How an Anteriorly Rotated Pelvis
Causes Low Back Pain, Scoliosis & Sciatica
In a normal person the spine sits on top of a neutrally positioned sacrum
(central portion of the pelvis) and has a slight lordosis (arch forward). When
the pelvis is anteriorly rotated the sacrum is tipped forward and the rest of
the spine has no choice but to follow suit. Rather than fall over forward, the
body compensates for this excessive forward tilting of the lower spine by
tilting backward at some point higher up the chain. This creates a large
increase in the amount of curvature (lordosis and scoliosis) of the lower back.
This deep curvature of the back can result in extreme pain and various problems
including muscle spasms, pinched nerves, and possibly damage to the
intervertebral discs. These problems can be made worse as compensatory muscle
patterns begin to develop, especially a tightening of the psoas muscle, since
this muscle attaches directly to the lumbar spine. As the psoas tightens, it
pulls the spine down and forward, further deepening the curvature of the back.
In addition, compensatory patterns also cause a tightening or hypertonicity
(inability to relax) in the piriformis muscle, which can put pressure on the
sciatic nerve creating pain. This is commonly known as Sciatica, an irritation
of the sciatic nerve that can send shooting pain through the lower back and down
into the leg.
How an Anteriorly Rotated Pelvis Causes Hip / Groin Pain ?
When the pelvis anteriorly rotates two things occur at the hip that can cause
problems. The first is a hypertonicity (or an inability to relax) of the lateral
thigh musculature. With the muscles in this state, there is an increase in the
amount of pressure placed on the bursa (fluid filled sacs between the bone and
muscle) of the hip. This increased pressure can cause irritation of the bursa
which, left untreated, can turn into a stabbing pain that is felt by the patient
during activities of daily living.
Second, there is also a repositioning of the femur (thighbone) that occurs when
the pelvis tips forward. The femur is forced to internally rotate due to the
shape of the socket and the ligamentous structure of the hip joint. With the
femur internally rotated, the pectinius (one of the groin muscles) is in a
lengthened (stretched) state. In this state the pectinius is predisposed to
injury. This can result in nagging groin injuries that never seem to heal
completely. When you combine this internal rotation of the femur with the
compensatory muscle patterns that have developed in the lateral thigh a
situation is created which, left unchecked, may eventually result in a
degenerative condition of the hip joint.
How Protonics Corrects Knee Pain
Patellar-femoral compression, is a leading cause of Patellar-Femoral Dysfunction
and Knee pain. Below is a review of two methods to treat Patellar-Femoral
Dysfunction. The first is the Conventional thought that the patella is
misaligned due to an imbalance in muscle strength. The second is the Protonics®
Perspective which describes how poor hip stability and posture affect the
patella/femur alignment problem associated with Patellar-Femoral Dysfunction.
Conventional Patellar-Femoral Dysfunction Description and Treatment.
In its simplest form, PFD is described as misalignment of the patella on the
femur. In addition to alignment, this dysfunction is also described as an
abnormal movement of the patella (kneecap) on the femur (patellar tracking).
This movement causes an excessive amount of pressure between the patella
(kneecap) and the femur (thighbone). This pressure or compression causes the
cartilage on the under side of the patella and the cartilage on the bottom end
of the femur to start to soften, degenerate, and wear away. If left untreated,
the cartilage can be worn away completely. This is known as chondromalacia
patella.
Clinicians were taught in the past that this compression was often due to an
imbalance in the thigh muscles (quadriceps) strength. The muscles on the outside
or lateral side of the patella (vastus lateralis) were too strong, the muscles
on the inside or medial side of the patella (vastus medialis) were too weak, or
a combination of both. It was accepted that this imbalance caused the patella to
track to the outside.
Traditional treatment for PFPS usually started with an exercise program that
concentrates on strengthening the vastus medialis. A special patellar brace,
strap, or tape was usually the next step. Both the brace and tape were used to
attempt to manually pull or push the patella back into its "normal?" position.
If these two forms of traditional treatment didn't work, surgery was sometimes
recommended. A procedure known as a lateral release was the most common. It
involves separating or releasing some of the fibrous tendon like material on the
lateral side of the patella. Another traditional option that was generally
recommended was to have knee joint replacement surgery. However, physicians
normally will not perform this procedure on patients unless they are 60-65 years
of age.
The Protonics® Perspective
Pelvic-Femoral-Patellar Alignment
In the diagnosing and treatment of patellar-femoral pain, the focus of attention
has generally been an area six to eight inches above and below the knee joint.
By concentrating on this small area, it seems as though the patella is being
pulled into the femur. Protonics® looks at the whole body for an answer rather
than just the knee.
