Pelvic Upslip and Rotation: Evaluation and Treatment

Pop quiz: What musculoskeletal issue could result in chronic low back pain, chronic Chronic-back-pain-image muscle strains, lower extremity tendinopathies, periscapular pain and tightness, glenohumeral and shoulder girdle pain, or tension headaches? I am sure you can think of a few possibilities, but few can result in all. Often, when a patient reports to our care with one of the aforementioned we immediately think locally. Unfortunately, the real problem could be pelvic upslip, anterior pelvic innominate, or both. Despite being oft-overlooked, these malalignments are not hard to identify if you know what to look for.

Upslip and innominate takes the foundation of our core and creates a ripple effect of imbalance through our body; from the trunk, superiorly to the upper extremities, and inferiorly to the lower extremities. It results in a cascade of altered arthrokinematics, changes length tension relationships, and reworks normal neurological feedback loop.  I wrote a post some time ago on the Treatment for Pelvic Rotation and Low Back Pain, which describes anterior innominate in detail.


99 times out of 100 upslip (or Posterior Iliac Subluxation) occurs on the left side and anterior innominate (pelvic rotation) occurs on the on the right. Here are some common signs for upslip and anterior innominate.


Anterior Innominate

Functionally shorter leg length on the left Functionally longer leg length on the right
Left Iliac crest superior vs. right Anteriorly rotated ilium (Right ASIS appears inferior)
Left PSIS superior vs. right Right PSIS superior vs. left


Iliac Crest Height

Iliac Crest Height left superior to right

ASIS Height

ASIS Height Right inferior to left











Anterior Innominate

Sacrotuberous Laxity + on the left + on the right
Seated / Standing forward flexion + on the left (no movement or superior movement on left) + on the right (no movement or superior movement on right)
Pubic Spring + for pain on left + for pain on the right
Seated flexion test

Superior migration of left thumb upon forward flexion

Clinically, I have seen many patients report to me complaining of hip pain, low back pain, as well as shin splints and Achilles tendinopathy who also presented with these malalignments. I have also experienced several patients have upper extremity pain with these same malaignments. My wife is a prime example. Routinely she complains of periscapulothoracic pain, tightness of the rhomboid, levator scapula, scalenes and an elevated first rib, these usually lead to chronic tension headaches.  Fortunately, by performing a few easy treatments techniques these problems can be fixed. Below I discuss clinician treatment options and self-treatment options.

Clinician Treatment:

In my experience treatment of postural disorders is best using manual therapy techniques and focused corrective exercise. I’ve seen many address functional leg length discrepancy by placing a heel lift in a shoe. If this is not an anatomical leg length discrepancy, then a heel lift will do nothing. You must correct the dysfunctional cause. When I see an individual presenting with upslip or innominate I perform three things: trigger point release (TrP), followed by muscle energy techniques (MET), followed by an isolated strengthening exercise.

Treatment of Upslip:

Step 1 – TrP release: For upslip, I almost always find trigger points and hypertonicity in the left Quadratus Lumborum (QL). The QL has 4 TrP, the medial are deep and very hard to access, thus I focus on the lateral (see figure below). Apply moderate ischemic pressure for about 30 seconds – 1 minute to the TrPs. If you feel for fasciculation (local twitch response), hold the point until fasciculation resolves.

Common Trigger point locations for QL

Common Trigger point locations for QL

Step 2(a) – MET to the Quadrautus Lumborum: When it comes to MET, I always prefer the techniques used by Leon Chaitow. However, I could find no video of his technique (someday I will shoot my own video). The technique demonstrated here is also very effective. Perform 2-5 repetitions of this QL MET technique.

Step 2(b) – MET for Posterior Subluxation (upslip): For this MET, the patient lies supine, while the clinician will holds the left leg and places it in 30° of abduction and flexion. The clinician pulls the leg inferiorly to apply gentle traction. Have the patient take a deep breath in and out normally. The clinician should add additional traction upon exhale. Perform this 2-3 times. After the final repetition, provide a quick longitudinal pull on the leg.

Step 3 – Isolated strengthening of right Quadratus Lumborum via right hip hike (approximation): Stand on a 6-12” box or step, with the right leg hanging off and weight shifted over the left leg. Slowly pull up or hike the right leg. The right iliac crest should move toward the right 12th rib. Hold the up position for 2 seconds and slowly return to the starting position. Repeat for 10-15 repetitions. For increased intensity, add a cuff weight to the ankle.

