This is the fifth article in a series about body alignment. Scroll down for the start of the article.
[thrive_text_block color=”green” headline=”Background”]I went from enjoying an active lifestyle to being unable to take a quick, short walk without significant pain and discomfort.
I wrote this series in hopes of helping other people avoid this fate or overcome similar problems. Don’t mistake this for professional advice – I’m not a physical therapist.
The culprit in my body’s misalignment is a left leg half an inch shorter than the right. Even if your legs are the same length, you could still be suffering from alignment problems and benefit from what I’ve learned. [/thrive_text_block]
[thrive_text_block color=”blue” headline=”Articles in the Alignment Series”]
- Is your balance worse on one side? Could alignment be the problem? Describes the progressive deterioration I experienced over the course of decades, slowly at first, then rapidly. My right leg mysteriously twisted inward and I lost my balance on that side. Figuring out what was happening was a long, frustrating and expensive process.
- If your body’s alignment is a problem, how will you know? In this article I tackle several topics, like does alignment even matter? The biggest message I hope you take away is that when we take a reductionist view of our injuries and pain points we miss the chance to make long lasting changes to our bodies.
- Surprising Signs of Misalignment: Assess Yourself Learn ways to get a sense of your skeletal alignment.
- Exercising for Alignment Remember, I am not a strength trainer. I’m not even pretending to be one on the internet. I’ve done many, many exercises and programs to try to improve my chronic problems, as prescribed by professionals. Nothing has been as effective at re-shaping my body as the way I exercise now.
- 12 Random Tips, Insights and Admonitions About Alignment [YOU ARE HERE] A mash up of things I’ve learned and things that have helped during this process.
I need to get off the topic of alignment and back to talking about cross-country skiing, but there’s so much left to say. Here’s a mash up of tips, random thoughts and a little bit of ranting.
I have it in mind to write one more article in this series about standards of care for leg length discrepancies, but I don’t know when I’ll finish that – maybe next summer. Suffice to say, I think the idea, popular amongst healthcare professionals, that “minor” leg length discrepancies don’t need treatment or need only partial correction is lunacy.
1. Use the leg press machine to improve weight distribution
You can’t out exercise gravity. Imagine gravity creating lines of force through your body. Those lines are moulding your bones and sculpting your muscles more powerfully than any treatment plan or exercise regime.
That’s why it’s so important to pay attention to posture and how you distribute your weight between your right and left sides and across the bottoms of your feet.
The leg press machine is a great tool for getting a better sense of your weight distribution and your lower body alignment and mechanics.
I don’t use the leg press machine in the conventional way. I used to, but it was hard on my knees, for obvious reasons.
I use the leg press to practice distributing my weight evenly between both legs. I sense how my weight is loaded across each foot and compare the pressure between each leg.
The padded seat is terrific for getting feedback on your pelvic position and the exertion of various muscles across your buttocks and back. I practice with a variety of foot positions and angles.
At first this was really hard for me. I had to learn to adjust my pelvis in the seat in order to balance out the load. After a few weeks of daily practice I was able to find better weight distribution.
From there I started adding small movements, trying to keep the pressure equal on each foot and to synchronize how my left and right legs worked at the feet, knees and hips.
I think it would be wonderful if the leg press machine was equipped with a pressure pad and read out so people could see how well they balance the work between their right and left sides.
2. Flexibility and Alignment
Flexibility and alignment are often conflated but they are not the same thing. It’s perfectly possible to be flexible and misaligned, although I think you would have different flexibility between your right and left sides.
There are many tools for improving mobility: long static stretches, myofascial release, trigger point release, Feldenkrais, massage, yoga etc. I think they can all work. Even strength training can make you more flexible. The key, like every other formula for altering your body, is consistent practice.
To improve alignment you’ll need to improve mobility throughout your body. Yes, hips, upper back and shoulders, but don’t neglect your neck, ankles and feet. It all matters.
I believe there’s a synergy between alignment and flexibility. I needed to improve my flexibility as a prerequisite to improving my alignment, because I needed enough mobility for my bones to shift position, but overall, I’d say it’s more true that improving my alignment improved my mobility than the other way around.
3. Yoga, Pilates, Nucca, oh my!
Many fitness disciplines and alternative health practices have co-opted the term alignment. I’ve invested in lots of them.
I feel agnostic and open minded about them. I think you can get results with many of these approaches. The biggest factors that will influence whether you get results are:
- The degree to which the practitioner successfully implements the principles of specificity and progressive overload.
- The degree to which the practitioner can assess your position and movement patterns. Very few people have a good eye for this. Many have no idea, despite being so-called professionals.
- Whether you put in the effort to build better body awareness and learn to correct your positioning.
