Found out from x-rays that my pelvis is tilted quite a bit, lower and more forward on the right side. Noticed it the last season or two and just getting worse. Have seen 2 chiro’s and a couple sports med’s and no help. Trying to do some of the obvious like strengthening any muscle imbalances etc.
Any other ideas…Anyone else had this? I wondered if shoe lifts or running on one side of the road etc might be helpfull to rehab?
Check this out. I tried pasting it in but I don’t think the pictures of the stretches came out. This helped me when pelvis got twisted from tight psoas and quads (highly likley culprit).
http://www.runnersweb.com/running/rw_news_frameset.html?http://www.runnersweb.com/running/news/rw_news_20051025_PRP_Pronation.html
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Posted: October 25, 2005
Sports Medicine: Four Simple Stretches To Correct Over-Pronation
By Chris Maund, B.S.
Runners as a group are constantly plagued with a host of annoying injuries, many of which are linked to excessive pronation. Plantar fasciitis, Achilles tendinitis, shin splints and an unending variation of knee problems are just a few of the more common ailments. The majority of these afflictions are dealt with by treating local symptoms. In other words, if you have an Achilles problem chances are that most of the care and attention will be focused on the Achilles area. While treating the symptoms is important, it is also important to address the cause of the injury. If you go to someone for help with an Achilles problem and they only look at your Achilles, I’d suggest finding someone else.
It is my experience that for the vast majority of running-related injuries a more holistic approach (looking at your knee, pelvis, spine and even your neck) will produce faster and more permanent results than the short-sighted approach that is usually taken when dealing with injuries. The reason for this is that in order to treat an injury properly it is necessary to determine the underlying cause of the complaint. Far too many sports injuries are dealt with by treating symptoms without consideration for identification and correction of the underlying cause. This is why so many running injuries recur.
Your Pelvis and Pronation
One of the major control centers in the body is the pelvis. The tilt of the pelvis affects the behavior of the entire leg. To prove this, try the following test:
Stand with your feet about 12 inches apart. Look straight ahead. Hold this position for a few seconds while you take note of how your weight is distributed over the soles of your feet. Now tip your pelvis forward slowly so that you assume a Donald Duck type posture with your chest up and backside stuck out behind you. Note how your weight shifts forward and toward the insides of your feet. Now slowly roll the pelvis backward until your rear end is tucked underneath you. You should notice that your weight moves backward and toward the outside of your feet.
As you tip your pelvis forward your femur (thigh bone) and tibia (shin bone) rotate inward, which produces pronation (rolling inward) of the foot. What you have just proved to yourself is that forward pelvic tilt (rear stuck out) will produce pronation and backward pelvic tilt (rear tucked under) will produce supination (rolling outward of the foot). This is a very important point because most runners who have gait problems are not aware that they can alter their gait through corrective exercises and stretches designed to alter pelvic tilt.
What is the point in trying to control over pronation with a huge heavy shoe or a custom built orthotic without ever addressing a potential cause of the problem up in the pelvis? If your pelvis is tilted forward excessively due to muscular dysfunction and length or tension imbalances, and you prevent your feet from over pronating with an orthotic or a motion control shoe, the knee experiences a lot of rotational forces. The knee joint is not biomechanically equipped to deal with these kinds of forces that are responsible for a significant proportion of runners’ knee problems.
Using the stretches in this article will help to correct your pelvic alignment. If you already wear orthotics to correct pronation or supination, be aware that you will need to have your gait reassessed after a few weeks of performing these exercises since your orthotic prescription will probably change. Some of you may even find that you don’t need orthotics anymore or that you no longer need the biggest, heaviest motion control shoe in the store.
