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This weekend at a fitness expo (think free, fast, and out of town) a chiro told me what I had been suspecting about me looking crooked.
His said my right hip is higher than the left, and the left pronates forward some(some curvature too, I think). Other than just looking at the height of my hips, he did a few tests such as pressing on my back near the spine and asking me which side I felt it on more.
On the little sheet of paper he gave me, these tests were the same on both sides:
forced dorsiflexion, left abduct (GMP), TFL
these tests have a + sign for the right side:
dorsiflexion/eversion peroneus, psoas
He said the right side seemed weaker and the left would be more prone to injury/soreness because the muscles are tighter. I have noticed that my left calf tends to get sore much more than the right. And a while back I actually had a knee injury on the left side.
Other than noticing in pics and some lower back pain(minor to medium), I don't seem to have any "issues" with this imbalance. Is this something I should get checked out? If so, should I see a chiro or a PT? Can it be corrected?
PS In case you're wondering why I would have a clip of me walking...this is from my chin-up video and where I first noticed I looked crooked. [img]smile.gif[/img]
Me running... can tell here a little bit.
Thanks mucho! Any guidance is greatly appreciated!
Okay...less than ideal photos and video, but here goes.
You appear restricted on the left throughout the left hip which rotates that side of the pelvis forward. If the pelvis rotates forward, the femur internally rotates and makes the knee angle toward the midline of the body (it's called genu valgus). The tibia will also rotate internally which results in pronation of the left foot. All this combined makes the left leg "shorter". That's why you see a bigger space between the left arm and your trunk.
What you find associated with this is a tight psoas and iliacus, tight tensor fascia latae and IT band, tight fibularis longus/brevis (peroneus longus and brevis).
Pain can vary in location to the L5 segment,SI joint, hip bursae (bursitis), IT band syndrome at the knee, patello-femoral pain at the knee, MCL ligament sprain, eventual medial meniscus injury, anterior or posterior "shin splints", plantar foot pain ("plantar fasciitis), and hallux valgus (bunyon).
Because the pelvis is rotated forward on the left, your left glutes will be inhibited so you'll substitute back extension and increased hamstring activity for hip extension. This will make you prone to lateral hamstring strains on the left and more back pain. You also use a lot of trunk rotation/hip rotation to substitute for your hip extension weakness. See your running photo arm position. If you look at the top half only, it looks like you're turning left. If you ran with your eyes closed, you'd most likely run in a circle.
Right now you're functioning like a car out of alignment. You'll experience intermittant break downs and a lot of wear n tear that will show up later as serious injuries depending on what activities you pursue.
Here's what you may need:
restoration of normal hip flexibility
restoration of normal hip strength/power
realignment of pelvis
Improved trunk strength
I can't really tell if this is structural or functional so orthotics may be beneficial
Yes, I'd see somebody. If you're really into the running thing, expect a lot of nagging injuries until you get straightened out.
It's probably fixable but it'll take some time and effort on your part and a really good practitioner to guide you.
Thanks Bill (and Danny for having the same info, just not as fast as Bill )
Bill, where were you 3-4 years ago when I was running much more than I do now and had this pain which I'm now learning is probably IT band syndrome:
My general practitioner referred me to an orthopaedic who basically gave me some celebrex and suggested I do leg curls to strengthen my quads which hold up my knee cap. (to his minor defense, it was a few months after the real pain so it was hard for me to replicate/explain by the time I got in to see him)
Still working on translating ( ) much of the other associations and pain areas you mentioned, but it appears you've nailed many of the symptoms I've experienced over the years. It's quite a treat to know there's a root cause!
On the first pic - I wasn't paying that much attention to my left arm position--it is a freeze frame from a video so it's possible my arm was on the way up to reach the chin-up bar or not all the way down yet...but it could also be that I hold it that way sometimes.
On the running pic I can now clearly see that it looks like I am rotating my whole trunk (and steering into a circle [img]smile.gif[/img] ). When Craig B. saw that pic he told me to keep my arms at my side and not in front of my body, so I've been working on that...it feels kinda awkward.
Imagine how fast I'll run once I'm straightened out.
What kind of practioner should I start with? Chiro, sports med, physical therapist, other??
Do you have any handy sites you would recommend where I can read up more on this? I've found a couple googling the terms you used above, but it would be nice to start with some recommended places.
Tight IT bands also plague cyclists who ride many miles. There are a few good stretches for that that you should be doing anyway.... you might want to look them up.
