Unlevel Pelvis in the High-School Athlete: Exploring Causes and Effects
Saturday, March 14, 2015 03:48 PM

The unlevel pelvis is all too common in the high-school athlete and if not detected, will likely cause a lifetime of musculoskeletal issues. Any provider who doesn't look for this common finding is missing critical information.

An unlevel pelvis, defined as a pelvis that has one ilium higher than the other ilium, is typically seen on an A-P lumbar X-ray. Let's explore the biomechanical consequences of the unlevel pelvis, along with common causes and how you can address the problem before it becomes a chronic issue.

This imbalance is a clear demonstration of asymmetry between right and left. For an athlete, this asymmetry increases the likelihood of injuries and decreases potential performance. The immediate effect of this imbalance is an increased likelihood of injury. When there is an imbalance between right and left, one or more areas of the body (ligament, tendon, muscle, cartilage or bone) will be under a greater degree of stress. This increase in loading sets tissue up for failure once there is a great enough accumulation of stress. For an athlete playing the same sport and the same position over a long enough period of time, the repetitiveness of this motion leads to premature tissue breakdown.

The long-term effect of this imbalance is an acceleration of degeneration of the tissue involved. This makes detection of the unlevel pelvis critical, even in the absence of symptoms. There are three common causes of the unlevel pelvis; detecting the exact cause is critical in making the proper treatment recommendation.

1. Anatomical Short Leg: The first cause is an anatomical short leg on the side of the low ilium. 

2. Increased Pronation: The second cause of an unlevel pelvis is increased pronation of the foot on the low pelvis side. 

3. Increased Knee Q Angle: The third cause of an unlevel pelvis is an increased Q angle (medial rotation) of the knee on the low pelvis side. This finding often accompanies pronation, but when the Q angle is greater on the low pelvis side, this finding must be addressed in order to attain better pelvic balance.

Our profession needs to continue educating and encouraging young athletes to be biomechanically evaluated prior to their season starting, and proactively address the imbalances and joint fixations before they become bigger, long-term problems.

Source:  http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=57297