Pelvic alignment paper

by SJ

Timgren & Soinila 2006 page 1

Timgren & Soinila 2006 page 1

Dear Dr. B,

I hope you are well. I have an academic question, and I am interested to hear your professional opinion:

I have tried to upload images of a paper 1 that describes "reversible pelvic asymmetry." The idea is that one side of the pelvis becomes rotated relative to the other, i.e. either posterior or anterior hemipelvis rotation. The resulting rotation causes problems all the way up to C1. It makes sense to me: if the foundation has gone crooked, the walls and roof are likely to be crooked as well.

Consider another look at my x-ray from https:// www.chiropractic-help. com /second-opinion-about-xray-of-pelvis-with-9mm-lift. html
If you measure the height of the lesser trochanters, I suspect you'll find the right side is ~8 mm higher than the left (recall there is a ~9mm heel lift on the right side; therefore my right leg is ~1mm shorter than my left). My iliac crest heights are ~5 mm different, with the left side higher (meaning my right side is ~14 mm shorter than my left).

So then I measured the iliac crest to acetabulum distance: ~8 mm difference, longer on the left side.

If there was a posterior rotation of the right hemipelvis relative to the left, this would tend to rotate axially the sacrum and lumbar spine just how it is in my x-ray. However, the right iliac crest is not elevated, as described in 1. My left shoulder does seem elevated relative to the right (based on several bits of circumstantial evidence). If the left innominate was more vertical, while the right was rotated in the sagittal plane, on an A-P radiograph the left side would appear longer than the right.

Many people have back pain while sitting (me included). A heel lift will make zero difference then; but it seems a misaligned, asymmetric pelvis could.

My chiropractor seems to think it is not possible for a pelvis to become asymmetric. I mentioned pelvic asymmetry to an osteopath, but alignment seemed to be a foreign concept. Does anyone consider pelvic alignment or asymmetry when assessing back pain? Or am I crazy to think this?

Thank you for you insights.

1 Timgren, J. and S. Soinila. 2006. Reversible pelvic asymmetry: An overlooked syndrome manifesting as scoliosis, apparent leg length difference, and neurologic symptoms. Journal of manipulative and physiological therapeutics 29(7): 561-565.

Hello SJ,
I'll certainly look at these papers but not overnight.

Because healthcare is a developing notion, with new ideas, some old ones discarded, some become foundational, you'll always get different opinions. In the light of day, years down the line we realise how false some of our theories were. Just look at the saturated fat and raised cholesterol debate that is being seriously questioned right now.

I'm no guru, I read and follow the science but don't bow and scrape to it. I'm convinced that daily gentle pelvic and lumbar exercises are vital, do them myself or I suffer, no matter what the pelvic alignment or short leg situation is.

And adding an insert to the shoe to correct a short leg is an art in itself. Under the heel only or the whole foot, how many mm etc.

For those of us in the field these considerations are important; for you as the patient, do the exercises faithfully, don't lift the grand piano or the deep freeze and do take a walk regularly.

Good luck.

Dr B

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Chiropractic help Questions (General).

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.