When I get clients in the gym and I tell them to simply stand up straight, here is often what I see:
The weird thing is that we can’t really know if we are rotated because it’s simply normal to us. In other words, your neutral is not neutral.
The problem is pelvic alignment is a big deal. The pelvis can of course effect the pelvis, but it can also affect the low back, the hip, the knee, thoracic spine, neck, all the way down to the ankles.
For individuals suffering from back pain or hip pain, I highly recommend taking the 10 seconds required to merely check for pelvic rotational asymmetry at every session.
What is pelvic rotational alignment? It’s simply this:
Put your fingers on the ASIS and make sure your thumbs are of equal distance to you. If you find that one thumb is farther away from you like this picture below, you have a pelvic rotation. (It's difficult to really tell in the picture, if you try it out, you'll quickly be able to tell.)
You can also do a self-assessment by putting your own thumbs on your ASIS and see if any of them are more forward than the other.
It might not seem like a big deal, but if you find one thumb is more forward than the other, this automatically entails:
·The lumbar spine is automatically rotated because of the close proximity to the pelvis.
·The thoracic supine and upper thorax are automatically rotated (or have a torque) because of the rotation going on in the lumbar spine. The upper thorax may compensate or not.
·One of the femur’s will internally rotate while the other will automatically externally rotate.
·The knee joint may be internally or externally rotated.
·The ankle joint may be affected either in internal/external rotation or pronation/supination.
Typically, the low back and the hip joint will experience the most discomfort or pain when there is a pelvic rotational malalignment.
Luckily, our corrections are fairly simple. While there are some specific muscles we could chase like the TFL, lumbar erectors, or even lats, we need to correct the posture which gave rise to our malalignment. (Releasing tight muscles can definitely help too, but let’s start with the posture.)
Addressing posture becomes fairly simple. Since our malalignment likely arose from either a sitting, sleeping, or standing position, we need to focus on correcting all of these.
Stand up, and reverse your pelvic position like this:
I will even try to rotate my clients pelvis towards the right and ask them to resist me. This will strengthen the muscles which have become weakened to the pelvis being rotated towards the right.
You need to hold this and then observe if your pelvis gets neutral.
If you are training, make sure that you always start neutral. Be careful for lifts like squats and deadlifts because it is very difficult to control your pelvis with these type of lifts, especially if you are lifting heavier weight. If you’ve had pain with these type of lifts and you have a pelvic rotation, it’s very possible the rotation has contributed to your pain.
This isn’t the end of the story. You need to make sure that your pelvis is corrected when sitting. Chances are that you got a pelvic rotation from sitting like this:
To correct, you need to have your clients sit in an eutral posture.
When lying down,
You need to make sure that you aren’t lying on a groove. Make sure your bed is flat. You can even check your ASIS while laying down to make sure they are level. If not, you should put something under the glute which is lower or sleep in a different part of your bed.
Let's assume you are correcting a pelvic rotation towards the right. This means, we need to make sure the pelvis is neutral or temporarily goes towards the left.
When sleeping on your side, you should discourage right sidelying because it promotes a rotated pelvis towards the right.
You could use a cushion under your top knee in the picture above if you really liked laying on your right side.
I would say more emphasis should be placed on sleeping on your left side because this promotes your pelvis rotating towards the left.
I'll find some individuals who only sleep on their right side, and sleeping could be the sole culprit.
Still, you should examine everything to help them get neutral.
Pelvic rotation is often a culprit in hip and low back pain. Once you correct it, you may not alleviate all of your pain, but it is definitely a step in the right direction.
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