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Old 03-26-2009, 03:21 PM   #1
Jeff Evans
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Lightbulb Ongoing back problems: a new hypothesis

Let me apologize in advance for the length of this post. tl;dr version: what to do about pelvic unleveling?

I've posted on this board before (once and twice, both w/fs) about an annoying back problem, mostly related to discomfort in my left mid-upper back around where the scapula borders the spine. Since then I've been to an orthopedist, who prescribed a course of physical therapy, which I did. But lately the problem has been acting up again.

So I gathered all my notes and records and went through everything again. A new hypothesis started forming in my mind, particularly when reading last year's radiologist report (reproduced in my "once" link above). These lines jumped out at me.

Quote:
Lumbar Spine and Pelvis
There is a pelvic unleveling, low on the right. A slight right list of the lumbar region is also identified.
This is also consistent with what both chiropractors and the orthopedist have all said - my right hip is lower than the left. From here I could visualize a scenario where my right hip, being lower, caused my lower-mid spine to curve right, which caused my thoracic spine to come up at an angle from the bottom right, which caused my shoulders to tilt left. Then the cervical spine would have emerged toward the left from the shoulders. Basically, instead of being a straight up "I" my spine would have looked slightly like a backwards "C" when viewed from behind me.

If this were the case, then the discomfort around my left scapula may have been a red herring the whole time. It could have just been a result of those muscles having to stretch a bit more to connect to the spine since it was slightly shifted right, or may have had some other similar cause. And even though this x-ray report was from last year, the hip/spine/shoulder disparity remains clear today; I recently did a self-photography test to confirm (the position of a hanging string was left relative to a marker on the center of my spine).

There are also several symptoms, both current and from past notes, which may support this hypothesis. A common theme seems to be asymmetry.
  • Cracking/discomfort on the left side
  • Over the past few years I have mostly slept on my right side (this would tend to tilt my spine toward the right), or back; the few times I tried to sleep on my left side it was difficult and painful (left arm falling asleep, shoulder pain)
  • When I started my latest chiropractor visits, I had a weight imbalance of +25lbs on the right foot (weight shifted to right due to listing)
  • Moving my left leg backwards while standing on the right foot is considerably more painful (felt near left of lower sacral spine) than the other way around (possible glute asymmetry)
  • Right shoulder was higher than the left by an inch or so (spinal listing)
  • Left side of neck was usually very tight and had relatively large lesions compared to the right during massage therapy (cervical spine list)
  • At my chiro visit a couple weeks ago (the first in 4 months), my entire head was slightly shifted to the left
  • Many different courses of exercise and PT focused on strengthening shoulders and back muscles were ineffective (this was never the problem)
  • Right ankle problems/pain during running, left ankle was fine (weight imbalance, posture)

Now... putting on my Dr. House hat for a minute... an unevenness in my hips may explain everything. And just like Dr. House I started treatment without confirming the diagnosis. Specifically, I have tried making a conscious and very deliberate effort (in short bursts) to tilt my right hip up and letting my left shoulder come up accordingly. This causes some interesting effects - most strikingly it causes the normally constant cracking to mostly disappear. And it definitely makes my upper body and neck "feel" better, almost like it's in a more natural position (it feels like my shoulders are touching the chair in a completely symmetrical manner which I noticed was conspicuously not the case before). Of course it also feels like I am now over-arching my spine the other way and my hips are not happy (it's much harder for me to tilt the right one up than the left).

So, does any of this sound reasonable or have I missed any important details? If this avenue seems promising, I guess the next question to ask is, what led to the uneven hips? From what I understand it's usually deep muscle pain or a vertebral disc problem. Or different leg lengths (unlikely but I'm having this checked soon). And finally, what course of action can I take in either case?

I really want to get this solved while I'm still young, but I don't want to let myself fall into a trap of affirming my own biases. So I would appreciate anyone looking at my thoughts with a critical eye. And I don't want to proceed with still more professional care before having some level of confidence my thousands of dollars will be productive. Therefore, while I will definitely consider visiting another type of doc going forward, right now I'm mostly looking for amateur advice.

