What does it mean when your hips are out of alignment?

You may or may not have heard this term before, but when your ‘hips are out’, there is much more to it than just the hips.

In biomechanical terms, when your hips are in alignment, they are not rotated forward or back or favouring one side. When your hips fall out of alignment, they move out of a centred position, and force the spine and lower limb to compensate.

Causes:

Some of the main causes of hips being out of alignment are:

  • Bad seating and standing habits
  • Scoliosis
  • Carrying bags on one side
  • Pregnancy
  • Twisting and rotating during sleep
  • Crossing or folding legs
  • Past injuries
  • Stretching imbalances
  • Congenital disorders
  • Post operation
  • Poor footwear
  • Poor core strength
  • Pronation (collapsed arches)

Symptoms:

Some of the symptoms people experience from their hips being out of alignment are:

  • Hip pain
  • Sciatica
  • Lower back pain
  • Upper back pain
  • Knee Pain
  • Foot/ankle Pain
  • Tight/Tense muscles usually on one side at the back of the legs, groin area, or buttocks

Treatment:

Effective treatment to realign the hips include:

  • Chiropractic hip alignment
  • Lower back adjustments
  • Massage to the lower back hip and leg region
  • Home exercises to improve strength around the hip and lower back region
  • Core strength exercises

Not treating these issues can lead to overuse and injury, disc, facet and joint complications. They can also lead to serious long term which may impact your quality of life. These may include:

  • Hip Replacement
  • Disc injuries
  • Surgery
  • Osteoarthritis

The Health Professionals at DHCTC are experienced with a specialty in helping with hip problems.

If you feel your hips might be out of alignment, don’t hesitate to contact us on 02 95645222 or go to our contact page and make a booking/ask a question!

Thank you

Dr Nigel Luis

Chiropractor

Your body is built like a machine, and like any machine, it is necessary for all of its parts to work properly in order for the entire system to function at its best. If one part of your body is not working right, it can throw off the entire system. In terms of the musculoskeletal system, which is basically the framework of your body, it is important for all of your bones and joints to be properly aligned in order for your muscles to be supported and move your body the way that they should. If you are experiencing any aches or pains within your body, chances are your body may be out of alignment.

As we deal with day-to-day responsibilities, often it may be difficult to be aware of how we are positioning our bodies. If this is something that you struggle with or you are just unaware of, don’t worry. Here are five quick and easy tests that you can do to decipher if your body is in good alignment.

  1. Check how you walk

One quick way to check if your body is in good alignment is by the way you walk. Simply walk around your home and take a look at how your feet are positioned. Ideally, your foot’s line of progression should form an angle of 4-7 degrees with a line from the center of your heel to your second toe. If you notice that the toes on one side of your body are pointed out more than the other side, or if both sides are pointed out (greater than a 7 degree angle), then that may indicate something in your lower body is out of alignment. This may cause you to be using different muscles within your body and may make you more prone to different injuries and pain in your feet, ankles, knees, hips, and even your low back.

  1. Check your Q angle

Your Q angle is the angle formed by your femur (upper thigh bone) and your tibia (shin bone). To measure this, a physical therapist may measure the angle formed by a line from a point on your pelvis called your anterior superior iliac spine (ASIS) to the middle of your patella (knee cap) and a line from the middle of your patella to your tibial tuberosity, which is a small bump on the upper part of your tibia, just a couple inches below your patella. A quick way that you can assess this is to look at where your tibial tuberosity is positioned in relation to your patella. Hold your patella with your thumb and index finger and find your tibial tuberosity. If your tibial tuberosity is not relatively close to the center of your patella then that may indicate that your knee is out of alignment. This may be due to different muscular compensations throughout your lower body and result in unwanted forces going through your knee, leading to various pains and risk of injury.

  1. Check your pelvis

To check your pelvis, you will need to find your ASIS and your PSIS, which are two bony bumps located on the front and back of either side of your pelvis. Now, look at the positioning of these two bumps in a mirror. Check to see if they are situated in a horizontal line or if one is lower or higher than the other. If the latter is true then your pelvic may be either in an anterior tilt or a posterior tilt. This, again, may be the result of an imbalance in your muscles and may result in different compensations and misalignments that potentially place your body at risk for greater aches and pains.

  1. Check your frontal posture

To check your frontal posture, stand in front of a mirror. While doing so, there are a couple of different things you can check to see if your body is in a good alignment. First, observe if both of your shoulders are level. Is one higher than the other? If so, then that may suggest that you have some muscular imbalance in your upper body. Next, check to see if your body is positioned straight. To do this, see if the tip of your nose makes a straight line down with your belly button. If it does then most likely your spine is straight. If the line is angled to either side then it may indicate that your spine is not properly aligned, and, again, may create different forces on your body that make you more prone to injury.

  1. Check your lateral posture

Now turn your body to the side to check your lateral posture. Ideally, you want the opening of your ear to be in line with your acromion process (a bony bump on the tip of your shoulder) and your greater trochanter (a bony bump on the outside of your hip). If this is in line then chances are you have a good standing posture. If not, that again indicates that your spine is out of alignment. This can result in different tensions through your spinal segments and may contribute to different aches and pains throughout your entire body.

If you notice that your body is out of alignment after performing one of these tests, the first thing you can do is to try and correct your posture or the way you walk. If this is difficult for you or you still experience your pain after doing so, then you probably have some muscular imbalance in your body that is preventing your body from working properly. If this is the case, then it may be wise for you to seek out a physical therapist who can determine what is specifically imbalanced and can help you to correct it before it progresses to a more severe injury.

6 Imbalances That Cause Pain—and How to Fix Them

Getty Images

Pushing through the pain? Stop. Now.

