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The Association Between Static Pelvic Asymmetry and Low Back Pain

Levangie, Pamela K., DSc, PT

Exercise Physiology and Physical Examination

Study Design. A cross-sectional case–control approach was used to estimate the association between low back pain of less than 12 months’ duration and pelvic asymmetry among 21–50-year-old patients seeking physical therapy services.

Objective. To evaluate the premise that asymmetrical positioning of the innominates of the pelvis is a source of low back pain.

Summary of Background Data. No published studies have been conducted to evaluate systematically the association between low back pain and pelvic asymmetry in a clinic-based sample.

Methods. Pelvic landmark data were obtained in 144 cases and 138 control subjects. The associations of low back pain with levels of pelvic asymmetry were estimated by use of odds ratios and 95% confidence intervals. Effect modification and confounding of the low back pain–pelvic asymmetry association by several factors was assessed and alternative asymmetry measures considered.

Results. Pelvic asymmetry was not positively associated with low back pain in any way that seemed clinically meaningful. Asymmetry of posterior superior iliac spine landmarks showed some evidence of a weak positive association with low back pain.

Conclusions. In the absence of meaningful positive association between pelvic asymmetry and low back pain, evaluation and treatment strategies based on this premise should be questioned.

From Sacred Heart University, Fairfield, Connecticut.

Acknowledgment date: June 25, 1998.

First revision date: October 15, 1998.

Acceptance date: November 17, 1998.

Address reprint requests to

Pamela K. Levangie, DSc, PT

9 Cot Hill Road

Bedford, MA 01730


This work was in partial fulfillment of the requirements of a DSc in Epidemiology at Boston University’s School of Public Health. The study was funded in part by the Foundation for Physical Therapy and supported by in part by Sargent College of Allied Health Professions, Boston University.

Device status category: 1.

© 1999 Lippincott Williams & Wilkins, Inc.