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Letters to the Editor  |   September 2005
Pelvic Postural Asymmetry Revisited
Author Affiliations
  • Stephen M. Davidson, DO
    Phoenix, Arizona
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   September 2005
Pelvic Postural Asymmetry Revisited
The Journal of the American Osteopathic Association, September 2005, Vol. 105, 403-425. doi:10.7556/jaoa.2005.105.9.403
The Journal of the American Osteopathic Association, September 2005, Vol. 105, 403-425. doi:10.7556/jaoa.2005.105.9.403
To the Editor:  
I enjoyed reading the original contribution “Prevalence of Frontal Plane Pelvic Postural Asymmetry—Part 1,” by Juhl et al in the October 2004 issue of JAOA—The Journal of the American Osteopathic Association (J Am Osteopath Assoc. 2004;104[10]:411–421). I found the article to be both insightful and informative, and I wish to present additional diagnostic and treatment information regarding pelvic postural asymmetry that I have found helpful in my practice. 
I have observed that the os coxae sometimes contains intraosseous strains, making the innominate assume the distorted shape of a “bent wheel.” These distortions usually originate along the developmental junctures of the ilium, ischium, and os pubis. All three of these bones unite at the acetabulum and at the iliopubic and ischiopubic junctions. 
I have also observed that intraosseous strains affect not only the width and depth of the pelvic structure on the side of the strain. They can also affect the flaring of the lower extremity (a crucial factor in tracking while walking) and the depth of the acetabulum (an important factor in leg length and in developmental dysplasia of the hip in infants). 
I have discovered an easy and effective diagnostic method for assessing the degree of pelvic asymmetry. It involves the use of two landmarks: (1) the pubic tubercle, and (2) the inferior aspect of the anterior superior iliac spine. One performs this assessment after normalizing pubic and sacroiliac mechanical malalignments. I usually place my thumb on the pubic tubercle and my index or middle finger under the anterior superior iliac spine to compare the relationships between these landmarks. 
I offer the figures on page 425 for your consideration. Figure 1 shows a normal pelvic structure, with width and height symmetrical on both sides of the structure. Figure 2 shows a pelvic structure with less height on the left side. Figure 3 shows a structure with greater width on the right side. These figures exaggerate the magnitude of the typical pelvic asymmetry condition and are offered only to illustrate the osseous aspect of the somatic dysfunction involved in pelvic asymmetry. 
Effective treatment of such asymmetric conditions consists of removing the intraosseous strain and normalizing the shape and symmetry of the right and left innominate bone. Many methods exist to achieve this normalization, but I usually find that myofascial release, peripheral application of the cranial concept, or neurofascial release are the most effective. 
Figure 1.
Normal, symmetric pelvic structure.
Figure 1.
Normal, symmetric pelvic structure.
Figure 2.
Asymmetric pelvic structure, with less height on left.
Figure 2.
Asymmetric pelvic structure, with less height on left.
Figure 3.
Asymmetric pelvic structure, with greater width on right.
Figure 3.
Asymmetric pelvic structure, with greater width on right.
Although I have found this normalization to be efficacious for leg length discrepancies, many of my patients have also reported improvements in pelvic organ function in various conditions, including irritable bladder syndrome, irritable bowel syndrome, painful menses and other menstrual conditions, recurrent cystitis, and dyspareunia. 
Figure 1.
Normal, symmetric pelvic structure.
Figure 1.
Normal, symmetric pelvic structure.
Figure 2.
Asymmetric pelvic structure, with less height on left.
Figure 2.
Asymmetric pelvic structure, with less height on left.
Figure 3.
Asymmetric pelvic structure, with greater width on right.
Figure 3.
Asymmetric pelvic structure, with greater width on right.