“Pain is a medical condition and a medical issue,” says Brett Jones, owner of Applied Strength in Pittsburgh who is certified for the Functional Movement Screen, a system of tests and corrective exercise strategies. “It’s a warning sign. The pain is there to tell you something’s wrong.”

And that warning sign could be more serious than “you’re going too hard.” Jones and the other coaches consulted for this piece all had a horror story to tell-when pain in a client meant a more serious condition such as a nerve issue, thyroid issue, or even cancer. The point: If you experience regular pain while exercising-or when you’re not-go to the doctor.

If you’ve been cleared by a doc and you’re still feeling discomfort, try these simple tests to see what’s truly causing the pain-it could be related to an imbalance in a completely different part of your body. The good news: With these drills, stretches, and corrective exercises, you may be able to fix them-no doctors necessary.

Neck pain and headaches? Could be your shoulders.

If you’re experiencing these symptoms and have been cleared by a doctor, check out the height of your shoulders, says Aaron Brooks, a biomechanics expert and owner of Perfect Postures in Auburndale, MA.

“Look in the mirror and see if one shoulder is higher or lower than the other,” he says. If one of your shoulders is higher than the other, you’ll be strengthening one more than the other, and it may wind up pulled forward more than the other-resulting an inward rotation of that hand. “When you do a row or a press, that side’s going to get pinched. There’s less room in the shoulder. You can wind up with bursitis or tendonitis.” Or headaches and neck pain.

Fix it: If the mirror test shows they’re uneven, try this single-arm doorway stretch, Brooks says. To do it, stand inside the threshold of a door, and place your right forearm inside the door on the right side of the jamb, palm against the jamb at about shoulder height. In this position, twist your chest slightly through the door to stretch your chest-alternately, you can take a step forward with your right foot, keeping your left foot in the threshold. This stretch will open your chest muscles and create room in your shoulder for movement.

Pair that stretch with this mid-back strengthening exercise: Grab a resistance band and stretch it in front of your chest so that your arms are straight out to the sides from your shoulders, palms facing up. At the full extension of your arms, the band should be stretched out. Return to clap your hands in front, and repeat the movement. Pair these two moves-in this order-three times per week.

Shoulders even? Your headaches could be from a forward-leaning head.

If you don’t see an imbalance in the height of your shoulders, turn to the side, says Robert Taylor, owner of Smarter Team Training in Baltimore. If your head is jutting far forward of your shoulders, it could ultimately decrease the amount of blood flow to your head and neck.

“The head leans forward, the spine leans forward, and it puts unnecessary stress on the lower spine too,” he says. With the decreased blood flow to your thinking cap, you could get headaches.

Fix it: Increase blood flow up top and return your head to its natural, up-tall position by strength training your neck, Taylor says. Try this one-arm shrug to even things out:

Sit on an upright bench, like one you’d use for a shoulder press. Holding a dumbbell in your right hand, place your left hand under your left butt cheek and grab the side of the seat. Let your right hand hang down straight by your side and pull your shoulder blades back and together. Now raise your right shoulder up towards your ear-raise it straight up instead of rolling your shoulder. Hold for a beat at the top, and then return to the start position. Complete a set of 10, and repeat on the other side.

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Knee pain when you run? Could be your hips.

“The knee has two bad neighbors-the hip and the ankle,” Jones says. The pain you feel in your knee could very well be tightness or immobility in those bad neighbors. “They sweep all their leaves into the knee’s yard. Everyone blames the knee, but it’s the neighbors.”

To see if your hips have a proper level of mobility, lay on your back in a doorway so that the middle of your kneecap is right on the threshold. Relax your arms at your sides, palms up. Bring your feet together, toes pointed at the ceiling. Pull your toes towards your shins to create a 90-degree angle at the ankle. Keep one leg straight and still as you slowly raise the other leg until either your knee bends on your raising leg, or your bottom foot bends or turns out to the side.

“See if the knobby part of your ankle can make it past the door frame,” Jones says. If it does, your hips are plenty mobile-check the ankle test below to see if that’s causing some knee issues. If either ankle can’t make it, foam roll your hips and glutes, and then work on this stretch using a belt or strap for instant improvement.

Fix it: Lying in the same position as during the test, wrap a strap or belt around one foot and raise it until you just start to feel a stretch-not to the level where it’s all the stretch you can take, but just the beginning of the stretch, Jones says. Once here, bring your other leg up to meet it. Return the non-strapped leg to the floor. At this point, you may find that the strapped leg can come up a little higher. When it does, bring the non-strapped leg up to meet it again. Continue until you no longer feel progress in the strapped leg, and switch.

Hips moving OK? Check your ankles.

If your hips are mobile (and even if they’re not), ankle mobility can also lead to knee pain, says Mike Perry, owner of Skill of Strength in North Chelmsford, Mass., who is certified in the Functional Movement Screen. To see how mobile your ankles are (or aren’t), assume a one-knee position facing a wall. Your knees should both form 90-degree angles, and the toe of your planted foot should be about four inches from the wall. In this position, Perry says, try to glide your knee over the pinky toe to touch the wall without lifting your heel. If you can reach the wall, your ankle is gliding correctly. If your foot comes up before your knee touches the wall, your calves are “incredibly tight,” Perry says.

Fix it: To help remedy this issue, foam roll your calves and try this variation on that ankle test from Brett Jones. Assume the same half-kneeling position, and place the point of a broomstick on the pinky toe of your planted foot. Hold the stick so it’s touching the outside of your knee. With the stick in this position, keeping your knee from flaring out to the side, glide the knee forward slowly, stopping when your heel leaves the ground. If you perform this as a drill, Jones says, you can see as much as half an inch of improvement in the first session. If you feel pain during the drill, stop and consult a physician.

