11/05/2026
Hip Alignment Influenced by Leg Length Discrepancy
The most common pelvic alignment sighted in my practice is a left hip in high range anterior rotation sagittally about the SIJ, with a level right hip and slight right leaning pelvic tilt in the frontal plane. This is not good posture but it is so common I call it normal. By my definition, high range anterior rotation amounts to 30 degrees or more. Very high range is 45 degrees.
Assessment for this is carried out with the client standing, therapist seated at their side placing fingers of one hand on the posterior aspect of the iliac crest and fingers of the other hand on the ASIS and noting the line between these two points in relation to horizontal. Where they are aligned horizontally in the standing position, that is normal. Where the ASIS is inferior, that is anterior rotation. Where the ASIS is superior, that is posterior rotation.
This method of examining hip alignment was taught in the Remedial Diploma at Swinburne University. On commencing practice, I identified a correlation between high range anterior rotation of the hip about the SIJ and dysfunction down the backline of the lower limb.
High range anterior rotation of 30 degrees is something like six times beyond normal range of motion for the SIJ. This binds and tightens the ligamental structure and connective tissue about the joint. My observation is it blocks energetic Qi flow, causing a subtle thickening and tightening from gluteals to plantar fascia that can escalate to acute pain, dysfunction and injury. Why the hip rotated in this manner and resisted attempts to realign it through treatment and rehab was a mystery.
The first case of plantar fasciitis resolved by normalising left hip position dates back to 2008 in my practise. This client afflicted by the condition for 10yrs had been examined by medical doctors in both Melbourne and London, and subjected to surgical intervention to release the plantar fascia to no avail. Massage and physiotherapy treatment was similarly ineffective. When I realised discomfort and binding at the SIJ from anterior rotation might be cause for distal effects in the lower limb, I applied an intense hip flexor stretch, reducing anterior rotation sufficiently to allow the energetic Qi flow to resume. Within 3 days, the plantar fascia symptoms resolved.
I understand there is scepticism for energetic Qi flow concepts. That is fine. Nevertheless, I have observed the correlation between the twisted SIJ and dysfunction down the backline of the lower limb. That I have repeatedly resolved acute conditions such as Piriformis Syndrome, unrelenting hamstring and calf tightness, and Plantar Fasciitis by normalising hip rotation and releasing the bound SIJ remains is a fact. One can give whatever reason they like to explain why a proximal anomaly at the hip and lumbro-sacral region has a distal effect in the limb. It does not invalidate the observation.
I suspect medico’s and therapists generally do not consider hip alignment as I describe above. If so, there would be considerably more discussion on the topic of an SIJ that is typically being forced into chronic high range anterior rotation multiple times beyond normal range of motion. This presentation is so common that despite it not being good posture, I consider it to be normal. Also too, it is not surprising the left SIJ being pushed six to nine times beyond normal range becomes symptomatic. In the short term experiencing pain and impacting the backline of the lower limb. In the longterm (decades), jeopardising stability of the joint and making it vulnerable to injury.
Why the left hip was in unilateral high range rotation was a mystery to me until in 2014 when I was told by an instructor that 68% of his clients had a structurally short right leg. I began examining hip alignment and structural leg length of every client presenting in my practice. I was sceptical of his claim but within two months I got back to him admitting it was true and if anything, it was more like 99% have the short leg condition.
Considering the mechanics of hip alignment, I realised anterior rotation the left hip is an unconscious anatomic adjustment functionally pulling up the longer leg, reducing pelvic tilt, making us feel more comfortable and protecting the lumbar spine to some degree. As the hip rotates sagittally about the SIJ, the femoro-acetabular joint moves in an arc posteriorly and superiorly. The occasional exception case sighted with both hips level will present greater right leaning pelvic tilt and more prominent lumbar symptoms.