Other things that plague riders (runners, of course, have their own litany of overtraining injuries):
-tight hip flexors
-misaligned patellar tracking due to relatively weaker VMOs
-osteoporosis in the lower back and hips (or decreased bone density) due to extreme demands on body while not weight-bearing, resulting in an inordinate amount of bone fractures in otherwise healthy athletes.
All of this makes me think Lou is right: the human body isn't made to do the same motion day after day, year after year for a long time.
Bill, this leads me to a separate question that I might as well post here: I know your stand on static stretching, but what about countering the supposed effects of aging and the shortening and less pliability you have in connective tissue as you age? I've always heard that is why yoga is so good as you get older and need less explosive strength. (I do realize your stand on static stretching had to do with athletic performance).
I think if you go back to that lengthy thread about flexibility training you'll find that I mentioned that for those simply interested flexibility for non-athletic purposes passive, static stretches are adequate.
Let's also clarify how I feel about static stretching. I'm not against static stretching just the use of passive static stretching where active forms of flexibility training should be applied. For instance, isometric stretches (say a split squat with a loaded barbell on shoulders held in the bottom position for time) that activate the nervous system strongly can be statically applied but influence both passive and active flexibility.
My issue with only using passive forms of flexibility training, even in an aging population, is that gains are hard to maintain because strength in not improved in the new range making it essentially unuseable. That also increases the flexbility deficit which in turn promotes a higher risk of injuries due to lack of control at end range of motion where most injuries occur.
I would also have to disagree with the need for less explosive strength as we get older. I can see how this may be a perception, but it's just the opposite. A lack of explosive strength is directly responsible for a higher risk of falls in the elderly. Great Grandma knows when she's going to fall, but she can't move fast enough to regain balance.
Also keep in mind that if you like yoga, do yoga. If you're doing strength training in addition to yoga, you're less likely to see detrimental effects unless your strength training does not address the gains in passive flexibility. You may however lose power capabilities over time due to changes in tendon compliance.
And of course, never passively static stretch before event that require power. Recent research shows a loss of force production up to 2 hours.
He said my right leg was about a cm shorter than my left and gave me an orthotic for my right shoe. I'm supposed to wear it as often as possible and especially while running.
Said the orthotic might make me sore...I guess I should have asked if that was a good thing or not. If it hurts, do I stop wearing it or wear it less?
Said to cut back a wee bit on the running. My left side is tight, especially the IT band area because it's the weight bearing side....
What I wasn't sure about is whether the shorter leg is causing the hip problem and/or if he was going to just watch and see if there's something else going on. I'll be going back in a couple of weeks to see if the orthotic is helping. (was supposed to be next week, but I'll be out of pocket)
Is the orthotic a cure all???
But most importantly, he said my biomecanics were good and I was in good shape. and that it was good that I came in before I was having severe problems. I'm guessing all these minor problems I've been having are related to this. Looking forward to being fixed.
Yep, for now at least. ?? But I'm supposed to go back...
He did work on my left thigh to loosen it up some. Didn't really say anything about my hip, other than it could be caused by the shorter leg.
I guess it's weird, I have this problem when I see a doctor. I'm healthy, but out of whack, so I can't really describe my problem. Almost like it would be better if I came in crippled in pain, which is exactly what I'm trying to avoid...
Bill, I just saw your response. Thank you - as usual you explained it clearly and succinctly.
C, did you see an orthopod or a podiatrist or some othr practioner?
Regarding soreness on a custom orthotic (or even a stock one): it will take time for your foot to adjust to something there. When I first got my custom orthotics, I was only supposed to wear them for an hour a day to start and then work my way up to having them all the time.
BTW, having that time of problem is the scourge of runners and active people. You avoid greater issues like heart disease and diabetes, but tned to have more joint problems and strains. Price to pay, I guess, and it keeps Bill in business. [img]smile.gif[/img] But biomechanics is nothing to mess around with - take it from somone who did and paid the price a few times.
What I think Bill may be hinting at is some sort of kinesiology issue that has developed from your biomechanics and any compensation you have been doing. You get tight areas, etc. At least I've found that to be true for me, which is why I need to see Bill at some time in the future.
K, he is a physical therapist and the clinic is for ortho rehab.
Didn't have any soreness wearing the orthotic yesterday. Will see how it goes when I run.
I expect minor aches and pains from being active, but I'm most concerned with exascerbating the problem by being out of alignment.
Well I measured and it does seem my right leg is about 1/2+-inch shorter...although I don't know how precise I can be measuring it myself.