Treatment of Anterior Innominate:

Step 1 – TrP release to the hip flexors: Two muscles to address here are the Tensor Fascia Latae (TFL) and the Rectus Femoris. The iliopsoas (psoas Major, psoas minor and iliacus) also plays a role in anterior innominate, but I find it near impossible to reach these tissues. However, the techniques discussed in step 2 and 3 below will help turn the iliopsoas off. Apply moderate ischemic pressure for about 30 seconds – 1 minute to the TrPs on the Rectus Femoris and TFL. If you feel for fasciculation (local twitch response), hold the point until fasciculation resolves. For best results, it might be best to slightly flex the hip to take slack off of the Rectus and TFL, allowing for easier and deeper palpation.

TFL rectus TP

Trigger points for TFL and Rectus Femoris

Step 2 – MET for Anterior Innominate: There are several ways to perform MET for innominate.  I think our peers (physios across the Atlantic) do a great job of manual therapy, thus I chose a video that was made in the UK (see below). The video here is the method I prefer. I think it is easiest for the clinician and most comfortable for the patient. In addition this particular MET technique can address both right anterior rotation and left upslip. Perform this MET technique for 3-5 repetitions.

Step 3 – Isolated strengthening of the Right Gluteus Max via single leg floor bridge: Lie flat on your back with the knees bent at 90 degrees. Extend the left leg. Engage the abdominals and squeeze the right glute as you press your heel in to the floor to raise the hips. The hips should remain level and not dip to the left or right. The hamstrings should not be overly engaged, so be sure the glute is firing. Also watch for and correct excessive low back arching during this exercise. Perform 8-12 repetitions. For added level of difficulty, perform with the right foot elevated or elevated and on an unstable surface such as  a foam roll.

Single Leg Floor Bridge

Single Leg Floor Bridge


A lot of individuals do not have access or the money to pay a clinician. Thankfully, there are alternatives to the above exercises that you can do at home in the form of self- treatment. When my wife suffers from neck tightness or tension migraines, she takes 5 minutes to do the exercises below and oftentimes, the issue is resolved. Keep in mind the content here is not intended to supersede or serve as physician recommendation and should not be used as a rehabilitation program for all. If you have low back pain or have been diagnosed with the above, make sure you follow their orders.

Self-treatment of Upslip:

Step 1 – Self Myofascial Release of the Left Quadratus Lumborum: Performing myofascial release to the QL is difficult, but not impossible. Grab a tennis ball or other medium density ball. Stand with your back against a wall. Place the ball on the wall and near the area of the left QL TrP. Lean against the ball with mild to moderate pressure. You will likely need to move around and ‘fish’ for the tender sport. Once located the tender spot is located lean back in to the ball with moderate pressure and hold for 30-60 seconds. Repeat for the second trigger point. You can also use a specialized myofascial release tools such as a Thera-Cane or Backnobber to release the QL.

QL self TP

Self Release for QL

Backnobber to QL

Self release using Backnobber








Step 2 – Statically Stretch the Quadratus Lumborum: Immediately following the myofascial release perform a static stretch to the QL. To begin, get in to the child’s pose, with arms extended overhead. Side bend to the right and you should feel a light pull in the left lower back. Breathe normally and relax. Hold the stretch for 30 seconds. Here is a great video from Brent Brookbush who goes over both myofascial release and stretching of the Quadratus Lumborum.

Step 3 – Isolated strengthening of right Quadratus Lumborum via right hip hike (approximation): See description above.

Self-treatment for Anterior Innominate:

Step 1 – Self Myofascial Release to the right Rectus Femoris and right TFL via foam roll: As mentioned above, for anterior innominate we must target the Rectus Femoris and TFL. For the rectus lie flat on the foam roll, the roll should be perpendicular to the front of the thigh. Begin at the hip and slowly roll toward the knee. You should feel tenderness around the area of the rectus trigger point. Hold the tender spot for 30-60 seconds.

Foam rolling the TFL is similar to the Rectus Femoris, but the TFL is difficult to find. I often refer to the TFL as the pocket muscle. If you imagine a the front pockets to a pair of jeans, the entrance to the pocket is where you would find the TFL. You will need to lie down on the foam roll and rotate to approximately 45 degrees to the side, so that the TFL is on the foam roll (near the area of the front pocket). You may have to ‘fish’ for the trigger point by rolling up and down a few inches and/or rotating to a more side lying or flattened position. Once you find the tender spot hold pressure on the spot for 30-60 seconds.

