INTRODUCTION: Symmetry is one of the criteria of correct body posture in upright position. The spatial positioning of the pelvic girdle is crucial to it. Functional and structural asymmetries within the lumbo-pelvic-hip complex can have a significant influence on the structure and functions of many human body organs and systems. The aim of the study was to present the results of inclinometer measurements of selected landmarks of the pelvic girdle in young adults aged 19-29. METHODS: The analysis of occurrence of spatial pelvic asymmetry was based on the authors' original, clinical classification and the significance of the body mass and height for the analyzed asymmetries. The inclinometer measurements of the selected landmarks of the pelvic girdle were performed in a sample consisting of 300 young individuals. Then, the occurrences of the spatial asymmetry of the pelvis were analyzed based on the authors' own clinical classification using alignment symmetry of the iliac crests, the anterior superior iliac spines and the trochanters major as a criterion. All study subjects with asymmetry <1 degree were treated as those with a symmetrical pelvis. RESULTS: The significance of gender, body mass and height for the analyzed asymmetries was assessed. Symmetric positioning of the iliac crests was observed in only 32% of the respondents. The iliac crest depression on the left side was more frequently observed - in 41% of the respondents. This occurred more often in women (44%) than in men (38%). In the group of women, the rotated pelvis was the most often observed (39.4%) asymmetry, while for men, it was the oblique pelvis (40%). More detailed analysis by pelvic asymmetry subtypes showed their statistical differentiation between women and men (p < 0.0001). Analysis of moderate rotation of the pelvis for men, were reported slightly higher values but these differences were not statistically significant (p = 0.253). Women, in turn, showed slightly higher mean values but here too, the differences were not statistically significant (p = 0.245). DISCUSSION: Asymmetries in the pelvis area are common; they were observed in less than three-quarters of the examined population. Oblique pelvis was found in less than a quarter of women and in more than one-third men with the predominant structural asymmetries. Rotated pelvis was observed in more than one-third of women and men with dominating functional asymmetries. There were no linear correlations between the body mass and height, and the angle of asymmetries.

Department of Health Care Studies College of Polytechnics Jihlava Czechia

Faculty of Arts and Educational Science University of Silesia Cieszyn Poland

Faculty of Health Catholic University Ružomberok Slovakia

Institute of Clinical Rehabilitation Faculty of Motor Rehabilitation University of Physical Education Krakow Poland

Institute of Health Sciences Podhale State College of Applied Sciences Nowy Targ Poland

Science and Research Center of Body Posture Kazimiera Milanowska College of Education and Therapy Poznan Poland

SNP Central Military Hospital Faculty Hospital Ružomberok Slovakia

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Al-Eisa E., Egan D., Deluzio K., Wassersug R. (2006). Effects of pelvic asymmetry and low back pain on trunk kinematics during sitting: a comparison with standing. Spine 31, E135–E143. doi: 10.1097/01.brs.0000201325.89493.5f, PMID: PubMed DOI

Allam A. M., Schwabe A. L. (2013). Neuromuscular scoliosis. PM R 5, 957–963. doi: 10.1016/j.pmrj.2013.05.015 PubMed DOI

Alqadah A., Hsieh Y. W., Morrissey Z. D., Chuang C. F. (2018). Asymmetric development of the nervous system. Dev. Dyn. 247, 124–137. doi: 10.1002/dvdy.24595, PMID: PubMed DOI PMC

Applebaum A., Nessim A., Cho W. (2021). Overview and spinal implications of leg length discrepancy: narrative review. Clin. Orthop. Surg. 13, 127–134. doi: 10.4055/cios20224, PMID: PubMed DOI PMC

Azizan N. A., Basaruddin K. S., Salleh A. F., Sulaiman A. R., Safar M. J. A., Rusli W. M. R. (2018). Leg length discrepancy: dynamic balance response during gait. J Healthc Eng. 2018, 7815451–7815459. doi: 10.1155/2018/7815451, PMID: PubMed DOI PMC

Betsch M., Wild M., Große B., Rapp W., Horstmann T. (2012). The effect of simulating leg length inequality on spinal posture and pelvic position: a dynamic rasterstereographic analysis. Eur. Spine J. 21, 691–697. doi: 10.1007/s00586-011-1912-5, PMID: PubMed DOI PMC

Bibrowicz K., Bibrowicz B. (2011a). “Evaluation of static asymmetry of selected bone point of lumbo-pelvic-hip complex in 14-year-old children from Głogów,” in Corrective and compensating procedure in ontogenetic development disorders. ed. Ewa Skorupka E. (Zielona Góra: Uniwersytet Zielona Góra; ), 25–38.

