I have bow legs. Why are you looking at my pelvis instead of my legs?

If you came in for bow legs and were puzzled that we spent most of the time measuring your pelvis

Key points in 30 seconds

1. There's no solid research showing that the angle of a fully grown adult's leg bones can be changed without surgery. We don't promise to change the angle.
2. But a good part of the bow legs you see in the mirror comes from how your pelvis is positioned. When the pelvis tilts forward, the thigh bones rotate inward, and the legs look more curved than their actual angle.
3. When the muscles on one side pull especially hard, the pelvis rotates, so the two legs curve differently and one looks shorter.
4. So there's an order. First correct the pelvis, then loosen the strong muscles and build up the weak ones. We also fix the habits that have been pulling the pelvis.
5. If your knee is swollen, hurts even at night, or one leg has been shorter since childhood, checking comes before correction.

What we often hear

• "I came in for my legs. Why do you keep talking about my pelvis?"
• "I think my right leg is more curved."
• "I did the correction exercises faithfully, and nothing changed."
• "I'm standing up straight, but you say my lower back is arched."

You came in for bow legs, but in the exam room we look at your pelvis longer than your legs.

We have you lie face down to measure the height of your pelvis, stand you up to see how much your lower back arches, and check which side your hips stick out more. Your legs are right there to see, so why do we keep looking at your pelvis?

The short answer: a good part of how curved your legs look comes from how your pelvis is positioned. Today we'll explain why.

Do the leg bones really not change?

First, let's restate what doesn't change.

There's no solid research showing that the angle of a fully grown adult's leg bones themselves can be changed without surgery. It's a principle we've repeated in earlier articles, and it still holds today.

But the bow legs you see in the mirror involve more than bone. How much the hip joints are rotated, muscle imbalance, the alignment of the feet, and how you stand and walk. And on top of all of these is the tilt of the pelvis.

Why do the legs look more curved when the pelvis tilts?

Think of the pelvis as a bucket.

Some people have a bucket that should stand upright but is tipped forward. The lower back arches too much and the buttocks stick out behind, a shape often called "duck butt." Yet the person feels this is standing up straight, because the body has memorized that posture as its baseline.

Just as tipping a bucket forward changes the direction of its handle, when the pelvis tilts forward, the thigh bones attached below it end up rotated inward. Then the knees face each other or gap apart, and the legs look more curved than the actual bone angle. The bones are the same; the base they're attached to is tilted, so the shape changes.

Why does one leg look more curved?

One more thing gets added on top.

If the muscles that pull the pelvis forward (the front of the thigh and deep in the lower back) are especially strong or tight on just one side, the pelvis tilts forward and rotates toward one side. Then the two legs curve differently, one leg looks shorter, and your weight lands on only one side when you walk.

When we look at the pelvis of someone who says, "I think my right side is more curved," the muscles on that side are usually pulling harder. A skirt or pants that keep twisting to one side can be the same signal (Is a skirt that keeps twisting to one side also a signal from your body?).

I did correction exercises. Why hasn't anything changed?

Most likely, the order was reversed.

There's something we often say in the exam room. "Piling on muscle while you're still twisted doesn't help." If you do strength exercises with your pelvis tilted and rotated, the already strong side gets stronger and the weak side stays the same, so the imbalance sets in further. It's like pouring more water into a tipped bucket.

So our order is this.

First, we correct the tilt and twist of the pelvis.

Second, from there, we loosen the strong muscles and build up the weak ones. Even with the same exercise, the weak side only starts working once the pelvis is more or less back in place. The side-hip muscle exercise and chair sit-to-stand introduced in the bow-leg exercise article also end up working the wrong muscles if done with a tilted pelvis.

Third, we fix the habits that have been pulling the pelvis. It's muscles that pulled the pelvis, and it's habits that made the muscles that way. Standing with your weight on one leg, crossing your legs, sitting to one side, carrying your bag on the same shoulder. If these habits stay the same, they'll pull even a corrected pelvis back again. Why corrected legs go back is covered separately.

Can I get a rough idea at home?

There are clues.

• Stand with your back against a wall. With the back of your head, your back and your buttocks touching the wall, if your hand slides easily into the gap between your lower back and the wall with room to spare, your pelvis may be tilted forward.
• Look at your waistband line. See whether the front sits noticeably lower than the back.
• Stand in front of a mirror with your ankles together. If your knees point in different directions or one side of your pelvis looks higher, there's a left-right difference.

Of course, these are only guesses. The tilt of the pelvis and left-right differences are hard to judge accurately by eye, so we measure them with equipment.

In these cases, checking comes before correction

• If the knee is swollen and warm, hurts even at rest at night, suddenly locks, or the pain started after an injury, we look at the joint first.
• If one leg is clearly shorter, or has been since childhood, it may be a difference in the bone length itself, so imaging comes first.
• If numbness runs down from your lower back into your leg, we sort out the lower back first.

How we work

First, we measure. With the X-body posture analysis, we measure the front-back tilt, left-right height and rotation of the pelvis along with the leg alignment below it. If needed, we check the angle of the leg bones in a standing position in partnership with the radiology clinic on the 2nd floor of the same building, to separate how much of your bow legs is bone and how much is pelvis, muscle and habit. If bone accounts for a large share, we tell you about that limit first.

Second, we correct, then work on muscle. We fine-tune the tilt and twist of the pelvis with Chuna (Korean manual therapy), and loosen the tight muscles pulling on the pelvis with acupuncture, pharmacopuncture (herbal acupuncture) and relaxation. Then we prescribe exercises to build up the weak side, down to the method and number of reps, and work on fixing the habits that have been pulling the pelvis. Right after correction, you may feel awkward or stiff. It's the body, which remembered the tilted posture as normal, reacting to an unfamiliar new position, and it usually passes, but if the pain is severe, let us know right away.

Third, we measure again the same way. At set times, we measure the pelvic tilt and alignment markers from the first visit using the same method, and look at the change in numbers. We don't promise to change the angle. We don't treat without evidence.

What changes

Eyes that only looked at your legs in the mirror now see your pelvis too. Understanding why exercise didn't change anything. And so bow-leg correction becomes a matter of holding up your own pelvis with your own muscles.

That's what we aim for.

How much can change and how quickly differs from person to person, depending on the share of bone versus pelvis, muscle and habit, and on age.

Today's takeaway

A good part of bow legs comes from how your pelvis is positioned. Correct the pelvis first, then loosen the strong muscles and build up the weak ones.

There are two things to try today. Stand with the back of your head, your back and your buttocks against a wall, and check how much of your hand fits between your lower back and the wall. Then take one front-view photo of yourself standing with your ankles together. Bring those two with you, and we'll measure together how much of your legs is your pelvis. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

The link between bow legs and the knee, and the evidence for correction, are summarized in the director's column Bow legs aren't about the shape of your legs, they're about your knees.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.