REVERSIBLE PELVIC ASYMMETRY: AN OVERLOOKED SYNDROME MANIFESTING

a Physiatrist, U Hospital, Helsinki b Professor of N University Central Submit requests Unit of Physiatry, 340, Helsinki 0002 Paper submitted 2006; accepted Ap 0161-4754/$32. Copyright D 20 doi:10.1016/j.jm Objective: The objective of this study was to investigate the occurrence of pelvic asymmetry in neurologic patients with symptoms not explained by their neurologic diagnosis. Methods: We analyzed 150 consecutive neurologic patients referred to physiatric consultation based on their clinical examination findings. Results: We observed pelvic asymmetry associated with either C-type or S-type scoliosis and apparent leg-length difference in 87% of the patients. Symmetry could be reestablished by all patients, although 15% showed immediate or imminent relapse. Maintenance of symmetry showed a highly significant (P b .001) correlation with improvement in functional ability and reduction of pain as evaluated during the last visit to the physiatrist. In the follow-up questionnaire, 78% of the patients reported improvement in functional ability and reduced pain. Conclusions: Our results support the view that leg-length difference and scoliosis may be more often of reversible nature than previously considered. Acquired postural asymmetry of the sacroiliac joint may be a neglected cause of several neurologic and other pain-related symptoms that can be relieved by a simple and safe treatment. (J Manipulative Physiol Ther 2006;29:561Q565) Key Indexing Terms: Leg-length inequality; Scoliosis; Sacroiliac joint C ommon causes of postural asymmetry include leglength difference, pelvic obliquity, and scoliosis. According to current clinical practice, radiologic or ultrasound examination has been used to assess leg-length difference. If differences in the level of the proximal ends of the femur or the ceiling of the acetabulum are observed, then differences in the bone length of the extremities are presupposed. Pelvic asymmetry is often caused by a dysfunctional sacroiliac (SI) joint. Unilateral rotatory malposition of the SI joint has also been referred to as subluxation, upslip, or compressed SI joint rotated anteriorly or posteriorly. Scoliosis (ie, abnormal lateral curvanit of Physiatry, Helsinki University Central , Finland. eurology, Department of Neurology, Helsinki Hospital, Helsinki, Finland. for reprints to: Jussi Timgren, MD, Physiatrist, Helsinki University Central Hospital, PO Box 9, Finland (e-mail: seppo.soinila@hus.fi). October 24, 2005; in revised form February 28, ril 26, 2006. 00 06 by National University of Health Sciences. pt.2006. 06.024 ture of the vertebral column) is considered to be most often structural and of spinal origin. The cited separate features of postural asymmetry have been studied over the past 90 years. However, the biomechanical interdependence of the 3 factors and even more so their clinical significance in causing symptoms are still controversial and clinical studies are lacking. Interdependence is called for, for example, by observations that innominate rotation inevitably brings about a tilted sacrum and that an uneven sacral base results in a compensatory lateral curve of the spine. The relation of postural asymmetry and clinical symptoms is under discussion. A positive correlation between low-back pain and leg-length difference and/or innominate rotation has been shown by some studies, whereas it remains a contentious issue in others. -8 Pelvic asymmetry is common among symptomatic and asymptomatic persons. No information is available on the prevalence of lateral curvature caused by unilateral innominate rotation. Because some patients showing asymmetry are asymptomatic, their abnormal posture is not predictive of pain. Although the correlation of asymmetry to symptoms such as low-back pain has remained contradictory, reestablishment of symmetric posture by applying a foot lift has resulted in significant relief from pain in symptomatic patients.