How To Test Your Pelvic Alignment
To determine whether you have abnormal pelvic alignment, perform the following test:
Stand in your bare feet and look straight ahead. Have a partner kneel down on one side of you and palpate (feel by touch) your Anterior Superior Iliac Spine (ASIS) and your Posterior Superior Iliac Spine (PSIS) with the middle finger of each hand. Your partner should note the height difference (in inches) on both sides of the pelvis. (See Photo 1)
Normal pelvic alignment is such that the ASIS (front of pelvis) should be a half-inch lower than the PSIS (back of the pelvis) in males and three quarters of an inch lower in females. If the height difference is three quarters of an inch for males or 1 inch or more for females, then your pelvis is significantly tilted forward. If you over pronate when running, you should find that your excessive pronation reduces as a result of performing the stretches outlined below. If you find that you have less than the normal height difference (less than a half inch for males and three quarters of an inch for females) between ASIS and PSIS you may suffer from excess supination when you run.
The Seven Muscles That Affect Your Pelvic Alignment
There are seven major muscles that will affect your pelvic tilt (See the Illustration below.). If you have excessive forward pelvic tilt (and hence excessive pronation when you run), you will need to stretch your latissimus dorsi, iliopsoas, quadriceps and lumbar erectors. You will also need to strengthen your lower abdominals, hamstrings and gluteals.
When these muscles are strengthened correctly they will tend to rotate the pelvis backward into normal alignment. If you have a backward rotated pelvis and you over supinate when you run, you will need to stretch your hamstrings and gluteals and strengthen your latissimus dorsi, iliopsoas, quadriceps and lumbar erectors.
Four Effective Stretches To Correctly Align Your Pelvis:
• Keep your rear end in contact with your heels and your arms straight. (See Photo 2 above.)
• Try to make the left arm longer than the right while keeping your backside in contact with the heels. This will produce a strong stretch in the left latissimus dorsi region. (See Photo 3.)
• Hold this for at least 30 seconds, then keep low and walk your finger tips around to the left and repeat for the other side.
• Keep low and return to a central position before lifting the upper body up away from the floor.
2. Iliopsoas
• You should have an angle between 90° and 110° at your front knee. Keep your back leg as straight as possible. (See Photo 4 above.)
• Suck your belly button gently in toward your spine and rotate your pelvis backwards so that you begin to feel a stretch in the front of the right hip. (See Photo 5.)
• Now maintain this position at the pelvis, keep the belly button sucked in gently and side bend the upper body to the left. This will increase the stretch in the right iliopsoas dramatically.
• Hold this position for 15-20 seconds and then repeat on the other side. Do at least three on each side to start with.
2… Quadriceps
• Kneel down next to a wall and position your body as shown. (See Photo 6) Adjust the distance between your back knee and the wall until the stretch in the front quadriceps is manageable.
• Make certain that you have a 90° angle in the front knee.
• Gently suck your belly button in toward your spine and tuck your rear end under until you feel a strong stretch in the front of the thigh. This “posterior pelvic rotation” is the single most important aspect of this stretch.
• Hold the stretch for at least 30 seconds and perform two to three on each side.
• Do not attempt to increase the stretch by leaning backward. (See Photo 7) This will mobilize your lumbar spine into further extension and you will reinforce the same errors that have led to excess pronation in your running gait. Most people do this stretch incorrectly — don’t imitate this error!
• Squat down as deeply as possible, keeping your feet flat on the floor and hold on to something to prevent yourself from falling over backward. (See Photo 8 above.)
• Let your backside relax into your heels so that your lumbar spine goes into flexion (convex curve) and perform small slow circles with your hips in this position.
• Circle clockwise for 20 seconds then counter-clockwise for another 20 seconds.
Summary
Pronation can have many causes. Often, however, your pelvis will play a large role in the degree of pronation in your body. It is essential that you perform these stretches right before you run so that your pelvis is held in as near normal a position as possible while you train. By stretching in this manner, you should notice a slight change in your posture and running stride. After three or four weeks on your new stretching program, remember to have your gait analyzed and any necessary changes made to the type of shoes you run in and/or your orthotics.
References:
Chek, P. (1997). Gym Instructor Series (video).