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Lower-back tightness? Might be your hips.

As with knee pain, back discomfort often isn’t a back problem at all, Brooks says. If one side of your pelvis is higher than the other, it can result in back pain, hip pain, groin pain, or even knee pain.

“If you try to do a lunge, the knee on the high side will cave in and the hip will angle inward,” Brooks says. The repercussions of this change over time can be knee pain, a patella tear, a medial meniscus injury, or hip bursitis.

But back to your back-the unevenness of your hips can pull on your lower back, causing that tightness while sitting all day.

Fix it: If you notice your hips are uneven, try this hip abduction exercise. Lie on your back with knees bent and feet flat on the floor, hip-width apart (the classic sit-up position). Wrap a small resistance band around your knees so that it’s already a little tight while your knees are together. Now press out against the strap to separate your knees until they form a V-shape, holding at the outermost edge of the press for a few moments. This move helps to fix the hip imbalance because “in the lying position, the muscles that are causing the pelvis to be out of alignment are shut off,” Brooks says. Repeat for 2 sets of 20 reps, 3 times per week.

  • By Greg Presto

Why Do I Have Uneven Shoulders?

Doing exercises will help you to stretch and strengthen your body and shoulders. This may promote symmetrical alignment and balance in your body, help to lengthen your spine, and increase mobility. Do these exercises at least three times per week to even out your shoulders. It’s best if you can do them in a few short spurts throughout the day. You’ll need dumbbells and a resistance band for a few of the exercises.

Shoulder raise

via Gfycat

  1. Bring your arms to your sides and align your spine.
  2. Squeeze and lift your shoulders up toward your ears.
  3. Hold this position for a few seconds and then relax your shoulders back down
  4. Continue for 30 seconds.

Ear to shoulder stretch

via Gfycat

  1. Sit or stand with your head and neck in a straight line.
  2. Keep your shoulders still as you tilt your head toward your shoulder.
  3. Use your hand to hold onto or massage your opposite shoulder.
  4. Or gently pull your head down toward your shoulder.
  5. Hold for 30 seconds.
  6. Do this stretch at least 2 times on each side.

Shoulder blade squeezes

via Gfycat

  1. While standing, bring your arms alongside your body.
  2. Squeeze your shoulder blades together and down.
  3. Hold for a few breaths.
  4. Release to the starting position.
  5. Do 2 to 3 sets of 10 repetitions.

Reverse prayer pose

via Gfycat

  1. Bring the backs of your hands together behind your back with your fingertips pointing down.
  2. Open your chest and bring your shoulders back.
  3. Flips your hands so that your fingers are pointing up.
  4. Bring your palms together, pressing into your hands and drawing your elbows back.
  5. Remain in this pose for 30 seconds.
  6. Do this stretch a few times throughout the day.

Resistance band shoulder squeezes

via Gfycat

  1. Hook a resistance band around something sturdy and hold it in both hands.
  2. Turn your hands so your thumbs are up and your pinkies are down.
  3. Squeeze your shoulder blades together as you bring your hands back. (This can be done with your arms at shoulder level and at hip level.)
  4. Then, turn your hands so your fingers are facing down.
  5. Squeeze your shoulder blades and pull your hands toward your hips.
  6. Do 3 sets of 12 repetitions for all three stretches.

Resistance band arm stretch sequence

via Gfycat

  1. Stand with your feet as wide as your hips.
  2. Grab onto the resistance band and bring both arms in front of your body so they’re parallel to the floor.
  3. Squeeze your arms together, then release.
  4. Then, raise your arms straight up, so they’re touching your ears.
  5. Try to make a “T” with your arms by stretching the band as wide as possible and return to the original position.
  6. Next, lower the band so it’s behind your neck and hold this position for a few breaths.
  7. Then, lift it back up again.

Do 3 sets of 12 for all three stretches.

Reverse fly

via Gfycat

  1. Sit on the edge of a bench with your waist bent forward.
  2. Face toward the floor and hold a dumbbell in each hand.
  3. Lift your arms out and up as you contract your shoulder blades.
  4. Hold this position for a few seconds, keeping your arms parallel to the floor.
  5. Return to the starting position.
  6. Do 3 sets of 15 repetitions.

Overhead external shoulder rotation

via Gfycat

  1. Hold a dumbbell in your right hand and lift your arm so your elbow is at shoulder height and your hand is down.
  2. Rotate your shoulder to bring your arm up so your hand is up toward the ceiling.
  3. Return to the original position.
  4. Do 3 sets of 15 repetitions on each side.

Could my arm pain be from my neck?

*This article originally appeared on Dr. Kristen Mitteness’ website. Dr. Mitteness is part of the Lifemark family. We are republishing the article here with permission.

Over the past few weeks, I’ve had a surge in patients with arm pain, tingling or numbness in their fingers or weakness in their hand. While some suspect carpal tunnel, others have associated the pain with their shoulder or neck. What’s really going on here?

The brachial plexus

There is a network of nerves that starts at your spinal cord within your cervical spine (your neck), go through muscles near your neck and shoulder and make their way down your arm and into your fingertips. As a whole, this network is called the brachial plexus.

5 main nerves (musculocutaneous, axillary, radial, median and ulnar) are considered the “terminal branches” of the brachial plexus. Depending on where the nerve is being irritated, you can experience different symptoms or signs.

When a tight muscle, a poorly moving joint, bad posture or other factors irritate a nerve in your body, it is likely to cause pain, tingling, numbness or a burning sensation. That being said, did you know that only 10% of your nervous system actually feels pain? Chances are, your nerve has been irritated for much longer than your pain has been present.