So the thought is the orthotic will even out the length of my legs and correct my left side from overcompensating? I think I 'd still like the kinesology / ART type therapy to make sure everything works together as it should...
Bill--
I've been reading these posts and wanted to propose and idea I learned from Dr. Evan Osar. Looking at the photos it appears as if you sink into your hips when you run. The gait development I've seen in young women is pretty poor. Young females grow up imitating mom and they walk from hip to hip. It could possibly be another source of the ACL distress we are hearing more and more about. The aches and pains this woman is describing could be a result of years of sacroiliac abuse that started when she was a child.
I've been reading this post with interest. I believe it may benefit you to see a massage therapist that has training in neuromuscular release techniques. The leg length difference may be real, most people have some difference in leg lengths. The degree, however, may be decreased with release of the tight areas contributing to the malalignment. I have a referral base for this type of treatment, if you would like, send me an email and I'll put you in contact with someone who may be able to help. I had an orthotic prescribed, still use it, but not until my pelvic instablity was corrected. I now have reversed the foot problem I was developing, plus several other benefits.
Originally posted by Will Haskell: Bill--
I've been reading these posts and wanted to propose and idea I learned from Dr. Evan Osar. Looking at the photos it appears as if you sink into your hips when you run. The gait development I've seen in young women is pretty poor. Young females grow up imitating mom and they walk from hip to hip. It could possibly be another source of the ACL distress we are hearing more and more about. The aches and pains this woman is describing could be a result of years of sacroiliac abuse that started when she was a child.
Will Haskell
Athletic Development Specialist
No doubt. The degree of pronation that you see in females with larger Q angles tends to prolong the "unlocking" of the SI joint which then becomes hypermobile and leads to a slew of overuse syndromes.
Howdy Bill! Any chance you're planning a trip to LR for your birthday weekend?
I've been seeing the ortho rehab PT for a couple of months now (started 2x/wk, now 1x).
After about the 3rd visit, he watched me run and has advised me to "hinge" forward when I'm running, walking, standing. I can tell this takes pressure off of my lower back, and helps me run faster. (he showed me on a skeleton, and praciticing it, it seemed like before I was running with my brakes on being so upright) However, this is not yet a cure. The exercises he had me doing were standing crunch type things where I'm practicing the hinge movement. Also was working on loosening up my IT band through massage at these sessions. I wear the orthotics (both shoes now) but only when running or when I have my running shoes on.
THEN I got back that pinching pain in the bottom of my RIGHT butt cheek and the resulting sensitivity in my RIGHT leg. This happened two weekends in a row, perhaps brought on by my lifting one day. (possibly made worse one weekend where I was standing up cooking all day)
NOW it appears that my legs are closer to even lengths, but the left leg rotates (hmm like you said happens above). He measures this by holding my ankles together and having me lie down and sit back up.
HOWEVER, I still have lower back pain, so now we're focused on the SI joint(which he's noticed now is pronated) and lower 5 of the spine (which he says are tight). He does some manual technique on my back that definately releases the tension (I can't say I'm normally in pain(guess that term is relative), but I can tell there is a "relief of pressure" as soon as I stand up afterwards as if I've all of sudden have more movement in that area and not "stuck"). Exercises now were a type of machine hack squat (or opposite of leg press on a slanted board). Also at home I'm supposed to do something similar to 1/4 wall squats for the SI joint. I see this as a way of "flattening" out my si joint or sacrum against the flat hard surface. Oh, and I did another standing exercise where I put one leg (underneath my knee) on a lever and push it down.
So this is helping...BUT what's driving me a little bananas is figuring out what's causing it and how to correct it for good. It seems like we keep piecing together little puzzle pieces (and after 2months, we've gotten to maybe 1/3 of what you mentioned above ) And we haven't done anything for hip flexibility or strength that I can tell (unless that was the last exercise I mentioned). Maybe it's to come?
So he might have a master plan, and perhaps it's working, but to me it seems like there isn't a one time fix and he hasn't put all the pieces of the puzzle together yet.
Is this how PT works? Once I'm deemed "cured" do I get sent home with a list of exercises and things to watch for forever?
Got any hip flexibility/strength exercises I could maybe work on until I get that far with my PT? Any other suggestions?
After about the 3rd visit, he watched me run and has advised me to "hinge" forward when I'm running, walking, standing. I can tell this takes pressure off of my lower back, and helps me run faster. (he showed me on a skeleton, and praciticing it, it seemed like before I was running with my brakes on being so upright) However, this is not yet a cure. The exercises he had me doing were standing crunch type things where I'm practicing the hinge movement. Also was working on loosening up my IT band through massage at these sessions. I wear the orthotics (both shoes now) but only when running or when I have my running shoes on.