Thank you for your time and input; please let me know if any more information would be useful.
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Old 03-26-2009, 03:23 PM   #2
Gabriel desGarennes
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Re: Ongoing back problems: a new hypothesis

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Old 03-27-2009, 05:24 AM   #3
Todd Dent
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Re: Ongoing back problems: a new hypothesis

Quote:
Originally Posted by Jeff Evans View Post
Let me apologize in advance for the length of this post. tl;dr version: what to do about pelvic unleveling?

I've posted on this board before (once and twice, both w/fs) about an annoying back problem, mostly related to discomfort in my left mid-upper back around where the scapula borders the spine. Since then I've been to an orthopedist, who prescribed a course of physical therapy, which I did. But lately the problem has been acting up again.

So I gathered all my notes and records and went through everything again. A new hypothesis started forming in my mind, particularly when reading last year's radiologist report (reproduced in my "once" link above). These lines jumped out at me.



This is also consistent with what both chiropractors and the orthopedist have all said - my right hip is lower than the left. From here I could visualize a scenario where my right hip, being lower, caused my lower-mid spine to curve right, which caused my thoracic spine to come up at an angle from the bottom right, which caused my shoulders to tilt left. Then the cervical spine would have emerged toward the left from the shoulders. Basically, instead of being a straight up "I" my spine would have looked slightly like a backwards "C" when viewed from behind me.

If this were the case, then the discomfort around my left scapula may have been a red herring the whole time. It could have just been a result of those muscles having to stretch a bit more to connect to the spine since it was slightly shifted right, or may have had some other similar cause. And even though this x-ray report was from last year, the hip/spine/shoulder disparity remains clear today; I recently did a self-photography test to confirm (the position of a hanging string was left relative to a marker on the center of my spine).

There are also several symptoms, both current and from past notes, which may support this hypothesis. A common theme seems to be asymmetry.
  • Cracking/discomfort on the left side
  • Over the past few years I have mostly slept on my right side (this would tend to tilt my spine toward the right), or back; the few times I tried to sleep on my left side it was difficult and painful (left arm falling asleep, shoulder pain)
  • When I started my latest chiropractor visits, I had a weight imbalance of +25lbs on the right foot (weight shifted to right due to listing)
  • Moving my left leg backwards while standing on the right foot is considerably more painful (felt near left of lower sacral spine) than the other way around (possible glute asymmetry)
  • Right shoulder was higher than the left by an inch or so (spinal listing)
  • Left side of neck was usually very tight and had relatively large lesions compared to the right during massage therapy (cervical spine list)
  • At my chiro visit a couple weeks ago (the first in 4 months), my entire head was slightly shifted to the left
  • Many different courses of exercise and PT focused on strengthening shoulders and back muscles were ineffective (this was never the problem)
  • Right ankle problems/pain during running, left ankle was fine (weight imbalance, posture)
Now... putting on my Dr. House hat for a minute... an unevenness in my hips may explain everything. And just like Dr. House I started treatment without confirming the diagnosis. Specifically, I have tried making a conscious and very deliberate effort (in short bursts) to tilt my right hip up and letting my left shoulder come up accordingly. This causes some interesting effects - most strikingly it causes the normally constant cracking to mostly disappear. And it definitely makes my upper body and neck "feel" better, almost like it's in a more natural position (it feels like my shoulders are touching the chair in a completely symmetrical manner which I noticed was conspicuously not the case before). Of course it also feels like I am now over-arching my spine the other way and my hips are not happy (it's much harder for me to tilt the right one up than the left).

So, does any of this sound reasonable or have I missed any important details? If this avenue seems promising, I guess the next question to ask is, what led to the uneven hips? From what I understand it's usually deep muscle pain or a vertebral disc problem. Or different leg lengths (unlikely but I'm having this checked soon). And finally, what course of action can I take in either case?

