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Pelvic Asymmetry


Original Editor - Purnima Raikwar

Top Contributors - Purnima Raikwar, Vidya Acharya and Alexandra Stead  

Introduction

Symmetry in biomechanics is essential for posture and movement, but the human body is inherently asymmetrical.[1] Pelvic asymmetry refers to any deviation from the symmetrical alignment of the pelvic ring, and it is a common finding in both symptomatic and asymptomatic individuals.[1] It may involve asymmetry of anatomical landmarks such as the anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS), iliac crest, or pubic symphysis. While the pelvis is often regarded as a symmetrical structure, its morphology is influenced by multiple factors such as age, bipedal locomotion, obstetric adaptations, and sexual dimorphism. These influences can alter pelvic anatomy, biomechanics, and function, sometimes leading to clinically relevant asymmetry.[2][3]

Pelvic asymmetry is broadly classified into two categories:[3]

  • Functional asymmetry, which is reversible and arises from soft tissue imbalances, altered neuromuscular control, or habitual postural loading patterns. This is the most frequently encountered type in physiotherapy practice and generally responds well to conservative management.
  • Structural asymmetry, which is fixed and results from congenital abnormalities, fracture malunion, growth disturbances, or degenerative changes. Unlike functional asymmetry, structural deviations persist regardless of positioning or muscle activity. [4]


Clinically Relevant Anatomy

The human pelvis is a complex anatomical structure consisting of three bones - the two innominate bones and the sacrum which together form the pelvic ring. Each innominate bone is formed by the fusion of the ilium, ischium, and pubis. It also includes muscles and fascia layers interwoven with vascular and nervous networks and connected to various viscera. The pelvis connects the axial skeleton to the lower extremities and plays an essential role in load transfer, postural stability, shock absorption, and movement during standing, walking, and other weight-bearing activities.[5]

Significant palpable bony landmarks are commonly used during clinical assessment of pelvic alignment and symmetry:[6]

  • Anterior Superior Iliac Spine (ASIS): used to assess frontal and sagittal plane pelvic position
  • Posterior Superior Iliac Spine (PSIS): commonly assessed for innominate rotation and sacroiliac joint motion
  • Iliac crest: assessed for pelvic obliquity or lateral pelvic tilt
  • Pubic tubercles: evaluated for pubic symphysis alignment
  • Sacral base and sacral sulci: assessed to determine sacral position relative to the innominate bones.

[7]

The sacroiliac joint is a strong synovial joint reinforced by extensive ligamentous support. Although the SIJ has minimal movement, it plays an important role in force transmission between the trunk and lower limbs. The primary sacral motions include nutation and counternutation, while movement of the innominate relative to the sacrum includes anterior and posterior innominate rotation. Muscles surrounding the lumbopelvic region contribute significantly to pelvic alignment and stability.[8]

Important muscle groups include:

  • Hip flexors (iliopsoas and rectus femoris),
  • Hip extensors (gluteus maximus and hamstrings),
  • Hip abductors and adductors,
  • deep stabilising muscles (transversus abdominis, multifidus, and pelvic floor muscles),
  • Lateral trunk muscles such as quadratus lumborum.

Altered muscle activation, weakness, tightness, or imbalance may influence pelvic positioning and contribute to the development or persistence of pelvic asymmetry.[9]

Biomechanics and Clinical Significance of Pelvic Alignment

Types of Pelvic Deviations: Pelvic deviations are classified according to the plane of movement and the direction of displacement:[10]

  • Pelvic Obliquity (Lateral Tilt) - Elevation of one iliac crest relative to the other in the frontal plane, resulting in a lateral tilt of the pelvis.
  • Innominate Rotation - Anterior or posterior rotation of the innominate bone relative to the sacrum in the sagittal plane, influencing lumbar posture and hip mechanics.
  • Pelvic Torsion - Opposite rotations of the two innominate bones, producing a twisting effect across the pelvis. This often leads to asymmetrical loading during gait.
  • Sacral Torsion - Rotation of the sacrum around an oblique axis, altering its relationship with both innominate bones and potentially affecting sacroiliac joint stability.