Getting started with recovery

So, how is something like this treated? My first action item is to check posture. Is one shoulder sitting higher than the other? Is the head tilted to one side? Are the shoulders rounded forward? Then, I check the range of motion. Can the patient move his or her neck through all ranges of motion without pain or pulling? Remember, pain is not normal! It’s a sign of dysfunction.

The next step is to palpate, or check the area through light touch, to find any muscles, joints or ligaments that aren’t moving properly, feel tender or aren’t in alignment. Think about your vehicle. If your tire alignment is off just slightly, will your car wear out faster? Will you notice right away?

Lucky for us, the human body is extremely resilient and adaptable…. until it isn’t. Chances are, the problem that is causing your finger numbness, tingling or pain has been there for a while, it just wasn’t sending you pain signals.

Adjusting the joints

After mobilizing the joints that I suspect are involved in the dysfunction, I’ll adjust any joints that are subluxated (not dislocated) or not in alignment or moving well, starting with the back, neck and shoulders. Then, I’ll use a myofascial release technique to mobilize the muscles in a way to release or remove irritation to the nerve.

More often than not, patients feel a bit of relief right after the treatment. Is it completely fixed after a single treatment? Probably not, but, we’re on our way!

Of course, we have to identify what caused the problem in the first place and implement necessary changes. Is there underlying inflammation? Is it your posture the culprit? If so, it needs to be addressed or else you’ll be in pain again in the future.

What we do in my office is one piece of the puzzle. To truly heal, we need to address all underlying causes. Pain and dysfunction are most often not from just one thing, but the result of a perfect storm. Through chiropractic, nutrition and self-care, we can work together to not only help you feel better, but function better.

If you’d like to schedule an appointment with a physiotherapist, check out our Locations page to find a Lifemark clinic near you.

The Cause for Uneven Hips and Shoulders and the Chiropractic Approach to Fixing Them

The body is designed to stand erect. Your spine – stacked tall with bony vertebrae and vertebral discs, and supported by a network of muscles, ligaments, and other connective tissue – allows you to maintain an even posture from head to toe. In a perfect world, the left and right sides of your body would sit perfectly in line with one another.

Unfortunately, our bodies are not perfect, and sometimes the body gets misaligned and out of whack. Over time, you may find that one of your hips or shoulders (or both!) sits higher than the other. This may be accompanied by soreness or pain when standing or sitting in certain positions.

The chiropractic team at Posture Works in San Francisco, CA and Denver, CO understands how frustrating it can be to view and manage uneven hips and shoulders. Fortunately, there is a chiropractic solution to this problem.

Uncovering the cause of your uneven hips

At first glance, it may not be as easy to identify uneven hips as it is to see uneven shoulders, but the two problems are closely related. The issue normally stems from uneven hips to start.

A lateral pelvic tilt is one of the most common causes of this problem. A lateral pelvic tilt is when your pelvis, which connects to your spine and hips, tilts to one side instead of forward or backward. This tilt pulls one hip up and pushes the other down rather than sitting parallel to the floor and your shoulders.

Lateral pelvic tilts may be caused by injuries or by prolonged postures in which one hip is raised. Usually, this tilt will cause the shoulders to also appear uneven, with the lower shoulder on the same side as the higher hip.

Uneven hips and shoulders may also be a sign of scoliosis, or an abnormal curve in the spine. Normal spines have a slight S-shape near your neck and tailbone when viewed from the side, but the vertebrae should be stacked evenly on top of each other when viewed head-on. People with scoliosis will have an S- or C-shaped curve laterally. In most cases, scoliosis occurs naturally, but it can sometimes occur as a result of spinal injuries or other spinal problems.

Other causes of uneven shoulders or hips may be muscular imbalance, where the parts of the body are shifted unnaturally because of stiff or shortened muscles. In addition, simple spinal misalignments can pull on your spine, muscles and more, causing imbalances.

How a chiropractor can help

If you have uneven hips and shoulders, visit a professional who can help you correct it. Letting shoulders and hips sit unevenly will not only look odd, but may lead to neck, shoulder, and back pain and immobility.

To help ease the stiffness and reverse the effects of uneven hips and shoulders, you’ll want to work with a chiropractor who can help you identify the underlying cause of your imbalance. Your problem may lie in undetected scoliosis, muscular tightness or a general misalignment.

From there, your chiropractor may be able to fix the misalignment through exercises and stretches to loosen your muscles and spinal manipulations to get each vertebra back where it should be. Once everything is lined up properly, you may notice a difference right away or soon after.

When you work with the spinal experts at Posture Works, you’ll be treated with our special approach to patient wellness called Chiropractic BioPhysics (CBP). Through CBP, we help patients in Denver, CO and San Francisco, CA identify spinal problems. Our goal is to fix them or mitigate symptoms, so you can live a better, healthier life.

Chiropractic BioPhysics, or CBP, is one of the most scientific, researched, and results-oriented corrective care techniques. CBP-trained chiropractors aim to realign the spine back to health, eliminating nerve interference and addressing the source of pain, fatigue, and disease. As with all chiropractic care, CBP is gentle, painless, and non-invasive.

The Myth of Uneven Leg Length

How to use Clinical Somatics exercises to alleviate functional leg length discrepancy

So, can we change our learned muscular patterns, restore normal gamma loop activity, and retrain our proprioception? Yes, we can! The movement technique of pandiculation allows us to do all of these things by sending accurate feedback to our nervous system about the level of tension in our muscles. Since this is already a long post, I’ll let you read more about pandiculation in this post.

If you’ve learned Clinical Somatics exercises from my online courses or from another Certified Clinical Somatic Educator or Hanna Somatic Educator, you can use this section to help guide you in releasing the muscles that are causing your functional leg length discrepancy.

