Leg length discussion with Anterior Innominate Rotation (SIJ) correction

www.johngibbonsbodymaster.co.uk
John Gibbons is a registered Osteopath, Lecturer and Author and is demonstrating how to assess for a rotational malalignment by using the leg length as a guide. John also shows how to correct an anterior rotation of the innominate bone. John also discusses the position of the iliac crest regarding leg length, anterior rotation and upslip of the innominate bone.These techniques and more is taught on the Spinal Manipulation and Mobilisation Master-Class at the University of Oxford.
John is also the Author of the highly successful book and Amazon No 1 best seller called 'Muscle Energy Techniques, a practical guide for physical therapists'. John has also written 3 more books, one is called 'A Practical Guide to Kinesiology Taping' and comes with a complimentary DVD. The other books are called; 'Vital Glutes, connecting the gait cycle to pain and dysfunction' and 'Functional Anatomy of the Pelvis and SI joint'.
All his books are available to buy now through my website www.johngibbonsbodymaster.co.u... or from Amazon www.amazon.co.uk
John now offers Advanced Training in all aspects of Sports Medicine to already qualified therapists in manual therapy to 'Diploma' Level. You need to have attended all of his Physical Therapy Courses before the diploma is awarded. His venue is based at the idylic venue of Oxford University, home of the first four-minute mile by Roger Bannister.

[@Bilal-jf3sq]

نرجو المزيد من الدروس شكرا ❤

[@theenlightenedone5429]

very cool. we are going to learn how to do this in PT school very soon and I definitely need this on my right side.

[@JohnGibbons]

Sounds great!

[@yousefrawashdeh_fs3394]

mannnn ammazingggg been looking for this for monthsssssss i hope i heal it

[@yousefrawashdeh_fs3394]

i am a PT student do you have any courses that relate to this topics ??? your explanation i so goood

[@JohnGibbons]

Of course - here are my online courses and click on each one for further information www.johngibbonsbodymaster.co.uk/training/bodymaster-online-courses/

[@JohnGibbons]

Thanks for the comments, regards jG

[@Samu.1980]

Thank you 🍀🙏😊

[@JohnGibbons]

You are so welcome

[@faicalbellizi83]

Dr you are the best

[@JohnGibbons]

Thanks for the message, regards JG

[@dralexfitness]

You say at the end of the video that you may need to correct the other side now. I read up on Malalignment Syndrome. If you were to correct the other side would you correct it according to what you just corrected? You posteriorly rotated the Right because the Right was anteriorly rotated if I am correct. When you corrected it did it make the Left more anterior now?

[@NelsonBiglar]

I would assume that there is a muscle tensegrity scenario where when that adjustment is made that it can still easily go back into its dysfunctional positioning if there isn't a adjustment in muscle strength or facial tensegrity to maintain that new pattern.

[@JohnGibbons]

I initially used a MET to help correct the position with a mobilisation technique at the end rather than a thrust. Many of my chiropractor friends only do an adjustment without any soft tissue work and they say it works for them, I on the other hand will look at what muscles might be changing the pelvic position and focus on changing their length. Hope that helps, regards, JG

[@armihoffman6131]

Hi John, is this a common combination findings: + R seated hip flexion test, + R anterior innominate, + R longer leg in supine, + R on L sacral counternutation?

[@tomgrove8491]

Hi john ! Not seen you for a few years now great video as usual. Very nice ! You did a video years ago with a Dowlings test I think you called it .is that test still useful or just do this new one ? Best regards Neath Tom climber like you remember? Wish I lived in oxford my pelvis is a mess !

[@JohnGibbons]

Hi Tom, both tests are good so use them both, regards JG

[@danhope77]

Hi!! I ve been told that my legs have the same length but due to a lumbar curve I should wear a heel lift. The discrepancy is of more than 1 cm however I wear a 6 mm heel lift on the left leg. This fixed my pain in the left side of my lower back and hip. all good for 5 weeks, then the pain came back , this time on the right side, a sciatica inflammation , a tingling feeling etc... I went to a chiropractor and before having the first visit a n assistant put me on a machine that checks weight distribution and posture. She says that there are 7 kilos more pressing on my right leg (which is the leg without heel lift). if I take the heel lift off I may go back having lots of pain on the left side...I will see the chiropractor soon however, after having spoken to my doctor, having seen a physiotherapist and also an osteopath I start to feel hopeless. Any ideas? Mostra meno RISPONDI

[@gissy1232]

DS so you have scoliosis? You should check a schroth institute in you’re area these exercises do not only help with that they also help reduce scoliosis curvature google it they make miracle wonders ! Also make sure you are using the correct heel lift since using the wrong measure can make the back pain worse! Ask you’re ostheo or physio

[@eslamzidan9766]

Would this be realligned at once or it needs many repetitions and sessions ?

