The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature.
OBJECTIVE
Although it is common to find assertions relating functional leg length inequality (LLI) to pelvic torsion and other states of subluxation, comments and/or data concerning anatomical LLI in this same context are uncommon. This review of the literature synthesizes the evidence on pelvic torsion in relation to anatomical LLI.


METHODS
The literature was searched using the PubMed; Manual, Alternative, and Natural Therapy Index System; Allied and Complementary Medicine Database; Cumulative Index to Nursing and Allied Health Literature; and Index to Chiropractic Literature databases for primary studies that related LLI, either artificially created or naturally occurring, to pelvic torsion. Extracted data included natural vs artificial LLI, method of creating or detecting LLI, subject selection, methodology for measuring pelvic torsion, and results.


RESULTS
Nine English-language studies were retrieved published 1936-2004. Seven determined the impact of artificial, transient LLI on pelvic torsion, whereas 2 studied the effect of naturally occurring LLI.


CONCLUSIONS
Across varying methodologies for measuring LLI and pelvic torsion, a consistent, dose-related pattern was identified in which the innominate rotates anteriorly on the side of a shorter leg and posteriorly on the side of the longer leg. This finding was contrary to the common assertion that the ilium rotates posteriorly on the side of a short leg and vice versa. Practitioners of manual medicine who derive vectors for intervention based on leg checking procedures should consider the possibility that the direction of pelvic torsion may be variable depending on whether the LLI is of anatomical or functional origin.
Cooperstein
Robert
R
Professor, Director of Technique, Director of Research, Palmer Center for Chiropractic Research, Palmer Chiropractic College, San Jose, CA 95134.
Lew
Makani
M
Rheumatol Rehabil. 1981 Nov;20(4):233-8
6458081
Spine (Phila Pa 1976). 1999 Jun 15;24(12):1234-42
10382251
Clin Podiatr Med Surg. 1988 Jul;5(3):509-20
3293752
Gait Posture. 2000 Jun;11(3):217-23
10802434
J Pediatr Orthop. 2007 Jan-Feb;27(1):46-50
17195797
Eur Spine J. 2001 Apr;10(2):107-13
11345630
J Am Osteopath Assoc. 1991 Jan;91(1):34, 37-44
1997458
J Orthop Sports Phys Ther. 1996 May;23(5):309-19
8728529
J Am Osteopath Assoc. 1994 May;94(5):383-90
8056627
Eur Spine J. 1999;8(1):40-5
10190853
Chiropr Osteopat. 2005 Jul 20;13:12
16080787
J Man Manip Ther. 2008;16(1):25-38
19119382
Spine (Phila Pa 1976). 1997 Sep 15;22(18):2073-82
9322317
Physiotherapy. 1976 Dec;62(12):384-400
802002
Arch Phys Med Rehabil. 2001 Jul;82(7):938-42
11441382
Spine (Phila Pa 1976). 2004 Dec 1;29(23):2593-602
15564907
J Manipulative Physiol Ther. 1992 Nov-Dec;15(9):576-90
1469342
Spine (Phila Pa 1976). 2000 Jan 15;25(2):214-7
10685486
J Biomech. 1987;20(10):971-7
3693378
Chiropr Osteopat. 2005 Jul 20;13:11
16026625
J Orthop Sports Phys Ther. 2003 Jun;33(6):319-25
12839206
J Manipulative Physiol Ther. 1988 Aug;11(4):290-5
3049890
Man Ther. 2003 Nov;8(4):207-13
14559043
J Manipulative Physiol Ther. 1983 Mar;6(1):13-6
6222127
Spine (Phila Pa 1976). 2000 Feb 1;25(3):364-8
10703111
J Back Musculoskelet Rehabil. 1998;11(2):89-130
11542803
Clin Orthop Relat Res. 2008 Dec;466(12):2910-22
18836788
Spine (Phila Pa 1976). 1989 Feb;14(2):162-5
2922636
J Med Libr Assoc. 2006 Oct;94(4):421-9, e205
17082834
J Manipulative Physiol Ther. 1995 Jul-Aug;18(6):343-6
7595107
Spine (Phila Pa 1976). 1995 May 1;20(9):1047-54
7631234
Phys Ther. 1988 Sep;68(9):1359-63
2971233
Spine (Phila Pa 1976). 1993 Mar 1;18(3):368-73
8475440