How to fix a Twisted spine

twisted spine

A twisted spine is where the torso is rotated towards one side.

It involves rotation of the lumbar and/or thoracic spine.

This can lead to:

  • Symptoms (such as pain and tightness) occurring on one side of your body
  • One shoulder in a more forward position
  • Asymmetrical posture
  • Uneven muscle development and strength

The content presented on this blog post is not not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. For more information: Medical disclaimer.


How to fix a twisted spine

Before starting the exercises: Make sure to address the following 2 points:

1. Address Pelvis Rotation

rotated pelvis

Since the torso is directly connected to the pelvis, any rotation in the pelvis will result in the spine being orientated in a twisted position.

Before you start any of the exercises to fix your twisted spine: Make sure that your pelvis is in a neutral position!

(Note: In some people – fixing the position of the pelvis will automatically improve the twisted orientation of the spine.)

How to tell if your pelvis is rotated:

a) ASIS method

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Locate the Anterior Superior Iliac Spine (ASIS).
    • These are the pointy bones that are located at the front of both of your hips. (see above)
    • (Use Google if you are not sure where they are.)
  • Place a finger at the front of each of these bony land marks.
  • Question: “Is one side more in front of the other?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

b) Thigh position

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Look down at the front of your thighs.
  • Question: “Is one thigh more forward as compared to the other side?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

(Note: Having your knee bent may give inaccurate results.)

c) Buttock position

twisted pelvis

Instructions:

  • Stand with your feet shoulder-width apart and level with each other.
  • Take a downwards facing shot of the back of your hips.
  • Question: “Is one butt cheek more forward?”
Results:
– Left side is forward: The pelvis is rotated towards the RIGHT.
– Right side is forward: The pelvis is rotated towards the LEFT.

(Note: Having uneven glute muscle size may give inaccurate results.)


How to Fix a Rotated Pelvis:

I have covered every exercise that you will need to do in this blog post: 
How to Fix a Rotated pelvis.


2. determine the direction (and level) of your twisted spine

At this stage – I am going to assume that your pelvis is in a neutral position (ie. not rotated).

The next step is to determine which direction and the levels your spine is twisting towards relative to the pelvis.

Note: I have listed 6 different tests to help you determine this.

(The more tests that confirm the same finding, the more reliable the result.)


Starting position for all tests:

  • Stand with your feet shoulder-width apart and level with each other.
  • Make sure that your pelvis is in a neutral position.

a) Belly button

(This tests for any rotation involved at the Lumbar spine.)

Instructions:

  • Look down at your belly button.
  • Question: “Which direction does it face?”
Results:
The side as to which the belly button is facing suggests that your Lumbar spine is twisting towards that same side.

(Note: Asymmetrical tension in the abdominal region, past abdominal surgeries etc can affect the position of the belly button.)

b) Lower ribs

(This tests for any rotation involved at the Lower Thoracic spine.)

Instructions:

  • Place your finger on the same points of the lower ribs. (see above)
  • Aim for Rib 7 or 8 if you know how to locate and trace yours ribs accurately.
  • Question: “Is one side more forwards?”
Results:
The side which is further behind is the side the LOWER Thoracic spine is rotating towards.

c) Chest region

(This tests for any rotation involved at the Middle Thoracic spine.)

Instructions:

  • Place your finger tips on the same points at the front of the rib cage.
  • Look downwards.
  • Question: “Is one side more forwards?
Results:
The side which is further behind is the side the MIDDLE Thoracic spine is rotating towards.

d) Sternal end of clavicles

(This tests for any rotation involved at the Upper Thoracic spine.)

Instructions:

  • Place your finger tips on the sternal ends of the clavicles. (see above)
  • Question: Does one side feel more forwards?
Results:
The side which is further behind is the side the UPPER thoracic spine is rotating towards.

e) Shoulders

how to tell if you have a twisted spine

Instructions:

  • Look down at the front of your shoulders
  • Question: Is one shoulder more forward than the other?
Results:
The net rotation of the spine is towards the the side that is further behind.

(Note: The results can be skewed if you have Rounded Shoulders or Uneven Shoulders.)

f)  Downward shot of the back

rotated torso

Instructions:

  • Take a photo from the above head position.
  • Find the line of your pelvis. (Orange line)
  • Find the line of your torso. (Red line)
  • If these 2 lines are not parallel, then you have a rotated torso relative to your pelvis.
Results:
The net rotation of the spine is towards the the side that is further behind.

(Note: Uneven muscular bulk can give the illusion of a rotation.)

Exercises to fix a Twisted Spine

Note: The following exercises address a twisted spine that is rotated towards the RIGHT side.

(If you have a spine that is rotated to the left, do the same exercises but on the other side mentioned.)


Read this:

  • As the spine can rotate and counter-rotate at multiple levels, it would be impossible for me to cover all of these different combinations.
  • Which specific muscles you need to target is really dependent on which level of the spine is your rotation coming from.
  • Focus on the muscles that are relevant to you.
  • Although I have listed all of the main muscles that are responsible for twisting the spine, you do not need to address them all!
  • You will need to do a bit of experimentation on yourself and see what works for you.

1. Releases

Instructions:

 

  • Place a massage ball directly underneath the target muscles.
  • Apply as much of your body weight onto the massage ball as tolerated.
  • Make sure to cover the entire length of the muscle.
  • Continue for 1-2 minutes.

Muscles to release on the RIGHT side:

Target muscles
(Note: Look on Google to see the exact location of these muscles!)

