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

[JackDempsey]

I have some malaligned joints which result in stiffness and distortions structures, mainly on the left hand side (LHS) of my body – spine and associated limbs. I have had these issues for 15+ years without much relief – it’s an ongoing battle to restore the balance. There is not much pain but rather a sense of being out of alignment/out of balance/ associated muscles and structures fatigued.

Occasionally I have no symptoms and feel balanced and restored – this can occur due to exercise or on its own. I can't seem to replicate the exercises that restore the balance consistently. Sometimes the exercises work and sometimes they make things worse (e.g. sometimes glute activation/external leg rotation exercise - 'prone clam' helps, but sometimes it makes things worse – joint structures seam to get inflamed/ irritated)


I have upper cross syndrome - tight pecs, rounded shoulders, tight neck trapezius, weak lower traps?, mild scoliosis -functional?)-high left shoulder which gets irritated from impingements. Constantly tight slumped posture – its difficult to sit up straight for a long time.

I think I also have lower cross syndrome - anterior rotated pelvis (especially LHS hip flexor is tight – which has difficulty responding to stretch).

I am also questioning my L4/L5 joint – which gets very tight and needs stretching (even after sleep) - not sure if it’s the joint or the psoas muscle pulling on the joint. Note, when I stretch this joint (axially) and psoas there is improved alignment and a sense of restored balance. Is this the cause of all my other issues ? Can one effected joint affect all other joints in the kinetic chain ? Would an MRI scan of spine help to determine if there is any compression or disk nerve issues? Perhaps I need traction on the spine - would this help?

I walk with a bit of a limp – mechanical behaviour is like a short right leg /long left leg. The left leg/pelvis does not seem able to take the load - actually whole LHS struggles – I’m not exactly sure why can’t I load through LHS effectively without glut activation? - is it weakness in LHS glutes, quads weakness?, gastroc weakness?, is it L4/L5 nerve compression effecting peronial nerve and then glutes activation?, or knee irritation (patella femoral or plica syndrome in knee? vmo weakness?), or foot stiffness (very tight left foot - stretch out rear foot and do get some needed flexibility/relief through kinetic chain), abdominal weakness?
I don’t know if all is cause by sedentary lifestyle -desk sitting (has it caused RSI or similar) - or if it is due to a specific injury(falling 5 m through a roof onto bum at age 10) or due to sudden stop in physical activity (age 19) followed by desk bound study /work for 15 years. Lounge and car sitting fatigues and irritates my back. Bending down to pick something off the ground irritates lower back –perhaps it is spondylitis or arthritis? (no swelling noticed).


Can anyone help with diagnosis, explain possible causes and the likely culprit structures and how to correct these alignment issues?


Are there any good books or internet sites with practical explanations/ pictures/videos of causes of malalignment - upper/lower cross syndromes scoliosis and kyphosis and how the body adapts to specific injuries and prolonged sitting and how to correct these issues? Note a lot of people live with these distortions but I’ve found it hard to find physios who can provide effective solutions.

Also, are there any documented examples of anyone recovering from similar biomechanical issues - before and after treatment pictures? Treatment exercise program?

Thank you
Jack

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[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

[vam44]

When trying to address such complex interrelated physical issues as you have described its often difficult to find and to focus on the key elements that is the source of the problem. It works best to address one problem adequately and then, as other areas may become symptomatic work on these. It’s a bit like peeling an onion where there are many layers. (this is why you may feels as though it’s a moving target!)

It seems as though addressing the knee muscle imbalance has been helpful so that is a great start. My advice is to continue to do your knee exercises at a maintenance level, always do your abdominal stability exercises and then start working your way through to the next problem.

It seems to me that your left piriformis may be very tight and or in spasm causing the left buttock pain. This will disrupt the functioning of the sacroiliac joint so it would be good to have your physio check out this area and mobilize it properly. This cant be done adequately online or without some hands on work. Often the asymmetry starts from the pelvis, which then affects up and down the spine.

You may find that once part of your problem eases then your whole pattern of symptoms change so don’t lose heart it just means that you haven’t got down to the bottom layer yet. Often the deepest layer is due to an old injury that has set off trail of responses in your musculoskeletal system ie weakness on one side, tight muscles avoidance of weight bearing on one side.

Don’t forget to work on your posture and balance also and do general exercise such as walking or swimming.
Some questions to ask…
How long have you been getting symptoms? What started ? and how old are you and what is your normal level of activity?

[JackDempsey]

Vam44
thanks for the advice

I am 36

I have had varoius symptoms in the spine back pelvis for approx 18 years. A lot of symptoms began when i started sitting down to study HSC - progressively i got stiffer, weak and unbalanced. Prior to study i was quite active with sports but suddenly stopped to focus on study.

I progressively got back into sports but seemed to keep the stiffness and malalignment that i have developed. I am still reasonably fit active but my job is requires me to sit most of the day so I think my quads and back are a little underutilized and weak.

Note, At about age 11 i fell through a roof at a scout camp ~4-5m onto my bum/back. I was in extreme pain. I could not walk and was in shock. But in those days they didnt seem to know what medical assitance or hospitals were. I was just dusted off and had to wait 2 days in pain till the end of camp. i had strong pain in my back and had a limp for over 3 months. I never felt that i had the same balance/strength after this event.

At approx age 12 some left knee - maltracking symptoms became apparent?

hope this helps

[vam44]

- 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. [COLOR="rgb(0, 191, 255)"] THis is probably due to some pelvic torsion or the left leg being longer [/COLOR]

- Note- QL and or Psoas also currently feel contracted/pulling on LHS. This is hyertonic muscle that is probably sustaining your assymetry The psoas is very deep and needs to be palpated through the abdomen. This is difficult enough for a physio to do so it would be difficlt to describe how to do this yourself. That being said to achieve some relaxation or stretch in these two muscles ( three in fact because piriformis is nearly always involved as well) Should be helpful in reducing pain, the assymetry,and enabling your stengthening efforts to be more effective.

- 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). [COLOR="rgb(0, 191, 255)"]This movement can rotate the left sacroiliac joint. the problem is that your tight muscles are stopping the SIJ form staying in a corrected position. After achieving some muscle releases you then need to exercise (carefully.... so that you dont fatigue and tighten those muscles that tend to tighten ie the tree in the previous paragraph)it would be good to get help with a graded abdominal stability programme from a physio.[/COLOR]

-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? [COLOR="rgb(0, 191, 255)"]This should give you encouragement. When these muscles are stretched they allow more normal patterns above and below the pelvis. There is not a good understanding of why poor joint alignment can cause pain because there are plenty of people out there with all kinds of assymentry who are not in pain. The most medical/scientific evidence is that correcting the muscle activation patterns around the joints is associated with reduction in pain. This is why physios try to encourage stability exercises sometimes known as core stability. In my experience the benefit are very slow to happen when there is unstable pelvic joints and tightness in the muscles around the pelvis as you have described.

The terminology you have used is based on that taught by Professor Janda who ( I did one of his courses in the late 1980s) Physios have used and extended these concepts using lots of research. He had some very sound principles. [/COLOR]

I would advise to concentrate on one area is the correct the SIJ on the left and the tight muscles ( maintain your knee exercises) and then your low lumbar spine will need to be strengthened.

[JackDempsey]

Does anyone know of a condition/symptom described as anterior femoral glide sydrome?

i've read a description a number of times and it sounds like i have this condition.

Does anyone have any anatomical pictures/descriptions of the condition?
and exercises to treat it?