Foam Roll Rectus Femoris

Foam Roll Rectus Femoris

Foam Roll TFL

Foam Roll TFL








Step 2 – Statically stretch the right Rectus Femoris and right TFL: Immediately following the myofascial release perform a static stretch to lengthen these shortened tissues. The key here is to engage the right glute. The firing of the glute will provide reciprocal inhibition to the Rectus Femoris and TFL allowing for maximal stretch. The images shown here illustrate proper stretching for the Rectus Femoris and TFL.


Rectus Femoris stretch

Rectus Femoris stretch

TFL stretch

TFL Stretch









Step 3 – Isolated strengthening of the Right Gluteus Max via single leg floor bridge: See description of the exercise above.


Despite easy recognition, pelvic upslip and anterior innominate are often missed on evaluation. These pelvic malalignments elicit musculoskeletal dysfunction across the entire, both to the upper extremities and lower extremities. Take the time to perform a quick evaluation on pelvic positioning. If you find left upslip, anterior innominate or both, performing the techniques here can really help alleviate pain and allow correction of the problem. Again, the information provided here should not replace a physician evaluation. If you are experiencing pain, be sure to consult a physician.



50 thoughts on “Pelvic Upslip and Rotation: Evaluation and Treatment

  1. jay barss MA ATC CSCS CES

    Great job Josh. I like reading your articles because it validates what I do and makes me feel smart. I would like to recommend the one leg bridge with contralateral knee to chest to avoid lumbar extension for glute max activation for beginners with poor glute activation

  2. Adam Meakins

    Hi Josh

    Sorry to be a ‘Negative Nancy’ but I’m afraid there is just no reliability or accuracy in any palpation tests for the SIJ that includes checking for up slips and rotations, lots of research and evidence has consistently shown this! Another issue to consider is the normal skeletal pelvic variation that we all have, for example the ASIS & PSIS angles range from 0 to 25 in normals with no pains or issues so there is no way to gain any info from palpating them! Also LLD are present in all, most are not a factor or a cause of pain or dysfunction again just normal skeletal variation is the cause which the body grows and develops with.

    It does make me wonder why so many therapists think humans should be symmetrical and work or try to make them so, we should be anything but symmetrical as nearly evey activity we do is asymmetrical.

    If you want to know if the SIJ is a source of low back pain, don’t check its position to see if its rotated or up slipped (by the way it doesn’t slip the SIJ such a strong and stable structure the only way it ‘up slips’ is if there is significant trauma, and I mean bone breaking trauma) instead stress it using Lasletts tests and see if its hurts, it’s that simple, it’s got nothing to do with its position which its 99.9% just perfectly normal



    1. Will

      Don’t get caught up in the nomenclature Adam, what josh is looking at is basically muscle imbalances, not joint subluxation as you are describing. He is not actually looking at the SIJ specifically (even if he thinks he is)…. more so the whole lumbo pelvic complex. The SIJ is stable yes, but it does move and can be a pain generator due to excessive or insufficient movement, which thus far is not able to be reliable tested for. There is good evidence for SIJ pain provocation tests when used as a cluster. I too was very skeptical when i first heard this terminology (up slip) but clinically this is exactly how it presents, although it is the whole pelvis which has tilted/rotated due to muscular spasm/tightness (often caused by a primary disc lesion or other lumbar pathology), not some subluxation at the joint itself, although the joint will be at end range nutation on the affected side of an ‘upslip’, and end range counter nutation in an ‘anterior rotation’ but as you say correctly this ITSELF can not be reliably palpated.

      As for symmetry, there obviously becomes a point when the tissue can not absorb the unbalanced mechanical stress due to their physiology and material properties.


      1. akash

        Incredible answer. This is exactly my problem Will and Josh. I had the above issue as detailed by Josh, developed a lumbar issue at the end of the day on my left (I guess spine flexion at end rotation) and my “pattern” reversed!!

        I have constant pain in my upper shoulder in the exact areas Josh has referenced, levator, rhomboid, scalenes, and upper trap developing TOS symptoms and shoulder injury. A whiplash injury to the left side of my neck worsened matters.

        Any exercise suggestion would be welcomed!!