 

  • Erector Spinae (Iliocostalis, Longissimus)
  • Latissimus Dorsi
  • Internal Obliques
  • Intercostals (Thoracic spine)

a) Longissimus/Iliocostalis

b) Latissimus Dorsi

c) Internal Oblique

d) Intercostals

Muscles to release on the LEFT side

Target muscles
(Note: Look on Google to see the exact location of these muscles!)
  • External obliques
  • Rotatores/Multifidus
  • Psoas (Lumbar Spine)

a) External obliques

 

b) Rotatores 

2. Stretches

Muscles to stretch on the RIGHT side:

a) Iliocostalis/Longissimus

Instructions:

  • Sit down on a chair.
  • Hunch forwards as much as possible.
  • Place your left hand at the back of your head.
  • Place your right hand on the outside of the left knee.
  • Pull your head down in the direction of the left knee.
  • Whilst maintaining this pressure, start to bend your torso towards the left knee.
  • Aim to feel a stretch on the right side of your back.
  • Hold for 30 seconds.
  • For more stretches: The 11 Best Erector Spinae Stretches

b) Latissimus Dorsi

Instructions:

  • Assume the position above.
  • Hold onto a door frame with your right hand.
  • Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
    • Use your body weight to sink into the stretch
  • Twist your pelvis away.
  • Aim to feel a stretch on the right side of your torso.
  • Hold for 30 seconds.

c) Internal Obliques (Front)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Lie down on your stomach.
  • Keep your pelvis connected to the floor.
  • Push your belly button into the floor.
  • Prop yourself up onto your hands (or elbows) and arch backwards.
  • Turn your torso towards the left.
  • Aim to feel a stretch in the Right abdominal region.
  • Hold for 30 seconds.

d) Internal obliques (Back)

(For Lumbar+ Lower Thoracic spine.)

 

Instructions:

  • Whilst standing, lean all the way over to your left side.
  • Twist your torso towards the left by placing your hands on your left knee.
  • Allow your right leg to lift and dangle.
    • Keep it relaxed!
  • Allow gravity to pull your right leg down.
  • Rotate your pelvis towards the right.
  • Aim to feel a stretch in the right side.
  • Hold for 30 seconds.

e) Intercostal

Instructions:

  • Place your right hand on top of a table.
  • Lock your elbow straight.
  • Lean some of your weight into the right hand.
  • Glide your torso towards the right.
  • Aim to feel a stretch on the right side of your rib cage.
  • Hold for 30 seconds.

Muscles to stretch on the LEFT side:

a) Psoas
(For Lumbar spine rotation.)

hip flexor stretch

Instructions:

  • Assume the lunge position with your right leg in front.
  • Perform a posterior pelvic tilt
    • “Tuck your tail bone underneath you” 
    • Keep your glutes contracted.
  • Make sure that your pelvis is facing forwards.
  • Lean your torso away from the side you are stretching.
  • Turn your torso towards the left.
  • Aim to feel a pulling sensation at the front of your left hip.
  • Hold for 30 seconds.

b) External obliques (Front)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Stand with a wide stance.
  • Bend your torso towards the right.
  • Reach your left arm backwards as you twist your torso towards the left.
  • Aim to feel a stretch in the left front abdominal region.
  • Hold for 30 seconds

c) External obliques (Back)

(For Lumbar+ Lower Thoracic spine.)

Instructions:

  • Lie down on your back with your arms spread out on the floor.
  • Cross the left leg across the body
  • Aim to feel a stretch in the left back region.
  • Hold for 30 seconds.

3. Joint mobilization

If your joints are stiff, it will make it very difficult to introduce any change into the twisted spine.


a) Spinal Segmentation

 

Instructions:

  • Whilst standing, wrap your arms around an exercise ball as much as you can. (see above)
    • Try to get your fingers tips to touch.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time all the way to the pelvis.
    • Think about: “Creating a wave in your spine”
  • From here, reverse your movements back to the beginning.
  • Remember to go slow!
  • Repeat 20 times.

b) Rotation

spinal rotation exercises

Instructions:

  • Sit down on a chair.
  • Place your hand on the outer side of the opposite knee
  • With the other hand, grab onto the back of the chair.
  • Rotate your spine. (Look behind you.)
  • Use your hands to help push you further into range.
  • Oscillate in this position for 30 repetitions.
  • Repeat on the other side.

c) Side Decompression

Instructions:

  • Sit on your side whilst leaning on your elbow or hand.
  • Bow your torso towards the floor.
  • Aim to feel a stretch at the side of your torso.
  • To increase the stretch, take deep breaths into the area of stretch.
  • Hold for 30 seconds.
  • Repeat on the other side.

If you would like more exercises to help get your spine moving,

Check out this blog post: 17 Thoracic spine exercises.


4. Strengthening exercises 

Aim to move at the levels where your rotation is originating from (i.e. Upper vs Middle vs Lower torso).


Target muscles:

Left side:

  • Internal Obliques
  • Latissimus Dorsi
  • Intercostals
  • Erector Spinae group

Right side:

  • External obliques
  • Rotatores

a) Wall twists

(For Middle to Upper Thoracic rotation.)

Instructions:

  • Assume a wall plank position.
  • Keep your pelvis and belly button facing forwards at all times.
  • Twist your torso towards the left.
  • Repeat 30 times.

b) Rotation

 

Instructions:

  • Assume the 4 point kneel position.
  • Do not move the pelvis.
  • Using your left hand, reach over and behind you.
  • Aim to rotate in the area where your rotation is originating from.
  • Aim to feel the muscles in the left side of your back.
  • Repeat 20 times.

c) Rotation (4 pt. kneel) 

Instructions:

  • Assume the 4 point kneel position.
  • Do not move the pelvis.
  • Using your right hand, reach under and towards the left.
  • Aim to rotate in the area where your rotation is originating from.
  • Aim to feel the muscles in the right side of abdominal region.
  • Repeat 20 times.

d) Seated rotation

strengthening exercises for a twisted spine

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level:
    • Maintain equal weight distribution between each hip.
    • The knees should be level.
  • Cross your hands over your stomach.
  • Proceed to rotate your torso towards the LEFT.
    • Do not initiate this movement with your left shoulder blade.
    • (Do not let the hands/arm slide over your belly.)
  • Aim to rotate in the area where your rotation is originating from.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets

e) Seated rotation with resistance

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level:
    • Maintain equal weight distribution between each side.
    • The knees should be level.
  • Using both hands, hold onto a thick resistance band that is anchored to your right side. (see above)
  • Proceed to rotate your torso towards the LEFT.
    • Do not initiate this movement with your arms.
    • Your arms should stay in line with the center of your body at all times.
  • Aim to rotate in the area where your rotation is originating from.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets

f) Pallov press hold

Instructions:

  • Sit up right on a chair.
  • Keep your pelvis level.
    • Keep equal weight distribution between each side.
    • The knees should be level.
  • Using both hands, hold onto a thick resistance band that is anchored to your right side. (see above)
  • Center your torso:
    • Belly button facing forwards
    • Rib cage equal on both sides
    • Sternal ends of collar bone equal
  • Extend your arms directly in front of you.
  • Do not let the resistance band rotate you to the right side.
  • Hold for 5 seconds.
  • Repeat 20 times.
  • Perform 3 sets.
  • Progression: Increase the resistance.

