Pelvic Block Resulting from Structural Leg Length Discrepancy

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The aspect of Short Right Leg Syndrome (SRLS) 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 (TCM) 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 beneficial side effects to digestive, reproductive and kidney function after commencing heel lift treatment for a structurally short right leg.

 

My initial reaction to their comments 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 and I experienced a sudden and dramatic improvement to digestion that I realised it was the result of improved energetic flow in the TCM organ channels. I then hypothesised that if it was having this effect on digestive organs, a similar effect is likely to occur with the reproductive organs and Kidneys. I now have anecdotal evidence this is the case.

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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 lower limb. In the longer term the left SIJ may become unstable and injured by the chronic strain. Both the Femoral-Acetabular Joint and the Sacrum are misaligned by this 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.

 

With the Second Cardinal Sign the right hip joint, musculature and connective tissue about the Acetablum and Iliac Crest become rigid and tight. A strong blocking effect occurs to the Bladder meridian in its convoluted passage through the lumbro-sacral region. I describe this as a primary choke point on the Bladder meridian starving the Kidneys energetically and generating Kidney deficiency symptoms as described in Traditional Chinese Medicine. These symptoms that can waft and wane initially, becoming chronic in advanced cases, include an aching lower back, dry mouth, constipation, insomnia, fluid retention in lower limbs, and lack of vitality and endurance. 

 

Additionally, the the right hip's range of motion is slightly restricted compared to the left side. The right Adductor Magnus will be chronically tight. Right Adductors require more stretching than the left. Gluteal musculature will be in spasm where the Left and Right Lower LImb Mechanisms become prominent. 

 

The effects of the Third Cardinal Sign with the Lumbar spine sitting on a tilted Sacrum force it into mild scoliosis with right convexity. The elevated left hip and dropped right hip encourage Lumbar disks 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, generally. 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. 

 

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 sighted often in my clinical practice where the Pelvic block has gradually become so thoroughly entrenched due to the course of time and 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 typically 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 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. This can develop into a chronic condition of a cute thickening, tightening and pain in the right lower limb.

 

Advanced cases may also have 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 from the Three Cardinal Signs of SRLS. That was part my personal story. The resulting loss of integrity in a previously injured knee joint that had always managed fine with training, forced me out of sport. Gradual decline of lower limb function over the following two years was a mystery.

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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 with heel lift treatment and rehab exercise to improve flexibility through the pelvis. 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, and TCM internal medicine.