    2. Melissa

      Adam, I totally agree with you on the point about assymetry in the body. However I’m not so sure about the SI joint. I have this issue with my pelvis and it honestly feels like my SI joint moves and gets stuck! When this happens I get locked and can’t move until I do some self adjustments! Maybe some day they will come up with solid evidence either way 😉

    3. Andrew

      The problem here is the fact that no one is integrating the possible upslip with the resulting dysfunction within craniosacral system (dural tension) and lumbar joints misalignment (the attempt of the body to compensate for it) The upslip dysfunction is one of the most troublesome dysfunctions and the fact that the author of this article sees it mostly on the left side, not the right, with a physiological anterior innominate on the right side creates a daubt whether he understands this dysfunction well.

  3. Marie

    I just did these exercises and feel better than I have felt in a long time. All my symptoms are on the left side, knee, sciatica down side of leg to knee, groin pain, IT band, lower back around SI joint, QL flares up, neck, shoulder pain. I’ve been told it’s basically my fault, it’s my movement patterns. I can get wound up to where when I move in a certain way everything gets locked up, back, knee, neck, etc.

    I’ve been told besides my movement patterns: it’s in the hip area but don’t know what the root problem is, my leg doesn’t fit into my pelvis right, the SI joint is messed up, it’s a glute muscle problem. I have researched: crossed syndrome, anterior pelvic tilt, short leg syndrome, piriformis syndrome, pelvis misalignment, hip external rotators, anyway I think the upslip could be a plausible explanation. It is the first time I’ve felt such relief from this wound up mess I get into.

    I’ve been prescribed exercises to strengthen my glutes, hips, abs, work on rotation but nothing like the exercises in this article.

    What is different from these exercises from what I have been doing is some are working the right side. I have been doing mostly symmetrical exercises but I have definitely been targeting the left side to strengthen. The suggested exercises for the right hip hike and right single leg glute bridge I never would have thought to do. I was doing left single leg glute bridge.

    My practitioners don’t like it when I suggest possible explanations. I am not the most assertive but I will bring this article to my practitioners and/or look for another who knows how to treat an upslip. Thank you for your time reading this.

    1. Brittany

      I find myself sympathizing with your comment. I have for the last 2 years been experiencing a shooting tingling sensation down the back side of my left leg. I have been put through X-ray, MRI, piriformis injection, and countless exercises and have gotten no relief. I’m a competitive athlete, gymnast, so I experience a lot of impact in my sport. The only time I get relief is when my training intensity is very low, but it spikes back up as soon as I increase training, making me think it has something to do with overuse. I recently have been experiencing back pain near my left SI joint and nagging pain in my knees near the front. I’m wondering if pelvic upslip might be an explanation…
      With your positive response to these exercises I will certainly give them a try. I’m also a strong believer in chiropractic as a chiropractor relieved extreme back pain for me some years back. At that point I did have unsymmetrical pelvic alignment, however without leg tingling, but the misalignment was corrected by my chiropractor. So I would highly suggest trying chiropractic if you still have issues. Unfortunately, not all chiropractors are alike. I am away from my normal chiropractor and have not found one that is as aggressive and proactive in their approach where I currently reside; therefore, am struggling to resolve my nagging leg tingling.
      I hope you continue to find relief and I will give these exercises a try to see if I can find the same.

      1. Joshua Stone Post author

        Thanks for your comment, Brittany.

        I’ve worked with many elite gymnasts in the past and low back / SI pain is, unfortunately, very common in these athletes. It’s the nature of what gymnasts do that lead to these injuries.
        I’m surprised your MRIs came back negative and doubt subluxation or upslip would have been missed if it was present.

        1. Brittany

          Every test that I have been issued has come back negative. Clean X-rays and clean MRI with no disc issues and yes I would assume no upslip as well since the doctors didn’t see anything irregular. I cannot seem to find the root of cause or methods for relief. Unfortunately I’ve just been told to deal with the pain from multiple doctors since the diagnosis is unknown. It’s extremely frustrating as it affects my ability to perform certain skills. I’m not sure where to go from here. I’ve resolved to crossing my fingers and hoping for a solution…

          1. Joshua Stone Post author


            Where are you from/currently live? I’m not sure if I can help, but there is a possibility we can do virtual training via Skype or Google. I do this on occasion and so far my results have been good.
            If this is something you might be interested in look at my website and pricing. For this I will waive the consult fee and do it for free, because I’m not sure if I can help, but based on your description here I might which is why I and doing this for you.
            I have never told someone this in my comments, but your story sounds crappy, so hopefully, I can help.
            If you want to chat more, use the context form on my page our email me:

      2. Sarah

        I find trigger points in the adductor group often have this sensation referral pattern and can cause issues with the hip and low back too. I hope you find some answers 🙂 Great post Dr.