5. Posture Reset

The goal of this exercise is to have the left and right side of your back EQUALLY in contact with the ground.


Instructions:

  • Lie down on the floor.
  • Support your legs in the 90/90 position.
  • Use a thin pillow for your neck. (if required)
  • Rest your arms in the “T” or “Y” position.
  • Aim to have your ENTIRE back completely FLAT on the floor.
  • Relax in this position for 15-20 minutes.

6. Avoid bad habits

There is absolutely no point in performing all of these exercises if you continue to place your body in the position which has lead to your twisted spine in the first place!


Here are some suggestions:

a) Workstation ergonomics

Place your computer screen and keyboard directly in front of you.

Avoid twisting your body to look at a screen.

b) Sleeping position

I generally encourage people to sleep on their back.

The reason being – it promotes the most symmetry of the body.

c) Sports

If you are involved with a sport which requires you to mostly rotate to one side (e.g Tennis, Rowing etc), it is a good idea to balance out the other side with the recommended exercises!

d) Driving

Be aware that reaching out to hold onto the steering wheel with one hand can lead to a twisted spine.

7. Maintaining neutral spine

Pay more attention to the position of your torso.

Here is a quick way to check if your torso is in a neutral position:

Check points:

  • Belly button facing forwards.
  • Front of rib cage equal.
  • Shoulders level

Note: I don’t want you to think about the position of your spine ALL of the time.

(This is an easy way to get overwhelmed!)

… Just be more aware of when you could make a small adjustment to your posture.

Keep in mind – the exercises will help keep your spine in a more centered position naturally over time.

8. Other things to consider

scoliosis

Along side having a twisted spine, it is common to have side bends in your spine as well.

If you also have side bends in your spine, please check out the following blog post:

Check out this post: Scoliosis exercises

9. Understanding counter-rotation

With a twisted spine – it is common for counter-rotation to occur at certain parts of the body.

This is your body’s automatic attempt to:

  • a) “de-rotate” your spine and
  • b) keep your head level.

The areas that compensate for the rotation in the spine are generally where people will experience their pain.

Main areas:

a) Neck

The neck can attempt to compensate for a twisted spine.

For example:

For a twisted spine to the RIGHT:
The muscles that rotate the neck to the LEFT will be recruited to keep the head more level.

As a result – pain can develop in the following muscles:

Left side:

  • Semispinalis
  • Posterior Scalenes
  • Levator Scapula
  • Sub-Occipital

Right side:

  • Sternocleidomastoid
  • Upper trapezius
  • Anterior Scalenes

b) Shoulder blade

The shoulder blade can attempt to compensate for the twisted spine.

For example:

For a twisted spine to the RIGHT:
The muscles that control the LEFT shoulder blade will be recruited to bring the shoulder backwards.

As a result – pain can develop in the:

c) Spinal segment above the rotation

This is where a particular section of the spine has attempted to partially/fully/over counter-rotate the twist in the spine.

For example:

For a twisted spine to the RIGHT:
The muscles on the LEFT side of the back will be recruited to counter-rotate the section above where the twist occurs.

As a result – pain can develop in the muscles that rotate the torso towards the left:

Left side:

  • Erector Spinae
  • Latissimus Dorsi

Right side:

  • External Obliques

What does this means for you?

If your symptoms predominantly occur on one side of the body, addressing your twisted spine may help completely eliminate your symptoms!


What to do next

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!

102 thoughts on “How to fix a Twisted spine”

  1. Hello Mark,

    thank you for your help, so many doctors already disappointed me. I have back pain (and thus a rotated pelvis/spine) for over 10 years now.

    I have a question, though. First I started off with your rotated pelvis article, because I noticed my thighs were uneven. I got it fixed pretty easily, but my problems were still there. By chance I saw this article linked in your other article. My problem is, my bellybutton is rotated to the left (main source of pain is right side over my butt), while my chest and shoulders are rotated to the right. No part is in center.
    I tried the seated rotation with resistance to fix the rotation in my belly button, but by doing so I only made the rotation in chest/shoulders worse. I cannot solely rotate my lumbar spine to the right, while keeping my thoracic spine neutral. Is there a trick to achieve this? Is there something else I could do?

    Reply
    • Hi there Kai,

      If you improved the pelvis rotation and there were no improvement in your symptoms, then it’s likely that addressing the pelvis might not be the most optimal area to start.

      With your belly button facing towards the left (and assuming you don’t have a history of trauma (eg. surgery) to the abdominal region which can skew the position of the belly button), it sounds like the pelvis is orientated towards the left? It then sounds like your spine has counter twisted towards the right side.

      The next question is, which level is your counter rotation occurring in the spine as this would likely help you target your exercises at that specific level.

      Have you had any scans ?

      Mark

      Reply
  2. Hi Mark,
    Thanks for all the detailed blogs. I did the exercises and stretching from the twisted pelvis and twisted spine blog and felt immediately better, not cured but substantially improved. My weight was more centred, the pain on the right erector spinae midback decreased as well as the other corresponding muscle groups you had listed. I had worked with a physiotherapist in the past but never had this degree of improvement before and had also stalled on progress. Thank you again.

    Reply
  3. Hey

    So my right side is rotated backwards and my left side is up and elevated. So Left shoulder higher then my right and right side roAted back. Very visible in photos. Neck and head off center now. Based off my reading of this I should perform all exercises to help the right side move forward. It’s been like this for awhile hard to work out when you’re so uneven.

    Reply
    • Hi Rich,

      It sounds like your torso is orientated in a right rotated position with side bending to the right.

      Try out the exercises mentioned in the blog post. You might be more tight on the right lower back region.

