Fix Me! Malaligned Joints Posture Upper / Lower Cross syndrome Back Pelvis Stiffness

[Musculoman]

Quick question, do you have an orthotic to help match your leg length difference? If so do you wear it regularly? If not has it been previously suggested and rejected for any reasons? And do you know the amount of difference in your leg length? (measurement)

Sorry, only have a minute, will tackle your post properly tonight after work

Quick edit just to let you know I am not just pushing orthotics / selling orthotics etc. Read a bit too much like that for my liking, just a physio curious to see if this avenue has been tried and tested already.

[JackDempsey]

Thanks for your reply

I have tried custom made orthotics. They haven't helped. I wore them for 6 months to start but no changes just additional pain in feet.

Left leg was measured at 8mm off xray but I don't think this is very accurate. I think difference varies with the stiffness in joints and the methods of measurement. Recently a physio measured difference at 45mm - whch seams outrageous.

Hope this helps

Jack

[Musculoman]

Hay Jack.

Thanks for answering my request.

I have reread your post to try and find some avenues to start my reponse. Cases like yours are generally multifactorial, and therefore each contributing factor has to be addressed. So, lets break things down one by one.

Your Upper Cross Syndrome:
http://www.lifewest.edu/courses/syll...edsyndrome.pdf

This guide has a good list of stretches, exercises etc. most of which I am hoping after 15 years you have tried. I am going to ask you to read this and begin following its protocols. If we are going to fix you, it is going to take active participation from your end.

Job: One of the main contributions to your above syndrome is likely your work habits. Can you please explain to me your workspace/job requirements/time seated vs moving/posture seated/chair.. if you can take a picture of your workspace and post it that would be even more helpful.

Working Well Ergonomics Information Website
The above webside has some good tips and guides on ergonomics.

I could type a hundred pages and still have some points to cover on this topic, so I will leave the reading to you. I gaurentee you, you can do all the exercise to correct your upper cross syndrome in the world, but if you are sitting at a desk job for 8 hours poorly your symptoms WILL return. Unless you can intergrate good ergonomics into your job.

All I have time for just now sorry. If you can start reading some of the above material that would be a good start. And I will comment on your lower back problems / inbalances / etc. a bit later on!

Regards,
Musculoman

P.S. 45mm is an INSANE leg length discrepency if he is right. I highly doubt it is this severe. One good way to test this yourself is to find the 2 bony points on the front of your hips (few cm down and ~10-15 either side of your belly button, unless you are a large person just up these distances a little) stand infront of a mirror, put your fingers on them, walk on the spot for 10 seconds then stop. does one seem > 4cm higher or lower than the other? Can place some objects 10mm, 20mm etc. under the low side , walk on the spot etc and find when they seem similar in height, you have your approximate length difference!

[JackDempsey]

Thanks Musculoman

The website info is good. I'll start reading and doing some of those exercises and setting up workspace properly.

I used a laser level to check pelvis levels and found that both sides of pelvis appear to be the at an equal height.

Note, I noticed a few things when I was observing the pelvis



- hip muscle tone looks different - ITB/hip flexor looks larger on LHS (overactive? feels very tight - contributing to anterior rotatation?) ?

- Hip bone LHS appears 'out' (internal rotation? like the gluts aren't keeping it tucked in and under (aiding anterior rotation?) compared to RHS which is feels more balanced/aligned.

- Note- QL and or Psoas also currently feel contracted/pulling on LHS.

- Note, Externally rotating LHS hip /activating glutes - relieves a lot of the symptoms in back ? Any explanations why the glutes activation , i think medius, helps restore balance ( activation seems to restores balance to joints above and below this point - even appears to alters foot mechanics /load transfer).

-Note, Also, stretching i think the QL/ Psoas helps heaps - (also seems to restores balance in all joints above and below, including foot mechanics and load transfer), any explanations for this?

Is any of this familar/make any sense mechanically or otherwise?



Thanks
Jack

[roycar]

remember pelvic assymetry can add to leg length difference also.

an area that you should certainly have assessed is your lumbopelvic stability.

i'd love to get a look at your single leg stand i'd say it'd be very interesting to see what hip/pelvis stability strategies you have.

you describe how your itb, psoas, ql are all hyperactive.

these muscles are larger global, moving muscles and more than likely the reason that they are hyperactive is that they are trying to compensate for weak local stabilisers like trans abs, multifidi, glute med etc. over time you will develop pther problems as sequelae to this but weak local stabilisers is more than likely a large component of your problem. in my opinion.

[Musculoman]

Yep, likely has some poor deep neck flexors etc. activation as well.

I will provide some more info in the morning Jack sorry, busy day today. Haven't forgotten about you!

[JackDempsey]

Thank you for your responses. Its great to discuss these issues and get some educated feedback.

I can relate to some of the comments made in your replies.

For instance, i do feel more balanced when i have contracted/ stimulated some of my core muscles (such as - multifidus/ internal obliques/TA). The lower limb mechanics do feel like they have more order and balance.

Also, i do have fears that i may have overworked the glut medius muscle and may have created other imbalances. My buttock sometimes warns me by flaring up. I sense that there are now significant differences in the muscular 'tone' between the left and right sides of my buttocks. I think I may have even created ‘trigger points’ in the LHS buttock. Also, I am concerned that I may have overworked the wrong muscles - perhaps overdoing the glut maximus or anterior fibers of glut medius in lieu of the posterior fibres of glut medius (as recommended) - (i sense there are subtle differences between each of these muscles and their affects on mechanics).