First, some general advice:

Identify which hip is higher. As I mentioned in the anatomy section, both sides of your body are tight—they’re just tight in different ways. This may sound obvious, but you’ll probably experience better results by first focusing on releasing the muscles that are hiking your higher hip up.

So as you practice the exercises, start by spending more time working with the side on which your hip is higher. Some days, try lying down and practicing the exercises only with that side. When you stand up, you’ll feel unbalanced, but that’s part of the learning and adjustment process that your nervous system needs to go through. Be sure to do the Standing Awareness exercise before and after—this is a critical part of the process of adjusting your proprioception.

As you begin to balance out your hips, you’ll become aware of the different patterns of tension you have on each side of your body, and you’ll figure out how to work with each side to release that tension.

When you do practice the exercises on both sides, notice how each side of your body feels different. Are you using your muscles differently? Can you sense your muscles more on one side than the other? Do you feel like you have more control on one side than the other? Is one side tighter or looser than the other?

You can then go back and forth from side to side, learning from your more coordinated side. If a movement feels easy or “right” on one side, try to replicate that feeling and way of moving on your other side.

Now, some specific exercises. From the Level One Course:

Back Lift: To release your lower back and gluteal muscles on your “higher-hip” side, turn your head to look away from that side. So, when doing the full movement you’ll be lifting up the leg on your higher-hip side.

Side Curl: This is a very important one for you to do every day. Lie down on the side of your lower hip, and practice this curling up to the side of your higher hip. Many people have difficulty sensing and releasing their obliques at first, so be patient with yourself. Really try to get a sense of the muscles on the side of your waist contracting, then release them as slowly as you possibly can—resist gravity as you lower down. Completely relax for a few moments before repeating the movement.

One-Sided Arch & Curl: To work with your higher hip, lift up your knee on your higher-hip side.

Iliopsoas Release: This is another very important one to do every day with the hip that is higher. Take it slow and be gentle—this can be an intense movement if your iliopsoas is tight.

Hip Slides and Hip Raises: These offer a wonderful opportunity to go back and forth from side to side, compare the differences between your two sides, and learn from your more coordinated side. You can also practice these only with your higher-hip side if you wish.

Hip Rotation: Explore these movements to figure out if your hip rotators are unevenly tight. For example, if your right knee moves out to the side easily, but your left does not, then spend some extra time gently lowering your left knee out to the side using the Internal Rotator Release.

Finally, be aware of how you’re using your body as you go through your daily life. Your progress with the exercises will be slower if you continue to do activities or habitual postures that are keeping you stuck in your patterns of tension.

Notice how you use the sides of your body differently when you:

  • Stand for a few minutes: do you lean to one side?
  • Carry your bag
  • Carry your child
  • Drive your car
  • Work on a computer
  • Use your phone
  • Sit to read or watch television
  • Sleep: do you sleep more on one side than the other?

How to Keep Your Hips in Balance

The hips are the powerhouse for tennis players.

You have to make sure that your hips are always in good muscular balance. You want them strong, powerful, evenly flexible, and explosive. They connect the lower body and the upper body to work in unity, while providing stability, strength and flexibility to both upper and lower body.

If your hips are not properly aligned, your movement pattern is not correct and your joints will be exposed to extra forces and frictions.

Misaligned hips can cause you many troubles, such as pain in your lower back, knees, shoulders or ankles, and will possibly even create some more serious future injuries. It’s extremely important to take good care of your hips to keep them strong, flexible, and properly aligned.

More: 9 Steps to Improve Stability and Prevent Injuries

Align hips regularly with this straight-leg hip twist, an important stretch for tennis players and all athletes because it rotates and relaxes the muscles of the spine while the muscles of the hip are contracted.

Besides a regular realigning, strengthen the hips and glutes regularly with different versions of squats, lunges, glute bridges and glute kicks and other hip-strengthening exercises. Additionally, stretch your hips with the seated groin stretch, supine groin stretch, glute stretch and cats-and-dogs exercise. Piriformis myofascial release will reach the deeper muscles in the hips.

More: 6 Exercises to Put Your Body Back in Balance

Straight-Leg Hip Twist

The straight-leg hip twist isn’t known to many, but it’s really effective stretch to balance and align hips. If you don’t know whether you have problems, just try this stretch. If both sides feel about the same, you’re doing fine. If one side is considerably tighter or less pleasant, you have issues and you need to keep working on getting the hips even.

Directions to Align Hips

  • Lie down on your back with straight legs and feet flexed.
  • Spread your arms 90 degrees away from your body with palms down.
  • Place the right heel on top of the left foot and keep both feet flexed at all times.
  • Contract the quadriceps of both legs and start lifting the right hip off the floor.
  • Continue to twist until the right hip points toward the sky.
  • Keep your upper body relaxed and turn your head the opposite direction.
  • If you cannot twist your hips completely at this time, that’s okay–one day you will be able to.
  • Keep your quadriceps and glutes contracted and hold the stretch for 30–60 seconds, while breathing deeply.Reverse the feet and stretch the other side.

You may feel tightness in different locations, such as your hamstrings, adductors, knees or lower back. Continue doing this stretch after your training, running or tennis practice until it feels quite comfortable. Align hips on a regular basis and feel and perform better.

More: The 3-Minute Stretch to Prevent Tennis Injuries

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This is the third article in a series about body alignment. Scroll down for the start of the article.

I went from enjoying an active lifestyle to being unable to take a quick, short walk without significant pain and discomfort.

I wrote this series in hopes of helping other people avoid this fate or overcome similar problems. Don’t mistake this for professional advice – I’m not a physical therapist.

The culprit in my body’s misalignment is a left leg half an inch shorter than the right. Even if your legs are the same length, you could still be suffering from alignment problems and benefit from what I’ve learned.