- How consistently you practice.
- The overall program structure. It’s hard to make progress with random exercises. You need to work on what you can just barely do until you can do it, then move on.
From what I know of the different options, I’d say Pilates probably has the best chance for success because the reformer table provides a frame of reference that could help get you closer to good alignment.
I didn’t have a great experience with Pilates because the instructor didn’t “believe” in my leg length difference and because she failed to understand and implement the concept of progressive overload.
Personally, I don’t see how a reformer table can help anyone with bones of different lengths unless your instructor is enlightened enough to gerry rig some compensations.
4. If it’s easy, there’s a good chance you’re doing it wrong
This is a no brainer for me because I already know I have an alignment problem.
If I do a movement and I can’t feel the imbalance then I know I’ve slipped into the well worn groove of misaligned movement. I need to stop, correct my position and retry.
Its more fun to do things you can do, but it’s more productive to do things you can’t do.
5. Advice for folks who “hate” the gym and only want to exercise outside.
You need walls, a floor and a ceiling, preferably with some sort of grid lines. You also need a mirror. These things are at the gym. Get over it.
6. Objection: it’s expensive
Go to an old age home. Look at the bent and crooked bodies. Imagine yourself in that state. Now ask your future self what price you’d pay for better mobility, independence and comfort.
For me, these things will be priceless. That’s the yardstick I use to measure the cost of both the time and money I invest in improving my body today.
7. Study anatomy – you have all the right parts
To improve my alignment, I knew I had to improve my body awareness and control. I had to teach myself to make tiny adjustments to my positions in order to retrain my muscles to be strong in the right planes of movement.
This is a cool, free anatomy app. I alternate between studying the muscles and bones then trying to sense and visualize my own anatomy with small movements.
When I fall into negative or hopeless thinking about my body, I look at the app and think about how I have all the same parts as anyone else.
8. Activating the right and wrong muscles
In a previous article, I described how my right leg lived in what I called, “panic mode.” I couldn’t carry body weight on that leg without strange sensations and lines of tension developing in it.
For a couple of years the problem was intractable and getting progressively worse. Even lying on the ground, the smallest movement would trigger it. I still experience these sensations, but the situation is getting better, not worse.
You don’t need a professional to tell you when your muscles aren’t working properly. Instinct lets you now you when a muscle gets involved in work it wasn’t designed for.
I once worked with an athletic therapist who tried to teach me to activate my left gluteus medius muscle. She’d make endless adjustments to my position, poke around in my muscles and tell me whether I had succeeded or not.
At the time I thought she was a genius, but in retrospect I see the harm. Despite endless practice, my glutes never got “active” and I internalized the message that I had flawed and hopeless butt muscles. Within 3 months of correcting my leg length discrepancy, my “inactive” glute muscles came online.
Today I would take a completely different approach. I’ll use my pec muscles as an example, because that’s an areas I’m currently working on. I can’t do any pressing movements or fly exercises without the right side of my neck activating and pain developing in my shoulder.
These are the things I will do to fix this problem:
- Study anatomy to get a better sense of what this part of my body looks like and to reassure myself that I have “all the right parts”.
- Work with a trainer or physiotherapist or other movement professional to get some ideas about exercises that will target that area. For the first few weeks, I’d mostly do isometric contractions with the goal of making a mental connection with the right muscles and relaxing everywhere else.
It will take a long time – certainly weeks, if not months, but eventually the right muscles will get busy and the others will settle down.
You need to have faith that you have a fully functional body that has much untapped potential. You can’t fall into the trap of thinking that you are somehow specially limited or dysfunctional.
Think of the endless inspirational stories of people who overcome horrific injuries and set backs. How does your shoulder injury compare to those? Are you really going to let it define the limits of your potential? Maybe it will, but at least put up a fight.
Too many times I’ve said, “I can’t do that.” How much better off would I be if I said, “I can’t do that… yet”?
9. Forget about anatomy and specific muscles
I know, I just said that you should study anatomy. You should. It will make your body less of a black box and give you confidence that you have “all the right parts”. You can use visualization methods to improve your body awareness.
But you have to get away from the idea that targeting this or that muscle will solve your problems. Misalignment is a global issue. Most of the sensations I feel have no correlation to my anatomical structures. It’s more like there are lines of force and tension throughout my body.
Instead of targeting muscles, I target posture, positions and movements. You want your muscles to work well in an infinite number of ways.
10. Body awareness and control
The muscles that attach to your bones are called skeletal muscles. Another name for them is voluntary muscles because you have conscious control over them (versus your heart and gut muscles).