      Mark

      Reply
  4. Hello Mark,
    So lately I have been struggling from a right rotated pelvis and back and i’ve tried many exercises and stretches to fix it and none of them worked. Recently, i saw your exercises on posturedirect and i am gonna try ’em surely. I have some questions though, I’ve actually been operated on my right side of abdomin for appendix removal so is this causing any problem and if yes so can it be fixed by these exercises… please answer…hope you’ll reply:)

    Reply
    • Hi Jim,

      If you have a rotated pelvis, be sure to check out this post: Rotated Pelvis.

      I believe surgery can impact the posture and how we move. You’ll need to make sure that the scar has healed properly and that you are able to move your mid torso in all directions.

      Mark

      Reply
  5. Hi Mark,
    I have a right rotated pelvis, my left thigh is in front and belly button pointed to the right. However, my left hip/foot-is internally rotated, and my right hip/foot is externally rotated. So I have been just doing the exercises in reverse. When my pelvis is neutral, it feels like I’m slightly over rotated to the left, and my right shoulder gets extremely rounded. When I try to straighten and pullmy right shoulder back, my belly button, right rib gets rotated to the right taking me out of alignment. What do you think I should focus on?

    Reply
    • Hi Jake,

      It sounds like your torso is twisted towards the left relative to the pelvis. It also sounds like your hips may actually be in line with your pelvis as your hips follow the direction of the pelvis.

      If this is the case- you’ll need to focus on exercises that rotate the torso to the right.

      Mark

      Reply
      • Ok, one more thing, I took a video of myself to look at posture when alligned at the pelvis, hips, belly button, there was a bigger gap between my right arm and body, than the left. It also looked like my torso was very slighlty rotated to left but my belly button was pretty centered. What could the difference in gap in the arm mean?
        Thank you so much!

      • Hi mark I just wanted to add a couple more things that could help you figure out what’s wrong with my body. My body feels naturally alligned when my left hip and foot is infront and my right hip and foot is about 3-6 inches behind. My left hip is internally rotated and left foot is slightly too. My right foot /hip is externally rotated. Belly button pointed to the right. I noticed when I do push-ups my left hand is slightly internally rotated, and my right hand is slightly externally rotated. (Right tricep always feels more pumped) My left calve and right hamstring feels like it’s doing more work. When I work on abs, it’s feels like my left hip is blocking the left side of my abs so I only feel activation on the right. Sorry I through a lot at you, I don’t have health insurance rn so I’m trying to figure this out bc I’m in some pain rn. This is bc I tried to force the allignment of feet, pelvis, etc. You mentioned in the rotated pelvis blog to make sure your feet, pelvis and knees are alligned. I’ve been doing this for the past 2-3 years but it feel right, my body seems to always want to fight back to the position I listed above. However, since I consciously/forced alligned my body, my body seemed to memorized the position, despite not feeling alligned, even though it’s looks alligned. Should I let my body just go to it’s natural position or should I keeps forcing the allignment?

        Sorry for the long post, thank you so much mark! Any advice is appreciated

  6. Hey! Very glad i found your page. The following problems you show is exactly what i have. Been to alot of Chiropractors, but zero progress. My problem is that my upper body is twisted to my right, and my left shoulder is rotated forward. I train alot with weights, and almost zero exercises feel comfortable to do.. Another problem is that i have bad mobility in my left shoulderblade, so when i try to to pull movement or retract my scappula, i can barely pull my left arm behind me. I got no problem with my right side. Do you have any tips or idea what this can be? Been trying to fix this for so many years and i rly need some advice. Thanks alot!

    Reply
    • Hi Eirik,

      If your torso is twisted to the right, this will certainly bring the left shoulder forward with it. This can lead to notable asymetrical movements in your shoulders.

      As I haven’t assessed you personally, here are some thoughts that you might want to run past your chiro.
      1. The first thing I would suggest is to make sure you have full control of your scapula on your rib cage. (Eg. Are you able to retract, protract, elevate, depress , posterior tilt etc). If not, you’ll need to learn how to move and control your scapula.

      2. If you can move your scapula with nil issue, you’ll need to make sure that you can move your humerus (upper arm bone) within the shoulder socket in its full range. Make sure you have full internal and external rotation especially.

      3. Address the twisted spine with the exercises mentioned on the blog post.

      4. Keep exercising! You might need to consider performing single arm exercises when you are at the gym. (Eg. single arm shoulder press, single arm lat pull down etc)

      Hope that provides some direction for you!

      Mark

      Reply
  7. Hi Mark

    Thank you so much for your blog and the accompanying exercises. I gratefully appreciate it.

    What you described is exactly the symptoms of my body. For the past two years or more I have noticed that my body felt misaligned and I seemed to be twisted.. I knew exactly what caused it (years of driving and one-handed).

    As I grew uncomfortable with the feeling of being twisted, I tried to correct it in my own little way. I drove with my right hand and also tended to lean to my left. I stopped the leaning and first tried just driving with my left hand only to counteract the right.My left hand struggled to have the same reach as my right did, and I chalked it up to my left hand muscles needing to be stretched more, so I continued that for awhile.

    I now consciously drive with two hands for the majority of the time, whenever I slip back into bad habits I self correct immediately. I also deliberately try to make my forward shoulder sit back on the seat. Due to years of bad posture it does seem unnatural but I make myself do it.

    I can feel the misalignment when I sit, stand, lie down and when I’m walking. It has definitely affected my gait. This year, I began having pains in my shoulders, one more than the other, whereby I am not able to rotate my shoulder / arm effectively. This is particularly apparent when doing any exercise that requires opening up the shoulder fully.

    I intend to do the exercises over the next 30 days and journal the changes, but will also make these exercises part of my daily routine to promote spine health. I will also be making adjustments to my car seating to ensure that I have the best support for my spine.

    Thank you again so much. Going to join you on FB.

    Regards

    Michelle

    Reply
  8. Hi Mark,

    I really appreciate the content you have put forth on your website. Thank you for addressing these
    postural defects in detail and provding solutions for them.

    After going through the list, I found that I have multiple postural imbalances. I seem to have
    uneven shoulders, lateral and or anterior pelvic tilt, hyperlordosis, rotated pelvis, twisted spine and accompanying compensations in neck
    and shoulders.