  1. Is your balance worse on one side? Could alignment be the problem? Describes the progressive deterioration I experienced over the course of decades, slowly at first, then rapidly. My right leg mysteriously twisted inward and I lost my balance on that side. Figuring out what was happening was a long, frustrating and expensive process.
  2. If your body’s alignment is a problem, how will you know? In this article I tackle several topics, like does alignment even matter? The biggest message I hope you take away is that when we take a reductionist view of our injuries and pain points we miss the chance to make long lasting changes to our bodies.
  3. Surprising Signs of Misalignment: Assess Yourself Learn ways to get a sense of your skeletal alignment.
  4. Exercising for Alignment Remember, I am not a strength trainer. I’m not even pretending to be one on the internet. I’ve done many, many exercises and programs to try to improve my chronic problems, as prescribed by professionals. Nothing has been as effective at re-shaping my body as the way I exercise now.
  5. 12 Random Tips, Insights and Admonitions About Alignment A mash up of things I’ve learned and things that have helped during this process.

Your body is talking. Are you listening?

After my legs were measured by X-ray last January I had the sole of my left shoe lifted 1 cm. It’s now at 1.3 cm, but that’s a story for another time.

These are a few of the changes I noticed in the first 3 months after altering the shoe:

  • Rib flare: My bottom left rib, which had always flared out, sank into my abdomen. I thought that rib was deformed during my development but actually my entire rib cage was off axis.
  • Missing muscle: I had a deep depression at the top of my left thigh, where my hands sits in my pants pocket. That disappeared. I now realize it was atrophied muscle – TFL or a quad muscle. Everyone loves to talk about hip flexors and glutes. No one ever notices your poor TFL.
  • “Inactive” glutes: Speaking of glutes, my left glute, which had long ago been diagnosed as “weak and inactive” and the likely culprit of my chronic hip pain, suddenly came to life and started to grow in size. This, after I dedicated nearly a decade to trying to activate and strengthen it.
  • Mysterious thudding in lower back: When doing a “Dead Bug” exercise, I felt a thudding sensation deep inside when I extended my right leg. That stopped. I’m pretty sure it was misalignment in my sacrum.
  • Asymmetrical tightness: With a standing side bend stretch, I was much tighter on my left side than the right. My pilates instructor, who insisted my leg length difference was “functional”, claimed the tightness was a sign I needed to “lengthen and strengthen” that side of my body. After adjusting my shoe, the asymmetrical tightness disappeared.

I was shocked by these changes. If I noticed any of these things previously, I thought I was just made that way. Even my height changed. Physical features I lived with forever, that I thought indelible, changed within a few months.

The experience upended my thinking. Now I understand the potency of position and alignment. I gave up the idea that exercising weak or tight muscles would fix my problems and I knew why all the methods I’d tried previously failed. If it’s true that our muscles hold our skeleton in position, it’s at least as true that the position of our bones shape our muscles.

I had a new mental model to work with: alignment would fix strength imbalances, not the other way around. With this insight I’ve arrested and begun to reverse the twisting in my right leg and am undoing the damage caused by living so many years with misalignment. In the next article I’ll explain how I do that in practical terms, but first here are some things you can look at in yourself to get a sense of your own alignment.

It’s easy, in retrospect, to see the signs of misalignment, but I didn’t notice anything until it was late in the game. I’ve been examined by many professionals. Most of this stuff was missed by them as well. Even when I asked about some of the symptoms, like joints that cracked more and more often, the symptoms were dismissed as unimportant. Everything on this list has started to reverse or diminish as my alignment has improved.

Asymmetries

I believe that any asymmetries between the right and left sides of the body are signs of misalignment and should be addressed as such. This includes visual signs, functional signs and persistent one-sided injuries.

Visual signs: mismatched muscle sizes, uneven shoulders and hips, knees and feet that point in different directions, arms that hang at your sides differently etc.

Functional asymmetries: differences in muscle tightness, strength or flexibility between the right and left sides of the body. Even my jaw doesn’t open and close straight.

Cracking joints

As my misalignment grew progressively worse, the joints in my ankles and feet started cracking – a lot. I also developed lines of tension across my feet and up and down my legs. That still happens, but is diminishing.

Restless Legs

This was another big surprise. There’s definitely a correlation between my alignment and my experience with restless legs syndrome.

Roller skis don’t track straight in double pole

Every couple of pole strokes I had to lift my roller ski and reposition it so it faced straight again. I tried roller skiing the other day for the first time in a year and my skis tracked straight, so, yeah.

Asymmetrical “overuse” injuries

If it wasn’t such a serious problem, this diagnosis would make me laugh. What if the treads on one of your tires wore down, but the others were OK? Then your mechanic said it was because you drove too far.

Wouldn’t you have some questions about your car’s alignment, to say nothing of your mechanic’s expertise?

Overuse is a common explanation for injuries, even when they are one-sided. Your knee hurts? How far did you run? Obviously, you overdid it and didn’t give your body a chance to “adapt”.

I’m not saying overuse injuries aren’t a thing, but if the issue is only on one side of the body, shouldn’t we consider the possibility that alignment is a problem? With better alignment could you have “used” your body more before it broke down?

Weight Distribution

This as enormously important and is something I work on every day. How you distribute your weight on your feet can tell you a lot about your alignment. It should be even between each foot and between the heel, big toe joint and little toe joint.

You can get a sense of this with a simple, body weight squat. With this set up, I can be fairly precise with my foot placement. (I practice with a wide variety of stance widths and toe angles.)

I imagine a plumb line running through my body and try to keep it aligned with the notch on the floor plate. Can I keep the line straight all the way through the movement or do I veer over to one side? What does my weight feel like on the bottom of my feet? Does it change as I move?