The pelvis plays a central role in load transfer between the trunk and lower limbs therefore, alterations in pelvic alignment may influence lumbopelvic biomechanics, posture, gait, and overall movement efficiency.[3]

Clinically, pelvic asymmetry is commonly associated with a number of musculoskeletal conditions:[11]

Effective clinical decision‑making requires integrating positional findings with symptom presentation, functional limitations, and movement analysis. Physiotherapists play a central role in assessment and management, with rehabilitation strategies aimed at restoring alignment, optimising neuromuscular control, and addressing contributing factors to improve quality of life.[12]

Epidemiology

The prevalence of pelvic asymmetry is reported to vary considerably across studies, reflecting differences in assessment techniques and the populations examined. Research indicates that pelvic asymmetry is not limited to individuals with musculoskeletal complaints, in fact, a retrospective review of 323 consecutive CT scans found it to be a common feature in the general population.[13]

Among people with low back pain, prevalence estimates range widely from 24% to 91%, though this variation is largely attributed to methodological differences rather than true epidemiological disparity. [3]One of the most frequent contributors to pelvic obliquity is leg length discrepancy, which affects up to 70% of the population.[13] Most discrepancies are minor and clinically insignificant, but larger differences can influence pelvic alignment and contribute to functional limitations. Lifestyle and activity patterns also play a role.[14]

Pelvic asymmetry is more commonly observed in individuals engaged in unilateral sports such as tennis or football, compared to those participating in bilateral sports or non‑athletes. This suggests that repetitive, asymmetrical loading patterns can shape pelvic morphology over time.[15]

Aetiology and Risk Factors

Pelvic asymmetry has a multifactorial origin, with causes ranging from soft tissue imbalances to fixed structural deformities. Broadly, these can be grouped into several categories:[16]

Musculoskeletal and postural factors

Imbalances in the muscles surrounding the lumbopelvic region - such as tight hip flexors, weak gluteals, or overactive quadratus lumborum - can alter pelvic positioning. Habitual postures like weight‑shifting or asymmetric sitting patterns, as well as repetitive loading from unilateral sports, may also contribute. Hip joint pathology, including osteoarthritis or hip flexion contractures, can further disrupt alignment.[16]

Structural causes

True leg length discrepancy, whether congenital or acquired (e.g., post‑fracture or growth plate injury), is a common driver of pelvic obliquity. Other structural contributors include congenital pelvic abnormalities, malunion or non‑union of pelvic fractures, and developmental dysplasia of the hip.[16]

Neurological and neuromuscular factors

Conditions involving upper motor neurone dysfunction, such as cerebral palsy, can result in spasticity and associated muscle imbalances that lead to pelvic asymmetry. Neuromuscular scoliosis often results in pelvic obliquity, while muscle weakness or paralysis affecting pelvic stabilisers may compromise alignment.[11]

Obstetric and hormonal influences

During pregnancy, hormonal changes, particularly the action of relaxin, increase ligamentous laxity around the pelvis. This, combined with altered load transfer, can contribute to pelvic girdle pain and asymmetry both during and after pregnancy.[17]

Trauma

Injury to the sacroiliac joint ligaments, whether from a single traumatic event or repetitive microtrauma, may result in innominate rotation and persistent asymmetry.[18]

Altered Biomechanics

The pelvis serves as a central link between the spine and the lower limbs, and any disruption to its alignment can have biomechanical consequences both above and below this region. Asymmetrical positioning of the innominate bones or sacrum alters load distribution through the lumbosacral and sacroiliac joints, often increasing unilateral muscle activity. Over time, this imbalance may predispose individuals to myofascial trigger points and pain.[19]

In cases of pelvic obliquity, unlevel iliac crests can create either an apparent or true leg length discrepancy. If left uncompensated, the anterior and posterior iliac spines on the shorter limb side may sit lower, leading to a sacral base tilt and a compensatory lumbar scoliosis. Conversely, a true leg length discrepancy can itself drive secondary pelvic obliquity. The relationship between leg length discrepancy and low back pain remains complex and somewhat inconclusive, though several studies suggest a positive correlation.[20]

An increased anterior pelvic tilt, commonly seen with anterior innominate rotation, places additional strain on the soft tissues of the lumbar spine. Beyond musculoskeletal effects, asymmetric pelvic alignment may also influence the kinematics of the diaphragm and pelvic floor, disrupting intra-abdominal pressure regulation and lumbopelvic stability.[21][22]