[@HemantSingh-mf3zt]

Hi John, thanks for this awesome video. I followed your technique and heard a POP sound first time around. Does this mean that the malalignment has been corrected "permanently" or would this technique need to be repeated a couple of times?

[@JohnGibbons]

Difficult to answer - I suggest my patients need 4-6 treatments to help overall, regards JG

[@matth7471]

Thanks so much for posting this. I’ve been diagnosed right hip anterior rotation which causes chronic pain at the hamstring insertion. Physios always assign me strength work for the right glute which inflames the hamstring even more. Since first watching this video I’ve been stretching right psoas, adductors, rectus femoris and tfl. I would like to find someone who can do the MET you demonstrate here in Miami, aside from a google search is there a way to find a qualified physio? Best, Matt

[@JohnGibbons]

Best of luck! Regards JG

[@josiecamilo7098]

How are you now? Did you find anyone? I'm also in Miami looking for the same.

[@xthinker2552]

Wow nice . Any alternative exercise for that pls.

[@JohnGibbons]

Treatment mainly and I have lots of videos for that, regards JG

[@annmartin1376]

Is there a MET I can do myself to correct this same dysfunction? Chiropractor confirmed this (dysfunction) as well as my PT at my first visit yesterday? What causes a rotation in the pelvis in the first place--muscle imbalances?

[@JohnGibbons]

Its tricky top explain what to do by a text message, ask the chiro you saw to show you a self MET as that could help. regards JG

[@RyleyRehab]

Is it posible to overcorrect a anterior rotated R SIJ by bringing it too far posterior? If so, do you need to do isometric R hip flexion to bring it back to the correct position?

[@JohnGibbons]

I doubt it as a safe technique. regards JG

[@nigaabusable]

What if my leg is shorter in line, but when I sit up my malleolus evens? Does it mean it’s an upslip of pelvis or not?

[@Silentpartner2176]

I got an xray of my pelvis because of sciatic pain down my left leg. It shows my left SI joint lower than my right SI, causing my sacrum to be crooked. Oddly it also shows my left sit bone higher than my right sit bone. How is this possible? Are people born with one side of their pelvis shorter than the other, or do I have an anterior rotation on my left side? When I do this leg test, it is exactly like the girl in the video, laying down my right leg is longer, when sitting legs are the same length.

[@emreuyank9998]

My legs and my hips are at the same level but that Bony on pelvis on right side is like 1 inch lower than the other. What should i do?

[@JohnGibbons]

Try and see someone like me where you live as sure they can help as not much i can do by a text message, regards JG

[@Silentpartner2176]

Do you have a video on how to correct a posterior innominant?

[@JohnGibbons]

I do indeed - so search for it on my website..regards JG

[@hafizhadi8185]

This is exactly what i have. Right leg is long while standing..and short while sitting..so it means that i have right anterior .but i also have right outflare and left inflare pelvis.its like my pelvis is rotated to right and my spine also rotated little bit. So my question, which one do i need to fix first? The anterior rotation or outflare?tq for your reply.

[@JohnGibbons]

I would probably fix the Anterior rotation first as that can be the primary and that normally corrects the flare...hope that helps, regards JG

[@davidd9325]

Have you fixed your issue? I have the same thing!

[@boscoblack]

I was taught that the leg that is longer in supine and shorter in long sitting is posteriorly rotated. Due to the position of the acetabulum, it does seem that this is true, or no?

[@JohnGibbons]

if you look at the Book called Malalignment syndrome by Wolf Schamberger as it is all discussed in there. If you are in a supine position and if the right leg appears to be longer then it is either a true long leg or an apparent longer leg - e.g. the innominate is anteriorly rotated on that side and it does change to become the shorter leg in sitting due to the anatomical change of the acetabulum. Hope that helps. JG

[@fineartlifestyling]

I want to know what your thoughts on postural restoration institute (PRI) regarding the right ASIS pattern is? They have a very interesting theory, a little revolutionary even about pelvic floor rotations.

[@JohnGibbons]

Never heard of it - regards JG

[@rihabsara7141]

hi if legs are level in supine and when sitting right leg gets longer . what does that mean? thank.

