Pelvic tilt and leg length discrepancy can be divided into different categories:

1. Anatomical leg length discrepancy: Actual differences in the bone length of one leg compared to the other.
2. Functional leg length discrepancy: Different leg lengths caused by muscular imbalances or joint misalignments.
3. Acute pelvic tilt: Temporary tilting of the pelvis, for example, after an injury.
4. Chronic pelvic tilt: Long-term misalignment, often caused by structural or muscular problems.

The main causes of pelvic tilt and leg length discrepancy can be divided into several categories:

- Anatomical causes:

- Congenital differences in the length of the leg bones.

- Consequences of injuries, such as fractures or surgical interventions that change bone length.

- Functional causes:

- Muscular imbalances, for example, due to unilateral strain or tension.

- Misalignments of the hip, knee, or ankle joints.

- Muscular causes:

- Weaknesses or shortenings of the muscles in the pelvic and hip area.

- Traumatic events:

- Falls, accidents, or injuries affecting the pelvis or joints.

The symptoms of pelvic tilt and leg length discrepancy vary depending on the extent of the misalignment. Typical complaints include:

• Back pain: Pain, especially in the lower back area, due to the uneven load on the spine.
• Hip pain: Discomfort in the hip due to the asymmetrical load.
• Knee pain: Pain in the knee, often caused by the misalignment of the leg.
• Posture problems: Visible asymmetries such as a raised pelvis or uneven shoulder height.
• Movement restrictions: Difficulties in walking or standing for long distances due to the uneven load on the joints.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- **Medical History:** The doctor inquires about the patient's medical history, existing symptoms, and possible injuries.

- **Physical Examination:** Assessment of posture, pelvic symmetry, and leg lengths through visual inspection and special tests.

- **Imaging Techniques:**

- **X-ray:** Accurate measurement of leg length and depiction of misalignments.

- **MRI:** Examination of soft tissues and muscles to identify muscular imbalances.

- **Leg Axis Measurement:** Detailed analysis of leg axes to assess functional leg length differences.

Conservative Therapy

Most cases can be treated without surgery:

• Physiotherapy:
  • Strengthening exercises: Strengthening of the pelvic and trunk muscles to stabilize the spine.
  • Stretching exercises: Promoting flexibility and relieving tense muscles.
• Shoe inserts:
  • Special inserts to compensate for a leg length discrepancy and stabilize the pelvis.
• Manual therapy:
  • Mobilization of the pelvis and joints to restore symmetry.
• Physical therapy:
  • Targeted training to improve posture and movement patterns.

Surgical Therapy

Surgery is only considered in rare cases and for severe anatomical leg length discrepancies:

• Leg lengthening: Surgical procedure to adjust the length of the shorter leg.
• Pelvic stabilization: Procedures to correct structural misalignments in the pelvic area.

To prevent pelvic obliquity and leg length discrepancy, the following measures are recommended:

1. Regular exercise: Building and maintaining strong core muscles through targeted training.
2. Ergonomic work practices: Adjusting the workplace to promote a healthy sitting posture.
3. Correct posture: Avoiding unilateral strain and consciously controlling posture in everyday life.
4. Suitable footwear: Using well-fitting shoes with optimal support.
5. Early treatment: Regular check-ups at the first signs of misalignment or discomfort.