Expert: Dr. J. Shawn Leatherman - 11/20/2006

Question
Hi,

About a year ago, I took a fall playing volleyball vertically on the right side of my butt.  The x-ray shows the right side of my hip is pushed up about 10 degrees compared to my left.  The chiropractor I saw tried to pushed it back down.  This relieves my pain, but my hip doesn't seem to move back to alignment.  I still have pain on my lower back and discomfort now and then.

Is there a way to fix this?  Hip excersize perhaps?

thank you,
Peter

Answer
Dear Peter,

Concerning your x-ray...being pushed up 10 degrees, there is no way that the chiropractor can push it back down...this is an anatomical fact.  Now what can happen is that he can correct improper joint mechanics in the sacroiliac joint which will decrease pain and inflammation while promoting improved joint mechanics. That is how the adjustment works, along with neurological imput to the brain from the joint receptors.

What needs to be checked is if you have any anatomical leg length inequality, which will show up on a front view lumbar/pelvic x-ray.  If one leg is shorter than the other, and the spine leans toward the short leg side, then you are a candidate for a heel lift. The chiropractor should also check to see if the sacral base is level or short and correlate this with the short leg.  Reason:  the spine sits on the sacrum, not on the legs.  If the leg was short on the right by 6mm, but the sacral base was short on the right by 3mm, then you would only need a 3mm heel lift for correction.

The heel lift fits inside the shoe and will help to accommodate for the loss of height in the leg.  I do not recommend placing a heel lift in a shoe more than 7-8 mm in height.  If you need a heel lift taller than that, you should have your shoes built up on the outside. (Although few people have inequalities great enough for this)  Placing the heel lift will ease biomechanical stresses in the ankle, knee, hip, and low back.  

It is much more likely that the leg is short on the opposite side of the high hip.  If you had actually moved the hip/pelvis by 10 degrees from a fall there would be significant ligamentous tearing and significant injury.

I understand your concern and realize that the chiropractor may have shown you the x-ray differences without fully explaining the actual measurement and how this relates to the spine.  But the truth is that even the best x-ray film has a small margin of error due to projection of the image...like when using slides how you can make your hand large or small on the wall depending on how close or far away you move it from the projector bulb.  If you moved even slightly when the film was shot, the sides of the pelvis can rotate which will create a projected image being higher on one side than the other.  This is why you need to use the leg heights and the sacral base height for a more appropriate measure.

Hope this helps Peter.  Feel free to follow-up with further questions or clarifications if you need .

Respectfully,
Dr. J. Shawn Leatherman