    Firstly I wanted to ask you how do we distinguish between kyphosis and the compensations in the neck due to due to twisted spine. Secondly
    I wanted to ask you what is the first issue that I address and how do I progress further. Finally I wanted to ask you if could do a section on
    correcting bow legs

    Thank you

    Reply
    • Hello K,

      Generally speaking – you will have pain/symptoms more so on ONE SIDE of the neck if your issues are related to the compensation patterns for the twisted spine.

      Where as with thoracic hyperkyphosis – the pain is usually same on either side.

      (Keep in mind – you can have a combination of both)

      In terms of what areas should you address FIRST: This really depends on what symptoms your body is experiencing. For example, if your main issue is neck pain, then I would likely start in the neck. Once your symptoms have reduced, then you need to ask yourself, what part of the body has lead to more stress in the neck? This would then tell you the next area to address.

      The general rule I go by is to focus on ONE area at a time, get the most out of this area with your exercises, narrow down the main exercises that give you the most benefit, then move onto the next area.

      Mark

      Reply
  9. Hi Mark,
    My left hip is lower(right higher and) and are twisted to the left.
    My left ribs flare in front. Pain is in left side of back(mid thoracic) and I have a slight scoliosis(c curve) to the left w/ a left twist(left shoulder is higher than right).
    This all causes pain at the rib spine junction on left side back, intermittent costochondritis(front rib pain), and grinding of scapula against ribs(winged scapula?)
    Any advise on what sides to exercise and stretch and how to battle this?
    Backstory: I was lifting weights quite a bit without any issues, I took a long time off and injured it twisting the the right side with a heavy suitcase. Chiropractor just cracks my ribs back and tells me to get back to lifting and wear a 5 mm lift in my left shoe(since “left leg is shorter, hip is lower”)

    Thank you in advance!

    Andrew

    Reply
    • Hi Andrew,

      Sounds like something on the right side of your torso is pulling you downwards. My guess would be the right latissimus dorsi, QL, posterior internal obliques and/or erector spinae muscles.

      This would explain the left flared ribs, left higher shoulder and C shape lateral curve. If your torso is being pulled to the right, the muscles on the left will have to compensate to prevent your body falling too far to the right. This can lead to left sided issues.

      If this is the case – a good place to start would be stretch/release those right muscles on the right side.

      You’ll also likely benefit from having a read of this post: Scoliosis Exercises and this post: Rotated Pelvis.

      A grinding scapula sounds like you might have Snapping Scapula Syndrome which generally occurs when the scapula sits too close to the rib cage.

      Mark

      Reply
  10. Awesome post. Could you please clarify, if the left side of chest is (twisted) more forward than my right side, am I “releasing” the left or right side?

    Thanks!

    Reply
  11. Hey Mark! I’ve been following you for a while now and keep coming back to your website. Top-notch information as always!

    Regarding the post you made, could I ask some guidance? For reference, I found I have:

    – Twisted pelvis (right side rotates towards the back, left side is more forward)
    – left hip hike
    – rib flare (left side)
    – loss of IR at left hip
    – loss of ER at right hip
    – weak left gluteus medius (training helped my gait and hip hike!)

    Now, I’m adressing these with succes, but I still have a nasty pain when rotating my spine towards the left side. It’s mostly mid back where the pain is. Doesn’t hurt when rotating to the right, not when actively stretching that side. It only hurts when rotating towards that side.

    Any clues as to what might be the issue?

    Reply
    • Hi Sydney,

      I am guessing your left lumbar side is in more relative extension as compared to the right side. (hence leading to the left rib flare.) When you rotate left, you are probably also extending further which then compresses everything on the left side. When you rotate right, you are decompressing and likely why there is no issue here.

      If you slightly rotate your pelvis to the left and depress the left rib flare, does it still hurt?

      Mark

      Reply
  12. Hi Mark, I recently checked your post it’s amazing. Mark I’m 35 years age and fitness trainer, I have right side twisted thoracic and hips I’m trying so hard to fix it but it’s not that effective and I would like you to help me in fixing it please I recently had a girl baby and I’m in too much pain near my ribs so please please help me I don’t mind paying the fees

    Reply
  13. Hi Mark,
    Thank you for explaining this so clearly and you have helped me way beyond my expectations.
    Would you have any information on how to relieve knee pain? I have osteo arthritis and cannot completely straighten or bend my knee. I walk 2 miles a day which relieves a lot of my pain and maintains my mobilty. I would be so grateful for your suggestions.
    Thank you very much.
    Bev

    Reply
  14. Hi Mark,

    THANK YOU for your work, you’re a life saver.

    Regarding the twisted pelvis and spine – should we first determine our pelvis rotation (mine is left) and do corrective exercises for that condition and then after that asses our spine rotation and work on it or is it recommended to work on both at the same time?

    I’m confused with point #2 where you say “At this stage – I am going to assume that your pelvis is in a neutral position (ie. not rotated).” Does this mean we should force it to be neutral for the assessment or correct our pelvis and after some time go to #2?

    Thank you.

    Reply
    • Hello Kristijan,

      If your pelvis is rotated and you have a twisted spine, I would address the pelvis rotation first.

      Sometimes addressing the pelvis will automatically improve the twisted spine.

      Mark

      Reply
  15. Man, why do you not have a youtube channel? You should start one! most rehab/prehab channels don’t delve into half of the info you talk about. This article is like $500 worth of a physical therapy session. I’ve been looking for this information for so long and just found your website yesterday. And you’re giving this much detailed info away for FREE? You, sir, are the man! Thank you so much

    Reply
    • Hey Mike,

      You left a really nice comment. Thanks!

      And yes – all this information for you guys for free. I try to make it as detailed as it needs to be.

      Hope it serves you well.

      Mark

      Reply
  16. Hi Mark, I’m a professional golfer that played at a very high level until running into biomechanical issues. It’s been about 15 years of struggling and after spending a lot of $$$$ on many many therapists (all kinds) I still haven’t been able to restore my rotation/pivot. I’ve fixed many things but still seem to struggle with alignment. I’ve had 2 separate MRIs and X-rays and nothing is wrong. I can fake a straight position but really feel like I’m rotated to the right in my thoracic spine. Should I follow the full program you’ve laid out and is there anything specific to golf you could further recommend?

