Leg Length Discrepancy and Short Right Leg Syndrome
in the context of Remedial Therapy
Clinical Observation of Symptoms Affecting the Back Line of the Lower Left Limb Due to Anterior Rotation of the Hip Causing Energetic Block at the Sacro-Iliac Joint
This article introduces the concept of proximal energetic blockage due to postural anomalies causing distal pain and dysfunction.
Few medical practitioners link tightness through the back line musculature of the lower limbs with Sacro-Iliac Joint (SIJ) dysfunction...it is not taught in scientific curriculums; the explanation for the phenomenon is based on the traditional Chinese philosophy of energy flow. Energy they call Qi that cannot be measured by instruments or felt by the uninitiated. A gifted few do have an innate awareness of Qi. More typically, individuals develop the ability undertaking the discipline and rigour of meditation and oriental martial training.
In Chinese medical philosophy, when circulation of Qi is blocked, pain and tightness results. My first awareness of this came resolving an RSI condition which disabled both arms to the point where I could no longer work. The next instance was treating a fit elderly gentleman afflicted with severe Plantar Fasciitis causing pain and tightness in the heel of the left foot.
This gentleman's chronic condition had caused considerable pain over many years. He had been examined by medical practitioners in both Melbourne and London and underwent a surgical procedure to release the fascial tightness to no avail. Extensive massage treatment to the left lower limb over a 12 month period proved ineffective too. Finally, extending my awareness further, I noted the SIJ pain he experienced only as a background discomfort not worth mentioning. Balancing his hip posture by applying an intense hip flexor stretch relieved the SIJ. He did squeal loudly stretching the hip flexors. They were tight, very tight. One week later the Plantar Fasciitis condition no longer afflicted him.
I now recognise a common cause for tightness along the back line from hips to the bottom of the feet is chronic rotation of the hip about the SIJ. There may or may not be noticeable pain or discomfort at the SIJ, yet dysfunction from this postural anomaly causing tightness through the soft tissue of the joint blocks energy flow to the backline of the lower limb. This is typically present on one side only, unilateral left sided forward hip rotation being the most frequent presentation.
The SIJ joining the hip and sacrum, carrying the full weight of the body, is heavily bound by strong ligaments and has limited movement. While the shoulders achieve 360 degrees of rotation, the SIJ is limited to roughly 15 degrees. Although I do see it pushed to 30 degrees under severe conditions. At full ROM the binding ligaments pull the bones hard together, impinging cartilage and tightening the soft tissue of the joint. This degree of tightness blocks the flow of Chi.
Generally, the condition presents as a background discomfort or ache in the lower back and a subtle tightness and thickening through the Gluteals, Hamstrings and Calves. One muscle group may be affected more than the others due to individual postural and gait habits.
In some cases, the patient is not aware of any discomfort in the lower back or dysfunction at the SIJ, but examination reveals forward hip rotation and palpation of the SIJ may or may not elicit sensitivity, tenderness or pain. More acute cases experience sharp pains at the SIJ they are only too aware of.
Regardless of discomfort levels at the SIJ, thickening and tightening in the lower limb is only partially relieved by massage or stretching while the hip posture anomaly/SIJ dysfunction remains. Tightness down the backline returns quickly after treatment.
Better understanding the nature of this phenomenon, not all cases of forward hip rotation will develop Plantar Fasciitis...some being more affected elsewhere along the back line....but generally, all cases of Plantar Fasciitis will have forward hip rotation. I have sighted all of the following in conjunction with the hip rotation anomaly...Piriformis Syndrome and Sciatic pain, Hamstring and Gastroc tightening/tendonitis/tears, chronic Compartment Syndrome, Achilles injury/rupture and Plantar Fasciitis. One client suffering all these effects successively before being assessed and receiving treatment for hip rotation.
Then too, some cases never progress beyond the subtle tightening and thickening of the back line of the lower limb and, of course, there are exceptions being the presence of other injury or degeneration of hip, SIJ, sacrum or lower back affecting soft tissues blocking the circulation of Qi. In my clinical experience, the incidence of the hip rotation dysfunction phenomena far exceeds the number of exception cases.
It was not for some years following this initial observation did I learn the underlying cause for the hip rotation is a bigger story called Short Right Leg Syndrome.
First published 7 Nov 2014 https://www.facebook.com/MassageWorksDandenongRanges