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

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