Research has lead to the conclusion that a large percentage of PFD patients have
an instability in the hip and pelvis area and can trace their problems back to
poor hip/pelvis posture (excessive lumbar lordisis). This biomechanical
instability of the hip results when the pelvis is tipped forward. Many
contributing factors can be linked to this condition. Forward head posture, weak
abdominals, excessive weight, tight lower back muscles, tight groin muscles,
weak muscles in the buttocks, and weak hamstrings (muscles on the back of the
thigh) are just a few. In this pelvic position, the femur is incorrectly
positioned inwardly. This incorrect position can restrict a patients ability to
flex the knee under a load due to lateral compressive forces of the femur on the
patella.
In a normal knee the muscles pull on the patella evenly. When the bone is out of
place the contact points of the joint are changed. Thus the pressure on the
normal points is changed. When the knee bends this additional pressure in the
joint causes pain and or degeneration of the cartilage on the back of the
patella.
The position of the pelvis and femur directly relates to the pressure that is
causes muscles normally used for postural support and normal function to
effectively shut down or become dormant. This forces other structures on the
outside of the thigh to hold the body up. Two of these structures are the vastus
lateralis (VL) and the iliotibial band (IT band). The VL is the muscle located
on the lateral side of the quadriceps group of muscles. This muscle directly
attaches to the patellar ligament on the lateral side. The patella is located
just underneath this ligament and attaches directly to it. The IT band is
composed of a fibrous tissue called fascia. It starts at the hip and runs down
the lateral side of the leg. It also attaches to the patellar tendon/ligament.
The kneecap is actually in its "normal" position and the femur is the bone
actually "misplaced" or turned in under the kneecap. This produces tightness of
the VL and IT band.
Protonics®
When muscles are activated or “turned on” other muscles need to be inhibited or
“turned off” in order for movement to occur. For instance, in order to bend or
straighten the knee, two muscle groups need to work together. The muscles on the
back of the thigh (hamstrings) cause your leg to flex/bend when they contract.
The muscles on the top of the thigh (quadriceps) cause the leg to
extend/straighten when they contract. In order for movement to happen, one set
of muscles needs to contract while the other set relaxes. This is known as
“reflex inhibition”.
Protonics® applies a programmable and variable resistance during the flexing
action of the knee. This patented resistance functionally activates or "turns
on" muscles in the back of the thigh (hamstrings), buttocks, and abdominals. In
response, each time the Protonics® resistance is engaged, there are three main
muscles that are inhibited or “turned off”.
1. Psoas (pronounced "so us"). This large muscle located in the groin area is
attached on one side to the lower spine and to the femur just below where it
(femur) inserts into the hip socket. By shutting down this muscle, the muscles
in the buttocks and abdominals stabilize the pelvis. As a result, the hip is
rotated back into its normal neutral position.
2. Tensor fasciae latae (TFL). This muscle is located on the front of the thigh
on the lateral side near the hip. This muscle attaches to the hip and to the IT
band. The TFL is the primary muscle used to rotate the femur inwards. If this
muscle is turned off, the internal rotation of the femur is lessened.
3. Vastus lateralis (VL). As discussed earlier, this muscle attaches to the
femur and directly to the patellar tendon on the lateral side. If this muscle is
turned off the amount of lateral pull on the patella is reduced.
The result of these three muscles being effectively “turned off” is that:
1. The hip is in a more neutral position reducing the tendency for the femur to
rotate inward.
2. The TFL is not rotating the femur inwards.
3. The femur is in its normal neutral position.
4. An appropriate femur–tibia–patella alignment during movement is realized.
The concept described above is why many patients report immediate pain relief
when initially using a Protonics® system.
Patients will also benefit in the long term because Protonics® provides a way
for the body to learn how to correctly function again.
A process known as feed forward activation is used. Feed-forward activation is
the process by which muscles “learn” how and when to contract or relax during
certain phases of movement. This process happens on a neuromuscular level
involving the muscles, nerve cells, brain, and other structures involved in the
central nervous system. To describe in very simple terms, feed-forward
activation is the ability of a muscle or group of muscles to learn a specific
pattern of movement through repetition. By having a patient wear the system
during functional daily activities in addition to when they are doing specific
exercises, the muscles of the leg and hip are stimulated by the Protonics®
resistance programs over and over again. In time, these muscles will learn to
anticipate this stimulus and therefore move in the correct manner even without
the system.
Postural and functional dynamic demands placed on the lateral side of the knee
(biceps femoris, vastus lateralis, IT tract) can be reduced through Protonics®
resistance applied to the hamstrings. Excessive internal rotation of the femur
and tibia, into the patella, secondary to overuse of the psoas and
biomechcanical instability of the hip (lumbar lordosis) creates high degrees of
patellar-femoral compression. Patellar femoral compression and pain is reduced
through “feed-forward” activation of the hamstrings, obliques, gluts and
abdominals and through reciprocal inhibition of the psoas, vastus lateralis, and
tensor fascia latae. Programmable Protonics® resistance applied to the
hamstrings normalizes dynamic stability of the hip and reduces abnormal rotation
of the femur on the hip. Therefore appropriate femur and tibial axial alignment
and position to the patella during active patella tracking is experienced.
