- Dr. Bob
Balancing Bent Twigs
Someone said, “As the twig is bent, so grows the tree.” Well, I think someone said that. If no one said it, consider it said now because it’s clever. It also has much to do with human bodies.
You’d be surprised how many folks I see have tilts in the pelvis. This causes curves in the spine and increases the work required to move around and walk. Eventually there is wear and tear on the spine and other structures that cause pain and problems.
I’d like to intervene before that cascade of events if possible, but people do not always know they have the issue. I have seen adults who have no idea they have scoliosis, and are surprised to know how much it impacts health.
Imagine this: we tilt the floor or ground on which you are standing down to your right. In order to stand upright, you will need to lean your body to the high side---to the left---to keep from falling over. That’s the picture: if the sacrum tilts down on one side, the lumbar spine usually tilts to the opposite side to maintain balance. This is frequently seen with a compensatory curve in the thoracic spine so that the shoulders are uneven, too.
In teens, we see misalignments with sports activities, falls, exercise, etc. You may notice this by looking a person with their back to you. Is the belt level, or does it dip to one side? This is sometimes a matter of a simple adjustment of the pelvis to correct.
There are some people who have anatomically short legs. We can find this on physical exam, and we can quantify the difference by looking at the hips on x-ray, measuring the difference in height from a weight-bearing film.
Sometimes we see leg length differences after trauma with fractures, or following surgeries such as hip or knee replacements. Usually the joint replacements are done with great precision, but I saw one last year with a full inch deficit on the side of the hip replacement.
So what can we do?
If the difference is not great, I will address the pelvis first and see if we can correct the problem that way. Many times this is sufficient, and a patient goes their merry way happy and whole.
If the difference is between 5 to 10 mm (that’s a smidgen), I will insert a rubber heel shim under the insole of the shoe on the low side to see if that improves balance and stability in the gait.
When there is as much as a quarter-inch of difference, I would consider having the patient find a pair of shoes they would enjoy wearing and have the sole built up on that side enough to balance the pelvis. We use a local shoe repair vendor for this work, and they do a great job at a reasonable price. A fortified sole is not noticeable from above, so it looks natural and gets the job done.
Most of the time when these issues come up, I will also scan the feet to look at the arches. Three arches in the feet must be present for the foot to work as designed, and very few of us have all of them. Fallen arches also affect the gait and cause increase wear on the knees, hips, sacroiliac joints, and spine. We can attach heel shims to these as well.
If the imbalance has been there for a while, it may take a little time to adjust feet, knees, hips, sacroiliac joints, and spines to get them working optimally, but balancing the pelvis speeds the return to a better quality of life. I will use all the tactics in my arsenal to make that happen.
So look in the mirror. If your shoulders are not level, or if your pelvis is not level, or if both are crooked, give us a call. Tell Karen your “twig is bent.”