I really want to get this solved while I'm still young, but I don't want to let myself fall into a trap of affirming my own biases. So I would appreciate anyone looking at my thoughts with a critical eye. And I don't want to proceed with still more professional care before having some level of confidence my thousands of dollars will be productive. Therefore, while I will definitely consider visiting another type of doc going forward, right now I'm mostly looking for amateur advice.

Thank you for your time and input; please let me know if any more information would be useful.

Have you got a congenital short leg?

With the uneven hips to the degree that it's causing discomfort, I'd suspect that you need a heel lift in one of your shoes.

Without orthopedic testing and x rays I can't tell you much.

If it's not a short leg it could be slight scoliosis.

Find out from your Chiropractor or DO if they've heard anything about these guys.

http://www.clear-institute.org/YOU MUST ENSURE YOU ANNOTATE ALL LINKS WHETHER WORK AND FAMILY SAFE.

There is a list of Docs that know the protocol on the site if you're interested or if it's even applicable to you.

Last edited by Lynne Pitts : 03-27-2009 at 05:45 AM.
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Old 03-27-2009, 05:39 AM   #4
Chris Terry
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Re: Ongoing back problems: a new hypothesis

A heel lift would be a great start. Also, in regards to the Clear Institute, I would hold off. They primarily deal with moderate to severe scoliosis cases, and it does not sound like you have a scoliotic curve, more of compensatory lists of the spine. I know you have had PT and other care. Find someone (DC, DO, PT, etc) who is familiar w/the work of Janda. Testing for muscular imbalance is a bi part of correcting this. Also, remeber that x-rays are a snapshot in time at that particular moment. They could be taken tomorrow and the pt positioning could be manipulated to show totally different findings. Some proprioceptive (balance) work might also be in order. Hope this was helpful.
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Old 03-27-2009, 11:26 PM   #5
Steven Low
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Re: Ongoing back problems: a new hypothesis

Get a PT who can do a gait analysis.

Also, check your SI joints to make sure they have not slipped.

Short leg would explain it...... but definitely check Pelvis disorders such as SI joint/pubic symphisis/etc. first as orthotics don't "permanently correct" problems.
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Old 03-30-2009, 08:27 AM   #6
Gaines DuVall
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Re: Ongoing back problems: a new hypothesis

Quote:
Originally Posted by Jeff Evans View Post
Let me apologize in advance for the length of this post. tl;dr version: what to do about pelvic unleveling?

I've posted on this board before (once and twice, both w/fs) about an annoying back problem, mostly related to discomfort in my left mid-upper back around where the scapula borders the spine. Since then I've been to an orthopedist, who prescribed a course of physical therapy, which I did. But lately the problem has been acting up again.

So I gathered all my notes and records and went through everything again. A new hypothesis started forming in my mind, particularly when reading last year's radiologist report (reproduced in my "once" link above). These lines jumped out at me.



This is also consistent with what both chiropractors and the orthopedist have all said - my right hip is lower than the left. From here I could visualize a scenario where my right hip, being lower, caused my lower-mid spine to curve right, which caused my thoracic spine to come up at an angle from the bottom right, which caused my shoulders to tilt left. Then the cervical spine would have emerged toward the left from the shoulders. Basically, instead of being a straight up "I" my spine would have looked slightly like a backwards "C" when viewed from behind me.

If this were the case, then the discomfort around my left scapula may have been a red herring the whole time. It could have just been a result of those muscles having to stretch a bit more to connect to the spine since it was slightly shifted right, or may have had some other similar cause. And even though this x-ray report was from last year, the hip/spine/shoulder disparity remains clear today; I recently did a self-photography test to confirm (the position of a hanging string was left relative to a marker on the center of my spine).