    Reply
    • Hey Larry,

      If rotation/pivot is your main goal:

      1. Make sure to reclaim full rotation in your thoracic spine. You can do rotation-based drills such as the ones listed here. The exercises will also help you decompress your rib cage which is important for rotation.

      2. Work on your diaphragmatic breathing. Breathing inefficiently can lead to compression of the rib cage.

      3. Make sure that you have full internal (leading leg) and external rotation (trailing leg) in the hips.

      4. Make sure that your feet have the ability to pronate (collapse arch) and supinate (create an arch)

      5. Lat stretches will help!

      6. If you’re starting out in a rotated/counter rotated position, focus on the exercises mentioned in this blog post for the appropriate direction.

      Hope this helps.

      Mark

      Reply
  17. Hi Mark. Excellent source of information which I have been searching for a long time. Thanks for putting such thorough analysis and description of exercises up on the web. My upper thoracic rotation is to the Right (right leg is shorter) and pain only comes from Right side Rhomboides (minor and major) and the Right Levator Scapulae. Your description mentions that Right rotation often causes pain in Left side muscles. In my case the Right side is painful and I wonder whether I should stretch or strengthen these muscle groups on the Right side. Thanks again for the great source of information.

    Reply
    • Hi Marcel,

      These techniques mentioned in this post should help reduce pain on the rhomboid region.

      If your upper torso is right rotated to the right and it hurts on the right, I would think that lower down the torso/pelvis you are probably rotating to the left or neutral?

      If this is the case – you would want to address the lower torso and/or pelvis rotation.

      Mark

      Reply
  18. Hi Mark,

    My lower left rib protrudes outwards, but my right shoulder is the one that sits forward and a bit down (this has aggravated my right pec muscle somewhat too). I think I’m experiencing a counter rotation like the final image you have posted on this page. I’m currently working on a left pelvic rotation (thank you for the exercises). But I was just wondering what is the best way to go about fixing the counter rotation problem further up my spine once I’ve addressed the initial pelvic rotation? I don’t want to accidentally make the right shoulder worse while trying to address the rib problem. Seems like there’s a fine balance – any tips on what to address first and frequency etc. would be greatly appreciated.

    Reply
    • Hey Duncan,

      Lower left rib protruding suggests a flared rib. This post might help with that: Flared Ribs.

      However since the flaring is only on the left side, this makes me think that you have some sort of rotation going on in your torso (assuming that you don’t have structural issues in the rib cage). This might also explain the lower right shoulder.

      Check out this post: Exercises for a Twisted spine and see if that relates to you. That should help with the counter rotation.

      If your pelvis and torso are neutral and you still have a lower right shoulder, I’d suggest going through this post: Uneven Shoulders.

      All the best.

      Mark

      Reply
  19. Hi Mark, thanks for the amazing website. It’s too good.
    I was wondering about the belly button test you mentioned. After that you’ve given a note saying that abdominal surgery can also cause a shift in the bb. I had an ab surgery around 20 years ago and my bb is pointing ever so slightly to the left (maybe 5-7degrees). Does that mean my lumbar spine is rotated to the left or can I ignore it due to the surgery effect? Thanks

    Reply
  20. Hey Mark,

    Information overload…..I have a pelvis that rotates left (thigh and bellybutton)

    Could you please recommend 3-5 exercises I can exclusively for this problem?

    Reply
    • Hey Bill,

      If your pelvis is rotated, probably best to check out this post: How to fix a Rotated Pelvis.

      It would be hard for me to give you the best 3 exercises as every one will respond to different exercises. Best to try them all out first and see which one you seem to respond to best.

      Mark

      Reply
  21. Hi Mark,

    Would like to ask that after I examine from your guide here, I should be twisted to left and my right hip is hike. But why my rib hump in lumbar area is on left instead of right? If I try exercise to bend to right or rotate to right then my hump become bigger and obvious. Is it wrong ?

    Thank you Mark

    Reply
  22. Hi Mark.
    I got lumbar plus thoracic scoliosis.
    Lumbar part is more severe, about 65 degree. My right hip higher n I feel my belly more turn to left. I see all your exercises look very useful but as there are to many,could you advise which I should start first? Is it rotate back my hip first to make it even first? What else i should follow you to do ?
    My last hope to do exercise to avoid further curve worsening. Otherwise, surgery is the only way for me which is I scare so much.
    Thanks you in advance

    Reply
  23. So my left foot is low arched and right high arched indicating that my pelvis is rotated to right but my upper spine is rotated to the right is this possible

    Reply
  24. Hey Mark, nice assessment and exercises!
    I do have a question about the Walltwists. Is this exercise more of an isometric contraction with both forearms remain in contact to the wall or do I actually rotate my upper spine and leave the wall with one arm?

    Reply
    • Hi Chris,

      For the wall twist, you will want to keep the forearms anchored to the wall and belly button facing forwards as you twist your middle to upper spine towards the desired side.

      Hope this makes things clearer.

      Mark

      Reply
  25. Hi Mark I am using a translator
    Forward Head Posture
    Rounded Shoulders
    Twisted Spine
    Flat Back Posture
    Flared Ribs
    Rotated Pelvis
    Knee Valgus
    Should I do all the exercise if I have any of the above symptoms? But it’s so hard and painful
    If I have to do all the exercises, can you tell me the order? Thanks Mark

    Reply
    • Hi Jung,

      It would be too overwhelming to do all of the exercises for all of the mentioned postural issues.

      I would start with 1 area first and go from there.

      Mark

      Reply
  26. Hi Mark,

    I have been doing a couple of different exercises like the APV. And I am also trying to see other situations that I can address together. So I wanted to ask you if you could help with the possibilities in the current situation: when doing the ring dips, my body (belly and chest + shoulders) twists to the left and I really can not turn the ring out with my right hand, I start to feel it in the front of my shoulder and like the shoulders wants to go to the neck, whilst the left I can turn out normally. I do not have spotted anything critical regarding the pelvis.

