Monthly Archives: September 2013

Low Back Pain and Asymmetries

I was just looking back through the last two years of blog posts and realized I really hadn’t written anything specifically discussing low back pain.  Low back pain ranks second only to the common cold when it comes to work days missed every year, and is also the second most costly ailment to treat.  Low back pain is also the most common complaint that I treat here at Elite Physical Therapy and Sports Performance.

I will admit there was a time when I dreaded seeing that diagnosis on the physician’s order, and I guarantee you most other PT’s would agree with me.  The spine is so intricate, there are so many muscles that attach throughout that area, and so much freedom of movement through the spine, pelvis, and hips that it used to be hard to know where to start.

Over the past five years I’ve learned a few more things and have really come to enjoy treating low back pain.  When you really study human movement and learn to detect common asymmetries in how we are aligned and move, it really isn’t that hard anymore to know where to start and make quicker changes in how someone feels and moves.

There are a number of great examples but today I want to look at one of the most prevalent:

Asymmetry #1 – Inability to Internally Rotate over the Left Hip

Check out the pictures below – seeing it will probably make more sense than me trying to describe it although I’m going to try anyway.

This guy is standing with more weight on his Right leg and pelvis rotated to the right. Check out how his trunk rotates back to the Left to compensate. You can even see how the rotation torques his abdominals and chest!

Almost all of us tend to stand more on our Right leg, and when we do our pelvis shifts and rotates over that hip just fine (this is relative internal rotation of the hip).  The pelvis in this instance is rotated to the Right just like in the  picture above and below.

Here is another great example from my friend Michael Mullin with some arrows drawn in to help you get the idea of the torque it can create in the body:

When we do stand on our Left leg, our pelvis tends to stay rotated to the right (this is relative external rotation of the hip).  This tendency results in a loss of internal rotation ability of the Left hip and a pelvis that does not rotate correctly when we walk or run.  Lots of other bad things happen right up the spine and down the lower extremities because of this.

Check out what happens with this runner who is stuck in this pattern.

No problem rotating into his Right hip during stance. No such luck on the Left.

Notice how when he is on his right leg, his right foot is directly under his body (in the mid-line) and his foot lands in a fairly neutral position.  Now check out his positioning on the left leg.  His left foot is more under his left hip than directly under him causing his knee and foot to roll inward to support him.  He cannot get over his left hip and rotate his pelvis as efficiently on the left as he can on the right.

This picture shows the proper positioning over the Left leg with the pelvis facing Left.

Michael is looking pretty content on his Left leg now

An inability to move out of this pattern will change the way we stand, walk, and run, and can potentially lead to a host of injuries even beyond the lower back.  Fortunately this asymmetry is manageable with some simple exercises that can be worked into warm-ups or between sets when at the gym.

If you’ve been suffering from chronic back, SI joint, or hip problems that have failed traditional treatment, then it may be because the underlying asymmetry has not been addressed.  I’ve had some great success treating these areas by identifying and correcting these asymmetries so definitely something to think about.

Stay tuned and next time I’ll talk about why your ribs flare more on the left than on the right (I’m such a geek!).  If you have any questions feel free to email me:  joe@elitepttc.com