There are also several symptoms, both current and from past notes, which may support this hypothesis. A common theme seems to be asymmetry.
  • Cracking/discomfort on the left side
  • Over the past few years I have mostly slept on my right side (this would tend to tilt my spine toward the right), or back; the few times I tried to sleep on my left side it was difficult and painful (left arm falling asleep, shoulder pain)
  • When I started my latest chiropractor visits, I had a weight imbalance of +25lbs on the right foot (weight shifted to right due to listing)
  • Moving my left leg backwards while standing on the right foot is considerably more painful (felt near left of lower sacral spine) than the other way around (possible glute asymmetry)
  • Right shoulder was higher than the left by an inch or so (spinal listing)
  • Left side of neck was usually very tight and had relatively large lesions compared to the right during massage therapy (cervical spine list)
  • At my chiro visit a couple weeks ago (the first in 4 months), my entire head was slightly shifted to the left
  • Many different courses of exercise and PT focused on strengthening shoulders and back muscles were ineffective (this was never the problem)
  • Right ankle problems/pain during running, left ankle was fine (weight imbalance, posture)

Now... putting on my Dr. House hat for a minute... an unevenness in my hips may explain everything. And just like Dr. House I started treatment without confirming the diagnosis. Specifically, I have tried making a conscious and very deliberate effort (in short bursts) to tilt my right hip up and letting my left shoulder come up accordingly. This causes some interesting effects - most strikingly it causes the normally constant cracking to mostly disappear. And it definitely makes my upper body and neck "feel" better, almost like it's in a more natural position (it feels like my shoulders are touching the chair in a completely symmetrical manner which I noticed was conspicuously not the case before). Of course it also feels like I am now over-arching my spine the other way and my hips are not happy (it's much harder for me to tilt the right one up than the left).

So, does any of this sound reasonable or have I missed any important details? If this avenue seems promising, I guess the next question to ask is, what led to the uneven hips? From what I understand it's usually deep muscle pain or a vertebral disc problem. Or different leg lengths (unlikely but I'm having this checked soon). And finally, what course of action can I take in either case?

I really want to get this solved while I'm still young, but I don't want to let myself fall into a trap of affirming my own biases. So I would appreciate anyone looking at my thoughts with a critical eye. And I don't want to proceed with still more professional care before having some level of confidence my thousands of dollars will be productive. Therefore, while I will definitely consider visiting another type of doc going forward, right now I'm mostly looking for amateur advice.

Thank you for your time and input; please let me know if any more information would be useful.
Jeff,
I totally know what you are going through. I have dealt with serious back problems my whole life and recently had a doct xray my hips and lower back. My right leg is about an inch longer, pushing my right hip up higher than my left. He gave me a lift for my left shoe and it has REALLY helped.

Last week, I was even able to do Grace and had no problems.

BUT, this weekend I didnt sleep much, didnt stretch enough before Fight Gone Bad and am paying for it this morning. My lower back is jacked. From years of problems (including 2 neck surgeries) I have learned that I simply need to stretch, drink a ton of water, and not workout for a couple of days and I will be fine.

The scapula pain that you described is probably a result of your offset hips or short leg. I deal with it as well.

Anyway, it sucks to hear that you are going through the same problems. But I know you will be ok if you get a lift, drink lots of water (keeps your discs full), and stretch often.

Take care,
Gaines
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Old 03-30-2009, 06:03 PM   #7
Dane Kottke
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Re: Ongoing back problems: a new hypothesis

I get much the same type of pain in my mid back. I also get tightness and will occasionally have it tighten up so that I can't drive or head to the gym. I've learned that working overhead squats with more than a bar will trigger the bad episodes. Another cause is long, stressed hours in front of the computer - which sucks because that's how I earn my living.

It took me some time to put it together, but I came to the same conclusion as you - my right shoulder is higher than my left, and my body is trying to compensate for the discrepancy. The cause seems to be that my right leg is longer than my left, but only by about 3/8'' or so. For me, this seems to be a genetic thing, as my mom, sister, daughter and son all have the same issue to some extent.

My sister and mother have done years of chiropractic w/ no significant change. I've found that trigger point therapy on the bad days and exercise are my best defense. (Stretching/yoga did nothing for me.) For me, I find that since my body will naturally try to level itself, I have to spend time giving those excessively tight muscles some relief through massage.