[@JohnGibbons]

I presume that from long sitting to supine the legs become equal - if that is the case then the left leg actually travelled further so lengthened - it could indicate an anterior rotation off the left innominate - hope that helps, regards JG

[@jasonhappycomedy8703]

Trying to understand this do you do the technique on the long leg first?

[@ramezmorshed7518]

Hello, Doctor, I want your opinion about my case, if possible. I had an anatomical difference in the right leg that was 1.5 cm longer because of a knee injury when I was a child. I used special shoes for this problem, but it did not help. I underwent several surgeries on the right knee, the ACL twice, and the meniscus. several months ago I had a leg lengthening surgery on the left leg to , but I still feel that the right leg is longer in the sleeping position, the right one is longer, and when sitting, it is also the longest. Is it possible that the dependence of all these years on the left leg makes it shorter to the point that even when you treat the anatomical reason, there is a functional reason that makes the leg shorter?

[@TravelHaole]

HI John, often I see a right side anterior rotation - the right asis is lower and the psis higher then the left. However when they are laying on the table the leg is often shorter which seems to contradict what you are saying here. Would you have any explanation for that? When checking the client on side on view (standing) the right side does seem to be more anteriorly rotated then the left... could it be that the left is posteriorly rotated? but if that's the case wouldn't the left leg be shorter?

[@JohnGibbons]

It could be the right QL is short which will hold the leg in a functionally shorter position but it could still be anterior, regards JG

[@llehaff]

My left leg is longer than the right when seated and it evens out when in supine position. This is after a bad fall on ice, where my pelvis got misaligned. The pelvis is back in place after receiving treatment etc. Also, when standing bare feet, my right arch is closer to the floor than the left. Is my right hip turned back? Thank you

[@JohnGibbons]

Hard to comment without looking at you, sounds like the treatment you had worked though, regards JG

[@llehaff]

@@JohnGibbons Thank you so much for replying. I live in Denmark, otherwise it would be great to go to your clinic it seems. Some parts of my pelvis are more in place, but I still have so much pain. And my left leg goes about 2 1/2 cm longer when I change from supine to sitting.

[@amishah6125]

Sir my client's rt leg is longer than the lt leg in supine and in sitting both becomes equal what should I interpret.

[@JohnGibbons]

The one that is longer is probably an anterior rotation of the innominate - regards JG

[@francosecchi9288]

Hi John, should we check leg length in prone or supine? Also, i was taught that an anterior pelvic tilt cause a shorter leg. Why do chiropractors think that it is the opposite, though? That is, anterior pelvic tilt causes a longer leg, and a post causes a shorter leg??? Could you possibly clarify this conundrum for me, please? Thanks

[@JohnGibbons]

An anterior innominate will give the appearance of a longer leg through internal rotation of the leg and a posterior tilt will give the appearance of a shorter leg due to external rotation of the leg - supine is more realistic to assess leg length - regards jG

[@pappachuco]

Dr. Gibbons, I was hit by a car as a child on my right Ilium and later in life discovered that my right leg is longer than the left. I currently am experiencing (R) Hip flexor tightness and (L) sided low back pain. Over the years this imbalance has affected my bilateral symmetry all the up to my neck. While sitting up in the supine position, it appears that my legs are almost even, the (r) side just a tiny bit longer. Once I lay down, the (L) leg appears to lengthen or the (R) leg shorten. I have been out of the health field for quite some time now and have not dealt with the rotational imbalance of my pelvis. This back pain is becoming a bit cumbersome, any suggestions as to the issue and treatment? Thanks.

[@JohnGibbons]

Thanks for the message and it is difficult to comment without looking at you, I would try and see someone like me where you live and see what they say and take it from there. Good luck, regards JG

[@cychee8779]

May I know this is for solved what kind of health problem ? Thank you 🙏🏻

[@JohnGibbons]

Depends on the cause will depend on the treatment, regards JG

[@redrum4100]

Do you ever do treatments in the north west? I was a decent middle distance runner many years ago, but decided to do a parachute jump for charity. On landing I planted rather than rolled - yes, I know that's dumb, and extraordinarily painful (feet and ankles the size of footballs). Nothing broke but I was laid up for weeks. These past 30 years I tried to get back to running but had myriad injuries, and these days walking is a struggle. I've found so-called experts not so expert, to the point that I'm still confused as to what hip/spine imbalances I have. Here's what I do know: my legs are the same length when lying on the floor but my right leg rotates outwards. If I go into long sitting my right leg gets sucked into my body - but is still rotated out. My right shoulder sits higher when walking. If I run with a hood up, it starts rotating to the right so I can't view anything with my left eye.