Clinical Features

Individuals with pelvic asymmetry may present with a wide spectrum of symptoms, or in many cases remain entirely asymptomatic. When symptoms are present, they often reflect altered load transfer through the lumbopelvic region and compensatory changes elsewhere in the kinetic chain. The most commonly reported features include:[23]

  • Low back pain, which may be unilateral or bilateral.
  • Buttock and posterior pelvic pain, often localised around the sacroiliac joint region.
  • Leg length discrepancy, either apparent or functional, contributing to uneven pelvic positioning.[24]
  • Gait asymmetry or altered walking patterns due to imbalance in load distribution.
  • Sitting imbalance, with difficulty maintaining equal weight on both ischial tuberosities.
  • Hip or groin pain, particularly when associated with hip pathology or iliopsoas tightness.
  • Referred pain into the lower limb, sometimes linked to neural irritation in more severe cases.
  • Visible shoulder asymmetry, where one shoulder appears elevated and anteriorly positioned on the side of pelvic deviation - a feature often noticeable to the individual themselves.
  • In cases of neuromuscular origin, additional neurological signs may be present, including altered sensation, weakness, or bladder and bowel dysfunction.

Assessment

A comprehensive assessment is essential to determine the presence, type, and contributing factors of pelvic asymmetry. This process combines a detailed history with systematic observation, palpation, and functional testing to guide clinical reasoning and management.[25]

Subjective Assessment

The clinical assessment should explore:[26]

  • Symptom characteristics - location, nature, aggravating and easing factors.
  • Onset and mechanism - whether gradual, traumatic, or postpartum.
  • Activity profile - including occupational demands and unilateral vs. bilateral sports participation.
  • Obstetric history, where relevant.
  • Previous investigations or treatments.
  • Individual goals and functional limitations.

Objective Assessment

Observation and postural analysis should be performed in standing (anterior, lateral, posterior views) and sitting. Key features include:[27]

  • Iliac crest height
  • ASIS and PSIS levels
  • Lumbar curvature - noting functional scoliosis secondary to pelvic obliquity.
  • Shoulder height asymmetry

Gait analysis may reveal Trendelenburg gait, trunk sway, unequal step lengths, or asymmetric foot progression angles.[28]

Palpation

Palpation of bony landmarks - including the ASIS, PSIS, iliac crests, sacral sulci, and pubic tubercles - should be performed in both standing and supine positions to identify asymmetries in landmark height, depth, and position.[7]

Leg length assessment
  • True leg length - measured supine from ASIS to medial malleolus with pelvis level.
  • Apparent leg length - measured from umbilicus to medial malleolus, reflecting pelvic tilt rather than bone length difference.[25]
Motion Palpation Assessment

Several tests may be used to evaluate sacroiliac mobility and innominate rotation, though reliability varies:

  • Standing flexion test - limited diagnostic accuracy; should not be used in isolation.
  • Gillet (Stork) test — assesses PSIS movement during single-leg stance, intra-examiner reliability is more acceptable than inter-examiner reliability.
  • Seated flexion test - reduces influence of hamstring tightness and lower limb mechanics.
  • Supine to sit test - detects innominate rotation via changes in medial malleoli position.[29]
Sacroiliac Joint Provocation Tests

Single SIJ tests have limited diagnostic utility. A cluster approach is recommended, combining distraction, femoral shear, sacral thrust, and compression tests. When paired with a McKenzie‑type assessment, this cluster demonstrates improved diagnostic accuracy for SIJ pain.[30]

Muscle Assessment

Evaluation should include:

Imaging

Imaging is not routinely required for functional pelvic asymmetry. It may be considered when structural causes are suspected, neurological features are present, or conservative management fails:

  • Standing postural radiographs - quantify pelvic obliquity, sacral base angle, scoliosis, and leg length discrepancy.[32]
  • CT with 3D reconstruction - useful in post‑traumatic cases or suspected structural deformity.
  • MRI - valuable for assessing soft tissue, ligamentous, and neural structures, particularly in pelvic girdle pain or suspected SIJ pathology.[3]