The doctor I spoke to said that uneven leg length was pretty common, but I've never known anyone who had these symptoms outside of my family until I read your post.
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Old 05-11-2009, 02:58 PM   #8
Mike Mallory
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Re: Ongoing back problems: a new hypothesis

Hi Jeff-

Looks like you're well on your way to solving your problem.......I work at a clinic where we deal with this type of problem on a daily basis for athletes and other nasty cervical issues.

It is VERY rare to have an ACTUAL leg length discrepancy, unless you've had polio, perth's or a serious fracture.

I can say with almost 100% assurance that you have an atlas misalignment. Having no facet joints, the atlas is the most prone segment to subluxation, and if the atlas is misaligned, everything underneath it will have to accomodate

The body will always compensate for an upper cervical misalignment by unleveling the hips, because it would rather keep the eyes and ears level than the pelvis. The spine will also bend and twist to accomodate rotation and translation of the atlas, and making for a leg length discrepancy. This is exactly why most of the population walks around with a 1/2 LLI..

Heres a basic diagram:

http://www.brooksspinalcare.com/images/both.jpg

If you go see a NUCCA Chiropractor, he will straighten you out, no pun intended. Do NOT go see a regular chirporactor for the regular 'neck crack'....There is no way of objectively realigning the joint this way. You will need X-rays, etc......But it usually isn't too costly.

According to the lovett reactor mechanism, the misaligned atlas will often keep the SI joint out of place also, which could account for slight leg length discrepancy.....

You could get this taken care of in literally one day......Why the rest of the medical community doesn't know this, I don't know

Good luck
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Old 05-13-2009, 09:48 AM   #9
Mike Mallory
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Re: Ongoing back problems: a new hypothesis

I should also mention that I've seen the pelvis come level after the first treatment in 100% of cases...........I really can't stress enough how amazing it is

It also balances the weight distribution on the feet perfectly (provided the correction is good).........When I get a correction, the difference in weight distribution on each of my feet drops down below 0.1% of my total body weight (normal is around 5 lbs difference)

The ONE exception where someone's pelvis and leg length didn't come even was a woman who had a stroke that turned her into a parapalegic
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Old 05-15-2009, 12:36 AM   #10
Robert Anthony
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Re: Ongoing back problems: a new hypothesis

Quote:
Originally Posted by Mike Mallory View Post
Hi Jeff-

Looks like you're well on your way to solving your problem.......I work at a clinic where we deal with this type of problem on a daily basis for athletes and other nasty cervical issues.

It is VERY rare to have an ACTUAL leg length discrepancy, unless you've had polio, perth's or a serious fracture.

I can say with almost 100% assurance that you have an atlas misalignment. Having no facet joints, the atlas is the most prone segment to subluxation, and if the atlas is misaligned, everything underneath it will have to accomodate

The body will always compensate for an upper cervical misalignment by unleveling the hips, because it would rather keep the eyes and ears level than the pelvis. The spine will also bend and twist to accomodate rotation and translation of the atlas, and making for a leg length discrepancy. This is exactly why most of the population walks around with a 1/2 LLI..

Heres a basic diagram:

http://www.brooksspinalcare.com/images/both.jpg

If you go see a NUCCA Chiropractor, he will straighten you out, no pun intended. Do NOT go see a regular chirporactor for the regular 'neck crack'....There is no way of objectively realigning the joint this way. You will need X-rays, etc......But it usually isn't too costly.

According to the lovett reactor mechanism, the misaligned atlas will often keep the SI joint out of place also, which could account for slight leg length discrepancy.....

You could get this taken care of in literally one day......Why the rest of the medical community doesn't know this, I don't know

Good luck

Has anyone followed through with this advice? I would love to hear it. My wife and I have had this upper back pain for a long time. It normally gets inflammed when we do a lot of running.(reason not to do a lot of running) Mine has always bothered me on the left side, my wife on the right side between the shoulder blades. The AF will send me to a chiropractor but I need to know if this works so I will specifically go to a NUCCA chiro instead. I am willing to pay out-of-pocket. My AF docs just give anti-inflammatory medicine and say deal with it. Thanks in advance.
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