[@JohnGibbons]

I dont travel anywhere to see patients and i am sure there are plenty of therapists near you that you can see, regards JG

[@redrum4100]

@@JohnGibbons I will come to you, in that case (I'll just have to wait a while as my daughter is long term in hospital). I've seen God knows how many therapists over the years, most of which have made things worse.

[@bornwin-sx9oz]

After a left total hip replacement 5 weeks ago my left leg feels longer than the right. I’ve been told it will correct itself by three months post op. I still have a lot of inflammation and my left butt muscles still feel very tight. I am getting worried about the leg lengths. The surgeon who operated on me is very reputable.

[@JohnGibbons]

You will have to give it a few months at least for things to settle down, regards jG

[@bornwin-sx9oz]

@@JohnGibbons Thank you for your encouragement!

[@dr.jashandhillon5041]

What ever god given uuu be satisfied😇😇😇😇

[@nabilbt8054]

Hi dr.John I got injured my MCL two years ago while i was doing gymnastics. And now i can't totally band my knee for unknowing reasons. I also can't train hard or flex properly as i used to .Therefor. I lost confident in myself. i'm 18 years old. My goal is to be a pro athlete. I actually was one. I've participated in many competitions aboard . But not anymore after the injury. I can't run very fast. i can't jump . I just can't do more with gymnastics. neither with any other sports except cycling. Please i'm looking forward to your suggestions and solutions as soon as possible. Best regards . Nabil

[@JohnGibbons]

It sounds like that the Meniscus (Cartilage within the knee and probably the medial meniscus) might be the reason why you can't bend the knee or run etc so I would try and have an MRI scan done to confirm or deny the meniscal tear as the MCL would have healed by now. Good luck, JG

[@adamgill7269]

How do I find someone that specializes in SIJ dysfunction. I live in the Bay Area, CA and there does not seem to be an expert or anyone that is knowledgeable regarding SI dysfunction. My PT assessed my as having a mild anterior annomonate on right side from a fall 6 months ago and I've been religiously doing strengthening, stretching and foam rolling/lacrosse ball with no improvement. I'm in great shape and can still function everyday and pain is around a 3/10 but nothing is resolving. Any recommendations on Bay Area specialist or anything else. Thanks!

[@JohnGibbons]

No idea of anybody in the US as I live in the UK so most of the therapists I have taught live here, regards JG

[@nwralnor9059]

I have a short problem in my Yemeni leg with 1 cm .... Doctor, is he treated in sport .... because when I walk ... I feel that I walk normal ... but the basin has a sense of crooked .... What is your advice to me. Note that I was a short leg with 2 cm ... and with time it seemed to decrease to 1 cent ... of course with treatment ...... Because in my childhood, I have a problem, and I did not walk a full month because of a health problem .... God willing, you will answer me .... and can I help myself with sport at home ....

[@da2hampton]

Mine are even when sitting up and one longer when laying?

[@JohnGibbons]

That means there is a pelvic torsion as when you are sitting to lying then one gets longer and typically will be the side that is anterior. regards JG

[@2fastnfurious4u]

If right butt appears flat and left one sticks out (right leg shorter in supine), would you apply same correction like in this video

[@JohnGibbons]

Hard to comment without looking at you, regards jG

[@erenix3909]

hi a year later. did you figure this out? i have the same issue thx

[@2fastnfurious4u]

@@erenix3909 it's left AIC right BC pattern, left hip is pushed forward... your center of gravity is pushed far forward and right (so you need get back and to the left). Biggest improvement I got with Feldenkrais integration sessions that reduced my anterior pelvic tilt, couldn't accomplished that on my own only with exercises..

[@jessicagertel3747]

I am so completely stumped by my LLD. Right hip higher in standing and lying down. And right leg longer in lying and sitting. But no true leg length discrepancy in xrays. How is this possible? I do have a right thoracic scoliosis but still isn't explaining things. Can figure this one out?

[@JohnGibbons]

Hard to comment without looking at you but if the X-ray shows no discrepancy then it will be a functional longer leg possibly, regards JG

[@jessicagertel3747]

@@JohnGibbons thx for replying. Yes its functional but confused about how to know what's causing it and therefore how to treat. Its not fitting the typical pattern of pelvic rotation...

[@vibefrequencyable]

is this a chiropractic technique class???

