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An imbalance in leg lengths can contribute to sacroiliac, lower back, and hip pain.
The imbalance can be from pelvic torsion, an anatomical short leg, or a sacral upslip. This assessment can help to differentiate the cause of the imbalance.
Have your client supine on the table and do several bridges. If your client is unable to do a bridge, you can shake out their legs to balance the pelvis before doing the assessment. If doing a bridge causes a hamstring cramp, have them try to extend their knee against resistance. This engages the quadriceps and inhibits the hamstrings, helping relieve the cramp.
Notice how the medial malleolus on both ankles lines up. If your client is obese and you can’t see the medial malleolus, place your thumb on each medial malleolus and see how your thumbs line up.
If you see a discrepancy, have your client sit up and reassess. If the discrepancy resolves when they sit up, the cause is likely pelvic torsion. If there is no change upon sitting up, the cause can be from an anatomical short leg or a sacral upslip.
If your client is unable to sit up because of pain or weakness, you may still proceed with treatment, both for pelvic torsion and for sacral upslip, and see how they respond.
An anatomical short leg may be congenital, or from an accident, or injury. It can be corrected by using a shoe lift.
Flow Chart
If testing shows Pelvic Torsion, perform these techniques:
Pelvic Balancing with Facilitated Stretch
If testing shows Sacral Upslip, perform these techniques:
Quadratus Lumborum – Resistance Release
Low Back, Sacroiliac, and Hip Pain – Self-Care
Relevant Studies
Leg Length Discrepancy: The Natural History (And What Do We Really Know)