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On leg length discrepancy…

I have a patient with what appears to be a longer left leg.  Her left piriformis is painful to touch, she has left pubic bone pain and feels like her right hip is forward and down and left is elevated and rotated posteriorly.  She lacks rotation (left FA ER/IR– 30/40, right FA ER/IR – 44/35) and Extension Drop Test is negative bilaterally.  She has thoracic kyphosis and a L1 compression fracture. She is lordotic, no butt, forward head and shoulders, tall and valgus in the knees. 
I placed her in a left sidelying position with her right leg in abduction and extension.  Am I on the right track?  I tried left glute med and 90-90 lift and it made things worse.  She fell onto her right buttock about a week ago and although the right side is better the last 2 exercises have made the left hip worse.

Someone who presents with a longer left leg tells you that she will more than likely have a negative Extension Drop Test reflective of an overly stretched iliofemoral ligament.  With that said, you will eventually need to perform left glute med activity but won’t be able to start this activity until you have maintained pelvic neutrality.  I would start her on repositioning activity in a sidelying position before working on any abduction or FA rotation.  Right Sidelying Adductor Pull Backs or Sidelying Scissor Slides would be a great activity to help achieve neutrality before moving onto sidelying left glute med activity.

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