[@JohnGibbons]

The course I teach is on the Pelvis, SI Joint and lumbar and most of the therapists attending are Sports Massage therapists that want to be able to assess and treat patients with back pain more effectively. Chiropractors, Osteopaths as well as Physiotherapists also attend the course as they to also benefit. Hope that helps. JG

[@artofdarknessllc]

John, thanks for the video! I have a question: My right PSIS is protrusive, and I have chronic tightness in the right obliques, adductors, psoas, glutes, and hamstring. Over time this tightness has progressed all the way up the back on the right side (paracostals are tight, levator is bound up) and down the leg to the ankle, resulting in full right-side tissue tension/shortening and over time has caused shoulder injuries and neck pain- there seems to also be a flattened arch in the right foot, and impact tends to get absorbed on the right side. My right shoulder droops noticeably, right foot wants to externally rotate- it has resulted in neck pain, trigger points at the right rhomboid and trap, and lots of snapping and cracking in my vertebrae has become routine upon spinal rotation or stretching the right side of the body. Pain always develops upon standing for long periods of time, and i'm generally very active but have become injury prone. Sitting and lying are not a problem. How can I determine if have a functional or congenital short leg? So far professional help has been disappointing. The PT's and chiropractors i've seen have failed to isolate and solve the problem. I've had to do all my own research and treatment to get any results, but i can only fix the issue permanently if i know the root.

[@JohnGibbons]

The best way to determine if a true leg length discrepancy or a functional leg length is to have an X-ray as the reliability between therapists measuring the ASIS to medial malleolus (usual way) is not very consistent. Regards JG

[@artofdarknessllc]

@@JohnGibbons thank you so much, i thought this might be the answer but having the confirmation from someone as knowledgeable as you gives me the confidence to move forward and schedule the xray.

[@JohnGibbons]

Glad I can be of assistance, good luck, regards JG

[@mrofnocnon]

Is there anyone in Ontario as good as you?

[@JohnGibbons]

No idea as only know therapists in UK, regards JG

[@debbieharris4468]

Homes Jeeica

[@JohnGibbons]

Thanks for the message, regards JG

[@henrygabigogo1275]

Naye akaana ako... 😒

[@evildead68]

This video is brought to you by the letter C.

[@JohnGibbons]

Thanks for the message, regards JG

[@bekithomson]

The transcript really makes no sense.

[@biomechanicsacademy]

John, I love your enthusiasm, however what you have explained is not actually correct from a biomechanics, evidence and engineering perspective. Anterior right innominate, posterior left innominate is the post common pelvic adaptation seen clinically (lots of evidence). You have not explained or shown why the right leg is a function LLD; you have not measured the PSIS to ASIS sagittal plane angle before correction it and obviously you didn't measure the same angle after correction; you have not explained how you differential between a structural LLD, apparent LLD or functional LLD; and you have not provided any clinical evidence to this effect. This is easy to do with a digital pelvic inclinometer. There are so many challenges to this video. Research has also shown that the SIJ moves very little in translation - less than 2mm in fact, so translation/shearing in any direction cannot explain the magnitude of LLD seen on your couch. The issue is that if you are trying to manipulate out an adaptation to a structural LLD, then you can make the SIJ dysfunctional because the structural LLD will always be present and you have taken away the signs of adaptation i.e. pelvic torsion that the practitioner can measure and recognise as an adaptation and deal with with a raise or orthoses etc. You cannot correct structural LLD - it will always be present. You have not provided enough evidence that the LLD was functional and why before correction.

[@JohnGibbons]

If you read my pelvis book you will see lots of information in there, explaining what you discussed as this is only one brief video, thanks for the comments, regards JG

[@biomechanicsacademy]

@@JohnGibbons Hi John, thank you for taking the time to reply. Happy New Year. You teach a lot of great techniques, however, technically some of the pelvic data you give out isn't quite correct and requires more clarity. I innovated the digital pelvic inclinometer (DPI) and Pelvic Equilibrium Theory. Times have moved on and clinicians need to quantify position and give an explanation of why there is a mal-position before making adjustments etc, and then measuring again to see if there is an improvement. Many mal-positions are adaptations, and once the origin of the abnormal force is identified and address, an adjustment is not required. I'd love to visit you at some stage and have a chat.

[@simonjones63]

That’s because all of this codswallop on pelvic up slips down-slips and rotations has zero evidence to back any of it up.. if only it were all so binary! We have moved on thankfully.. a bit like palpation of the Psoas! Ain’t happening…