Differential Diagnosis

When assessing pelvic asymmetry, it is essential to consider a range of conditions that may present with similar clinical features or contribute to the presentation. The following conditions should be considered during clinical reasoning:[25]

Physiotherapy Management Consideraitons

Management of Pelvic Asymmetry

The management of pelvic asymmetry depends on its underlying cause, the individual’s clinical presentation, and their functional goals are as follow:[25]

  • Restore optimal pelvic alignment and symmetry.
  • Correct underlying muscle imbalances (tightness and weakness).
  • Improve neuromuscular control and proprioception of the lumbopelvic region.
  • Reduce associated pain (particularly low back pain and SIJ-related pain).
  • Restore functional movement patterns and activity tolerance.
  • Prevent recurrence through education and long-term self-management.

Physiotherapy is the primary treatment modality for functional pelvic asymmetry. Management should be individually tailored based on assessment findings.

Manual Therapy

There are multiple manual therapy techniques that can be applied for pelvic asymmetry:

Muscle Energy Technique (MET)

MET is the most widely used manual therapy for pelvic asymmetry and sacroiliac joint (SIJ) dysfunction. It involves the patient performing an isometric muscle contraction against the clinician’s resistance, using autogenic or reciprocal inhibition to lengthen tight muscles, improve joint mobility, and restore pelvic alignment. Evidence suggests MET can reduce pain and improve pelvic symmetry when used alongside exercise and education, though its effectiveness as a standalone treatment is limited.[33][34]

Spinal manipulation

Spinal manipulation or high-velocity low-amplitude (HVLA) is a thrust techniques may be considered for lumbar or SIJ hypomobility, but only when clinically indicated.[35]

[36]

Soft Tissue Technique

Soft tissue techniques including myofascial release, trigger point therapy, and deep tissue massage, can address muscle tightness and fascial restrictions that contribute to or perpetuate pelvic asymmetry.

Muscles frequently requiring soft tissue intervention include:

  • Iliopsoas - anterior pelvic tilt and rotational asymmetry
  • Quadratus lumborum - lateral pelvic tilt (pelvic hike)
  • Piriformis - SIJ and transverse plane asymmetry
  • Tensor fascia latae / iliotibial band - lateral pelvic tilt
  • Hamstrings - posterior pelvic tilt and sagittal imbalance.[6]

Exercise Therapy

Exercise therapy forms the cornerstone of conservative management for functional pelvic asymmetry. The programme should be individually tailored based on assessment findings, targeting the specific muscle imbalances, movement impairments, and postural habits identified.

Stretching Technique - The stretching of shortened muscles- priority targets include hip flexors[37], iliotibial band [38], piriformis[39], quadratus lumborum.[34][40]

Infographic showing stretching techniques for Hip Flexor, Iliotibial Band, Piriformis and Quadratus Lumborum muscles - Pelvic Asymmetry

Strengthening of weak muscles- Exercise intensity and frequency depends on type, cause and severity of the asymmetry.[41] Muscle groups involved in lumbopelvic stability and example rehabilitation exercises: gluteus maximus[42], gluteus medius[43], deep core muscles [44], hip abductors[42], hip adductors[45], hamstring [46]and obliques[47] -

Infographic showing strengthening exercises for muscle groups and their functions which are responsible for pelvic asymmetry.

Key features: Romanian deadlift, Deep Core (Transversus Abdominis, Multifidus), lumbopelvic stabilisation, Hip Abductors, Sumo squats, Nordic curls.[41]

Neuromuscular re-education and Motor Control Training

Neuromuscular re-education focuses on restoring efficient muscle recruitment and coordinated movement across the lumbopelvic region. In people with pelvic asymmetry, compensatory activation patterns can persist even after structural issues are addressed, reinforcing malalignment. Training should therefore target not only strength but also the timing, sequencing, and coordination of muscle activity during everyday tasks.[9]

Key Components

  • Deep stabiliser activation — early retraining of the transversus abdominis, multifidus, and pelvic floor muscles helps restore lumbopelvic stiffness and sacroiliac joint force closure.
  • Movement pattern retraining — correcting faulty strategies during functional tasks such as standing, walking, sit-to-stand, and stair climbing, where asymmetries are often seen.[48]
  • Proprioceptive and balance training — progressive loading on unstable surfaces and single-leg activities challenges pelvic stability and reinforces neuromuscular responses in weight-bearing positions.
  • Gait retraining — addressing issues such as uneven step length, trunk sway, or altered foot progression angles that may contribute to pelvic malalignment.