  4. Mealoshe

    Is it possible that I could have both up slip and anterior inonimate. The right side of pelvis is rotated more forward relative to the left and is more hiked up. I think it’s because of my tight psoas and quadratus lumborum. In addition I also have right lumbar and thoraic scoliosis looking from the back.

    1. Ellie

      I also have this!! Pretty much identical. I have been told so many different reasons for the cause. Leg length discrepancy, one hip considerably higher and thoracic scoliosis ….trick is to figure out which one has caused the other ….but how?!? So much pain and stiffness. My hamstrings are so tight, quads tight, weak core, no glute strength ….help!!

      1. Joshua Stone Post author

        My guess is that your hamstrings are not tight due to shortness, rather they are long, overactive and tight. Addressing the core, glutes can help.

        1. Monty Mullins

          Hoping you can help, Joshua. Your response to this person’s question, is exactly what I have experienced for decades now. I have told GP, Orthopedic Surgeons, PTs, and chiropractor that I feel “like I can never stretch my hamstrings enough.” I had a failed ACL reconstruction in “84….Went to another Surgeon a few years ago, and it so happened that a long-time team trainer for an NBA team came to the door of my exam room. Surgeon stated, hey check this guy out….without explaining anything to me. Argh. He mentioned iliac upslip, and the trainer begin pulling violently on my right leg. Then told me to stand up and asked if I felt taller. I didn’t. I have researched these type of releases, but have never been told which side is affected. I stretch both. I sometimes put a heel support in left shoe….still I feel imbalanced, and waiver between which side is shorter…..makes dialing in my golf swing, crazy hard, lol.

  5. Justin

    Great article! Is something new for me to try. I started with back pain when I landed extremely hard on my right hip. Now I feel knee pain with every step I take. Physical therapy didn’t work, and since my right hip is about an inch higher than the left a chiropractor gave me a heel lift. It made the knee pain much worse, so now I’m trying a full foot lift. Much better , but the knee and back pain is still there. So if my hip is significantly higher on the right, do I strengthen the glute and ql muscle on the high right side? Also the right high side is twisted in really bad, and my shoulder level is much lower on the right side. Hope to hear from you soon I’m miserable in pain every day 🙁

    1. Joshua Stone Post author

      Thank you, Justin.

      Without being able to see you and assess, I would be unable to provide exercise guidance. It would be a tortious act and negligence to give someone an exercise regimen without knowing what truly needs to be done. That would only be done via a comprehensive exam. You can share these techniques with your Chiropractor or Therapist. They can then apply the proper techniques after evalution.

      All the best

    2. mealoshe

      Hi Justine. I also have knee pain with every step I take. In addition, I have the same problem with physio. Your problem is exactly like my problem. My right hip is also an inch higher than my left. In addition, my glutes are weak in my right side and my quadratus lumborum is tight also. I think you have to stretch the quadratus lumborum, but not strengthen it. Just simply contract and release. I believe. In addition I also have my right shoulder lower and my cervical neck curved to the left.

  6. interestedobserver

    Hi Josh, what a post. Can you please tell me any tests to check for anterior rotation and up/downslip which i can check with my PT? Also, many physios say sacrum cant move much so all this is unrealistic but my symptoms speak for themselves. If a knee to the chest doesn’t come as much as the other side, does it mean its anterior rotated innominate on that side? Any tips would help.

  7. Mark

    So my left leg is rotated internally, & ankle now pronate. I believe the cause of this is my left foot pronates to shorten my left leg. My arch is functional but over the last year I have begin to see foot roll inward more & more. Would I want to perform the hip hike with my left leg? Wouldn’t that strengthen my left QL and help pull/restore my leg back to proper length?

  8. Jordan

    Hi Josh,
    I just found your article about the upslip and anterior rotation. I know you said that its usually always the left side that has the upslip and right leg is longer, but i think mine is the opposite. I’m usually in a lot of pain and chiro visits don’t last me long. I’ve also been to 2 therapists and everyone tells me I’m a mystery. All i know is my right leg is usually always shorter, I have funtional scoliosis in my lumbar spine, an overavtive QL on the left side and my foot rotates inward on my right side. I just feel like I have so much going on that its overwhelming and I don’t know where to start or how to fix it. I’m so exhausted from the lack of sleep, because i’m constantly in pain. If you have any suggestions or help………I would greatly appreciate it!
    Thank you!

