Pelvic Obliquity – Systemic Compensation


Pelvic Obliquity and Medical Errors

Most patients going to see an osteopath or an orthopedic clinic have an obvious pelvic obliquity.
Many of those concerned are not aware that they suffer from pelvic obliquity because they have no pain in the pelvic area or the locomotor system; others, due to lack of information and misdiagnoses, see their pelvic obliquity as the main cause of their medical problems.

There is almost no other topic in medicine like pelvic obliquity, which is accompanied by so many misunderstandings and lack of information.

There are many misleading layman’s and medical terms, which circulate as an explanation, even among supposed experts, doctors, naturopathic therapists, osteopaths, and patients. This includes work-related poor posture, muscular dysbalance, tension, difference in leg lengths, functional tilt, structural tilt, blockage, dislocation etc.

Pelvic Obliquity and Medical Misdiagnoses

Frequently pointless and expensive diagnosis procedures to analyze the pelvis, e.g., x-rays, MRTs, or 3-D spine measurements are actioned, which can neither help to explain the cause of the pelvic obliquity nor can they indicate a therapy approach.
To understand how pelvic obliquity develops, static images are extremely unsuitable, because the static of the locomotor system adjusts to dynamic and functional aspects in the sense of compensating for them.

Pelvic Obliquity and Therapy in Conventional Medicine

The most frequently applied therapies are inserts, with or without the raising of one leg, a heel wedge, physiotherapy, and quite often doctors allege that the problem was caused by a lack of movement and that exercise would correct the pelvic obliquity, or that children would grow out of it. Also quite frequently, the pelvic ring and individual vertebrae are repositioned by way of chiropractic intervention.
Only very rarely do such measures eliminate pelvic problems, since the real reason for the pelvic obliquity can usually be found in the specific compensations of the craniosacral system due to systemic pathologies. These correlations are, however, only rarely recognized.

Pelvic Obliquity and Integrative Osteopathy

Pelvic Obliquity

If you look at the static of the human body in the context of integrative osteopathy, it becomes clear that almost all pelvic malpositionings are directly connected to the skull – sacral system, (craniosacral system), and the organs.
Constant organic stress situations lead to a force transfer to the occipital, sphenoid, or temporal bone via changed fasciae tension.

Stressed organs enlarge and lose the movement in their fasciae flaps, which directly triggers a specific compensation in the craniosacral system as well as the entire locomotor system. The longer this problem exists, the more severe are the changes in the static of the body, the nervous system, and the position of the organs.

The occipital bone is where the central nervous system leaves the skull through the Foramen magnum and runs to the 2nd lumbar vertebrae inside the spinal canal where it then attaches itself as a bunch of nerves, similar to a pony tail (Cauda Equina), outside the spinal canal to the lumbar spine and the sacrum.

Through the constant pull on the occipital bone this compensates and changes its position, whereby it usually rotates and tilts forwards or sideways. If the position of the central nervous system at the Foramen magnum changes the occipital bone, our organism will compensate according to specific patterns, e.g. by rotating the spine, changing the pelvic position, eventually also with organ relocation. The best possible functioning of the central nervous system and flow of fluids is a priority for our organism. Because of this, it accepts restrictions in the functioning of other systems, like pelvic symmetry.
Other possibilities from the viewpoint of osteopathy are a genuine up-slip or down-slip, whereby injuries can cause a shifting of the iliosacral joint, or a genuine anatomical difference in leg lengths, which is only rarely congenital. The anatomical difference in leg lengths develops most frequently after leg fractures or hip operations.

Therapy of Integrative Osteopathy

Prior to pelvic obliquity therapy a comprehensive diagnosis is made by utilizing all the possibilities of naturopathic diagnostics.
An exhaustive medical history gives information on systemic previous illnesses and the patient’s current medical problems.
Through knowledge of the compensation patterns, the osteopathic examination will show which organs are stressed and the leading cause.
Kinesiological muscle tests and neurological function analyses collate the information together and identify pathologies which have a permanent effect on the organism through chronic infections or intoxications.
It is only possible to eliminate the pelvic issue long-term, if the systemic stresses are effectively treated alongside visceral (organ), parietal (locomotor system), and craniosacral (skull-sacrum) osteopathic correction.
Infections and intoxications can be treated by Western as well as Chinese herbal medicine, as well as orthomolecular medicine.
Frequently, in the context of environmental medicine, a change in lifestyle habits is also indispensable, because in principle every person is the creator of his or her state of health, which to a large extent manifests itself as a result of one’s way of life.

Pelvic Obliquity as a Result of Anatomical Difference in Leg Lengths

Pelvic Obliquity through an anatomical difference in leg lengths is rare. In case of a true anatomical difference in leg lengths, the iliac wing is pushed posterior (backwards) on the side of the longer leg and turned anterior (forwards) on the side of the shorter leg.

