Hip Rotation and Muscle Imbalance

By Dr. Michael Cerami

Hip Rotation is very common in almost all of my new patients. I usually see an imbalance of anywhere from ½” to 1 ½” of discrepancy between the left and right leg. In most cases it takes less than 6 visits but sometimes the correction process takes quite a while (6 months) when it’s a complicated case and post surgical as I’ll discuss later.

  

During an initial examination, I check pelvic alignment front/back and side to side as well as foot position and knee alignment. I also will muscle test the upper or lower extremities to make determine whether there is appropriate neural integration to the all of the muscles in the area.  These tests along with other functional movement screenings will paint a picture of where the source of the problem is located and that’s where we’ll go to work; unwinding the “focal loading” points of the body to create sustainable change.

The reason I mention this process is to describe how we assess and correct hip rotation. To the untrained eye/person/therapist/physician,  it would It would seem much easier to just put a lift or shim in the shoe and call it fixed except for the fact the problem was not really corrected. In my 27 years of practice I have prescribed a heel lift less than 10 times when I couldn’t correct the imbalance using chiropractic adjustments and muscle work. 

The patient I’m referring to above is a bike rider that had labrum (hip) surgery which caused a severe imbalance in his hip alignment and leg length. When this patient went for his bike fit, the only way the fitter could make him balanced was to provide an extreme amount of shimming (photo). This helped but caused other problems and the patient could not ride comfortably for any extended distance.

When I started making corrections on this patient with the Impulse IQ Adjusting Instrument we would get a ¼ to ½” change each visit and a lot of the imbalance would return before the next session which was scheduled weekly. The progress was slow but measurable so we stayed with it and eventually got 90% of the rotation removed by summer’s end and the patient celebrated by riding his fastest ever Snowbird Hillclimb race and finished in the top 10 of his classification.

I think there are a few important take home points here for athletes and patients:

·         Hip rotation and resulting muscle imbalances cause bio-mechanical distortions that affect the hip knee and feet.

·         It you have lift in your shoe or a lot of shims in your bike shoe consider finding out if the “upstream’ cause is your hips.

·         Once the problem is resolved, exercises can help maintain the correction.

·         It’s difficult if not impossible to tell if you have rotation on your own. See here on how to check:  http://saltlakerunningco.com/home/2010/09/symmetry-muscle-imbalance-and-hip-rotation/

·         Get your hip rotation fixed BEFORE you get fit for that expensive or new bicycle.

 Dr. Michael Cerami is a local Utah sports chiropractor and triathlete who has been treating patients for over 25 years. He writes a weekly patient blog and monthly athlete article for community education on a wide variety of topics including treating sports injuries, nutrition, exercise, motivation and wellness.