    1. Linda carina

      Hey Jordan, I have the exact same, but things are clearing up for me. I tell u what helped me; after a kick in the butt My sacrum was rotated because it was stuck between the ilia. Thus the functional scoliosis. One ilium was pulled inward (one hip was noticeably thinner) I had to push out the ilium (bf lifts me up holding sit bone and ilium every day severa times for months and I pushed the ilium outward, just by placing my hand on my hip, making a wide leg squat with feet outward and push it down 1000 times per day for 3 months, this took forever) this was to create space for the sacrum to be able to move freely again and find it’s place. And it did. The moment it got space it could actually be moved and rotated very easy and the L5 twisted back and the rest of the vertebraes. The scoliosis is now almost gone. (I had been jamming on that sacrum to make it rotate and move vertically with rough methods for 1,5 years but it was STUCK. And I was in pain exactly like u. The main thing causing the pain was the psoas. That was still killing me. But it immediately relaxed when I released my left SI, very gently. I can see that it’s stuck when I lay on my back, knees bent 90 degrees up and when I see one knee higher, that side is stuck. In the same position, I lay my sacrum on a half rubber bal (tennis bal size) and bf pushes the 90 degree bent knee very softly down into the ground,while I relax ( this is important, your body will keep the pelvis thight when it feels some strange movement like somebody pushing in an unnatural direction, u have to relax to be able to move it that little bit)Bf can actually see if the hip rotates. Many good gyro practices can release your SI’s. Psoas relaxes; al back Pain is gone immediately. SI jumps out of place on daily basis, but it can be fixed within seconds. I really hope this helps for you in any way, I obsessed for two years before I found my holy grail, I can only hope this helps for you as well. I would like to see if Joshua can help me further, I wish I found him sooner!

    2. John


      Your presentation layout looks professional; however, disagree on left dominate upslips as well as a few other thoughts. Please take Dr. Fred Mitchell’s METs course(s) and see if you change your thought process. Fred’s father Fred Mitchell, Sr. is the osteopath who created METs and Fred Jr. improved or evolved METs. You can also order their three book volume. I spoke to a colleague of Fred’s who is also a DO and shook his head about your thoughts regarding upslips. They will inform you that most upslips are on the right; however, you are correct that individuals have a left short leg unless you catch or dx an upslip in the early phase before the brain starts making adjustments, which is a right anterior hip rotation due to a left on right backward torsion. Overall, if you follow the correct METs steps most of the time there is no anterior hip rotation to correct because the body will self correct after correcting the torsion. I could type all night on METs because I’ve taken Fred’s courses several times and continue to enjoy and learn from Fred, Kai (son) and Dr. Jay Sandweiss!!

      Kind regards,


  9. Faiyaz Khan

    Can I get a research article with references on Anterior/Posterior Innominate and up slip / down slip as the major cause of low back pain which are often unnoticed…plz I need it for my dissertation.. Plz help me somebody…plzzz…

  10. Ningquan

    Hello Mr Stone,
    I am in China, where I can’t find qualified PT to conduct your method to fix my left Upslip ( I believe it is left Upslip after self-test according to your article).
    I am just wondering whether your self-treatment can fix left upslip ( left pelvis will go back to proper position) or just relieve the pain (but left pelvis will stay the current wrong higher position). I have tried three steps and have felt better. Thank you very much for this . I really appreciate it.

  11. Blake

    I have had a problem with the right side of my pelvis rotating back for a while. I’m only 18 play sports and also I am a roofer. It is very annoying and also painful that it keeps happening . I go to the chiropractor and he puts it in place but it only lasts a few days. Could you give me some advise that would help this heal? Thanks

  12. Blake

    Hello , I am only 18 and I am having problems with my right side rotating back . I play sports and also do roofing . Chiropractic only corrects it for a few days . What should I do ?

