some symmetry issues

[hardd0m]

Hi people!

I've some symmetry issues and have tried all sort of method but i'm not seeing much results. I need some help here =(. Attached is my front and back pics.

First the most disturbing issue. My left shoulder girdle is protracted and much higher than the right. I use to be a archer but has quit the sport for some time. I have visited the sports masseur and i was told that archery could be the cause. I was told to do rowing exercise to pull my scapula back as well as some lateral pull down exercises which will work my lats and lower traps. My left pec minor and major is tight too. I was advised to do some stretching on that as well. I've been doing the suggested exercises from close to 6 months but have seen limited results. Am i missing something? I also notice that my rhomboids tender to the touch and there seems to be a tight band near the spine of the scapula which i suspect is the levator scapulae.

Next, some other problems. I realized that my torso is shifted left relative to the pelvic and my head is shifted to the right relative to the thorax. I've just finish reading anatomy trains by thomas myers and understand that all these asymemtric problems are related by the means of compensation by the body. But still i'm not sure if i'm doing the correct exercises and stretches which i'm required to perform. Will exercise and stretching put me back into symmetry or do i need some other form of treatment?

I will appreciate your feedback

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[thomasng90]

Exercise is exercise, the main things is to maintain your correct posture throughout ur Activity of Daily Livings. Postural awareness is very important.... else ur stretching and watever exercise ll be nt significant.anyway, ur posture is still okie... nt too bad....

[HercPehl]

Hello,

Yes you are right stretch and strengthing will help but treatment such as hands on therapy will help to improve faster.

Anatomy trains and myofascial release are really good however is complementary to the whole treatment approach!

Stretching will help however you need to stretch some muscles prior activity. In ur case ur Left side requires the most stretching while the Right requires more strength. Therefore You may want to consider prior exercising to stretch only the Left side and strengthen only the right side. At the end of the session stretch again only the Left side till things are balanced. Find a specialist that can further assess the tight areas and to provide you with protocols or even to get hands on modalities.

The Pelvis sounds again subject to selective muscle tightness and elongantion. same with above more or less you need to isolate those and indentify what is doing what with the help of a professional. Nevertheless if you fix the scapulas the pelvic distortion you have observe may disappear aswell

Have you done any athropometric xrays are your bones symmetrical (Am reffering to big differences and not milimeters)

And Yes it was your sport that has cause that imbalance makes perfect sence considering the sports muscular and postural demmands.

Are you demostrating the exercises to your clients with one side only? That can also contribute to your imbalances

Lastly i see you Patellas are quite externaly rotated you may want to also have a look at that as well

[hardd0m]

Exercise is exercise, the main things is to maintain your correct posture throughout ur Activity of Daily Livings. Postural awareness is very important.... else ur stretching and watever exercise ll be nt significant.anyway, ur posture is still okie... nt too bad....

Thanks for the advice! Haven been looking into my posture during activities, have been concentrating on exercises and stretching only.

[hardd0m]

Hello,

Yes you are right stretch and strengthing will help but treatment such as hands on therapy will help to improve faster.

Anatomy trains and myofascial release are really good however is complementary to the whole treatment approach!

Stretching will help however you need to stretch some muscles prior activity. In ur case ur Left side requires the most stretching while the Right requires more strength. Therefore You may want to consider prior exercising to stretch only the Left side and strengthen only the right side. At the end of the session stretch again only the Left side till things are balanced. Find a specialist that can further assess the tight areas and to provide you with protocols or even to get hands on modalities.

The Pelvis sounds again subject to selective muscle tightness and elongantion. same with above more or less you need to isolate those and indentify what is doing what with the help of a professional. Nevertheless if you fix the scapulas the pelvic distortion you have observe may disappear aswell

Have you done any athropometric xrays are your bones symmetrical (Am reffering to big differences and not milimeters)

And Yes it was your sport that has cause that imbalance makes perfect sence considering the sports muscular and postural demmands.

