Second Cardinal Sign, Assessment for Rigidity at the Right Hip

 

I suggest rigidity noted at the right hip tractioning from the ankles is due to three factors. Firstly, the Pendulum Effect altering gait causing uneven footfall and, secondly, the effect of the First Cardinal Sign on gluteal stability on the pelvis and, thirdly, the effect of pelvic tilt and mild right leaning scoliosis causing right sided lumbro-sacral dysfunction.

 

With the Pendulum Effect on the short right leg, there is a momentary hesitation before planting the right foot with each and every step. Footfall is uneven…solid on the left and hesitant or lighter on the right. The right hip is ever so slightly forced to tense and hang on while the foot searches for the ground rather than confidently plant. In the course of time, the hip becomes rigid from the strain. The right Adductor Magnus tightens. It is clearly evident the right Adductors are consistently tighter than the left when stretching. Rotation of the Femur in the Acetablum will be restricted.

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Due to left SIJ binding from the First Cardinal Sign, the left Glute Med becomes inactive due to energetic Qi flow blockage at the SIJ. It is in partial spasm and does not adequately stabilise the pelvis. As a result, the left TFL and the right QL’s are loaded compensating for this. This contributes to the tightness observed in both the right QL’s and left ITB, and knee pain.

 

The other aspect of the story is owing to an elevated left hip and inferior right hip, the spine's foundation at the sacrum is tilted to the right causing a right leaning pelvic tilt and lumbar scoliosis with right convexity. The lumbar vertebrae are not parallel, opening wider to the right and compressed closer together on the left. Geometrically forming a slight wedge shape in the disk spacing that applies pressure forcing disks to bulge to the right. Mild and rarely catastrophic, nevertheless causing tightness and tenderness in the QL's. While in a normal position and not rotated, the right SIJ frequently becomes locked and rigid causing manipulative therapists to attempt joint mobilisation. This dysfunction and rigidity contributes to the woodenness through the right hip generally. When escalating to more acute levels, pain in the SIJ is noted. Ultimately, catastrophic disk bulges may occur. 

 

The most dramatic and convincing assessment for this aspect of SRLS is with client in supine on the treatment table and therapist tractions the legs gently from the ankle. Starting with the right leg, grasp ankle with both hands and gently traction inferiorly three times slowly. Release ankle and repeat the process on the left leg. Do not tell client what to expect or feel. They will not usually be able to note the difference from the first attempt. After tractioning both left and right, return the the right leg and traction slowly several times again. They usually get it by then. Both practitioner and client will detect the difference. Only clients with a huge mind/body disconnect may remain unaware. The right hip affected by SRLS will be wooden and ungiving. The left hip will be soft and extend/stretch through the joint. Even in instances where the client is diligent with mobilising and rehab activity or committed yoga practice, a difference will be noted side to side even if they are largely unaffected symptomatically.

 

There are other indicators of rigidity and tightness through the right hip. Adductor stretching in supine will be tighter on the right side. Rotation of the head of the Femur in the Acetablum in prone position will be restricted on the right. Knee bent to 90 degrees, pushing ankle medially (lateral rotation of the Femur) will lift hip off table sooner than when applied to the opposite side.