It means you can learn to sense and control the positions of your bones, every single bone in your body: ribs, vertebrae, clavicle, the bones in your feet, etc.
The more you can do this, the better. Now when I squat, I can exercise a degree of control over the position of my femur and pelvis. I can deliberately and quite precisely control the rotation of the femur in my pelvis as I bend. I didn’t even know that was possible.
Instead of “lengthening” your spine, try “unwinding it” with tiny, gentle adjustments to your posture.
We hear endlessly about our forward head posture and rounded backs, but that suggests our spines are misaligned in a single plane. What are the chances? Isn’t is far more likely the spine is misaligned in all 3 diemnsions? Tilted and twisted, not just bent forward.
The lines of chronic tension through your back and neck are clues to your positioning. You don’t need to yank on them, just try small adjustments to your posture to discover ways of easing them.
11. My body is a giant rubber band
When I saw how dramatically and quickly my body changed after my shoe was adjusted, I hoped for a magically quick recovery.
Sadly, it doesn’t work that way. It like my body snaps back to a bad place without daily attention. Going a day without the gym is awful for me.
12. The Hip Hinge: The holy grail of pelvic alignment
Your hip is a ball and socket joint. The top of your thigh bone is shaped in a ball, and that ball sits in a round socket in your pelvis.
A “hip hinge” is a movement at that joint. To learn to “hip hinge” is to learn to move at that joint without simultaneous movement in the spine.
It’s harder than it sounds and is important because it teaches you to stabilize your lower back and core while you move.
Two classic exercises that include a hip hinge are the deadlift and squat. If you watch someone perform one of these exercises from behind, you may notice that their hips don’t move straight. Often the hips follow a wobbly path on the way up and down.
In the past few years I’ve done thousands of these movements. I hoped that because they are foundational movements, they would help me rehabilitate my body.
The more reps I did, the better I could sense my hip joint and understand that movement. Over time I was able to sense how badly I’d veer off course during the movement. I swivelled no matter how much I tried to control the movement.
I came to understand this wobble as the hallmark of a misaligned pelvis. I found the terms “pelvic distortion” and “pelvic torsion” online. This resonates deeply with me.
There’s an idea that’s pretty popular on the Internet right now referencing the fact that many people have anatomical asymmetries in their hips. Their ball and socket joints are shaped differently on their right and left sides.
Anatomical asymmetries will cause a wobbly hip hinge. The suggestion is (while squatting) to position the right and left feet at different angles or to step one foot a little forward to compensate for the anatomical asymmetry and help straighten out the wobble in someone’s hip hinge.
A misaligned but anatomically symmetrical pelvis will also cause a wobbly hip hinge. Imagine a pelvis that isn’t just tilted higher on one side, but is torqued out of alignment in all three dimensions.
That’s what my leg length difference did to my pelvis and that’s why my hip hinge was so wobbly. I could try altering my foot placement and probably I’d discover positions that felt better, but ultimately that would just feed into my existing misalignment.
A symmetrical hip hinge is my “holy grail”. That movement is one of the primary measures I use to assess my pelvic alignment and monitor my progress. My dream is to have a perfect hip hinge in an infinite range of stance widths and foot angles.
I also dream of walking pain free.
No Easy Answers
Sadly, I don’t think there are any magic solutions or easy answers if you suffer from problems stemming from misalignment.
I’m a big believer in paying for professional help, but a lot of the professional advice I’ve invested in has been a waste of money. I think the main reasons are:
- Physiotherapists take too much of a reductionist view and try to pinpoint problems to specific muscles that are “tight” or “weak”. Part of this problem is short appointment times and harried schedules. It also has to do with the ethos of evidence-based treatment, which is necessarily reductionist.
- I think it’s more true that the position of our bones affects our muscles than the other way around, but learning to reposition your skeleton and hold it in better alignment while you move is extremely challenging. Finding professionals to help with this is key.
- Regarding leg length discrepancies: I think the current bias towards thinking LLDs are “functional” and/or don’t need treatment is harmful, and, from the point of view of physics, ridiculous.
- Many professionals don’t understand movement well enough, can’t think adequately in three dimensions or don’t have a good enough eye for understanding movement and position.
I don’t mean to bash professionals. Like I said, I believe in paying for professional help and will continue to do so.
I think most professionals are good people who want to help. They are often just as frustrated by the ineffectiveness of their treatment plans as their patients.
Ultimately, it’s up to us to understand our bodies and our movement. In the end, no one can help us but ourselves. I know that. You know that.
But we need help understanding what’s happening to us, why it’s happening and practical steps we can take to change it.
After years of frustration, I’ve made some small steps forward on these fronts. In this series, I’ve tried to share some of what I wish I had known years ago.