You can even check how you distribute your weight on your sit bones. Sit on a flat bench with your feet supported on the floor. Shift from one sit bone to the other and compare how that feels.

You’ll feel a difference if your pelvis is tilted or torqued out of alignment. My Feldenkrais practitioner helped me discover that I had trouble shifting over onto my sit bone on the same side where I had lost my balance.

Body Scans

Relax, lying flat on your back. Spend a few minutes sensing your shape against the ground. Feel the impression your body makes on the ground. Do your feet point in different directions? How do your calves, thighs, buttocks, shoulder blades and head rest against the ground. What are your hands and arms doing?

In standing: Stand with your heels backed up against a wall, but your body tilted slightly forward. Gradually tilt back against the wall and feel how your body makes contact with the wall. Do your shoulder blades strike at the same time? How far back do you have to go to make contact with your head?

Bad-side balance

In hindsight, it’s so obvious that misalignment sabotaged my balance. Why is this never talked about amongst ski coaches? Balance is a critical skill for nordic skiing, but balance is almost exclusively framed within the context of proprioception and hip stability and strength.

It’s Endless

Once you know what to look for, you’ll be amazed by what you notice, both in yourself and in others.

I study everyone’s walking gait now, including my own. I watch how legs and arms swing. I look at hands and feet. I try to sense how my pelvis rolls as I walk. I look at how people land on and come off their feet.

Movement patterns are a big tell for alignment problems, but difficult to detect until you’ve had some practice.

Problems unfold over decades

Seniors’ homes are filled with bent and crippled bodies. This doesn’t suddenly happen in our seventies or eighties – the process is underway long before then – probably in our teens and twenties.

My right leg was literally twisting beneath me. Defining it as a problem of whole body alignment was key to arresting the process and beginning my rehabilitation.

So how do we fix alignment?

Physiotherapists prescribe treatment plans that target areas of weakness and inflexibility in hopes of correcting imbalances and improving alignment. I think it’s more true that improving alignment is a powerful way to improve muscle imbalances and tightness. I’m unconvinced it works the other way.

I base this on my experience of diligently following many such treatment plans, all without success, then experiencing profound physical changes to my body within just a few months of getting my shoes altered. (Note: A partial heel lift inside my shoe didn’t cause any changes I could notice.)

This insight has been a guiding light for me. It helped me define a process I call “exercising for alignment” which has led to more rapid and profound changes to my body than anything I’ve previously experienced, except for pregnancy.

Next Article: Exercising for Alignment

Mar 2017 03

If I had a dime for every time one of my patients told me “my hip is out of place,” I’d be a rich man. While I can understand why this is such a common notion, I’m here to tell you that your hips simply do NOT go out of place (for the most part). Furthermore, telling people this may actually do more harm than good!

What You’re Actually Feeling

First, it’s not your actual hip that’s “out of place.” If your hip was out of place, it would be dislocated, it would be painful, and you’d be already on your way to the emergency room. Second, when people say their hip is “out of place” what they really mean is that they are experiencing one-sided low back pain in the region of the SI joint. It is usually a perception of something being stuck, not moving properly, or even just feeling out of whack.

What many have been told is that in order to “correct” this, you need specific hands on techniques like muscle energy or manipulation to put your hip “back in” in order to move correctly again. However, I will show you, this mindset can have serious repercussions.

Muscle Energy Technique

In physical therapy school, I was taught that muscle energy techniques (MET) could help realign a pelvis that is “out of alignment.” To perform them, you have the patient contract a specific muscle against the pressure of your hand or body to help “pull” the pelvis back into alignment.

After the muscle energy technique is completed, you then tell your patient that your maneuver helped realign their pelvis, essentially “putting their hips back into place.” What gives?

Fear Avoidance of Movement

While most people will temporarily respond well to muscle energy, what often happens after is a fear avoidance of movement. People are TERRIFIED to move in fear of “throwing their hip out again!”

If simply pushing your leg against your therapist’s hands is enough force to “put your hip back in” that implies that it is very easy to “throw it out” again. How in the world are patients going to buy into the concept of exercises such as loaded lunges and squats (things that actually DO cause permanent structural change) if their hips are “thrown out” so easily by the manual pressure of your hands!

I’ve had this happen to me multiple times with my patients. Everything is going well, he/she is in no pain, and it’s time to teach a loaded lunge or squat, and what do I get?

Oh no, I can’t do that, I’ll throw my hip out again…my chiropractic just put it in last week!

Here’s the truth. While hands on techniques can cause a rapid reduction in pain and perceived tightness, proper education is KEY in order to prevent this subsequent and inevitable fear of movement.

It’s Time to Promote Resiliency

If your hips could go “in and out of place” with something as simple as manipulation or muscle energy techniques, your body would crumble to pieces under a heavy squat or deadlift. The last time I checked, it doesn’t. This is because your body is made up of RESILIENT structures. In fact, your body is so resilient that it takes over 1,000 lbs. of force to deform fascia by even 1%. Tell me again how your hands on techniques are causing structural changes?

Do muscle energy techniques and spinal manipulation cause instant reduction in pain? Absolutely. Is this instant reduction in pain due to correcting a biomechanical abnormality or changing something structurally? Absolutely not!

So What Do I Do Instead?

If you are someone who likes performing muscle energy techniques or manipulations (I utilize manipulations in the clinic every day) it is very important to utilize proper education. I tell my patients that I’m NOT realigning their bones or putting something back into place, I’m simply doing something that their brain seems to like so it rapidly decreases pain in the area after the technique…that’s it. I also stress that these techniques do not offer a permanent solution to their pain, and heavily promote threat-free movement and loading immediately after these techniques.

For those who do experience a sensation of imbalance or “locking” on one side of your back, one of my favorite loading strategies is to perform a loaded lunge variation with extra range of motion, such as the reverse lunge from a step.

