ORTHOMORPHY

Articles

Hip Story

This article was originally published in Positive Health issue 85 – February 2003

When Mrs S came to me for her first appointment, she was suffering from advanced osteoarthritis in both hips, spondylosis, osteochondritis, chondromalacia, bursitis of the trochanter and disc prolapses at L4/5 and L5/S1.

She was indeed suffering from these pathologies with strange names. At night, a pain in her knees kept her awake and she would be tossing and turning in search of a comfortable position. She couldn’t enjoy walking as her legs got easily tired and her knees painful.

She couldn’t climb stairs without pulling herself up on the rail, nor bend down to tie her shoelaces. She walked like a robot with little flexion in the knees and feet thumping flat on the ground, producing a limping gait from pain on the left side.

In April 2001, following a further X-ray and an MRI, she was told by another specialist that the MRI showed necrosis in the left femoral head and that she should book up for a left hip-replacement in the autumn. In spite of this shocking news, Mrs S was not ready yet for such invasive treatment – she wanted to try to keep her natural hip a bit longer. In her late 50s, she felt it was too early for artificial hips.

She made the right choice in not rushing into surgery as a computer tomography revealed that the diagnosis of necrosis was wrong – she ‘only’ had a reduction of circulation caused by the outer edge of the acetabulum digging into the femoral head.

After a few attempts at some alternative approaches, Mrs S came to me to try the Mézières Method. Her postural analysis revealed many departures from the normal shape. The first examination requires the patient to stand up with feet together, a difficult position for Mrs S who had great difficulty in keeping her balance. Her right foot was constantly going into supination and she was using her arms as an aid to redress her precarious balance. The front view showed the right hip bone higher than the left one and the left shoulder higher than the right; an anterior tilt of the pelvis; knees turned inwards, and a tightness of the adductors muscles of the thighs, which was responsible for a gap between the top of her legs. The profile view revealed a marked thoraco-lumbar lordosis spread from the lower back to the lower tip of the shoulder-blades. As a result, the lower ribs were sticking out, suggesting also a contracted diaphragm. The lower legs were pushed backwards from the ankles and the torso was bent slightly forwards from the hip joints. In the supine position, the thoraco-lumbar lordosis was considerable. The left leg was rotated inwards with the knee slightly flexed. This proved to be a position that Mrs. S. could not maintain for more than few minutes before an agonizing pain in the left knee forced her to flex it – with the help of a few expletives!

Still in the supine position, but with the legs lifted at right angles to the torso, there were compensations galore in an unconscious effort to escape the strong pull on the posterior muscular chain that this position brings about. The knees turned resolutely inwards, the sacrum was not touching the floor, her feet were in supination, especially the right one. Any attempt to correct these distortions provoked more compensations and complaints from Mrs. S. Realigning the feet, turning the knees outwards and pushing the sacrum onto the floor provoked a painful stretch behind the knees instantaneously followed by a rounding of the shoulders off the floor, in particular the left one, which also became inclined towards the head. Her head was tilted back and leaned to the right. There was a strong tendency to hold her breath and breathing out was very limited. The abdominal muscles were weak and inhibited by the tight back muscles so that they had great difficulty in flattening the protruding lower ribs.

Mrs S told me recently that she found her first Mézières session so difficult, uncomfortable, exacting and frustrating that she nearly abandoned the idea. But she did return and is now delighted that she persevered. For the second visit, I introduced her to the Alexander Technique. Sitting into a chair was a very difficult task and Mrs S would, after much flapping of the arms, collapse into the chair in an uncontrolled fashion. There was very little possible flexion at the hip joints and much weakness in her quadriceps. Standing up was no better and could only be achieved with the use (for which read misuse) of the arms and much shortening of the spine. I explained to her that her musculo-skeletal pathologies were caused by a strong shortening of her muscular chains and that, although I could not ensure that an operation could be avoided, we could greatly improve her condition.

Here is an extract from her diary about her treatment: “It’s September, Friday the 13th, 2002. I feel great, on top of the world, spring in my step, head up high. I really like myself today, use every shop window possible for a mirror and am proud of what I see – head even higher!” These days, Mrs S comes to her sessions with a big smile on her face. She looks radiant and much younger than she did when I first met her. She walks tall and relatively gracefully. She now can sleep without pain and can walk long distances without fatigue or discomfort. Climbing stairs is no longer a problem. She can sit and rise out of a chair without much ado. Her hips have regained some flexibility and her quadriceps are starting to tone up. The pain in the left leg that has caused Mrs S to curl up when she is in a supine position has been the most stubborn symptom. But in this regard, her latest session was a breakthrough: when I lowered Mrs S’ legs to the floor after a long and difficult Mézières posture, she noticed how the left leg was resting unusually flat and relaxed on the floor and the familiar pain hadn’t kicked in. For the first time since she developed her osteoarthritis, Mrs S had the sensory experience of a contented leg.

Although it’s still too soon to say if the operation will be unnecessary, we’ve made great progress and the prognosis looks rather positive. Mrs S has been rewarded for having persevered with a demanding form of psycho-physical re-education

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