Causes of Anatomical Difference in Leg Lengths

The most frequent cause of anatomical difference in leg length is a fracture (break) of the thigh or lower leg through accidents.
Receiving an artificial hip joint can also result in an anatomical difference in leg lengths.
Another possible origin is a congenital anatomical difference in leg length (very rare).

Diagnosis of an Anatomical Difference in Leg Length

In conventional medicine, a diagnosis of pelvic obliquity because of a difference in leg length is made exclusively by an x-ray of the legs, whereby both legs are fixed by a splint while the image is taken and subsequently measured.
Practiced osteopaths will have mastered additional examination methods, which can give clarification depending on training, experience, and skill.
The simplest examination method is to evaluate the knee heights, e.g. by using a spirit level. If there is a true anatomical difference in the leg lengths, the knees will show a different height when lying on the back while bending (during flexion).
Additional evaluation options can be derived from osteopathic therapy and knowledge of the compensation chains in the human body.

Therapy of Pelvic Obliquity due to Anatomical Difference in Leg Lengths

Therapy of pelvic obliquity due to an anatomical difference in leg lengths is by raising the sole of the shoe at the lower leg, or by a heel wedge which is placed in the shoe under the heel. As a rule, such a correction only makes sense if the difference in leg lengths is more than 0.5 – 0.8 cm.
Should there be a subsequent correction, one has to keep in mind that the shoe raising should be permanent so that the locomotor system is not exposed to continued static changes.
In additional the compensation of the problem should always be treated by an osteopath, particularly if the pelvic obliquity has existed for quite some time. As far as osteopathy is concerned, the craniosacral (skull – sacrum), visceral (organs), and parietal (locomotor) systems have to all be examined and corrected.
If the cause of the pelvic obliquity is not an anatomical difference in leg lengths, raising the shoe or inserting a heel wedge is contraindicated and amounts to medical malpractice, because the body is robbed of its options to compensate.
In the vast majority of cases the anatomical difference in leg lengths only appears to exist, because the legs look like they have different lengths due to so-called pelvic torsion. If an iliac wing is rotated posterior (backwards), the leg seems shorter because of the center of rotation. If the iliac wing is rotated forwards (anterior), the leg in turn seems to be longer.
A true anatomical difference in leg lengths is only the cause of less than 5% of the cases of pelvic obliquity and either has a probable genetic cause in very rare cases, or is the result of fractures, extensive leg operations, or developed because of incorrect prostheses.

Pelvic Obliquity and Compensation Patterns in Osteopathy

Following I would like to outline a short overview of the compensation patterns that lead to pelvic obliquity from the viewpoint of integrative osteopathy. It is only possible to have a brief look here. The processes are naturally much more complex and have neither been researched scientifically nor proven by studies. They are my conclusions as a result of many years of experience working as an osteopath and naturopath.
The explanation given for pelvic obliquity in the context of integrative osteopathy makes no claim of completeness or absolute correctness.
The explanation models described should be understood as a guiding principle which I use for indication diagnosis of systemic stress factors; they can contribute to the general understanding of how static problems of the locomotor system develop.
In reality, the individual patterns described only rarely occur in isolation. As a rule, in practice one can find mixed patterns that are either accumulative or overlap with each other.

Liver Stress and SSB – Sidebending (Lateral Inclination) on the Right

In cases of so-called sidebending on the right, the osteopath finds an enlarged, or stressed, liver with a loss of movement at the right costal arch, often with blockage of the thoracic – lumbar transition.
The occipital bone is rotated to the left in relation to the sphenoid, the left iliac wing is tilted posterior (backwards) and if the condition is chronic, the left leg is rotated outwards. The left foot is in a supinated position to support the shorter leg on the left. The fibula is cranial-posterior and lowered. The left knee joint is hyperextended. The right shoulder appears to be higher than the left shoulder.
On the left, the eye socket is further back than on the right and is smaller.

The kidney is lowered on the left side and, analogous to the occipital bone, all transitions of the digestive system are rotated to the left (clockwise).
Liver stresses are often caused by intoxications with environmental poisons like heavy metals, chemicals, and domestic poison, e.g. mold.
Additionally, chronic infections through infected teeth, bacteria (e.g., Yersinia), or viruses (e.g., Hepatitis A, B, C) as well as certain parasites can lead to stress conditions of the liver.
Gall bladder dysfunctions, which usually have a functional cause (see below urogenital pattern), also lead to liver congestion.