    Sorry, forgot to mention that I have less rotation to my right side, I generally feel my right shoulder blade forcing to go further.

    Thank you very much in advance for all your support and posts, they are very helpful and informative.

    Reply
    • Hi Gabriel,

      How is the mobility of your shoulder extension?

      If you keep both arms straight and extend at the shoulders, does it feel the same or is one side more tight?

      Reason why I ask is that uneven shoulder mobility can make the torso twist when performing a dip.

      Mark

      Reply
    • Hi Mark,

      Apprecciate the response. By attempting the extension, the difference I felt is that my right triceps started to work hard. Does that mean something to work on?

      Reply
      • Hi Gabriel,

        If there is an imbalance between the left and right, it could suggest some asymmetries of the shoulder joint itself, or perhaps even the scapula position.

        Mark

  27. Hey marc just wondering about the lats because when i do pull ups or chin ups under neath my shoulder blade hurts and im rotated to the left???

    Reply
    • It doesnt hurt during the actual excercise its more after the excercise right underneath the shoulderblade basically where my rib hump is. Basically where you describe about twisting like a knot and the muscles under the shpulderblade and rotator cuff

      Reply
      • Hey Chad,

        If your torso is rotated to the left and your right shoulder blades is painful after the pulls up, this could be due to the muscles in this area over working.

        Make sure that yor torso is neutral when doing your pulls up should help.

        If pain persists, this blog post will help: Shoulder blade pain.

        Mark

  28. Hey mark thanks for answering all these questions in a timely manner, quick question if your rotated to the right like you describe why would you want to strengthen the lats on the left side? Your left shoulder would usually be more forward if your rotated to the right and your lat is a muscle that pulls your body forward which i know you know. Just wondering if im missing something thanks marc

    Reply
    • Hey X,

      What a great question.

      The lats have quite a few actions. (shoulder extension, adduction, internal rotation)

      However- The main action when addressing a twisted torso would be to work on spinal rotation.

      As you can see in the suggested strengthening exercises, there are no specific exercises addressing the shoulder. (The arms/shoulders are used to help guide the rotation in the spine)

      Hope this makes sense!

      Mark

      Reply
    • It certainly makes sense i had left shoulder surgery as well and i believe i have rotated to the left because my right side is over compensating, so i kept thinking doing lots of pull ups would pull my right shoulder back because basically all muscles getting hit on pull ups work your upper back muscles which help pull your shoulders back but right shoulder still internally rotated, i have mild scoliosis 12 degrees s shape and never had pain until a year ago, i didnt even know i had it til year ago, now im in pain everyday usually sitting i do have a rib hump now which i dont understand because i never did before, i can feel it now in between my shoulder and torso, they did check make sure my scoliosis hadn’t increased and they say no so im pretty lost

      Reply
  29. Hi mark I have the exact same issues explained here because of having a pronated foot and ankle on the left side I just start wearing orthotics they seem to be helping also a lot over my pain has vanished but I’m still having tightness in the right side of my neck and right hip

    Reply
  30. Hi Mark, when I’m sitting before and after the exercises, I’m assessing the imbalances (e.g. one rib more forward than the other) and adjusting my body more to the left to correct it but there’s a good deal of discomfort. Is it okay when trying to sit up straight to do this or is it best to not try and force it it into the right position and just sit up normally and let the exercises alone correct the imabalances? Thank you!

    Reply
    • Hey Jacob,

      Don’t force it, but be aware of your position.

      If the exercises are working over time, it should naturally return to the neutral position.

      Mark

      Reply
  31. Hey mark how are you?
    Can you please tell me what this condition is called? Since I have all these problems tilted head one rib forward and other rib inward same goes for my back to and I have tilted pelvic one leg shorter than the other and one shoulder more forward than the other all of these also affected the symmetry of my face. But still my doctors says I dont have scoliosis and they dont pay heed to what I explain them. Please tell me what this condition is called?

    Reply
  32. Hi Mark thank you so much for making all of this great information available in such an easy to understand, concise presentation. Can I ask, I have a twisted spine and flared rib cage (both on the right) and funnily I then have trouble with the left side of my neck. Is it correct in saying that one reason why my left side of my neck feels so out of alignment and weak is due to the troubles with my spine (how it twists to the right)? I have a slight asymmetry to the left side of my face and my right side of my body and face both appears and feels stronger, is this all possibly interlinked? Thank you again!

    Reply
    • Hey Jacob,

      Absolutely possible!

      If there is any difference in the body, I would always look for some sort of rotation and/or tilt in the body.

      If you are twisted to the right, the left side muscles naturally need to work to try to support this right rotation orientation. As a result – the left said can be symptomatic.

      Mark

      Reply
  33. Hey marc you explain the seated rotation with resisitance of only doing it to right but im rotated slightly to the left so should my band be anchored to the left and pulling to the right u seem very smart you shpuld do you tube videos

    Reply
  34. Mark sir , Below are the abnormalities due to which I feel discomfort while seating , sleeping & even while doing push-ups .
    I) head is tilted.
    II) right shoulder is lower & rotated inward.
    III) right side chest is protruding near sternum while left is depressed .
    IV) Spine & pelvis are also rotated.

    Overall , My whole body is asymmetric. I feel very sad about my posture …I can’t even wear t-shirt because of that issue. Due to discomfort in body , I am unable to focus on study . Sir , Please help me…I have shown these defect to many doctors in India .. but they say, It’s normal but I know it’s not normal , it is affecting my day to day life and also my personality.

    Reply
    • Hey Shubham,

      You can start with balancing out the pelvis and see if that helps with the asymmetry of the torso.

      If the torso is still twisted, you can try out the exercises mentioned in the blog post.

      If your right shoulder is lower, It may be due to some side bending of the torso. (See: Scoliosis Exercises)

      This may also affect the head tilt.

      Mark

      Reply
  35. Hie mark! My right side is forward so please tell me which side i should do these exercices as m little confused plzz

    Reply
    • Hi Amanat,

      1. Address any pelvis rotation first.
      2. If your torso is still significantly twisted to the left (ie your right side is forwards), address the muscles that rotate the torso to the right (back to neutral)
      3. Pay attention to how you are sitting every 1 hour or so. You don’t want that right side coming too far forwards to encourage this twist.

