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Copyright © Alastair McLoughlin 2015    Revised © Alastair McLoughlin 2019 and 2022

The right of Alastair McLoughlin to be identified as the original Designer, Developer and Author of the Work has been asserted by him in accordance with the Copyright, Design and Patents Act 1998.

All rights reserved. No part of this text may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover, or reprinted in any physical or electronic manner without the written consent of the author.

The ideas and concepts explored within this text are those of the author. For educational purposes only.

No diagnosis is being offered nor any cure promised by the application of this information.

Alastair McLoughlin cannot be held responsible for any injury arising from the application of this work by the practitioner to any third party however caused.

This work is not a substitute for medical attention. Please seek your physician’s advice if in doubt.

  • Low back pain
  • Lordosis
  • Leg length difference
  • Pelvic balancing
  • Sacro-iliac joint dysfunction


Caution should be taken when flexing the hip with patients who have hip joint replacement.
Do not take beyond 90 degrees - or less if the hip is restricted and the client knows they cannot flex the hip beyond a certain point.

Refer for medical diagnosis if you are unsure about any undiagnosed medical condition.

Position of the patient:

The patient lays supine on the treatment table.

The patient’s knee should be flexed and their foot resting on the couch as demonstrated on the video presentation.


There are several ways to determine if this AOB procedure is indicated.

  1. Tenderness upon palpation of either ASIS (Anterior Superior Iliac Spine) as shown (a)

  2. With the client‘s legs extended on the table there may be a gap in their lumbar spine into which you can slide your flattened hand.
    Check both sides for evenness of the gap as shown (b)

  3. There may be an apparent leg length difference shown as (c) when the client lays supine.
    (The longer leg is the more affected side).
    This is due to an anteriorly rotated ilium as indicated (d).
    The objective is to posteriorly rotate the ilium as indicated (e).

Additionally it may be noted that the client cannot lay comfortably in the supine position without flexing their hips and knees to create more comfort for the lower back.
When that is the case, you can immediately suspect a lordosis due to rotated ilium/ilia and use the other tests mentioned above to confirm this suspicion.

Movements of the AoB procedure:

The AoB procedure consists of three parts. This sequence demonstrates the three moves:

(i) Superior move on the inner edge of anterior crest of the pelvis - on iliacus - using thumb or first two fingers as shown.

(ii) Posterior move (towards the table) on the tensor fascia lata just below the crest of the ilium (using thumb or fingers as shown)

(iii) A move along the top edge of the liac crest whilst flexing the hip towards the chest. Make the move with fingers and thumb as shown.
You may need to make two or three moves to cover the length of the ASIS and iliac crest.

Moves should be done on both sides - the longer leg first, or the side with the most concave lumbar region.

Application of the AoB procedure:

Note: if there is a leg length difference, the longer side should be worked upon first.

This section shows the complete sequence of moves 1, 2 and 3 on one side of the body.  

The sequence (i) is shown with the leg resting in the extended position on the table.
This is for ease of viewing - so you can see the sequence with more clarity, and understand how one move follows onto the next.  

There are multiple views of sequence (i). The second view of sequence (i) shows move 1 performed with fingers instead of the thumb.
This is helpful if you’re not veryflexible in the wrists or hands.

Sequence (ii) shows you how the move is actually performed when treating your patient - with the knee and hip flexed.
When the hip is flexed, the muscles of the abdomen for move 1 become softer, allowing more depth to be applied to the move.

Moves should be done on both sides - the longer leg first, or the side with the most concave lumbar region.

The client should feel an immediate drop of the lumbar curve towards the treatment table.
Any leg length difference should now be equalised.

Leave the client to rest for a few minutes and re-assess for any of the indications discussed in section

Help the client to a seated position:

Pause and check the client experiences no dizziness or light-headedness.

If they are dizzy or light headed then wait for a minute or two to allow that feeling to clear itself (a).
Only then may the client step down from the couch placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.

If the client continues to be dizzy after waiting two minutes then lay them in a fetal position (b), cover them with a blanket and wait for the dizziness to pass.

Ask them back into a seated position and check any dizziness has subsided.
Then, ask them to stand - placing BOTH feet on the floor at the same time to allow even weight-bearing into both knees and hips to occur.

The client may need to sit for a few moments before dressing and leaving your office.

How it works:

The combination of the three AoB moves together with the leverage on the hip through flexion helps the anteriorly rotated ilium back into it correct and functional position.

Be careful with pressure, especially on move 1, as this can be a sensitive area.
No excessive force should ever be used.

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