Recent E-mails

One of the great questions that I have been asked is the reasoning for some of the differences between the PRI L AIC, R BC, and R TMCC patterns from the Common Compensatory Pattern (CCP). In this article, there seems to be a slightly different attitude with respect to the right side of the hemipelvis and the convexity of the right lumbar spine. I’ll share a quote below outlining this difference.
 
"Other findings associated with the ana- tomical short right leg include a pronated left foot with a supinated right, an anteriorly rotated right innominate, and a posteriorly rotated left innominate. Functional rotoscoliosis is also observed with a lumbar convexity to the right, thoracic convexity to the left and cervical convexity to the right."

It seems as though the way Pope has describes this CCP phenomenon is with a left ASIS and hemipelvis that is higher than the right with a shortened and concave left lumbar spine. I would be so curious to hear the stance of the institute on this subject.

I appreciate your question regarding Zink’s and Pope’s thoughts and findings about leg length and innominate positions. There are so many juxtapositional discussions in this article. Although I believe the majority of it I can personally make sense of, I cannot follow their explanation of the lumbosacral junction discussion. Without getting into details regarding Denslow and Chace, and Mitchell findings, I want to remind every reader of this article, that when the left innominate anteriorly rotates and the right innominate posteriorly rotates, the sacrum (right rotation of sacrum on a right oblique axis) directs the entire column to the right through the sacral promontory base the spine sits on. Both femurs are also directed to the right, and the right leg needs to rotate inwardly (adduct) as the tibia also compensates into supination as weight of the body is dispersed over to the right side. Often the left internally positioned femur will be rotated out or externally to compensate for both top down and bottom up neurologic patterning of this lateralized displacement of body weight and function. This compensatory activity on the left often lends to a longer leg on the left because of femoral head outward and forward translation on an innominate or acetabulum that is anteriorly positioned when you lay someone with this orientation in supine.    

There are so many possibilities on what “they” see or perceive from an osteopath perspective, that may or may not correspond to what is actually true or not to neurological function from the top down. Although I agree with figure 22 regarding the feet, I do not believe there is a majority of people with this compensatory (left on left OA axis) pattern that is “commonly seen” with “an associated supinated foot on the right” because of a “left on left” patterned sacrum; when in actuality if you look at the soft tissue ligaments, and the frontal plane, like we objectively do in the Myokinematic Restoration course you will find there is no short leg issue on the right as much as there is a long left LE. The left LE more than likely is externally rotated forward, in the inwardly or medially directed oriented acetabulum that could contribute to the left femur appearing longer as it translates out of an acetabulum that is pulling the femur slightly up because of right on right axis positioned sacrum; with an innominate on the left that is anterior to the one on the other side. But because of a number of factors associated with supine or standing testing, subjective measurements (palpation) do not reflect the ligamentous muscle that is limiting or providing the appearance of a longer leg on the right, and thus comparatively a shorter leg on the left. The same would be true regarding convexity and concavity of the spine... Supine? Or standing?    

I do know this, there are many researchers, especially of the sacral iliac joint that would whole heartedly disagree with both Zink, Pope, me and others. “Compensation” and “Orientation” are two very different words and worlds. I try to do everything I can to clarify what is doing what for compensation of a directed and positioned pattern because of cortical, visuo-spatial, binaural echolocation and dental occlusion. There is no “common compensatory pattern” that multidisciplinary researchers will ever agree with in total. Although there are many things I agree with in this article, there are MANY that I don’t agree with. I hope you can respect me for who I am and not who I agree or disagree with.  

I would like to cover more, in detail, “Other findings associated with the anatomical short right leg ..." but quite honestly it really will not help the student who is interested in compensation as a result of the “Common Orientation Pattern” as it relates to the human asymmetrical respiratory AND hemi-cortical asymmetrical pattern. Compensation will always follow orientation, and trying to make sense out of someone else’s lexicon and perspective is difficult at best. I have been asked about this article more than any other article on the internet, and although will often refer to it for Janda, Greenman, Zink, references, the fetal growth, fascial bias, etc. I don’t believe there is a predominance of asymmetric leg growth as depicted, nor do I believe figure 28 (short right leg structural findings) is accurate. The most common finding of the thoracic curve in those with “common scoliosis” is convexity, not concavity on the right, and concavity not convexity at the thoracic lumbar curve, reflecting the L AIC and R BC pattern I reference in this Institute. Supported by many multidisciplinary evidence based studies. The osteopathic field is wonderful, but it is not universal.

- Ron Hruska, MPA, PT

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