Bibrowicz K., Bibrowicz B. (2011b). “Evaluation of the repeatability of measurements of the position and mobility of the pelvic girdle using a duometer,” in Physical education, sport, health – Research problems, empirical verifications, applications. eds. Kwieciński J., Tomczak M., vol. 2011 (Konin: State Higher Vocational School in Konin; ), 9–21.

Bibrowicz K., Szurmik T., Lipowicz A., Walaszek R., Mitas A. (2022). Tilt and mobility of the hip girdle in the sagittal and frontal planes in healthy subjects aged 19-30 years. J. Back Musculoskelet. Rehabil. 35, 1203–1210. doi: 10.3233/BMR-200176, PMID: PubMed DOI

Bishop C., Turner A., Read P. (2018). Effects of inter-limb asymmetries on physical and sports performance: a systematic review. J. Sports Sci. 36, 1135–1144. doi: 10.1080/02640414.2017.1361894, PMID: PubMed DOI

Brady R. J., Dean J. B., Skinner T. M., Gross M. T. (2003). Limb length inequality: clinical implications for assessment and intervention. J. Orthop. Sports Phys. Ther. 33, 221–234. doi: 10.2519/jospt.2003.33.5.221, PMID: PubMed DOI

Chen C. L., Chen H. C., Tang S. F., Wu C. Y., Cheng P. T., Hong W. H. (2003). Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am. J. Phys. Med. Rehabil. 82, 925–935. doi: 10.1097/01.PHM.0000098040.13355.B5, PMID: PubMed DOI

Dickstein R., Abulaffio N. (2000). Postural sway of the affected and nonaffected pelvis and leg in stance of hemiparetic patients. Arch. Phys. Med. Rehabil. 81, 364–367. doi: 10.1016/s0003-9993(00)90085-6, PMID: PubMed DOI

Dubey L., Karthikbabu S., Mohan D. (2018). Effects of pelvic stability training on movement control, hip muscles strength, walking speed and daily activities after stroke: a randomized controlled trial. Ann. Neurosci. 25, 80–89. doi: 10.1159/000486273, PMID: PubMed DOI PMC

Duboc V., Dufourcq P., Blader P., Roussigné M. (2015). Asymmetry of the brain: development and implications. Annu. Rev. Genet. 49, 647–672. doi: 10.1146/annurev-genet-112414-055322 PubMed DOI

Furian T. C., Rapp W., Eckert S., Wild M., Betsch M. (2013). Spinal posture and pelvic position in three hundred forty-five elementary school children: a rasterstereographic pilot study. Orthop. Rev. 5:e7. doi: 10.4081/or.2013.e7, PMID: PubMed DOI PMC

Garvey J. F., Hazard H. (2014). Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 18, 815–823. doi: 10.1007/s10029-013-1161-0 PubMed DOI

Gnat R., Bialy M. (2015). A new approach to the measurement of pelvic asymmetry: proposed methods and reliability. J. Manipulative Physiol. Ther. 38, 295–301. doi: 10.1016/j.jmpt.2015.02.002, PMID: PubMed DOI

Gordon J. E., Davis L. E. (2019). Leg length discrepancy: the natural history (and what do we really know). J. Pediatr. Orthop. 39, S10–S13. doi: 10.1097/BPO.0000000000001396 PubMed DOI

Güntürkün O., Ocklenburg S. (2017). Ontogenesis of lateralization. Neuron 94, 249–263. doi: 10.1016/j.neuron.2017.02.045 PubMed DOI

Gurney B. (2002). Leg length discrepancy. Gait Posture 15, 195–206. doi: 10.1016/s0966-6362(01)00148-5 PubMed DOI

Handrich K., Kamer L., Mayo K., Sawaguchi T., Noser H., Arand C., et al. . (2021). Asymmetry of the pelvic ring evaluated by CT-based 3D statistical modeling. J. Anat. 238, 1225–1232. doi: 10.1111/joa.13379, PMID: PubMed DOI PMC

Harvey W. F., Yang M., Cooke T. D., Segal N. A., Lane N., Lewis C. E., et al. . (2010). Association of leg-length inequality with knee osteoarthritis: a cohort study. Ann. Intern. Med. 152, 287–295. doi: 10.7326/0003-4819-152-5-201003020-00006, PMID: PubMed DOI PMC

Heilig D. (1978). Principles of lift therapy. J. Am. Osteopath. Assoc. 77, 466–472. PubMed

Holmes C., Brock K., Morgan P. (2019). Postural asymmetry in non-ambulant adults with cerebral palsy: a scoping review. Disabil. Rehabil. 41, 1079–1088. doi: 10.1080/09638288.2017.1422037, PMID: PubMed DOI

Juhl J. H., Ippolito-Cremin T. M., Russell G. (2004). Prevalence of frontal plane pelvic postural asymmetry – part 1. J. Am. Osteopath. Assoc. 104, 411–421. PubMed