Progression: Training should follow a staged approach:

  1. Begin with isolated activation of deep stabilisers in supported positions.
  2. Progress to integration of global muscles within functional movement patterns.
  3. Advance to dynamic and sport-specific tasks where appropriate.

Evidence suggests that combining motor control exercises with balance training is more effective than using either approach alone in individuals with pelvic asymmetry and sacroiliac joint dysfunction.[49]

Postural and Movement Re-education

Postural and movement re-education is an important component in the management of pelvic asymmetry. The aim is to improve body alignment, correct faulty movement patterns, enhance neuromuscular control, and reduce compensatory stress on the lumbopelvic region. Interventions may include postural awareness training, gait retraining, pelvic control exercises, ergonomic modifications, and functional movement correction during activities such as sitting, standing, walking, squatting, and lifting. These strategies are commonly combined with strengthening, flexibility, and motor control exercises to improve overall movement efficiency and functional outcomes.[6] Correcting habitual postures that perpetuate asymmetry (e.g., unilateral weight-bearing, asymmetric sitting), providing ergonomic advice for work and daily activities, modifying activities where relevant, especially for athletes in unilateral sports. [11]

Orthotic Interventions

Orthotic interventions may help improve alignment, reduce pain, and optimise functional movement in individuals with pelvic asymmetry. Common approaches include heel lifts or shoe inserts for leg length discrepancy (heel lifts or foot orthotics may be considered for true or apparent leg length discrepancies greater than 1 cm), sacroiliac belts for pelvic stabilisation, and customised foot orthoses to address lower-limb biomechanical contributors.[50] Orthotic support should be individualised based on clinical assessment findings and used alongside exercise therapy, postural correction, and movement retraining for optimal outcomes.[51] Radiographic studies show that people using heel lifts for chronic low back pain associated with pelvic obliquity often report symptom improvement.[52]

Other Interventions

Pharmacological: Short-term use of analgesics or anti-inflammatory medication may help manage pain associated with pelvic asymmetry and related pelvic girdle dysfunction. Pharmacological treatment is generally used as an adjunct to exercise therapy and activity modification, with medications prescribed at the lowest effective dose for the shortest duration necessary. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for short-term pain relief.[53]

Surgical: Reserved for severe cases such as post-traumatic pelvic instability, leg length discrepancy >3 cm, neurological compromise, or urogenital dysfunction. The goal is to restore symmetrical pelvic ring anatomy.[53]

Bracing: Sometimes used in neuromuscular scoliosis with associated pelvic obliquity, particularly during growth phases.[25]

