Pelvic Torsion
and Structural Alignment in the Gravitational Field
by
Robert Schleip
Published in ROLF LINES, May 1996
While I am usually
very skeptical with any kind of "structural logic" in our work and
prefer to think instead more in terms of nonlinear system dynamics within the
complexities of human motor organization, there are few exeptions
in which I have come to agree to linear mechanical relationships.
Most of them deal with gravity and its long-term effect on human structure. The
following article, taken from a recent class handout of mine, is one example.
In
the practice of Rolfing as well as in several other methods of bodywork it is
not uncommon to experience the following scene: the practitioner discovers a
pelvic torsion in the client. After successfully unwinding it (with usually
either direct or indirect technique) the pelvis does indeed look more balanced
on the table. But when the client stands up, the trunk and spine are now
suddenly less good balanced than before; sometimes an underlying scoliotic pattern becomes more apparent. The question then
comes up: Has the practitioner done something wrong, or something
disintegrating to the structure? Or is it an acceptable sign of a necessary
"healing crisis" (like in homeopathy and some other natural healing
practices)? Or is it a sign of "a beautiful unwinding" of some hidden
deeper patterns that are now surfacing and which we gladly appreciate since we
can now work with them? This article will explore some anatomical relationships
in order to help us to decide.
A
pelvic torsion is usually defined as an intrasegmental pelvic pattern in which
one ilium is tilted more anterior in relation to the other. Another way to say
it is that one ilium is tilted more anterior and one more posterior in
comparison with each other. For reasons not totally understood by me most
torsions are - according to several published studies - "right
anterior" (i.e. right ilium anterior & left ilium posterior in comparison with each other). When the ilium tilts more forward this brings the anterior superior
iliac spine (ASIS) more anterior & inferior (and in most cases also more
lateral). The ischial tuberosity
will go more posterior and superior (and in most cases more medial). The posteriorly torqued ilium will perform the opposite changes. So
far so good.
Let's
now look at the relationship between acetabulum and
sacroiliac joint. Their distance form each other won't change of course. But
what can change is what I call "the vertical distance" between them;
i.e. the difference in height between them.
1)
As you can see in the enclosed illustration
an anterior rotation of the ilium will increase
the vertical distance between the sacroiliac joint and the head of the femur.
A posterior rotation of an ilium will decrease the
vertical distance between the sacroiliac joint and the caput femoris. (Hint: Please check the meaning of the last two
sentences - and especially of the words "vertical distance" - at
the above illustration before you continue reading. Otherwise you run a
considerable chance of missing the main point of this article.).
Imagine
now some outside force (e.g. an accident) putting such a pelvic torsion into
the body. How would this influence the overall alignment of the person standing
in the gravitational field? Obviously the position of the sacrum will be
influenced by this. The sacral base will be moved higher on the side of the
anterior rotated ilium. In other words the base of
the spine will be tilted towards the side of the posterior rotated ilium. Supposing that the sacral base can be either seen as
an important support for the spine or at the least as an important indicator
for the pelvic support for the spine above, we will now quite likely see a
trunk pattern with less a good vertical alignment than before. This is of
course all based on the assumption that the height of the top of the femur is
the same on both legs.
Now
imagine a healthy person standing with her pelvis on top of two legs where one
head of the femur is higher than the other. The reasons for this could be many:
a higher arch in one foot which might be more supinated
than the other, or for example a slightly different length of the femur or
tibia, the two longest bones in the body (be it because of the fact that bone
growth rates are never one-hundred-zero-zero-percent exact and symmetrical -
just look at the asymmetrical faces of people -, or be it because of a previous
fracture of one leg). A pelvis with no previous torsion between its ilii will be tilted now with the acetabulum
downward on the side of the lower femoral head. This will tend to tilt the sacrum
to that side and make it quite difficult for the person to maintain a good
balance with its trunk above. One way to cope with it (and not an unintelligent
one) will be to drop the sacroiliac joint a bit lower on the side of the higher
acetabulum and a bit higher on the other side in
order to decrease the sideways tilt of the sacrum. We know from orthopedic
measurements that a lot of weight is transmitted through those joints, therefor such a
compensatory torsion will be quite easily achieved if the person tries to keep
her trunk as evenly as possible balanced over her legs. The weight of her trunk
will simply tend to rotate one sacroiliac joint further down. Looking at the
above first illustration we understand that this will move the ASIS forward on
one side and backwards on the other, but it will also be quite successful in horizontalizing an important base of support for the trunk.
