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 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 passing through the pelvis. 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 some weeks or months after commencing heel lift treatment 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 subsequently experiencing a dramatic improvement to digestion that I immediately realised incrementally backing off the strain through the joints of the pelvis 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 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 Two Signature Traits and Three Cardinal Signs of Short Right Leg Syndrome. The pelvis is on a right leaning tilt straining the lumbar spine and encourages a swayed stance to the right. The First Cardinal Sign's anterior rotation of the hip about the SIJ, binds the joint twisting it several times beyond normal range of motion. Causing a subtle thickening and tightening through the connective tissue down the backline of the lower limb. Under loading and other influences this can morph into pain, dysfunction and injury. In addition to differing short and long term effects at the SIJ, the Femoral-Acetabular Joint and the Sacrum are also misaligned. The left hip flexors are held short, will be chronically tight and require more stretching than the right side. Rigidity through the right hip described by the Second Cardinal Sign generates tightness on the right side at the QL's adjacent to the lumbar spine and across the full length of the iliac crest. At the core of the pelvis is the sacrum. Force vectors from each leg and the spine come together and meet at the sacrum. Pelvic tilt and hip rotation distort and strain the extensive connective tissue and ligamental structure about the sacrum. In the absence of regular full range movement as we become sedentry with age, a rigidity sets in about the sacrum blocking energetic Qi flow and restricting mobility.

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An example of the Pelvic Block impacting internal health that I know well from both personal and clinical experience is the development of Kidney deficiency symptoms due to blockage of the Bladder meridian in its convoluted passage through the lumbro-sacral region and hips. Kidney deficiency symptoms as described by Traditional Chinese Medicine include insomnia, constipation, tinnitus, anxiety, dry mouth, reduced vitality, and fluid retention in feet and ankles. Presence of these symptoms does not necessarily correlate to kidney disease as described by a Medical Doctor diagnosed through blood testing. This is an energetic Qi deficiency preceding the onset of disease. These symptoms may waft and wane with changing activity and conditions to become more acute with advancing age when the Pelvic Block becomes more entrenched. Advanced stages impact reproductive organs due to reduced vitality in the Chong Mai channel originating in the Kidneys and passing through the womb and prostrate.

 

The Bladder meridian originates in the canthus of each eye travels over the top of the head and down either side of the spine...two parallel channels on either side of the thoracic spine, four in total. On reaching the Kidneys, the channels closest to the spine dive deep to wrap three times around the Kidneys, then travel down along either side the lumbar spine and sacrum, to then ascend to the hip and move out along Iliac Crest before descending along the backline of the lower limb to the foot and little toe and then joins the beginning of the Kidney meridian at the sole of the foot. The route taken down the backline of the limb is through the centre of the hamstrings and calf with a diversion to the lateral aspect of the the knee and heel. This is particularly relevant because where meridian pain develops in the leg it will directly correlate with points along this line.

 

Distortion and strain through the pelvis and lumbro-sacral region due to structural leg length discrepancy can readily block the Bladder meridian's passage. I describe primary choke points on the Bladder meridian at the QL's adjacent to the lumbar spine, the heavily fortified connective tissue about the sacrum and muscular insertions along the full length of the iliac crest. The strain from pelvic distortion is compounded by muscular spasm and inflammation from lumbro-sacral injury. Owing to the effects of the Second Cardinal Sign's rigidity about the right hip, the right side is more affected than the left but I have sighted instances of bilateral blockage. The Bladder meridian feeds the Kidneys energetically. Should it be blocked, Kidney deficiency symptoms as described by TCM result. ​

 

The Lumbar Spine's foundation at the sacrum that has a right leaning tilt encourages mild scoliosis with right convexity through the Lumbar spine. Geometrically, the elevated left hip and dropped right hip incrementally creates a wedge shape opening to the right in each of the lumbar disks encouraging right sided disk bulge. Not necessarily catastrophic and contributing to tightness and tenderness frequently sighted at the right QL’s. This is a part of the common presentation of SRLS. Where the client has experienced acute injury in the past, the asymmetrical strain from leg length discrepancy will constantly nag the old injury causing ongoing pain and dysfunction.​

 

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. However, it is only too apparent to the client who has chronic low back pain, acute SIJ, adductor or hip flexor issues. SRLS is a condition we live with generating effects that slowly creeps up on us as we age beyond the life expectancy of our prehistoric ancestors. It is rarely connected to the underlying causation of structural leg length discrepancy. 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. Loading mild underlying states morphs 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 thoroughly entrenched over the course. The nature of the the individuals life, activity and employment are contributing factors. 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 into retirement 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. However, energetic healing practices alone without addressing the leg length discrepancy and Pelvic Block provides limited temporary relief.