The development of Trigger Points that refer pain to the groin, and dysfunction of the joints of the pelvis that cause pain locally, are often caused by structural asymmetries. These factors are often overlooked by the medical profession, so I always check a patient’s posture in my Boston area Neuromuscular Therapy office when there is a one-sided complaint.
Structural asymmetries: Check for a difference between the length of your legs and the relative size of your two pelvic bones. Also check your feet for fallen arches, and a long second toe (Morton’s Foot). Make corrections with a heel lift, butt lift and custom orthotics. With an asymmetry, you might consider having an osteopath or chiropractor check your pelvic alignment and sacroiliac joint alignment.
Iliopsoas: Lower Limb Length Inequality (LLLI) and pelvic bones of different sizes can distort the lumbosacral and sacroliliac joints of the low back that can aggravate Trigger Points in this muscle. Osteopathic or chiropractic manipulation, correction of the asymmetry with a heel lift and/or butt lift are recommended. Use of a moist hot pack across thee lower abdomen will help because there is a reflex area in the skin of the abdomen associated with the muscle. (Travell and Simons Vol II, p.105)
Sartorius: LLLI can affect the sartorius by the tendency to adduct the longer leg. Greater extension is required at the hip of the longer leg when running. Above the crease of the thigh at the angle of bone you feel there, the sartorius can entrap a nerve that goes to the skin of the lateral thigh and cause burning and abnormal sensations.
Pectineus: LLLI and hemipelvic asymmetry can cause adduction of the thigh of the longer leg and rotation of the pelvis. Both can increase tension at the groin. Correct with lifts and manipulation.
Quadriceps: LLLI, a flat foot or Morton’s Foot Structure can adduct the thigh at the hip and affect the vastus medialis. Trigger Points in the rectus femoris can rotate the pelvis forward causing increased flexion in the groin.
Adductors: This muscle group don’t seem to be affected by strucural asymmetries. Systemic factors and prolonged shortening of these muscles are the corrections that need to be made.
Hello Christina-very good article, thanks for the follow on Facebook. One simple suggestion with leg length discrepancy…if you have patient supine and do a long axis pull for 5 minutes on the short leg you can often quickly correct the si assymetry-sometimes with a simple “pop”… and if this works the patients partner can easily replicate and they do not need any medical background because it is very safe. BILL
Hi Bill,
Yes that can work nicely. With this asymmetry, however, as soon as you stand up the pelvis rotates again because the bones are different lengths. Your body compensates and the problem recurs. Long term correction means correction of the leg length with a heel lift or orthotics. In 20 years of practice, I’ve seen this often dramatically correct back problems with a $7 heel lift with little followup maintenance required. Thanks for your suggestion! I welcome the opportunity to talk about it. Christina