Kanchan T., Mohan-Kumar T. S., Pradeep-Kumar G., Yoganarasimha K. (2008). Skeletal asymmetry. J. Forensic Leg. Med. 15, 177–179. doi: 10.1016/j.jflm.2007.05.009 PubMed DOI

Khamis S., Carmeli E. (2017). Relationship and significance of gait deviations associated with limb length discrepancy: a systematic review. Gait Posture 57, 115–123. doi: 10.1016/j.gaitpost.2017.05.028, PMID: PubMed DOI

Kilby J., Heneghan N. R., Maybury M. (2012). Manual palpation of lumbo-pelvic landmarks: a validity study. Man. Ther. 17, 259–262. doi: 10.1016/j.math.2011.08.008, PMID: PubMed DOI

Kobayashi K., Ando K., Nakashima H., Machino M., Morozumi M., Kanbara S., et al. . (2020). Scoliosis caused by limb-length discrepancy in children. Asian Spine J. 14, 801–807. doi: 10.31616/asj.2019.0374, PMID: PubMed DOI PMC

Kurki H. K. (2017). Bilateral asymmetry in the human pelvis. Anat. Rec. 300, 653–665. doi: 10.1002/ar.23546, PMID: PubMed DOI

Lee A. S., Pyle C. W., Redding D. (2015). Accuracy of anterior superior iliac spine symmetry assessment by routine structural examination. J. Am. Osteopath. Assoc. 115, 482–489. doi: 10.7556/jaoa.2015.102, PMID: PubMed DOI

Levangie P. K. (1999). Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain. Phys. Ther. 79, 1043–1057. doi: 10.1093/ptj/79.11.1043, PMID: PubMed DOI

Li Y. M., Li J. H., Li B., Wang J. X., Chen Y. S. (2016). The radiological research for pelvis asymmetry of unilateral developmental dysplasia of the hip in adult. Saudi Med. J. 37, 1344–1349. doi: 10.15537/smj.2016.12.15945, PMID: PubMed DOI PMC

Maloney S. J. (2019). The relationship between asymmetry and athletic performance: a critical review. J. Strength Cond. Res. 33, 2579–2593. doi: 10.1519/JSC.0000000000002608, PMID: PubMed DOI

Medina-Rivera J. M. (2016). Craniofacial asymmetry: a literature review. Int. J. Orthod. Milwaukee. 27, 63–65. PMID: PubMed

Mine K., Ono K., Tanpo N. (2022). The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and metaanalysis. Phys. Ther. Rev. 27, 181–190. doi: 10.1080/10833196.2021.2019368 DOI

Mundorf A., Peterburs J., Ocklenburg S. (2021). Asymmetry in the central nervous system: a clinical neuroscience perspective. Front. Syst. Neurosci. 15:733898. doi: 10.3389/fnsys.2021.733898, PMID: PubMed DOI PMC

Murray K. J., Molyneux T., Le Grande M. R., Castro-Mendez A., Fuss F. K., Azari M. F. (2017). Association of Mild leg Length Discrepancy and Degenerative Changes in the hip joint and lumbar spine. J. Manipulative Physiol. Ther. 40, 320–329. doi: 10.1016/j.jmpt.2017.03.001, PMID: PubMed DOI

Osterhoff G., Petersik A., Sprengel K., Pape H. C. (2019). Symmetry matching of the medial acetabular surface-a quantitative analysis in view of patient-specific implants. J. Orthop. Trauma 33, e79–e83. doi: 10.1097/BOT.0000000000001373, PMID: PubMed DOI

Petrone M. R., Guinn J., Reddin A., Sutlive T. G., Flynn T. W., Garber M. P. (2003). The accuracy of the palpation meter (PALM) for measuring pelvic crest height difference and leg length discrepancy. J. Orthop. Sports Phys. Ther. 33, 319–325. doi: 10.2519/jospt.2003.33.6.319. PMID: 12839206, PMID: PubMed DOI

Piepiora P., Kwiatkowski D., Bagińska J., Agouridas D. (2021). Sports level and the personality of American football players in Poland. Int. J. Environ. Res. Public Health 18:13026. doi: 10.3390/ijerph182413026, PMID: PubMed DOI PMC

Piepiora P., Piepiora Z., Bagińska J. (2022a). Personality and sport experience of 20–29-year-old polish male professional athletes. Front. Psychol. 13:854804. doi: 10.3389/fpsyg.2022.854804, PMID: PubMed DOI PMC

Piepiora P., Superson M., Bagińska J., Zając M., Stackeová D., Witkowski K. (2022b). Anthropometric predispositions for kumite specialization in traditional karate. Arch Budo 18, 203–209.

Pitkin H. C., Pheasant H. C. (1936). Sacrarthrogenetic telalgia: II. A study of sacral mobility. J. Bone Joint Surg. 18, 365–374.

