IOL Strength and Conditioning

Dave’s newsletter last week spurred a lot of questions about hip mobility in general and an elevated hip in particular, with readers asking how to recognize the problems in themselves, and what to do to fend off the back surgery Dave eventually needed.

When I first met Dave in 1984 he had the elevated hip; I noticed his stiff, one-sided walk a long time ago. He says he’s had it a lot longer, but doesn’t remember when it started. I had an elevated hip — one hip higher than the other — for at least a couple of decades, that I know for sure.

Here’s the thing: It wasn’t until this year we learned it wasn’t a structural deficiency and that it could be fixed. I’d never heard of such a thing, and I suspect that’s true of most of the readers, and is the reason I’ve been nagging at this joint mobility and corrective exercise stuff all year.

In some cases there’s an actual leg-length discrepancy; usually it’s a functional issue, not a structural issue. Only about one in six people with a higher hip have a physically longer leg; the rest have an elevated hip that can be fixed in fairly short order. Muscles on one side are pulling the hip up, while muscles on the other side are weak and unable to offset the stronger side. We do weight training around here to make things stronger; this should be easy enough to fix, right?

If you look in the mirror at the top of your pelvis (that spot where we erroneously put our hands when we put our hands on our “hips”) and think one side looks higher than the other, you may have an elevated hip. If you’re unsure, take a couple of photographs — straight on, not at an angle, front and back shots. Print them and use a ruler to draw a straight line if you can’t tell for sure by looking. Better yet, take the photos in front of something straight, a window frame for example, to help you see level. In a clinical setting, the modern rehab folks will take photos with a grid background, full length with the patient wearing nothing but shorts or shorts and a bra top so they can really see what’s going on.

Once you’ve determined one hip is higher than the other, have someone measure your legs with a tape measure from the top of the anterior superior iliac spine (ASIS), the front of what we wrongly call the hip, to the inside of the ankle bone. If there’s a discrepancy of more than a quarter-inch, go to a medical doctor or chiropractic physician for an x-ray — that’s the only way to know for certain if the actual bone lengths are different.

Structural issues should definitely be addressed, usually meaning an elevated shoe on one side, to limit the problem so it doesn’t contribute to a cascade of whole-body pain.

Most commonly you’ll find no difference in leg length and can go to work on fixing the elevated hip on your own.

Why it’s worth the trouble fixing it is the list of other problems that tag along with an elevated hip. We can trot along fine with this in our 20s, 30s and maybe even 40s, but in my experience and in Dave’s, trouble is just around the bend after that.

Picture a skeleton hanging from a rod. Now visualize pulling on one hip to lift it higher than the other. Is it obvious in your imagining that other parts of the skeleton have to shift to allow that to happen?

That’s exactly what happens in real life, too. When the hip comes on up one side that leg gets a little shorter on the way to the floor, and upwards, the spine bends a little toward the opposite side, making the waist a little shorter on the elevated side and putting the person in functional scoliosis. It’s not structural scoliosis, where the spine is permanently bent, it’s functional and can be fixed.

It also means it will stay that way if not fixed, indicating a future of back, hip and leg pain for the person who’s either uninformed or unwilling to step back from their training long enough to fix what could eventually be a serious physical issue. If the sufferer ignores the pain long enough, maybe he or she will need back surgery such as Dave’s, getting another chance to go back and fix the functional problems after recovery from a major surgery.

With an elevated hip where one side is higher than the other there’s fascial or muscular tightness pulling the spine, and weakness on the other side allowing it to be pulled. We get regular massages or work on self-myofascial release with a foam roller and a tennis ball, add a little stretching and over time the soft tissue normalizes, the pulling stops and the spine goes back into its normal alignment. This is quite common… just most of us haven’t known that before.

We then work to balance the endurance strength of the two sides so that normal posture becomes easy to maintain.

This would also be the time to sort out any pelvic tilt and rotational issues to bring the pelvis back to its optimum position of a *slight* anterior tilt, which puts the spine in a mild lumbar lordosis, exactly where we want it.

At the same time, we would be working on joint mobility, especially in the hips and upper spine. In fact, this is exactly what Dave began working on this past week as part of his back surgery rehab. The more mobile and freely moving those areas are, the easier it is for the postural muscles to hold us in good static positions.

Here’s a review of joint mobility and foam roller rehab programs. I hope you’ll take some time with this and treat it seriously even if you don’t have an obvious hip elevation, because free moving hips is the key to easy movement now and into the later decades. If you do find an elevated hip, here’s how to get started fixing it.