Pelvic Block Resulting from Structural Leg Length Discrepancy

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The aspect of Short Right Leg Syndrome that took me the longest to recognise but has arguably the biggest impact on health is the Pelvic Block. The asymmetry of structural leg length discrepancy generates the Three Cardinal Signs of SRLS setting in place chronic strain through the soft tissue of the Pelvis inhibiting the energetic Qi flow through the fourteen organ channels or Acupuncture Meridians described by Traditional Chinese Medicine travelling through the pelvis. I am not able to say too much about this because it is outside my scope of practice as a Remedial Therapist. However, clients undertaking heel lift therapy for SRLS frequently report coincidental benefits to internal health after commencing heel lift treatment for a structurally short right leg.

 

My initial reaction to clients comments about improved digestion was to say, “That’s interesting but why are you telling me? I am treating your leg and back pain.” It was not until commencing heel lift treatment for my own condition when I experienced a sudden and dramatic improvement to digestion that I realised it was the result of improved energetic Qi flow in the TCM organ channels. I then hypothesised that if it was having this effect on digestion, a similar effect is likely to occur with the reproductive and kidney function. There is now anecdotal evidence to this effect in my practice. This is supported by Traditional Chinese Medical theory and is known to a few TCM practitioners.

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The physical mechanisms generating the Pelvic Block are the Three Cardinal Signs of Short Right Leg Syndrome. Specifically, the left SIJ is twisted in high range anterior rotation due to the First Cardinal Sign compressing the cartilage and straining the ligaments. It may or may not be painful. Regardless, sufficient tightness is present in the ligamental structure of the SIJ to block energetic flow down the backline of the left lower limb. This causes a subtle thickening and tightening through the connective tissue that under loading and other influences can morph into pain, dysfunction and injury affecting mobility. In the long term the left SIJ may become unstable and injured by the chronic strain. Both the Femoral-Acetabular Joint and the Sacrum are misaligned by the anterior rotation of the hip. The left hip flexors are held in a short position, will be chronically tight and always require more stretching than the right side.

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An example of the Pelvic Block impacting internal health is often due to low back strain on the Bladder meridian. This meridian has a convoluted passage down either side of the spine, diving deep to wrap three times around the Kidneys, then travels down the lumbar spine and sacrum, to then ascend once again to the Iliac Crest, travelling out across the hip before descending down the back of the lower limb to the foot where it joins the beginning of the Kidney meridian. Distortion and strain through the pelvis and lumbro-sacral region due to structural leg length discrepancy can readily block the Bladder meridian's passage through this area. This is compounded by lumbro-sacral injury. The Bladder feeds the Kidneys energetically. Should it be blocked, Kidney deficiency symptoms result.

 

With the Second Cardinal Sign the right hip joint, musculature and connective tissue about the right Iliac Crest and QL's become rigid and tight. The Femero-Acetabular joint’s ROM is slightly restricted compared to the left side. The right Adductor Magnus will be chronically tight. Right Adductors requiring more stretching than the left.

 

Gluteal, hamstring, calf and plantar fascia will be subtly thick and tight on either side where the Left and Right Lower LImb Mechanisms become prominent. The effect of other loading and influencing factors can escalate these subtle effects to acute pain and dysfunction.

 

The effects of the Third Cardinal Sign with the Lumbar Spine sitting on a tilted Sacrum force it into mild scoliosis with right convexity through the Lumbar spine. Lumbar disks are encouraged to bulge to the right due to the geometric wedge shape generated between the vertebrae. This contributes to tightness and tenderness frequently sighted at the right QL’s  and lower back pain. Particularly where the client has experienced acute injury in the past, the asymmetrical strain is constantly nagging the old injury causing ongoing pain and dysfunction.

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Also contributing to QL tightness is an inactive Glute Medius from either a prominent Left or Right Lower Limb Mechanism which does not properly stabilise the Pelvis in locomotion forcing the adjacent TFL and contra-lateral QL to take on greater load. I expect too there will be strain about the Sacrum and internal aspects of the Pelvis in ways well described by the Osteopathic and Chiropractic professions.

 

Some of what I describe is subtle and may only be noticeable to a therapist with finely attuned palpation skills, or to clients who are dancers or yoga practitioners. Some of these effects are only too apparent to the client who has chronic low back pain, acute SIJ, adductor or hip flexor issues. Because it is a condition we live with that slowly creeps up on us year by year as we age beyond the life expectancy of our prehistoric ancestors, it is almost undetectable. Also too, not understanding the energetic Qi flow effect on mobility through the lower limbs and spine, and on internal health, therapists and patients alike do not make the connection and dismiss what they perceive to be minor postural anomalies.

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First coming to my attention in clinical practice were mobility cases impacting the backline of the lower limbs due to the effects of the First and Second Cardinal Signs at the Pelvis. The energetic blockage causing a subtle thickening and tightening of the connective tissue through the backline that under loading escalates to acute conditions such as Piriformis Syndrome, Plantar Fasciitis, chronic hamstring and calf tightness and dysfunction up to and including rupture. These type of cases are not uncommon. The youngest such case I have sighted was a fourteen year old athlete and heel lift treatment resolved his issues entirely within two weeks. These mobility symptoms generally afflict those undertaking athletic and/or repetitive physical activity, particularly where inadequate mobilising and stretching recovery action is undertaken. There is a link between loading mild underlying states being pushed into acute symptoms. There are exceptions to this but this is the common pattern.

 

Advanced cases are not often sighted in my clinical practice where the Pelvic block has gradually become so thoroughly entrenched due to the course of time and perhaps the nature of the the individuals life, activity and employment. A structural leg length discrepancy combined with a job that has the subject on their feet for many hours of the day will amplify the the effect of the blockage. These advanced cases are in their 50's and 60's and are beginning to have difficulty with mobility. They may not have experienced the acute phases through the lower limbs described above. Yet leg function is gradually deteriorating and they begin to experience chronic low back pain, pain in the lower limb, rheumatic knee pain, tight hip, knee and ankle joints, skin infections on the feet, toe nail injuries that will not heal, fluid retention in the ankles. The right leg will typically have greater pain than the left...the Second Cardinal Sign at the right hip blocking the Bladder Meridian in its circuitous passage through the lower back and hip causing a thickening and tightening through the limb and pain in hamstring, behind the knee, in the calf and about the lateral aspect of the heel following the line of the Bladder Meridian.

 

Advanced cases may have also experienced catastrophic lumbar disk bulge injury. Hard physical activity combined with the structural effects of mild scoliosis from a tilted pelvis encourages this. Lumbro-sacral spasm from such an injury compounds the effect of the Pelvic block.

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Conventional therapy for the symptoms being experienced only ever provides limited temporary relief until the leg length discrepancy is addressed and Pelvic block eliminated. I do not sight many advanced cases in clinical practice as it can force an individual to retire from active life. Should I visit old age retirement homes, I might find many such cases. Advanced cases will benefit greatly from heel lift treatment, supplemented with massage, mobility exercise to increase pelvic flexibility, TCM internal medicine, and energetic healing practices to clear blocked energetic passages in pelvis and lower limbs and reinvigorate/activate weakened vitality.