Examining Unilateral Anterior Hip Rotation - First Cardinal Sign, SRLS

 

It is a fact the most common hip presentation is anterior rotation of the left hip with a level right hip. It is so common I call it normal. It is not good anatomical posture but it is normally what is seen in clinical practice.

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Anterior rotation of the hip functionally adjusts leg length. Rotation about the SIJ in the Sagittal plane causes the head of the femur to move in an arc posteriorly and superiorly, pulling the leg upwards. If leg lengths are structurally even, such an action would cause a tilt in the pelvis and result in mild scoliosis toward the side demonstrating rotation.

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The catch is, this is not what we see in clinical practice. We are presented with left sided anterior rotation but rather than the expected left leaning pelvic tilt and left leaning scoliosis, in virtually all cases I observe a right leaning condition. This can only happen if the right leg is structurally shorter than the left by an amount greater than the functional adjustment caused by the left hip’s anterior rotation.

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I propose the observed unilateral hip rotation occurs when the contra-lateral leg is structurally short. We feel uncomfortable with the tilt through our pelvis caused by the structural imbalance. By some mechanism the hip of the longer leg unconsciously flops forward functionally shortening the longer leg. This is an anatomic adjustment reducing the leg length discrepancy. Typically, we are not aware of the compensatory action. It feels more comfortable and it protects the spine. This is good but chronic hip rotation tightens the heavily bound ligamental structure and cartilage of the SIJ and can lead to other issues.

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This proposal is supported by my observation the postural hip anomaly will resist attempts to normalise its position through treatment and rehabilitation exercise/stretching until an adjusting prosthetic wedge is inserted beneath the heel of the structurally short leg.

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I recently read "Postural Restoration: A Tri-Planar Asymmetrical Framework for Understanding, Assessing and Treating Scoliosis and Other Spinal, Dysfunctions"  It is a complex analysis of internal body mass distribution and the mechanism of breath that might influence spinal curvature, hip alignment and posture. The end result of a long chain of actions described through the torso from chest, lungs, diaphragm and hip flexors is a mechanism causing the left hip flexors to tighten/shorten. This may be accurate and explain the mechanism for the "unconscious anatomic adjustment" I describe at the left hip functionally pulling up the longer leg. Obviously, they too have noted this most common of hip postural anomalies...I am a little surprised because it usually does not rate a mention. However, in the authors' extensive assessment of the condition, there is no consideration for structural leg length. I can only comment that in the few instances where I have sighted a structurally long right leg, the right hip was rotated anteriorly and the left was level. This does not conform to their analysis. Left hip position, which is normally what we are dealing with, responds readily to varying amounts of leg length adjustment. Too small an adjustment and only partial realignment occurs. Changing thickness of the heel lift is a variable control mechanism for realigning anterior rotation of the hip in the Sagittal plane.

 

This suggests to me it may be less about the complexities of breath and spinal curvature, and a more fundamental architectural issue of an uneven foundation impacting the pelvis working up the torso. Addressing this structural anomaly frequently resolves the many functional issues. Also too, from an internal health perspective, clearing the Pelvic Block generated by chronic distortion and strain from structural leg length discrepancy improves energetic Qi flow in the fourteen acupuncture meridians or organ channels passing between torso and lower limbs. The effect of this on digestive, reproductive and kidney function, and overall vitality is also overlooked by the authors. ​

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First published 13 May 2021 at https://www.facebook.com/MassageWorksDandenongRanges