Chek, P. (1996). Swiss Ball Exercises for
Athletes (video).
Magee, D.J. (1992). Orthopedic Physical Assessment.
W.B. Saunders Company, 2nd Edition.
Chris Maund is a corrective exercise specialist working at the C.H.E.K Institute in Encinitas, California (www.paulchekseminars.com). He has a Bachelor of Science degree in Physical Education and Sports Science from Loughborough University, England, and is a Level IV C.H.E.K Practitioner. He has extensive experience as both a coach and athlete in running, triathlon and duathlon. For questions, personal evaluations and program design please contact him at the C.H.E.K Institute: (800) 552-8789 or e-mail: ginfo@chekinstitute.com.
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I have the same problem. If I stand with my feet square, my right hip is much farther ahead than my left hip. I spoke with my A.R.T doc about it and he said my case wasn’t that bad. I’ve had no pain and he said that it should have no affect on my performance.
I’m not sure if you are having pain. If you are, I would recommend seeing an A.R.T./chiro. My A.R.T. guys has done wonders for me. If you are in Las Vegas check out Dr. Savatgy at http://lvprc.com/ .
Also, from my knowledge the only reason you would want to put lifts in your shoes is if you have a leg length discrepancy. If you do not, I would suggest running on both sides of the road to prevent always having the ground sloped in one direction. I know that helps me.
Chris Thornham
www.paintingwithpurpose.com
paintingwithpurposeblogs.blogspot.com
Pretty vague post, so things to think about:
What kind os x-rays? Standing or supine (on your back) what views, were you rotated at all in the views? These are critical factors in reading a radiograph.
Is it a structural or functional issue? Structural meaning (in example) that one leg is longer causing pelvic rotation/obliquity. Functional meaning that there is a muscle restriction somewhere causing the problem.
You really should not mess with any changes until you know the problem. Strengthening and or shoe inserts are used to fix specific problems, with your information there is not really enough to decide what do do.
It sounds like that the professionals you have dealt with have not given you enough information (or the correct information) to make an informed decision. So there is some work to do in finding out what is wrong and why prior to treatment.
Good luck,
Martin
You might want to try a different chiro. I’m currently getting adjusted 3x a week for a 30mm tilt which I had suspected due to my belt not being straight, but had never confirmed. I decided to sign up for a free exam at the Livestrong vendor fair and get checked out.
Anyway, my chiro is very “fix oriented” and provided a schedule and a re-exam/x-ray where we better see results with the tilt being reduced or gone. My disks and other parts are all in good shape, so he says it’s completely correctable. Besides adjustments, he’s got me doing wobble board and will add on more exercises and stretches as treatment progresses.
Thanks, I’ve noticed my right hip flexor (psoas), left hamstring, and left hip abductor are relatively weaker than their counterparts.
So the weaker right psoas could be making the right pelvis side pull forward then you think? I can’t really seem to tell if it’s any less flexible, but definitely weaker. If I sit on the floor and do straight leg lifts I can’t do as many in my right leg.
Sorry I went in to detail but my internet connection took a dump so I just abbreviated!
Xrays were done standing, and was rotated in all views. I am fairly positive it’s functional. None of the docs have noticed a leg length discrepancy, and I didn’t have this problem until about 2 yrs ago then started developing it worse and worse.
I had the same problem. I couldn’t believe how rotated my hips were on the XRay, though I sure felt it. I’ve always had “duck feet” but I just figured that was the way I was built. I bought the book “The Egoscue Method of Health Through Motion: Revolutionary Program That Lets You Rediscover the Body’s Power to Rejuvenate It” and did the exercises they recommended. I think a good stretching/yoga program would work the same, but a few of the exercises really seemed to help.
Anyway, I did the recommended course of stretches 4x a week for 6 weeks, and the rotation is gone. I’m still working on the tilt, but I notice it’s getting better.
Good luck, it can get better - just takes some time to get there.