Are you demostrating the exercises to your clients with one side only? That can also contribute to your imbalances

Lastly i see you Patellas are quite externaly rotated you may want to also have a look at that as well

Hi,

Thanks for the feedback and suggestions! I've not done any anthropometric x-ray. But i've done a manual measurement though. I found my left scapula a few millimeters further away from the midline compared to the right scapula. Does this mean that the rhomboids or the middle trapezius is "locked long" according to anatomy trains? Can i conclude that the upper trapezius or levator scapulae is the culprit for the elevation since the rhomboid is unlikely to contribute to much elevation as it is "locked long"? Whenever i perform horizontal pushing exercises like push ups my left scapula tends to jut out more than the right? Is that because of "locked long" rhomboids? My left shoulder is also slightly more rounded compared to the right.

Thanks for pointing out the externally rotated patellas as well! didn't realized it until you mentioned it.

[david peterson]

Hi
Have you checked leg length discrepancy?.Most of those eyeball tests have poor reliability /validity etc but could give you an indication.Looking at your photos and reading your posts i'd be suspicious of a fixed skeletal assymetry - possibly long (L) leg?. Can't really stretch that away! Could try a (R) 2cm heel raise tho !

[happy12]

I believe I can do well, and refueling. Thank you for your help



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[HercPehl]

Hello,

The milimeters are not a problem the rounded soulders are though. If the rhomboids are elongated then they need sortening with strength training. While the upper trap and Levetor scap need stretch since they already sort.

"Whenever i perform horizontal pushing exercises like push ups my left scapula tends to jut out more than the right? Is that because of "locked long" rhomboids?" That is what we called winging of the scapula which can be due Seratus anterior subscapularis or infraspinatus weakness or lengthening.

I will suggest you leave the Anatomy trains out since the fascia will be the final touch up if things dont get sorted with classic approach as i have mentioned. For your further reading and understanding i strngly suggest you have a look at:

Active Release Techniques for direct fascia release here : Active Release Techniques: A.R.T.

And

NASM for the imbalances and for your Job :Personal Trainer Certification, Fitness Certification | NASM more specific look at the CES module and obtain the book from amazon or similar website you will find that explains the problem you have. Is quite simple to understand not hard definitions and provides a really good clinical tools for personal training and rehab.

Let me know when you done looking the NASM and trust me you will most appriciate the info in the book that they have.

[cam474]

Hello,
I would start with the pelvis and correct the centre of gravity. It seems when you stand you favour the right side and are possibly right handed.If you sit on a gym ball you can try and centralise your position doing some core muscle work and try and correct the lateral shift by moving the pelvis side to side.
In dealing with the upper body, I think you have downwardly rotating scapulae.
(The right shoulder may have dropped more due to working with a computer mouse, so it may be lower instead of the left being higher.)
If you elevate both shoulders slightly and then retract your shoulders, this should help to improve the position.I would then use a theraband to strengthen the rotator cuff muscles resisting external rotation.I would also include neck stretches.You also mention that levator scapulae is tight.It doesn't appear that you have a forward head posture. There is no lateral view.To stretch the left levator scapulae you can rotate the neck to the right side and tuck your chin in.
Hope this helps,
cam474

[HercPehl]

Hi
Have you checked leg length discrepancy?.Most of those eyeball tests have poor reliability /validity etc but could give you an indication.Looking at your photos and reading your posts i'd be suspicious of a fixed skeletal assymetry - possibly long (L) leg?. Can't really stretch that away! Could try a (R) 2cm heel raise tho !

Isnt that a bit too much of raise?

[hardd0m]

"Whenever i perform horizontal pushing exercises like push ups my left scapula tends to jut out more than the right? Is that because of "locked long" rhomboids?" That is what we called winging of the scapula which can be due Seratus anterior subscapularis or infraspinatus weakness or lengthening.