While the position of the legs do look familiar to the muscle energy technique mentioned above, there are some key differences:

  1. This variation is loaded, which prevents fear of movement
  2. It is performed bilaterally, which prevents a fear that moving the wrong way will throw it out again
  3. It can be done without the help of a practitioner, promoting self empowerment

I’ve just found that there’s something about loading the hips at end range that helps clear up perceptions of one-sided tightness in both the low back AND hips, when something like squats and/or deadlifts cannot be tolerated. Give it a try and let me know what you think!

Conclusion

If you’re someone who constantly feels the need for frequent manipulations, take a deep sigh of relief. Your hips don’t go in and out of place, and you don’t need someone to routinely “put them back in.”

If you are dealing with recurring one-sided hip/low-back pain try taking a break from heavy loaded squats and deadlifts and opt for loaded lunge variations instead. Most importantly, stop walking around in fear of throwing your damn hips out and go MOVE!

It might be your Sacroiliac!

As we are treating a lot of runners at our clinics at the moment due to training for London and Brighton marathons we thought it would be good to share with you a common problem runners complain of. This is a problem where your pelvis goes out of alignment, also known as Sacroiliac joint (SIJ) dysfunction. Pregnant ladies often have problems with their pelvis too due to hormone changes which relax the sacroiliac ligaments.

What is the SIJ?

The sacroiliac joints are the linkage between your lower spine and pelvis. The connection of your sacrum and the right and left iliac bones form the sacroiliac joints.

What is Sacroiliac Joint Dysfunction?

When your sacroiliac joints are not moving normally due to excessive movement or stiffness, it is referred to as Sacroiliac Joint Dysfunction, which normally results in sacroiliac pain.

It is important that you have both normal movement and muscle control around this area to avoid SIJ pain.

What are the Symptoms of Sacroiliac Joint Dysfunction?

  • Lower back, hip, buttock, groin or sciatic (leg) pain
  • Pain is often worse when walking and standing
  • It can be painful getting in and out of the car and standing on one leg to get dressed
  • Painful when lying on your side
  • It can be painful bending, climbing the stairs and standing up from a seated position
  • Reduced hip movement

Treatment

The best treatment for SIJ dysfunction is a thorough assessment to determine the cause of the pain.

It maybe there is a dysfunction with the right SIJ which is causing left sided lower back pain.

Correction of pelvis alignment using mobilisation, manipulation and muscle energy techniques (manual therapy where the patient uses gentle muscle contractions then relaxes to allow muscles to lengthen and joints movement to normalise – guidance is given by your physiotherapist)

Exercises to strengthen your core and gluteal muscles once your pelvis alignment has been corrected.

Please be aware of your body and take advice from your GP before exercising if you have lower back pain, pain around the back of your pelvis or hip pain then please get in touch for advice and guidance.

“After having a baby last year, I found that I had very limited outward rotation from the groin in one of my legs. My doctor dismissed it as a strained muscle, but I knew it was something more. Physio-logical instantly realised that my pelvis was slightly out of place and began effective treatment immediately. After a few sessions of manipulation and strengthening exercises, my pelvis and leg rotation were back to normal. Thank you so much for the fantastic treatment I received. I would highly recommend Physio-logical to anyone. I found them to be professional, friendly, knowledgeable and most of all effective” Mrs. E

No, your pelvis is not out of place…

You often hear your patients tell you: “My pelvis is misaligned, can you put it back in place?” A lot of people have beliefs about their back that are not evidence based.

Chiropractors, manual therapists and physiotherapists often check leg length assymetries.

Leg length is often checked in supine.

Why is it a bad idea to tell your patients that they have a leg length difference, and it has to be re-aligned with a manipulation?

The big problem is this:

  • They have the feeling their spine is vulnerable and weak.
  • They will be moving more carefully in their daily lives.
  • They can’t carry things, because their pelvis or vertebrae can become misaligned again.
  • They have to be corrected every 1-6 weeks.
  • They feel dependent of their physio/chiro.
  • They have passive coping style and external locus of control, so they don’t feel empowered to help themselves, their physio/chiro has to help them.

Yellow flags

All those factors, like fear of movement, wrong illness beliefs, catastrophizing, passive coping style, external locus of control have been documented to be negative prognostic factors (yellow flags). So when patients have these characteristics, they have more risk for chronic pain. (1,2)

You can’t change the position of the SI joint with a manipulation. You find the study here.

Your communication is very important to your patients.

Don’t get me wrong, I’m a manual therapist myself, and all these manual techniques can help very well with some patients.

It’s about your explanation why it works, that counts.

You can empower patients, or make them dependent on you.

If your ego is so big that you want patients to be dependent on you, choose another job or something.

We have to make the healthcare system less expensive. We can do that by making the patients more:

  • independent
  • self-efficious
  • have internal locus of control (they have the control over their pain/body, not the physiotherapist or doctor)
  • have active coping strategies (they help themselves by doing activities/exercises that can help them)
  • have adequate illness beliefs (they know why they have pain, and it’s not because their pelvis is out of alignment)
  • understand the latest/best evidence through education (sitting slumped is fine, activity is good, back can be trusted, etc.)

You find 2 blogposts with more information about this topic below.

Why do people think their pelvis is out of alignment?

In this blogpost by Darren Beales from Body in Mind, a alternate hypothesis why people feel their pelvis is out of place, which is about a changed body perception:

A plausible, alternate hypothesis for patient reports of asymmetries within the pelvis

Another great blogpost about the misconceptions about low back pain, by Peter O’Sullivan:

Common misconceptions about back pain in sport: Tiger Woods’ case brings 5 fundamental questions into sharp focus

Sources:

Hips out of alignment

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