Muscle News Vol I.20:  Small Hemipelvis  
Funcitonal Scoliosis: Do You Have a Condition Setting You Up for Curvature of the Spine?
You're probably familiar with Scoliosis, a condition where the spine curves sideways into a C or S-shaped appearance from the back.  Individuals with Scoliosis can suffer from shortened stature, physical deformation of their vertebrae, many physical pains and even lung and heart problems in severe cases.  

It is commonly believed that around 65% of scoliosis is "idiopathic", meaning that we don't have a known cause for it.  But could this be yet another case where Myofascial Trigger Point Therapy has some answers for us?

President Kennedy's personal physician and pioneer in the field, Dr. Janet Travell, found that many of us are already predisposed to developing a type of scoliosis called "Functional Scoliosis".  Functional Scoliosis is a sideways curve in our spines that develops due to physical factors we can correct ourselves.  

As an example, when one of our legs is shorter than the other, it causes us to slightly lean to that side (as in the drawing).  This tilts the base of the spine (sacrum) and forces the spine to curve in compensation to keep us standing up straight.  

As a solution, using a heel lift (as shown) under the short leg can relieve the need for the compensating curve in the spine, thereby preventing the progression of Functional Scoliosis.

In today's modern lifestyle, sitting is a practically a marathon event.  Many of us are sitting as much as 8 or more hours per day.  That's more than most professional or Olympic athletes practice their sports.  If there were a physical factor that caused Functional Scoliosis while we sit, that would be one of the most important factors to correct to keep our spines straight and healthy throughout our lives!  

Indeed there is such a factor and it is the subject of this issue of Muscle News.  This factor is called a Small Hemipelvis. 

Having a Small Hemipelvis means that one half of the pelvis is slightly smaller than the other.  When you sit, you sit on two bones at the bottom of your pelvis - your "sit bones", technically called the Ischium on both sides.  Like a short leg, a Small Hemipelvis means that the Ischium on one side is higher than the other, causing the base of the spine to tilt, especially when sitting.

In the diagram, Hemipelvis B is smaller than Hemipelvis A.  As a result, the spine is tilting to the right side.  Notice the curvature in the spine that compensates so that the individual can sit up straight.  Sitting for 8 hours a day can cause major physical issues over time for this individual.

Having a 
Small Hemipelvis affects us to varying degrees.  Some of us may develop visible curvatures in our spines.  Many of us suffer from low back pain, mid back pain, shoulder problems and especially neck pain, headaches and TMJ (jaw pain).

The good news is that this form of Functional Scoliosis and accompanying symptoms can be addressed with a simple solution called an Ischial Lift.  Like the heel lift for a short leg, an Ischial lift does the compensating for the Small Hemipelvis so that the spine and muscles don't have to.  

The diagram to the left shows how placing an Ischial lift under the right side compensates for the Small Hemipelvis.  Note how the spine straightens.  The muscles all along the spine from the low back up to the neck no longer have to strain to keep the individual upright when sitting.  

This relief of strain is sometimes so dramatic, severe pains are alleviated in a short period of time.  A recent patient who had been dealing with chronic pain in her back expressed her relief in tears when an Ischial lift was placed under her Small Hemipelvis.  

Dr. Janet Travell and other trigger point therapists since her time have found that using this simple technique can prevent, improve and even correct many cases of Functional Scoliosis.  

Perform the quick Self-Assessment below to get a good idea whether you have a Small Hemipelvis or not.  As always, if you need assistance, your myofascial trigger point therapist is a great resource.   
*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.

(3) Steps of Self-Assessment and Correction for a Small Hemipelvis & Functional Scoliosis:

STEP 1:   Self-Questionnaire

Ask yourself the following questions:
  • Do you often sit with one foot tucked under your buttocks?
  • Do you have a hard time sitting for long periods or finding a comfortable seated position?
  • Do you cross one leg over the other frequently?
  • Do you prefer standing to sitting?
  • Do you have back pain when sitting?
  • Do you have headaches?
  • Do you have TMJ?
  • Do you have a scoliosis-type curve in your spine?
Answering yes to any of these questions may indicate that you have a Small Hemipelvis.  

STEP 2:   Seated Assymetry Assessment

For this step, it is best to have another person assist you, but you can also perform this assessment using a mirror if no one can assist you.

1.)  Sit on a hard surface without a backrest (such as a piano bench) with the clothing removed from your upper body so your spine is visible.  A board can be placed on top of a softer surface, as well.  If performing alone, have your back facing a large mirror and hold a small mirror in front of you so that you can see your spine in the reflection.

2.)  Now have your helper check for the following 5 Signs of Asymmetry that indicate a Small Hemipelvis:  (If performing alone, look in the small mirror without turning your head)
  • Is the head tilted (one ear higher than the other)?  If so, note to which side.
  • Is one shoulder higher than the other?  Note which side.
  • Is one shoulder blade higher or stick out more?  Note which side.
  • Is one skin fold at the top of the hips larger or deeper on one side? 
  • Does the spine appear curved from side to side?  (The tips of the vertebrae can be marked with a pen to see the alignment more easily.)  

STEP 3:   Ischial Lift Correction

If you found any asymmetries, the next this step is to place a small lift under each sit bone individually to see if it makes the symptoms and asymmetries better or worse:

1.)  Stay seated in the same position as Step 2.  Have a stack of a few magazines within reach.

2.)  Place a magazine about 1/8th inch thick under the right buttock (sit bone/Ischium)

3.)  Note how you feel.  Is there any tension relieved in the muscles of your spine from your back to your neck, shoulders and jaw?  Do you feel more balanced? Or do you feel worse?  Now switch the magazine to the other side / left buttock.  Note how you feel.

4.)  Next look at your back.  Are any of the asymmetries corrected with the magazine under the right side?  Add another magazine or two to increase the height of the lift.  Look to see if the asymmetries even out or get worse.  Now switch to the other side.  Is is better or worse?Increase the height of the magazines on the corrective side until symmetry is achieved.  In the diagram below, Picture B indicates symmetry with the ischial lift on the right side.

5.)  Switch back and forth a couple of times to experience the difference with the lift on the correct side versus the incorrect side.

6.)  Sit with the magazine(s) on the correct side for 5 to 10 minutes.  Take note of how you feel again and how your back looks.  If the improvements last, you know you have made the proper correction.

7.)  Take the magazine(s) out and measure their thickness.  This is the thickness of the ischial lift you will need to use whenever you sit for any length of time.  You can purchase ischial lifts from your trigger point therapist or online at G/W Heel Lift, Inc.  You will need the same height lift for hard surfaces as in the above test.  However, you will need twice this height if the surface you are sitting on is soft, and three times this height if the surface is cushy, such as a couch.

Over time, it is important to re-evaluate to make sure the correction is still needed.  Sometimes, the asymmetries may be caused by muscles more than by a Small Hemipelvis.  Stretching these muscles or having trigger point therapy performed can correct the muscular dysfunction, eliminating the need for the Ischial lift.    
If you correct these asymmetries, you may prevent or even reverse Functional Scoliosis and a lot of other pains and physical problems, as well.
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Link Highlights:

NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

"Healing through Trigger Point Therapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction" by Devin J. Starlanyl and John Sharkey, with illustrations by Amanda Williams.
 This book is written in reader-friendly language for patients and care providers, with treatment options for migraines, irritable bowel syndrome, plantar fasciitis, symptoms associated with aging, and much more. The book explains the source of pain and many non-pain symptoms.

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