What
follows is quite simple. If a person is not complaining of any sacroiliac pain
and if our main job continues to be to improve her overall alignment with
gravity, then we should look at the sacral base in standing before derotating a pelvic torsion. If in a standing client the
sacral base is higher on the side of the anterior rotated ilium,
then it's probably useful for us as structural integrators to work on getting
the torsion out of the pelvis.
If the sacral base is lower on the side of the anterior rotated ilium, then it is probably a good idea to leave the torsion
as it is, since gravity as the therapist has been doing already a better job
than we would (Fig.3).
I
have watched this several times, even with several advanced bodyworkers
that I know in our field as well as in osteopathy, chiropractic, etc.: A
practitioner discovers a pelvic torsion in a client lying on the table and
works on getting it out. So the pelvis looks more balanced aesthetically to the
practitioner when lying on the table. But when the client stands up her upper
body is now less balanced than before. Sometimes the practitioners then start
to work on the trunk in order to correct it, sometimes
they call it a healing crisis, or even worse "a beautiful unwinding".
But they simply forgot to relate the pelvic torsion to
gravity before trying to correct it, and by doing so they disintegrated the
body actively themselves. Luckily "gravity as the therapist"
will be usually quite successful to retain the previous pelvic torsion again
after a few minutes of walking around or after walking down some stairs. So I
don't think that any serious damage is usually done in those manipulations, -
but it is simply a waste of time and energy.
What
are the best ways to diagnose a pelvic torsion and to diagnose the position of
the sacral base? Put a finger on the ASIS and another on the Posterior Superior
Iliac Spine (PSIS) of the right ilium and compare
their height in a standing client. (Note: The firmer you palpate the PSIS the
more exact will you be able to locate it ). Then do
the same with the ilium on the left side. This is
simple to do and is a reliable indicator for a pelvic torsion pattern. Then
look from behind at the so-called "dimples" in the skin over the
sacrum and compare their height from the floor. Their relative positions are a
fairly reliable indicator for the position of the sacral base. You could also
look at any visible side-tilt of the lower portion of the lumbar spine and
include that in your picture.
Doing
this you will find out that it is actually not so uncommon to see a
"structurally intelligent" pelvic torsion where the sacroiliac joint
has simply dropped down on a slightly lower femoral head. And of course there
are also cases where a "structurally unintelligent" pelvic
torsion (originating often by forceful outside events) has pushed the sacrum
higher on one side and thereby decreased the structural integration of the
whole person.
To
sum it up: Except in cases where sacroiliac pain conditions are more important
than overall structural alignment or in cases with some rare but extreme
side/side asymmetry fixations above, just follow this simple rule of thumb:
|
When the sacral
base is more superior on the side of the anterior rotated ilium: work on derotating the
pelvic torsion. |
|
In all other
cases2: leave the torsion as it is. |
"When you force a local misaligned
area into line, you only shift the strain.()
This is what manipulators call a chronic lesion.
A guy gets his back or hip out of order and
goes to a manipulator, who adjusts it.
He says `Oh, that's wonderful!', but he
goes down the stairs and by the time he's on the street it's back again.()
Gravity is the only tool that we use. I
think my experience justifies making this very broad assumption.
Gravity is the only tool that deals with
chronic situations in the body."
- I.P.Rolf
Footnotes:
1) Details
for this drawing taken from: Ackermann, Die gezielte
Diagnose,
2) "In
all other cases" means: If either the sacral
base appears to be horizontal OR if the sacral base is more inferior on the
side of the anterior rotated ilium.
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