthopaedic Surgeons, OrthoInfo, accessed November 2026. orthoinfo.org/en/diseases--conditions/the-limping-child
- Hip pain: Causes. Mayo Clinic, December 22, 2025. mayoclinic.org/symptoms/hip-pain/basics/causes/sym-20050684