  13. Maria

    I am currently seeing a therapist who diagnosed an upslip of my right SI joint and treated with “inferior distraction”, i.e. he gives a very vigorous pull to my right leg. I have a relatively acute injury (6 months ago) , which happened while exercising, on top of previous injuries/falls in which my right hip was affected. Symptoms include pain in low back, groin,knee, hip area (all around) and down the right leg. Walking and sitting make it worse. I am in my early 60s and this condition has severely restricted my life and I am always in pain. Do you have any recommendations?
    Thank you.

  14. Claire Hamilton

    I am a 38 year old female, who has been having unresolved pelvic issues for last 5 months. It started after I began running. I have seen countless physio, with little help. Everyone seems clueless. I mention upslip/downslip to them and receive very little acknowledgement. The problem is on my left. When I walk I feel as if my left hand side is behind my right, causing tension and palpable pain around points in by thorocolumbar spine and 12th rib. It kind of feels like the movement of my swing leg is hinging around that area.

    I have been told to live with it. My left glutes are weak, I have mild s1 compression from bad discs, i also have a small labial tear on left too.

    The confusing thing is that I feel my hip on left is in a down slip position. When standing it feels more anterior tilted than opposite side. This is compounded by the fact I have a structural leg length discrepancy so although my hip on left is slightly elevated the leg is still slightly longer.

    Any insight would be greatly appreciated as I feel quite hopeless right now with the lack of any confirmation of what the problem is, but no change in so long. I hate walking now as it feels completely wrong.

    I know downslip are apparently rare. I don’t remember any significant trauma although this all started when I decided to run. Physio did check my si joints and thought them not problematic. I am very body aware, perhaps to much, but this feels plausible. The problem is trying to confirm which it is down or up. Please reply. Thanks for your time.

  15. nicky

    Hello Mr. Stone,

    I just want to thank you for this post. I have been struggling with knee, pelvic issues since past 6 years. Tried many techniques for correcting my twisted and tilted pelvis…but could not find answer. Just yesterday….I found your article and followed your advice on correcting misalignments of pelvis. My pelvis is in perfect alignment now. QL stretch, strengthen on one side and on opposite side rectus femoris , TFL stretch and glute max strengthen …..this formula worked for me!! I can’t thank you enough for this article…it is short and sweet…very informative and well explained….

    Your article has is a great blessing to me….Thank you so much!! 🙂

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  17. John L Bray

    Me. Stone:

    I’ve been blessed to be trained by traditional osteopathes including Dr. Fred Mitchell, Jr. Dr. Mitchell has dedicated his life towards manual therapy and his father Dr. Mitchell, Sr. is the osteopath who invented muscle energy. Your described common pattern: left upslip and right anterior innominate hip is not shared by Dr. Mitchell, Jr. or Dr. Jay Sandweiss, which I discussed with them. Most upslips are actually right and the right anterior hip rotation is the brain trying to keep the eyes and ears level by left sacral rotation. Overall, I could submit a lengthy response but I would encourage you to take classes under Dr. Mitchell and/or Dr. Sandweiss. Your website looks very professional; however, very misleading to healthcare professionals who could treat someone incorrectly, which results in reoccurring restrictions – they may feel better for a few hours but the symptoms return. Once again my response was discussed by top osteopaths before submitting; therefore, supported by elite traditional osteopaths. Please research and take classes from Dr. Mitchell and/or Dr. Sandweiss.

    1. Thomas

      I have a a structural leg length inequality (7mm Tibia, and 1mm Femur) as confirmed by a C.T. scan on my right side leg (which they’re guessing I walked around with for at least 10+ years (I’m 26 now). For 2+ years I have been wearing a whole foot lift within my shoe (not a heel lift), yet I am still experiencing extreme pelvic disfunction.

      Obviously the maleoli would not produce a valid test for me because of my tibial inequality, but even using my compensated shoes (measuring at the sole of the shoe), I am having difficulty replicating an accurate result in this test.

      How could I produce a more valid test to see which innominate is rotated anteriorily, and which is rotated posteriorly?


  18. Linda

    I just wanted to thank you for this great article. I have already helped 3 different patients resolve back pain due to their upslips this week! I plan on reading more into this. Have your read “Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without back pain” by PK Levangie? According to the author, the forward flexion test has a 17 sensitivity and 79 specificity accuracy for diagnosing SIJ dysfunction. Do you have a recommendation for other reading material? I am a new grad PTA who is looking to improve my clinical skills. Thanks again for your article!

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  21. Lynn

    Is it possible to have a left upslip with horrible trigger points and tightness in the right QL? My left QL feels fine but I have a left upslip.


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