Thank You for your feedback! I believe the reference materials will be very useful. I'll try to get it asap. I understand that winging of the scapula can be caused by serratus anterior weakness but how does the subscapularis and infraspinatus affect it as well?

[HercPehl]

Reverse muscle action for the subscapularis especialy in closed kinetic chain. For the infraspinatus was wrong sorry for that

[hardd0m]

Hello,
I would start with the pelvis and correct the centre of gravity. It seems when you stand you favour the right side and are possibly right handed.If you sit on a gym ball you can try and centralise your position doing some core muscle work and try and correct the lateral shift by moving the pelvis side to side.
In dealing with the upper body, I think you have downwardly rotating scapulae.
(The right shoulder may have dropped more due to working with a computer mouse, so it may be lower instead of the left being higher.)
If you elevate both shoulders slightly and then retract your shoulders, this should help to improve the position.I would then use a theraband to strengthen the rotator cuff muscles resisting external rotation.I would also include neck stretches.You also mention that levator scapulae is tight.It doesn't appear that you have a forward head posture. There is no lateral view.To stretch the left levator scapulae you can rotate the neck to the right side and tuck your chin in.
Hope this helps,
cam474

Hi thanks for the feedback!
Actually my left leg is around 1cm longer. I've the tendency to put my weight on my left leg. I think my scapulae is slightly upward rotated instead? And yes you are right! i noticed when i use the computer my right shoulder is always lower. I'm not too sure if my posture is ok. Attached is the pictures of my lateral view. Hope you can take a look and give me some feedback

physiobob left view.jpgphysiobob right view.jpg

[cam474]

Hello,
Your left pelvis may be anteriorly rotated. Use muscle energy technique to rotate it posteriorly. This may correct the 1cm leg length.
You appear to have a sway back.
Elongated and weak are hip flexors,external obliques,upper back extensors,neck flexors.
Short and stong:hamstrings, upper fibres of internal oblique, lumbar paraspinal muscles (not short)

This is taken from Neuromusculoskeletal examination and assessment by Petty and Moore page 41.
Once the shoulder blade is corrected then do some rotator cuff muscle strengthening.
Do mostly external rotation (teres minor and infraspinatus)You can use theraband to resist the movement.
Some internal rotation (subscapularis)but this may be strong due to press ups.

Try standing against a wall, pull in your core muscle and bend your knees slightly. You can check your pelvis level in this position also(ie left and right)
This position must not be forced but used as a guide to correcting the sway back.Also tight muscles such as hamstrings would need stretching etc.
Let me know how you get on!
Good luck!
cam474

[hardd0m]

Hello,
Your left pelvis may be anteriorly rotated. Use muscle energy technique to rotate it posteriorly. This may correct the 1cm leg length.
You appear to have a sway back.
Elongated and weak are hip flexors,external obliques,upper back extensors,neck flexors.
Short and stong:hamstrings, upper fibres of internal oblique, lumbar paraspinal muscles (not short)

This is taken from Neuromusculoskeletal examination and assessment by Petty and Moore page 41.
Once the shoulder blade is corrected then do some rotator cuff muscle strengthening.
Do mostly external rotation (teres minor and infraspinatus)You can use theraband to resist the movement.
Some internal rotation (subscapularis)but this may be strong due to press ups.

Try standing against a wall, pull in your core muscle and bend your knees slightly. You can check your pelvis level in this position also(ie left and right)
This position must not be forced but used as a guide to correcting the sway back.Also tight muscles such as hamstrings would need stretching etc.
Let me know how you get on!
Good luck!
cam474

But shouldn't it be
"Short and strong are hip flexors,external obliques,upper back extensors,neck flexors.
Elongated and weak :hamstrings, upper fibres of internal oblique, lumbar paraspinal muscles (not short)"
instead?

[cam474]

Yes, to correct the sway back it would need to be short and strong hip flexors etc.as you mentioned.
In my post those are symptoms of sway back, so to correct it would be the opposite.