Yes, I think now that my neck flexors – (ones at the front of neck?) are weak. This seemed counterintuitive (as head is already postured forward) at first but now it makes sense (as explained in the ‘Lifewest - Uppercross Syndrome’ - website - Thanks Musculoman )


Astonishingly, I have had some relief of symptoms today. The trigger for the relief may open up new territory in our discussion and may give further insight into the cause of my condition and solutions.
Basically today’s trigger has come from contracting the LHS knee muscles, in particular, activating the VMO (contracting VMO last 10-15 degrees). This resulted in restored balance, strength and coordination of joints above and below this location (including the knee). After rebalancing the knee joint I felt I could transfer load effectively through the pelvis. The pain in the LHS knee was no longer there; Tightness in LHS thigh no longer there; Pain in left foot (fascia tendon/pronation) no longer there – improved push off; Scoliosis (twisting spine stiffness feeling) reduced – less stiff in lower back and mid thoracic area (under and below shoulder blades).
I find this amazing and bizarre!
I improve one joint function in the kinetic chain and my symptoms almost disappear. This happens to me from time to time. (I wish I could maintain it!)
In this particular event I sense that the ITB/Quads are so tight (they feel like steel - so inhibited) that they are overpowering the VMO causing it to ‘sleep’ or missfire? the result - the knee joint won’t transfer load (to avoid ‘harm’) as it’s designed – Further, the other joints above and below have to ‘adapt’ (stiffen/contract) to avoid loading the ‘injured’ knee joint. Hence, the overactive hip joints, overactive QL/ pronated painfull foot/weak calves, etc ?

Does any of the above make any sense?

Is it usual that one unbalanced joint can refer symptoms to other areas of the body?

Is this issue different to core stabilty or leg length differences as previously mentioned? or could they be related?

I can’t find much information about this kind of situation. Is there any information on common adaptive patterns? internet /books? and approaches to treatment ?

Jack

[Musculoman]

Hay Jack Back again sorry been busy the last few days.

Yes it is possible that one problem in the kinetic chain can improve your symptoms

If your VMO / knee stability is contributing this much, I would highly suggest really focusing on retraining your LHS knee support systems.

There are a lot of good VMO exercises out there. I will list a few for you to add into your daily exercises which may improve things

1. VMO contraction: Simply sit with your knee out straight on the bed, push into your VMO with your hand/fingers. Practice pushing the muscle bulk of the vmo out into your hand/fingers. Do this with a 25.50.75.100% force, a few times each and building it up. Try and isolate your VMO as best you can as you step up how hard you are activating it.

2. Squats w/ a ball / large towel rolled between your legs. Do some slow squats against a wall while pushing in on a ball or towel between your legs. Keep them slow and controlled, and try and keep even pressure when you push in. (75% the hardest you can). A single squat in this exercise should take you 10 seconds, including a 3 second hold once you are at the bottom of the squat. Only squat deep enough so you don't have any pain etc.

3. Taping. You can try to tape your knee to improve VMO activation. Can help in retraining activation patterns while exercising. Have a friend help you here, you have to slide your knee cap medially (inwards) slightly and tape it down. Make sure you are not allergic / sensitive to any tapes etc. before doing this. If it irritates at all, take the tape off immediately.

If you search McConnell taping you will find some videos describing this technique. i.e. YouTube - Patellofemoral McConnell taping

Give some of these a shot, while still releasing your ITB/glut med etc. Work on increasing your hip stability and activation so that you aren't overusing glut med/tfl etc as well.

Hope some of this helps! We are getting there piece by piece, put all these suggestions are make a daily routine which you can follow and progress to ensure you cover the many aspects of your problem. Make sure not to forget about your body mechanics and ergonomics when you perform daily tasks. it's all well and good to do these exercises each morning etc. but if you are not transferring the ideas into things you do during your day, you will probably not get as good of an outcome!

Regards, musculoman.

[Musculoman]

Wow 5 Smileys in that one... Should try and change it up a bit me thinks

[JackDempsey]

Thanks for your input. I will try your recommendations for the knee vmo.

At the moment my knee and hip balance is feeling better. However the stiffness patterns seem to have readjusted.

Now i am more stiff in thoracic and neck area - (kyphosis pattern upper cross -Rounded shoulders). It seems to be that that this posture cannot be fixed without some sort of control in the abs - Any internet sites on how the abs work - for portural support/ stability? how do the various sets of abs work to create postural support? Is it just the transversusmuscles that need strengtherning What about the internal obliques - are they important (posterior pelvisrebalance?) Other important abs? Is it just strength or is it about other things like balance/ brain conditioning-propreception?

Also, I still wake up almost every morning with spasm in lowerback (L4L5? - between LHS pelvis and LHS spine-could this be the psoas). Its really tight and throws me out of balance - Needs to be stretched to get rebalanced. Any reasons for the reoccuring spasm tightness. What muscles would be out of balance here? Any acute injuries? spondalytis? refered stiffness from thoracic area scoliosis

I will send some photos to you soon of single leg stance - when I find my camera

Sorry about all these questions