Question
I take Pilates and I have some problems with the hip area. First, I have a (batwing?) hip and it doesn't have enough inversion. When I pull my leg in for the single leg stretch my hip won't let my leg come in enough. Also, when I do a warrior pose my hips don't balance well on one leg. Is that something that can change? My left knee patella isn't stable either, it goes out alot. I've recently been t-boned in an auto accident and now my shoulder is out, lifting it high is a problem. I have cervical spinal stenosis and a L-5 S-1 annular fissure other than that, Pilates has helped alot. I was thinking about quiting the chiropracting for  awhile and going to a Pilates Physical Therpist. What do you think I should do? By the way I am 51,if that helps.

Answer
Dear Sharon,

I have to confess I have never heard of a condition called Batwing Hip, and neither had my partners or a radiologist friend of mine.   So, I took some time to research it in a few medical texts as well as online, but couldn't find any descriptions.  So I must ask is this a congenital (from birth) deformation of the hip joint, or a developmental/degenerative problem?

Anyway, if you have the loss of inversion and it is from a congenital or degenerative condition, it is not likely that you will be able to create an increase in the inversion of the joint unless there is a fascial or myotendinous restrition.  If an bony anatomical difference/restriction to joint movement exists, then you will not be able to create increases inversion unless there is a surgical resolution available.

As fas as pilates goes, I encourage you to continue.  Pilates is a great form aof rehabiliative exercise, and will continue to provide conditioning and stability. Balance should improve over time, but you may never be able to perform the warrior pose completely if there is an anatomical problem.

Concerning the unstable patella, does it float out laterally from the knee?  If so you are likely to have a common problem with the Q angle.  This is an anatomical measurement and concerns the forces generated by the quadriceps muscles of the anterior thigh and the tracking of the patella.  Most common is lateral displacement of the knee cap which can easily be rectified by strengthening of the VMO (vastus medialis obliques muscle).  This is the muscle located medially to the knee cap (inside of the leg).  To train it for stability, seated leg extensions are thr preferred exercise.  Some trainners will say that the last 10-15 degrees of movement is the most important, but research shows that the VMO is active through the full range of motion of the knee joint, and that is how it should be exercises.

If you have instability medially and laterally, this could be the indication of patellar subluxation whic lies at the end range of tracking problems and results from a combination of static alignment problems that can include femoral rotation or anteversion, muscle imbalance, ligamentous laxity, and tibial rotation. There is ususally some degree of pain with this condition. The bottom line is that this condition needs a focused examination of the knee and specific treatment protocls that should be assessed by a sports medicine orthopedist.

Concerning the shoulder injury, again this should be evaluated by an orthopedist with training in sports injury, and you should be undergoing rehab for any shoulder instability...shoulders tend to be unstable forever if they are not actively addressed.  The shoulder is not an inherently stable joint due to its increased range of motion and the lack of a true bony stabilization.

Depending on what the chiropractor is doing for you, I am not inclined to recommend you to stop treatment.  The spinal stenosis you have is not likely to improve as it is a narrowing of the space where the spinal cord is housed.  Spinal manipulation from the chiropractor will help keep the areas affected by the stenosis moving freely which will limit the progression as well as inhibit excessive scar formation and increased pain in that location. The chiropractor should be encouraging you to pursue rehabiliative efforts for spinal stabilty for the low back, the knee and the shoulder, and teaching you specific exercises for those areas.  If this is not being addressed, then I would agree that you need to see a physical therapist.  Most chiropractors trained in the last ten years, and all sports trained chiropractors incorporate physical rehab into their treatment programs.  IF your chiropractor is not doing this, then I would suggest you find one that will, or look for a physical therapist who has training with sports type injuries.  The American Board Chiropractic Board of Sports Physicians can help you locate a Chiropractor with advanced training.  www.acbsp.com  

If you have any additional comments or questions, just write back.

Respectfully,
Dr. J. Shawn Leatherman