Chapter 9 Conclusion

Malalignment of the pelvis and spine is present in 80-90% of the population. Approximately 30% of these are symptomatic; another 20-30% have evidence of discomfort when soft tissues and joints are stressed on examination. There are specific biomechanical changes that can help diagnose the three common presentations: ‘outflare/inflare’, ‘rotational malalignment’ and ‘upslip’; the ‘malalignment syndrome’ is associated with only the last two. In addition to the distortion of the pelvis and spine, the syndrome is characterized by asymmetries from head to toe: the changes in weight-bearing, leg length, joint ranges of motion and muscle-tendon unit tone and strength are easily detectable in most people, especially in the lower extremities, and help to establish the diagnosis.

The altered biomechanical stresses predispose to restrictions and injuries. Typically, right pronation increases tension in medial soft tissues of that extremity, tendency to knee valgus and stress on the lateral tibiofemoral compartment; left supination stresses are in the opposite pattern and predispose to left knee varus and ankle inversion sprain (Fig. 3.37). A person may find these asymmetries result in an advantage or a hindrance when carrying out some activities. For example, a secondary increase in right rotation of the pelvis and trunk could improve a golfer’s backswing; whereas the decrease to the left could limit follow-through (Ch. 5; Fig. 3.5)

Specific muscles show asymmetries of tension and strength. However, over the past decade, there has been an increasing emphasis on the fact that muscles act less in isolation but more as part of a system of ‘inner’ and ‘outer’ core slings ( Figs 2.28–2.40). Surface electromyography (EMG), Real-Time Ultrasound and MRI are used increasingly to help:

The asymmetries noted with malalignment eventually result in soft tissue changes that can predispose to recurrence:

The respective limitation of motion and joint instability makes it more and more difficult to achieve and maintain alignment the longer malalignment has been present. However, these structures usually can gradually regain their normal length with ongoing efforts. Treatment should, therefore, include teaching the person:

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Treatment: Manual therapy modes Horses, saddles and riders The malalignment syndrome: Related pain phenomena and the implications for medicine Clinical correlations in sports The Malalignment Syndrome A comprehensive treatment approach

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