Ploumis A., Trivedi V., Shin J. H., Wood K. B., Grottkau B. E. (2018). Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy. Scoliosis Spinal Disord. 13:18. doi: 10.1186/s13013-018-0166-y, PMID: PubMed DOI PMC

Preece S. J., Willan P., Nester C. J., Graham-Smith P., Herrington L., Bowker P. (2008). Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J. Man. Manip. Ther. 16, 113–117. doi: 10.1179/106698108790818459, PMID: PubMed DOI PMC

Rommens P. M., Hofmann A. (2017). Fragility fractures of the pelvis. Cham, Switzerland: Springer.

Sorensen C. J., Johnson M. B., Norton B. J., Callaghan J. P., Van Dillen L. R. (2016). Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing. Hum. Mov. Sci. 50, 38–46. doi: 10.1016/j.humov.2016.10.003, PMID: PubMed DOI PMC

Staszkiewicz R., Chwała W., Forczek W., Laska J. (2012). Three-dimensional analysis of the pelvic and hip mobility during gait on a treadmill and on the ground. Acta Bioeng. Biomech. 14, 83–89. PMID: PubMed

Stovall B. A., Kumar S. (2010). Reliability of bony anatomic landmark asymmetry assessment in the lumbopelvic region: application to osteopathic medical education. J. Am. Osteopath. Assoc. 110, 667–674. PMID: PubMed PMC

Stover M. D., Edelstein A. I., Matta J. M. (2017). Chronic anterior pelvic instability: diagnosis and management. J. Am. Acad. Orthop. Surg. 25, 509–517. doi: 10.5435/JAAOS-D-15-00338, PMID: PubMed DOI

Tile M., Helfet D., Kellam J., Vrahas M. (2015). Aotrauma. Fractures of the pelvis and acetabulum: principles and methods of management. Davos, Switzerland; Stuttgart, Germany, New York, NY: AOTrauma, Georg Thieme Verlag.

Tobolsky V. A., Kurki H. K., Stock J. T. (2016). Patterns of directional asymmetry in the pelvis and pelvic canal. Am. J. Hum. Biol. 28, 804–810. doi: 10.1002/ajhb.22870, PMID: PubMed DOI

Traver-Vives M., Guillén-Villar A., Del Río L., Casinos A. (2021). Asymmetry in the length of human humerus and radius during ontogeny. Anthropol. Anz. 78, 151–162. doi: 10.1127/anthranz/2021/1068, PMID: PubMed DOI

Verheyden G., Vereeck L., Truijen S., Troch M., Herregodts I., Lafosse C., et al. . (2006). Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin. Rehabil. 20, 451–458. doi: 10.1191/0269215505cr955oa, PMID: PubMed DOI

Vogt B., Gosheger G., Wirth T., Horn J., Rödl R. (2020). Leg length discrepancy – treatment indications and strategies. Dtsch. Arztebl. Int. 117, 405–411. doi: 10.3238/arztebl.2020.0405, PMID: PubMed DOI PMC

von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., Vandenbroucke J. P. (2008). Initiative STROBE. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 61, 344–349. doi: 10.1016/j.jclinepi.2007.11.008 PubMed DOI

Wells J., Nepple J. J., Crook K., Ross J. R., Bedi A., Schoenecker P., et al. . (2017). Femoral morphology in the dysplastic hip: three-dimensional characterizations with CT. Clin. Orthop. Relat. Res. 475, 1045–1054. doi: 10.1007/s11999-016-5119-2, PMID: PubMed DOI PMC

Yu Q., Huang H., Zhang Z., Hu X., Li W., Li L., et al. . (2020). The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system. BMC Musculoskelet. Disord. 21:596. doi: 10.1186/s12891-020-03617-3, PMID: PubMed DOI PMC

Zalewska M. J., Niemiro W. (2022). Biostatystyka. PZWL Warszawa, 256, 51–53. doi: 10.53271/2022.072 DOI

Zhang Y., Chen H. X., Shi Z. Y., Du Q., Wang J. C., Wang X. F., et al. . (2022b). Brain structural and functional connectivity alterations are associated with fatigue in neuromyelitis optica spectrum disorder. BMC Neurol. 22:235. doi: 10.1186/s12883-022-02757-4, PMID: PubMed DOI PMC

Zhang F., Zhang D., Huang Z., Wang Z., Cai X. (2022a). Morphological asymmetry of pelvic rings: a study based on three-dimensional deviation analysis. Orthop. Surg. 14, 967–976. doi: 10.1111/os.13246, PMID: PubMed DOI PMC

Pelvic Asymmetry and Stiffness of the Muscles Stabilizing the Lumbo-Pelvic-Hip Complex (LPHC) in Tensiomyography Examination