Sure,
Check for a LLD first with all the standing and supine points (in a clinical exam), and if you are concerned get a scan-o-gram, which is a series of 3 xrays that will tell you perfectly where and how much LLD there is.
If there is no LLD at all, then you have to assess what is causing it…
Lastly, what brought on all this 2 years ago? Intro to endurance sports? Increase in milage? Car accident? Any ideas what set this off in the first place.
Lastly, what brought on all this 2 years ago? Intro to endurance sports? Increase in milage? Car accident? Any ideas what set this off in the first place.
Been racing for over 10 years, about the same higher number of races, ~15-20 training hrs, etc so not sure what the heck. No accidents or anything that I can think of that would have set it off. There’s zero pain from it, and if I were a normal non-athletic person I would never even know it! Really the only reason I even started noticing it was that I could tell on the bike that I was not in allignment (knees pointed slightly more to the left, right hip feels lower on the saddle than left, etc)
WOW your story sounds just like mine. Ortho says existing imbalance/injury need surgery. 2 chiros no help. A number of physical therapists, no help.
An ART guy who tells me it is muscular and he beats the crap out of me. No help.
Figured I just live with the daily pain, heating pad, heat rubs, pain killers etc. Actually use a heating pad til I get out of the car to do a triathlon.
Sometimes cancel road trips because of the pain.
Happen to be visiting one of my spouses relatives get to talking to her about the problem She has her doctorate in physical therapy.
Offers to try and help. She says hip is lower and more forward on right side and too far back on the left side.
Also one leg is a full inch shorter than the other and she wondered why I walked strange.
I nor any of the Drs ever noticed any of that.
30 minutes later after some stretching and massage and the legs are almost even. She gives me some exercises. Bike the next day almost zero pain even while in aero position. Bad thing is I got a pain in my knee on the leg that WAS shorter. I am guessing it is because now the seat may be a bit low compared to how I have been riding.
I still have to make sure I try to keep a slight arch in my back. Still have a bit of pain but so far so good.
BUT it has only been 2 weeks. BTW went for testing at a local running store and find out one foot is over half size larger and weight on one foot significantly diff than the other. Should probably have 2 different shoes lol FINALLY a reason I am SO slow at running!
Can you introduce us to your friend?
She works for a company which only does in house pt for their patients read: nursing home. So not available unfortunately.
YOU might want to try a different chiro.
I don’t mean to be harsh but I think you’re getting hosed. Your chiro seems to be more “scam” oriented than “fix” oriented
Please explain your position.
I’ve seen my x-rays and we’ve discussed what is normal how it should look when the condition is corrected.
It’s very black and white (so to speak). Either there is improvement or there is not and once it’s fixed, we’re done.
This is very unlike chiropractors that want to adjust you on a regular basis with no specific goal in mind other than cracking your back to make you feel good. I see that as a scam.
X2,
I bit my tongue the first time I read androids original post.
@ qboss and android, (sorry to take away from the OP)
I suggest picking up all the xrays and getting them read by an unbiased 3rd party…
@ qboss and android, (sorry to take away from the OP)
I suggest picking up all the xrays and getting them read by an unbiased 3rd party…
You mean like this… What additional info would I gain?
Nope,
I mean taking them to a local trained specialist in imaging (in Canada the credentials are DACBR) and showing them the changes over time on the different dated x-rays that have been documented for you by the chiropractor, and asking for a second opinion.
with all due respect, adjustments will do nothing for this. guaranteed.
For example, lets just say I bent one knee, say 10 degrees. As a result, one side of my pelvis would drop. Now if I was taking an xray with that one knee bent, it would show on the film.
Ok so now I go for an adjustment 3 times a week till infinity. Then I take another xray, now with a straight knee. Voila, my iliac crests are in line. Damn that chiro was good.
Obviously, I’m exaggerating but take that theoretical concept to heart and you’'ll know what I’m talking about.
All in all, I just don’t want to see you get hosed.