Stress of the Lymphatic (Immune) SSB – Sidebending on the Left

In cases of so-called sidebending on the left, analogous to SB on the right, the osteopath will find a stressed and enlarged spleen with a loss of movement at the left costal arch, often with blockage of the thoracic – lumbar transition.
The occipital bone is rotated to the right in relation to the sphenoid, the right iliac wing is tilted posterior, and, if the condition is chronic, the right leg is rotated outwards. The right foot is in a supinated position to support the shorter leg on the right. There is a posteriorisation and lowering of the right fibula. The left knee joint is hyperextended and the left shoulder appears to be higher.
On the right, the eye socket is further back than on the left and is smaller.
The kidney is lowered on the right side and, analogous to the occipital bone, all transitions of the digestive system are rotated to the right (anti-clockwise).
On the left side, the lymphatic system is much more pronounced that on the right, whereby the left costal arch shelters the largest lymphatic organ, the spleen.
Stress conditions of the lymphatic system are mainly triggered by chronic infections, but intoxications caused by solvents can also affect the lymphatic system negatively.

The Liver / Lymphatic Spleen Pattern – SSB – Double Sidebending

The so-called double sidebending corresponds to the inferior strain of classic osteopathy; however, here not the sphenoid, but the occipital bone is the leading dysfunctional skull bone.
In relation to the occipital bone, the sphenoid bone is blocked. Both iliac wings are tilted backwards.
If the problem persists, both thighs are rotated outwards. The knees are hyperextended, both feet are in a supinated position, and the fibula on both sides is lowered and caudal (posterior).
The kidneys, womb, small intestines, and bladder sink, whereby the stomach is pulled up into the diaphragm. Frequently this results in reflux esophagitis, caused by a functional disorder of the stomach entrance, the cardia.
This pattern is typical for e.g., people who fell ill with borrelia, because a chronic bacterial burden through borrelia stresses both the immune system (spleen) and, through neurotoxins, also the liver.
This form of compensatory pelvic obliquity, however, can develop through practically every chronic infection, while at the same time burdening the liver.

The Bowel or Bladder Pattern – Inferior Strain

This form of pelvic obliquity is almost identical to the pelvic malposition that develops through double sidebending. However, here the organ that is the cause of pelvic obliquity is usually the bowel.
Because of tensions of the small intestines which are attached to the sphenoid by way of the digestive system via the fasciae, the sphenoid is blocked towards the inferior in relation to the occipital bone.
A blockage of the sphenoid towards the facial skull or palatine bone is characteristic, in contrast to double sidebending.
This structural compensation is often caused by unrecognized food intolerances, chronic bowel infections, or illnesses of the digestive track caused by parasites. Chronic bladder infections, however, will also show a similar compensatory effect in the long term.
However, a mixed pattern with SB left – lymphatic / immune pattern is most frequently found, because the cause are usually infections.

The Cranial (Upper) Genital Pattern – Torsion


Pelvic obliquity caused by compensation through genital infection in the upper genital area (e.g., ovaries) is frequently initiated unilaterally.
Through the infection in the upper groin area, the leg rotates outward on the inflammatory side of the pelvic ring, while the opposite leg rotates inward so that both legs bend towards the direction of the inflammatory side.
The sphenoid bends compensatorily downwards (caudal) in relation to the occipital bone, towards the inflammation.
The zygomatic bone moves towards the inside, whereby this can lead to functional bile stasis if the problem is on the right, and the pancreas can be negatively affected if the problem is on the left.
The eye socket on the inflammable side is clearly lower and smaller.
In cases of cranial torsion, a blockage of the palatine bone on the affected side can also be found. Because of the occlusion problems, affected persons often complain of headaches and pain in the neck vertebrae.
This type of pelvic obliquity is mainly caused by infected inflammations, which is why the upper genital pattern often occurs in combination with the lymphatic immune pattern (SB left).
Frequently there are swollen lymph nodes at the throat and painful blockages in the iliosacral joint, often with pain radiating into the groin and hip.

The Caudal (Lower) Urogenital Pattern

The low urogenital pattern in the lower urogenital region usually develops unilaterally, caused through bacterial vaginal or testicular infections.
Here the outward rotation of the leg at the affected side and an associated strong inversion (inside rotation) and supination (inside tilting) of the foot are most conspicuous.
The pattern can nearly always be found in combination with the lymphatic spleen pattern, because here, too, an infection is the causal factor. The right iliad wing is also often tilted posterior, whereby here, if the inflammation process is on the left side – which, based on experience, happens much more frequently – the left lower extremity is more conspicuous.
The cause for this is usually a bacterial infection which is transferred by sexual contact, or at birth from the mother to the newborn. Women suffering from this frequently have vaginal mycoses and discharge, because the defense of the urogenital mucous membranes is lowered as a result of the bacterial infection.

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