2 visits too late on the running assessment. While the hinge forward may make you feel better, I'm not sure where he's going with this concept during postures that are typically upright. Massage ain't gonna cut it with the ITB. It will most likely have some adhesions that will require high tension and even abrasive method to free up. Does JP have a foam roller at the gym for self myofascial release?
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NOW it appears that my legs are closer to even lengths, but the left leg rotates (hmm like you said happens above). He measures this by holding my ankles together and having me lie down and sit back up.
This is called a piston test. As you sit up, the forward rotated side of the pelvis will make the same side leg longer. If they match, the legs are equal WHEN YOU'RE NOT STANDING UP. That doesn't mean they'll be equal in standing. You must check both ways because of all the muscles that are involved in standing vs. laying down.
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HOWEVER, I still have lower back pain, so now we're focused on the SI joint(which he's noticed now is pronated) and lower 5 of the spine (which he says are tight). He does some manual technique on my back that definately releases the tension (I can't say I'm normally in pain(guess that term is relative), but I can tell there is a "relief of pressure" as soon as I stand up afterwards as if I've all of sudden have more movement in that area and not "stuck"). Exercises now were a type of machine hack squat (or opposite of leg press on a slanted board). Also at home I'm supposed to do something similar to 1/4 wall squats for the SI joint. I see this as a way of "flattening" out my si joint or sacrum against the flat hard surface. Oh, and I did another standing exercise where I put one leg (underneath my knee) on a lever and push it down.
The tension is probably a postural adaptation. If one leg is longer or shorter, the spine will have to side bend in compensation to keep your eyes level (it's an inborn reflex). A machine anything exercise will not be of benefit. The hip extension exercise (pad under your knee and push down) is a step in the right direction.
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So he might have a master plan, and perhaps it's working, but to me it seems like there isn't a one time fix and he hasn't put all the pieces of the puzzle together yet.
This is YOUR body and YOUR treatment. You have every right to ask what's going on. Do not be a passive participant.
I can't realistically provide any absolutes via forum discussion. Perhaps you need to chat with your PT and see if there is a master plan or sequence that he's working on. Regardless, you should know what that is so you don't do something inappropriate.
Thanks Bill. I understand how all of this can be very unclear via forum discussion and I really appreciate your input!
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2 visits too late on the running assessment.
And this only happened after I told him that someone(you) saw a picture of me running and said I looked like I would be running in circles if I had my eyes closed.
The only other assessments I can think of is that he looks at my spine while I'm bending forward and backwards and asks me if there is pain. Problem is I'm not injured(just crooked and trying NOT to be seriously injured), so nothing "hurts" during that assessment. What I do feel is completely normal to me (how am I supposed to differentiate that from pain and be much help in this assessment?) I figure he might be able to SEE/FEEL something from looking at my spine...
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Does JP have a foam roller at the gym for self myofascial release?
I saw Q's post about the foam rollers and have been interested in them ever since. Also saw the Core Performance book with the roller exercises and pics. I'll up it on my priority list. Found a website where I can get one for less than $10.
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This is called a piston test. As you sit up, the forward rotated side of the pelvis will make the same side leg longer. If they match, the legs are equal WHEN YOU'RE NOT STANDING UP. That doesn't mean they'll be equal in standing. You must check both ways because of all the muscles that are involved in standing vs. laying down.
I had the same thought about this test, especially since the first time he did it it seemed like my RIGHT leg was the short one. After measuring myself(with help) I realized that I got a different answer depending how I was standing/sitting, etc. But measuring standing up was very tricky, since it was hard to gauge if I'm starting from the exact same point on each side. (much like hanging a picture on a crooked wall) So I figured that's why he stuck to the piston test...
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This is YOUR body and YOUR treatment. You have every right to ask what's going on. Do not be a passive participant.
Very true, thanks for being forthright. I tend to give people benefit of the doubt and have virtually NO experience with practitioners, so now I'm trying to educate myself on what's going on (getting your thoughts, reading up on anatomy and other info sources) Some of what we're doing seems to help, and I don't think any of the exercises are inappropriate (unless useless counts here), I'm just not convinced it helps past the visit itself. So apparently this is what I need to discuss with him.
Thanks again, this is quite helpful and gives me a lot to think about!
)
) And we haven't done anything for hip flexibility or strength that I can tell (unless that was the last exercise I mentioned). Maybe it's to come?
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