Hi - your case sounds so interesting (and frustrating for you).

1. Was the clamshell exercise given to you as described above? Hip over hip, knees bent to 90deg, hips bent to 45deg, heels in line with bottom? If so, that exercise usually reinforces TFL/RectFem (RF) dominance in dysfunctional people. I advocate a position that has you quater-turned onto your tummy, only the top leg bent up and the top arm supporting some weight too (simple base of support reasons).

2. You say your psaos tested weak, not short. How did they test for that? If they did a thomas test, the TFL would drag your knee laterally and not allow for proper testing of your true psaos position. Also, with your pelvis anteriorly rotated, the psoas is lengthened but the RF is shortened so it may allow RF to dominate in that way.

If holding your knee above 90deg in standing is your Psoas test, then you may find that tight hip extensors might add extra "load" to the test etc. Also, your positioning during testing will determine what other muscles are being used.

3. Are you sure that it is upper traps that is overactive? It is usually levator scapulae which is overactive and drags the top inside edge of the scapula upwards and points the bottom of the scapula towards the spine. Upper Traps does lift the scapula but by jamming the clavicle into the sternoclavicular joint then pulling on the clavicle (it doesn't attach to the scapula as most people assume) to outwardly rotate the scapula. Lower traps helps this process by attaching to the spine of the scapula and giving the scapula a place to rotate around. THe biomechanics get a bit complicated but people think the lower traps is a depressor or retractor when in fact it stabilises the scapula then assists to outwardly rotate it.

4. I would like to know more about your movement patterns during bending over and leaning backwards and sideways. It is hard for my minds eye to see what is happening. There are many reasons as to why your L/S may not move much compared to your T/S. Are your erector spinae (ES) muscles co-contracting with your obliques to give you this pattern?

5. The ASLR test results are interesting. Can you tell me if your physio has used this test a lot in the past with other clients? I found it is a fine art to get it right in complicated people - the art is in figuring out what is the relevant information from the test.

Is your starting position in neutral spine. If not, then you are asking for biased results. I use pilows etc to get people in the a good position. If you are in too much extension/anterior pelvic tilt, then EVERYTHING will feel hard to do because it puts your TrAb in a weak pos.

Do the compressions of the ALSR make things harder?? i.e. the left leg is heavy and the pelvis lifts and rotates but is it worse with compressions? If it is, it may indicate EXCESSIVE compression by your muscles (eg multifidus/ES, inferior internal obliques with TrAb). Believe it or not, you can over do your "core muscles"!! The secret is to have ADEQUATE compression, not the most amount possible! Just enough to achieve stability with mobility.

6. Anterior pelvic tilt will drive your knees into hyperextension. Fix the pelvis and the knees whould follow...easier said than done by the sounds of it.

7. Have you tried Trigger point injection therapy? Apparently you inject local anaethestic into the trigger points of the TFL and ITB. It has really helped one of my patient's TFL...

Thank you for all your information. It is only 2 chapters of that book that are about what i am talking about - both by O'Sullivan. The chapter by Diane Lee is similar to the Pelvic Girdle book so it doesn't really matter.

Keep us informed of how you are going!