Resources

References

  1. ↑ 1.0 1.1 Cibulka MT, et al. Comprehensive Analysis of Pelvic Asymmetries in Low Back Pain, Scoliosis, Post-Traumatic Pelvic Dysfunctions and Obstetric Changes: A Narrative Review Focused on Clinical Relevance. Symmetry. 2024;16(10):1304.
  2. ↑ Bibrowicz K et al. Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the LPHC. Journal of Clinical Medicine. 2025;14(7):2229.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Cruz-Medel I, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Comprehensive analysis of pelvic asymmetries in low back pain, scoliosis, post-traumatic pelvic dysfunctions and obstetric changes: a narrative review focused on clinical relevance. Symmetry. 2024;16(10):1304. doi:10.3390/sym16101304.
  4. ↑ Breum BM, Víbeche I, Jakobsen BW, et al. Reversible pelvic asymmetry: an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms. Spine. 2007;32(14):E414–E419.
  5. ↑ Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Philadelphia: Wolters Kluwer; 2018.
  6. ↑ 6.0 6.1 6.2 Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of Anatomy. 2012;221(6):537–567.
  7. ↑ 7.0 7.1 How to assess pelvis position with palpation (anterior/posterior tilt, hip elevation, rotation) [Internet]. YouTube; 2013 [cited 2026 May 17]. Available from:
  8. ↑ Muscular Strategies for Correcting the Pelvic Position to Improve Posture—An Exploratory Study. J Funct Morphol Kinesiol. 2024;9(1):25. doi:10.3390/jfmk9010025.
  9. ↑ 9.0 9.1 Lee D. The Pelvic Girdle: An Integration of Clinical Expertise and Research. 4th ed. Edinburgh: Churchill Livingstone Elsevier; 2011.
  10. ↑ Zhang F, Zhang D, Huang Z, et al. Morphological asymmetry of pelvic rings: a study based on three‑dimensional deviation analysis. Orthop Surg. 2022;14(5):967‑976. doi:10.1111/os.13246.
  11. ↑ 11.0 11.1 11.2 Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed. St. Louis: Elsevier; 2017.
  12. ↑ Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine. 2006;31(3):E71-E79. doi:10.1097/01.BRS.0000197665.93559.04.
  13. ↑ 13.0 13.1 Young M, Cynn H, Choung S, et al. Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives. Journal of Anatomy. 2001;199(Pt 3):347-354.
  14. ↑ Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Chiropractic & Osteopathy. 2005;13:11. doi:10.
  15. ↑ Grabara M. Comparison of posture among adolescent male volleyball players and non-athletes. Biology of Sport. 2015;32(1):79-85. doi:10.5604/20831862.1127286
  16. ↑ 16.0 16.1 16.2 Khamis S, Carmeli E. Relationship and significance of gait deviations associated with limb length discrepancy: a systematic review. Gait & Posture. 2017;57:115–123.[1]
  17. ↑ Bjelland EK, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG. 2013;120(1):32–40.
  18. ↑ Kibsgård TJ, Røise O, Stuge B. Pelvic asymmetry of the sacroiliac joint following corrective treatment. Journal of Orthopaedic Research. 2014.
  19. ↑ Sung PS, Danial P, Danial P. Comparison of lumbopelvic-hip rotation asymmetry and pelvic asymmetry between individuals with and without nonspecific low back pain. Open Journal of Therapy and Rehabilitation. 2024;12(3).
  20. ↑ Liu H, Tan R, Zhao Y, et al. The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system. BMC Musculoskeletal Disorders. 2020;21:590.
  21. ↑ O’Sullivan PB. Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management. Man Ther. 2000;5(1):2-12. doi:10.1054/math.1999.0213.
  22. ↑ Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourology and Urodynamics. 2007;26(3):362–371.
  23. ↑ Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy. 2005;10(3):207–218.
  24. ↑ Vogt B, Gosheger G, Wirth T, Horn J, Rödl R. Leg Length Discrepancy—Treatment Indications and Strategies. Dtsch Arztebl Int. 2020;117(24):405–411. doi:10.3238/arztebl.2020.0405.
  25. ↑ 25.0 25.1 25.2 25.3 25.4 Magee DJ. Orthopedic Physical Assessment. 7th ed. St. Louis: Elsevier; 2021. (this is already Ref 27 and Ref 33 — consolidate numbering)DJ. Orthopedic Physical Assessment. 7th ed. St. Louis: Elsevier; 2021.
  26. ↑ Cruz-Medel I, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Comprehensive analysis of pelvic asymmetries in low back pain, scoliosis, post-traumatic pelvic dysfunctions and obstetric changes: A narrative review focused on clinical relevance. Symmetry (Basel). 2024;16(10):1304. doi:10.3390/sym16101304.
  27. ↑ YouTube. Mastering Balance: The Science of Center of Gravity and Base of Support | Muscle and Motion. Available from: https://www.youtube.com/watch?v=5s1gEi5wfLg [last accessed 26/July/2025]
