Anterior Hip Rotation and Consequent Lower Limb Backline and Plantar Fascia Tightness, Pain and Injury

 

Few medical practitioners link tightness through the back line musculature of the lower limbs with Sacro-Iliac Joint (SIJ) dysfunction...it is not taught in scientific curriculums; the explanation for the phenomenon is based on the traditional Chinese philosophy of energy flow. Energy they call Qi that cannot be measured by instruments or felt by the uninitiated. A gifted few do have an innate awareness of Qi.  More typically, individuals develop the ability undertaking the discipline and rigour of meditation and oriental martial training. 

 

In Chinese medical philosophy, when circulation of Qi is blocked, pain and tightness results. My first awareness of this came resolving an RSI condition which disabled both arms to the point where I could no longer work. The next instance was treating a fit elderly gentleman afflicted with severe Plantar Fasciitis causing pain and tightness in the sole of the foot. 

 

This gentleman's chronic condition had been the cause of considerable pain over many years. He had been examined by medical practitioners in both Melbourne and London and underwent a surgical procedure to release the fascial tightness to no avail. Extensive massage treatment to the left lower limb over a 12 month period proved ineffective too. Finally, extending my awareness further, I noted the SIJ pain he experienced only as a background discomfort not worth mentioning. The left hip was anteriorly rotated in the Sagittal plane about the SIJ. Normalising hip posture by applying an intense hip flexor stretch relieved the SIJ's. He did squeal loudly stretching the hip flexors. They were tight, very tight. Within days the Plantar Fasciitis condition no longer afflicted him.

 

I now recognise a common cause for thickening and tightness along the back line from hips to the bottom of the feet is chronic hip rotation about the SIJ. There may or may not be noticeable pain or discomfort at the SIJ, yet dysfunction from this postural anomaly causing tightness through the soft tissue of the joint blocks energetic Qi flow to the backline of the lower limb. This is typically present on one side only, unilateral anterior rotation of the left hip being the most common presentation.

 

The SIJ joins the hip and sacrum, carrying the full weight of the body, is a heavy joint bound by strong ligaments having limited movement. While the shoulders achieve 360 degrees of rotation, the SIJ is normally limited to roughly 15 degrees. Under the influence of other postural anomalies, I have sighted cases pushed to 45 degrees of rotation binding ligaments and forcing the bones hard together, impinging cartilage and tightening the soft tissue of the joint. This tightness in the soft tissue blocks energetic Qi flow.

 

Generally, the condition presents as a background discomfort or ache in the lower back and a subtle tightness and thickening through the Gluteals, Hamstrings and Calves. One muscle group may be affected more than the others due to individual loading and gait habits. 

 

In some cases, the patient is not aware of any discomfort in the lower back or dysfunction at the SIJ, but examination reveals forward hip rotation and palpation of the SIJ ellicits sensitivity, tenderness or pain. More acute cases experience sharp pains in the SIJ they are only too aware of. 

 

Regardless of the intensity, tightness in the lower limb is only partially relieved by massage, release or stretching while the hip posture anomaly/SIJ dysfunction remains and tightness down the backline returns quickly after treatment.

 

Better understanding the nature of this phenomenon, not all cases of anterior hip rotation will develop Plantar Fasciitis...where due to loading factors, some being more affected elsewhere along the back line....but generally all cases of Plantar Fasciitis on the left side are accompanied by anterior rotation of the hip. I have sighted all of the following in conjunction with the hip rotation anomaly...Piriformis Syndrome and Sciatic pain, Hamstring tendonitis/tear, chronic Compartment Syndrome, Achilles injury/rupture and Plantar Fasciitis. One client suffering all these effects successively before being assessed and receiving treatment to normalise hip posture. 

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Some cases never progress beyond the subtle tightening and thickening of the back line of the lower limb and, of course, there are exceptions being the presence of other injury or degeneration of hip, SIJ, sacrum or lower back affecting soft tissues and blocking the circulation of Qi. The incidence of hip rotation dysfunction phenomena far exceeds any exception cases presenting in my clinical practice.

 

Typically the underlying cause for hip rotation is a bigger story called Short Right Leg Syndrome. Anterior rotation of the hip being an anatomical adjustment pulling up the longer left leg, reducing pelvic tilt, making us feel more comfortable and protecting the spine from scoliotic strain.

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Right sided cases can look similar to the left sided cases described above. However, while the underlying cause is frequently the structurally short right leg, the mechanism at the right hip is different. Scoliosis with right convexity through the lumbar spine due to right leaning pelvic tilt, plus tightness at the right hip and a jammed/stuck right SIJ due to gait effects from the structurally short leg generate a blocking action. Right sided cases are less common than left sided. The presence of pelvic or lumbro-sacral injury can prove problematic.