      If in doubt or not sure of what to do, best to see your health professional who can provide you with a much more detailed assessment.

      Mark

      Reply
    • Well, I checked again and if I press harder to see how the bones are on my hip, they seem to be fine. It’s in the muscles where I can see that the right hip has more of an anterior slant than the left one. My hips are more to the right side because of the scoliosis. My buttocks are very uneven, the left one has barely any muscle tone. The right one has more developed muscles, but it is also more slanted than the left. I guess I should do the twisted spine series since it seems my hips are not rotated. Is there a way to address the uneveness of my hips? Also should I try to improve the anterior tilt before doing the twisted spine exercises? I will probably be releasing for a while because everything makes my muscles hurt, but I’m looking for a way to address my spine since that is what is causing all the other problems. My side curvature doesn’t even look that bad. The rotation is what makes my body very uneven. Thanks again!

      Reply
      • Hey Karen,

        If you have uneven hips (ie. lateral pelvic tilt where one hip is higher), I have listed all the exercises here:

        How to fix a Lateral Pelvic Tilt.

        This commonly occurs with Scoliosis of the spine.

        If your rotation stems from a rotated pelvis, I would start there.

        Mark

  36. I have lumber and slight toracic rotation to the right, but my hips tests are failed for twisted pelvis. I think I have anterior lift, but only on the right hip. In what order should I do the exercises, address the lateral tilt first? I have lumbar scoliosis with rotation towards the back on the same side as the curve (left lumbar, right hip is anterior probably as compensation).

    Reply
  37. Hey mark i have anteriar tilt as my upper body is forward and legs backward and rotated pelvis and rotated same side shoulder too… please help me and what all is causing this, m really very scared

    Reply
  38. Mark,
    My right hip is high and and internally rotated, tight right thigh, right leg longer, extremely tight right psoas. I feel !like the top front of my left hip is back more than the right. I’m not sure where to start, can you help? I have been commuting to work for a year, recently retired at 50. Need my back, back in shape. Thanks

    Reply
  39. Hey mark if I have spinal fusion removal and remove the hardware, will my spine be able to move around with no limitations?

    Reply
    • Hi Musaab,

      Honestly – I have not seen someone who has had the rods removed before.

      You can get the rods removed, but the Surgeon would have removed the discs between the vertebra to fuse the bone together.

      This would mean there would be poor movement in this area.

      Mark

      Reply
    • Hi Amanat,

      If one leg is more forward than the other, I would think that you would have a pelvis rotation.

      If that is the case – it might be an idea to focus on the pelvis first and see if that improves the torso.

      If not – focus on the torso.

      Mark

      Reply
      • This focus on the hips and pelvis has just helped me so much but I’m trying to deduce why!

        I have a leg length discrepancy and have been wearing a platform in my right shoe for the last several months (and have to keep shoes or a sandal on most of the time)

        I thought this would remove pain in my back but it never has so far… my body and muscles are adjusting slightly but always struggling.

        An X ray showed that my leg length discrepancy (from a broken bone) meant my left hip was higher than the right. Probably less so now! Having worn a platform & keeping my shoes on a lot, for a while.

        I believe I *must* have more than one twist in the spine because… all my lumbar and thoracic tension is on the left side of my back.

        And yet, my neck is always ‘scrunched’ on the left side. Why would that be…? surely my neck would be compensating with a tilt to the right…

        So there must be a fairly complex curve & twist in my thoracic spine that was outside of the X Ray.

        When I do your analysis my tummy button points a bit left. And when I do your exercises & twist my hips to the right, my lumbar spine feels better for the first time in months.

        I suppose my shoulders must be twisting to the right or tilting to the right (or both) for my neck to be so bunched up on the left.

        It’s hard for me to straighten my thoracic spine so I have a bit of a hunching issue too. This is likely to be because the base of my spine is about 1 vertebrae too long (a congenital abnormality) and sticks out.

        So in addition to correcting a hip tilt I am trying to tuck the base of my spine *IN* a lot.

        I will check out your hunchback exercises! 🙂

        But your hip rotation exercises (pushing my lumbar spine muscles to twist my hips to the right) last night achieved a lot of release!

        So I think that is the starting point and I’ll try to figure out what the twist or lean is between my shoulders next.

        **The reason I say all this is to suggest to the people who are confused: try doing the hip twist exercise and see whether there is a release & where in your back that release comes… even if it seems counter intuitive based on where you’re told your curves are… your twists might feel different to your curves**

        Also I’ll mention: the lumbar spine X ray never made my twists clear, only the curves. Although my chiropractor said that I probably have a hip twist to the left based on how my feet lie. I can only really figure out where twists are by trying out some of the exercises above, analysing the pain and my positioning …

        Thanks again

  40. now i am trying to fix my spine rotation quite a while but it won`t get better for real. i have almost no tension in my right pectrorals. also problems in my forearms and lower legs. i cannot hinder my elbows from out flaring during pushing excersices and both of my tibias is offset to the laterals but on my right leg i have a huge valgus. slowly i will have depressions because of that all.

    Reply
    • Hi Mark,
      My husband would like to know, where it says “aim to rotate in the area where your rotation is originating from” he is rotated from the very bottom, everything is twisted, he has already done this before for a month and a half giving himself a bad shoulder impingement have about gotten the shoulder back in place and straightened out the neck and had caught the twisted torso muscles tightening up severely. Lateral tilt muscles tightened up pretty good and twisted pelvis not so much. The psoas muscle seems to have tightened up. So question is the first time around he started the rotation at the base and rotated all the way up the spine seems this time he is thinking he should start the rotation at the base and only go up above the belt line vs all the way up the spine because the upper part seems ok because he has done rounded shoulders, hunched posture, uneven shoulders, and some shoulder impingement work along with the neck he had mentioned, and the dowingers hump, flared ribs, and lumbar lordosis that he is doing now. Also after three days of the twisted torso and lateral tilt everything is loosening back up fine.
      Thank you for your time,
      Doug and Tanya

      Reply
      • I’m not sure why this comment is out of order, it hasn’t been answered, is this feature working correctly?

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