  28. ↑ Maricelli JW, Lu Q, Lin DC, Rodgers BD. Trendelenburg-like gait, instability and altered step patterns in a mouse model for limb girdle muscular dystrophy 2I. PLoS One. 2016;11(8):e0161984. doi:10.1371/journal.pone.0161984.
  29. ↑ Licciardone JC, Kearns CM, King HH, Hodge LM, Minotti DE. Pelvic Palpatory Tests in Manual Therapy and Osteopathy: A Critical Review of the Literature and Suggestions for New Research. Cureus. 2024;16(7):e64066. doi:10.7759/cureus.64066.
  30. ↑ Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. J Pain. 2009;10(4):354-368. doi:10.1016/j.jpain.2008.09.014.
  31. ↑ Arab AM, Chehrehrazi M. The response of the pelvic floor muscles to abdominal maneuver and pelvic floor muscle contraction in continent women using transabdominal ultrasound. Neurourology and Urodynamics. 2011;30(1):126-132. doi:10.1002/nau.20942.
  32. ↑ Fann AV. The prevalence of postural asymmetry in people with and without chronic low back pain. Archives of Physical Medicine and Rehabilitation. 2002;83(12):1736–1738.
  33. ↑ Thomas E, Cavallaro AR, Mani D, et al. The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropractic and Manual Therapies. 2019;27(1):35.
  34. ↑ 34.0 34.1 Soomro RR, Karimi H, Gilani SA. (2024). Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Diagnostics, 14(21), 2413.
  35. ↑ Jung WS, Kim JH, Park SY. The immediate effects of muscle energy technique in chronic low back pain patients with functional leg length discrepancy: a randomised and placebo-controlled trial. Healthcare. 2024;12(1):58.
  36. ↑ Hesch J. MET Muscle Energy Technique for the Pelvis and Sacroiliac Compared to Hesch Method [Internet]. YouTube; 2019 [cited 2026 May 17]. Available from: https://www.youtube.com/watch?v=oN8uH6Rsgnw
  37. ↑ Almazán-Polo J, et al. (2024). Comparison of two different stretching strategies to improve hip extension mobility in healthy and active adults: a crossover clinical trial. BMC Musculoskeletal Disorders, 25(1), 853.
  38. ↑ Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. (2024). Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Frontiers in Sports and Active Living, 6, 1386456.
  39. ↑ Ahmad S, et al. (2022). Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release. Cureus, 14(12). doi:10.7759/cureus.32952.
  40. ↑ Lee D, Hodges PW. Behavioral changes in pelvic pain and pelvic asymmetry: mechanisms, assessment, and management. Journal of Clinical Medicine. 2021;10(4):628. doi:10.3390/jcm10040628
  41. ↑ 41.0 41.1 Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Human Kinetics; 2010.
  42. ↑ 42.0 42.1 Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. Journal of Orthopaedic and Sports Physical Therapy. 2013;43(2):54-64.
  43. ↑ Baik SM, Cynn HS, Kim SH. Understanding and exercise of gluteus medius weakness: A systematic review. Physical Therapy Korea. 2021;28(1):27-35.
  44. ↑ Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Current Sports Medicine Reports. 2008;7(1):39-44.
  45. ↑ Harøy J, Clarsen B, Thorborg K, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine. 2019;53(3):150-157.
  46. ↑ van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine. 2019;53(21):1362-1370.
  47. ↑ Escamilla RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports Health. 2016;8(4):372-379.
  48. ↑ O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders—Part 1: a mechanism based approach within a biopsychosocial framework. Manual Therapy. 2007;12(2):86–97.
  49. ↑ Van Dieën JH, Reeves NP, Kawchuk G, van Dillen LR, Hodges PW. Motor control changes in low back pain: divergence in presentations and mechanisms. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(6):370–379.
  50. ↑ Khamis, S., & Carmeli, E. (2018). A new concept for measuring leg length discrepancy and its clinical implications. Medical Hypotheses, 111, 63–66.
  51. ↑ D’Amico M, Roncoletta P, Di Felice F, et al. Lumbopelvic alignment and leg length discrepancy in patients with nonspecific low back pain. Eur Spine J. 2017;26(2):349-356. doi:10.1007/s00586-016-4650-5.
  52. ↑ Defrin R, Ben Benyamin S, Aldubi RD, Pick CG. Conservative correction of leg-length discrepancies of 10 mm or less for the relief of chronic low back pain. Archives of Physical Medicine and Rehabilitation. 2005;86(11):2075–2080.
  53. ↑ 53.0 53.1 Newman DP, Soto AT. Sacroiliac Joint Dysfunction: Diagnosis and Treatment. Am Fam Physician. 2022;105(3):239-245. PMID: 35289578
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