ExRx.net

Hi,

I'm trying to fix this problem, and was wondering if I considered everything.

The program I came up with:


Is this correct so far?

I was also wondering what exercises would be best to do on what side



Any more suggestions? Things to read?

What's causing the lateral pelvic tilt? Do you have one leg shorter than the other? By all mean, work on muscle imbalances but you may have an issue that can't be fixed by training. Maybe orthotics in your shoes could help.

Consider uniltateral movements like single leg RDLS, step ups, split squats, etc. Any strength imbalances need to be corrected. The ones you have seem to be targeting the gluteus medius which is the likely culprit, but you should work the larger muscles as well. It's the overall movement patterns that matter. If you have access to an FMS trained person, maybe they can help you sort it out.

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Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

Yes I have had a motorcycle accident in 2006 which caused my left femur to shorten (1.5cm I believe), got orthopedics. Then after 1 year of back pain I went to chiropractor and I got a new pair of orthopedics (2 months ago, these allegedly also help with the flat feet I have and pronation). Yesterday I let my girlfriend inspect my pelvis and apparently when removing the right orthopedic my pelvis is more balanced. So right now I'm only standing on my left orthopedic (which is far from ideal probably but actually I'm already feeling better walking).


Ok, gluteus maximus strengthening. If I have a slight imbalance in one leg, should I do 3x8 on the weak leg and 2x8 on the stronger (or something alike?).


I feel like there's not a lot of professionals out there who are very capable, I feel like I'm always doing the suggesting. Which one do you think will be most effective in helping:

-Orthopedic physicians
-visceral osteopaths
-manual therapists (chiropractor I think falls under this category)
-physiotherapists

FMS is a certification that trainers can get and it's a screening tool that can help identify issues. It's a simple test where they watch you do some basic movements and then they can focus the corrective techniques. It's bit of physiotherapy and sports conditioning mixed together. There is a self screening tool in "Athletic Body in Balance" by Gray Cook. It's an inexpensive book, well worth picking up.

Look beyond glutes to hamstrings, quads, adductors, and muscles above the hip. Imbalances could be anywhere. The muscles around your core and knees can effect your hips but in the larger scope, it starts at the floor and works up. As an example, anytime you can exercise with a weight in one hand and your opposite leg planted on the ground, you'll involve the whole body. And it's not always static posture that matters. Sometimes it's dynamic. I always like the Turkish Get Up. It's that type of exercise that if there is something wrong somewhere, it will jump out at you.

_________________
Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
_________________
Thanks TimD

I will definitely look into that book, thanks.

My problem is mostly dynamic I think, I sometimes even have problems bending down to brush my teeth. Like I don't know what muscles to contract.

Identifying imbalances will be the biggest challenge I think the next workouts, do you have any more tips for this?

I think you mean to say "orthotic". That's a device that affects body positioning. You probably don't need the usual kind of orthotic that helps foot position. You need a lift on the shoe of the short leg. Exercise will not correct this problem. Chiropractic or other manipulation will not correct it (although it might provide some short-term relief of pain, which is a good thing.

The doctor (any kind, but either a Family Doctor or an Orthopedist would usually do this) should do a series of x-rays of your pelvis and lower spine with you standing in stocking feet, and the food of the short leg on a lift equal in thickness to the estimated difference in your leg-length. I have found books to be the best for this, but I suppose that some doctors have shims of various precise thickness to use for this. I estimate the discrepancy, then look over my bookshelf for a book that is about that thickness. The patient stands on the book, the x-ray is taken, and then I look at the picture to see if the pelvis is level. If the floor in the x-ray room is level, and the wall-mounted cassette holder (holds the film while it is being exposed) is level, then the pelvic crests should be level, parallel with the bottom edge of the picture. After the first film is taken, I measure, see how much out of level the pelvis is, change for a thicker or thinner book, and repeat the process until I get it right. Usually the patient will comment that standing on the book feels good, relieves some discomfort as well. When the pelvis is about level (it doesn't have to be super-precise), I measure the thickness of the book or books used, and write a prescription for an elevated shoe. This has worked well for some of my patients in the past.

Very small discrepancies can be corrected with inserts for the shoe, but more than about .5 cm will need a shoe with a built-up sole. These are expensive, but health insurance should pay for at least 1 pair, maybe 2. Any kind of shoe can have a thick sole added. Some fancy ones disguise the thick sole, so that it is less noticeable.

You're just creating a frustrating situation for yourself by trying to train this tilt away. Won't work, so give up the frustration, and just train for strength or whatever it is that you'd like to get out of exercise other than a level pelvis.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

Exactly, yes.


My chiropractor actually has used the same book-standing method (though without the x-rays) on me, I also felt some relief at the time by the pelvis leveling. Then he referred me to a podologist who then let me undergo a couple of tests (testing strength while short leg elevated, gait analysis barefoot) and made these orthotics for me. The left orthotic has elevation for about 6mm and the actual leg difference measured (3 years ago with x-ray) was about 15mm.
I must add to this that although on paper it sounds very professional, I have serious doubt that both the chiropractor and podologist were convinced that this was 100% gonna help me.
Anyway I've been walking 2 months with the orthotics and I think the elevation is too small, so when I removed the right orthotic my pelvic looks level and I again feel instant relief, also while walking it feels much more natural.


But by walking with a pelvic imbalance for 4-5 years and training with it for 3 years I've created some imbalances, these will surely need some SMR / Stretching and strengthening right? And probably a different approach for the left and right side?

I would also like to add that my chiropractor said my first orthotics were not good because they were too high. He said that the actual elevation for the orthotic should be lower than the actual leg discrepancy measured with an x-ray. Would you agree or is this something you have to see on a case by case basis (provided that this is the only thing you're taking care of).

Thanks again by the way for your input, as always it's very much appreciated.

Well, there you go. Good information.
Maybe not. If you can identify a specific difference, then some supplementary work for that would be good, but don't just assume that you need to do something complicated.

It may be true that you shouldn't completely correct the deficit right away, but I think it would probably be best to gradually correct it so that the pelvis is neutral.

_________________
Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

It's because my back hurts, that's why I've been looking for solutions and assuming several stuff. I've tried a few professionals for about 15 sessions and i'm actually feeling worse than 4 months ago. A lot of it comes from my right glute which feels really bad, even after 2 months of tennisball work.
Now I'm thinking that it still feels bad because of the lateral pelvic tilt, and it didn't get a chance to recover to a better muscle quality. That's why I came up with this new stretching and SMR plan.

I'm just gonna go to another professional (orthopedic this time) and see what he thinks of this. I feel like I have this really simple back problem which can be fixed in a matter of a month and these 'professionals' are just playing around and getting money.

Yes, my next suggestion was going to be a "real" doctor. An orthopedist is a good choice. Also, if there is a specialist in Physical Medicine and Rehabilitation (called "PM&R" for obvious reasons), that also might be a good choice. These doctors are not very common, and many people don't even know that this specialty exists. They are also called "physiatrists", but don't confuse this with "psychiatrists"! Quite different.

_________________
Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan