T Nation

Mobility Symmetry Syndrome Affecting Left Kinetic Chain?


#1

Hey TNation community,

I'll give you the short and sweet version and allow you to ask all the questions you want.

WHO: Me. Tdhbb. Male, 26, 6'4'', 200lbs. I have been a fan of this website and forum for almost 6 years now and attribute much of the health and fitness knowledge I have gained to it and the people it references. Goals are mainly in the ream of bodybuilding/hypertrophy.

WHAT: Mysterious and progressing injury causing asymmetrical behaviour and reduced mobility in the left side of my body while my right remains seemingly unaffected. This is severely harming my form for all exercises in the gym to the point where it is almost impossible to have a full range of motion.

WHERE: Main points of concern are the kinetic chain of my left side, mainly my knee, just above the glute around the iliac crest, and the shoulder area especially the scapula.

WHEN: Noticeable symmetry differences in September 2013, mobility problems with left shoulder in Jan 2014, mobility issues with hips, and tightness of the knee Feb 2014, with treatments commencing soon after.

WHY: After going through self prescribed treatments and multiple doctor examinations I am still severely limited in the gym and I am turning to the fitness community in hopes to find a solution specific to help me lift properly again, as well as help others who might be experiencing a similar problem.

HOW: This is still somewhat unknown at this point. X ray and ultrasound results have come back normal and the doctors I have seen are still not sure of the cause. After months of investigating the best way I can describe it is a ''black hole'' in my lower back tightening and pulling in the muscles of my left side.

I am desperate at this point to find a cause and remedy for my situation and since this issue mainly affects my gym performance the next thing I am wishing to pursue is inquiring and taking advice from the fitness/bodybuilding community. I know it is next to impossible to diagnose something online but I am willing to try anything.

More detailed information to follow. Thank you in advance for your help and advice!

  • tdhbb (you can call me Jake if that's easier)

#2

Alright so here are some more in depth specifics:

SYMPTOMS

One way I would put it simply is that in terms of current mobility it seems my right side goes between a 7-9 out of ten and my left side is more of a 3-5. It also feels as if though the muscles of my left side are being pulled and stretched into my pelvis so much to the point that using a medieval stretching table to cause traction on my left side is sounding like a suitable option.

But lets get to the details:

In terms of progression I first noticed my left knee experiencing tightness or pain while squatting, as if it was going to be torn off the lower I went. This was followed by my left leg feeling like overall it was getting sucked up into my pelvis and rotating outward slightly making my foot more duck footed. Now if I let my body ‘‘squat naturally’’ it tends to want my left knee to cave inward and my hips to shift to the right.

Soon after the issues with my knee I started having issues with my shoulder. I noticed during movements like facepulls and band pull aparts my shoulder was sloping forward and having a harder time pulling back into proper posture. I especially was having a hard time retracting it back into a proper range of motion for pushups and dips. For shoulder presses, especially with dumbbells, the left shoulder leans forward and the trap involuntarily shrugs up.

Symptoms Summary

  • Left knee feeling pulled laterally while doing squats

  • Extremely tight left hamstrings

  • Tight left hip flexor

  • Compressed feeling just above left glute, difficult to transfer force from ground up through this area

  • Left shoulder slopes forward and down

  • Unable to depress scapula (while performing a pushup for example)

  • Unable to fully lift left arm above head

  • Unable to pull left shoulder back into proper posture

  • Lying flat on my back, I can feel my left shoulder blade protrude and touch the floor

  • Forcing scapula back makes lower traps and lats lock up

  • Lots of â??clickingâ?? when moving my shoulder through normal ranges of motion.

TREATMENT

Before I started experiencing this problem I regularly practiced tight form on my lifts, did compound movements (programs such as Boring But Big) and did a mobility warm up (bands, foam roller, light weight movement patterns, activating muscles) before each workout with relative success. Everything I had experienced in the gym before this point was expected and was able to be remedied ie muscle soreness, evenly distributed tightness etc. I was able to do my workouts without any issues. I would also like to point out my

So early 2014 I started getting my knee looked at by a doctor who recommended me to a sports therapist while I was also seeing a chiropractor. I also started yoga once a week in addition to mobility drills found on Tnation such as the Agile 8.

My shoulder started to have the mobility issues as described above and I sought out a physiotherapist. At one point I was seeing 3 separate doctors who were all baffled and all said I should stop weight training which I was not prepared to do. I love training and kept seeking new doctors upon recommendations from friends and colleagues.

I have now since seen 6 different doctors (1 general doc, 2 chiro, 2 sports therapy, 1 physio) and they all can acknowledge something is wrong but they cannot find the cause. I also had a personal trainer for 6 months in 2014 and restarted all my lifts with just the bar, emphasizing good form but the tightness persists.

Iâ??ve tried electro muscle stimulation, cork insoles, foam rolling, using a lacrosse ball, weightlifting shoes, yoga, various stretching positions, every mobility exercise that introducing varying forms of cardio, rowing, stationary bike etc etc etc and nothing seems to make a consistent improvement.

I even finally took a whole month off of lifting in August 2015 and stopped driving my car as I thought it produced uneven development but neither improved my condition.

I am now stuck as I cannot continue to afford doctors whose treatments arenâ??t doing anything and my shoulder is so bad that I cannot physically pull my shoulder blades back anymore to even do rehab exercises properly.

PERSONAL OBSERVATIONS

I will start this section with a disclaimer that I am not a doctor, do not have a degree in sports therapy and am only listing my observations to help fill in some details that may possible click with some readers to describe the sensations I have been feeling.

  • Again my right side responds just fine to all workouts and mobility training. I have no issues with it. If I were to draw a metaphor it would be like my right stretches like an elastic band, while my left stretches like a piece of string ie it is very painful and feels like something is going to pop that shouldnâ??t.

  • I cannot progress in the gym anymore because my left side fatigues out of pain before the muscle actually fails.

  • Issues with my shoulder I donâ??t feel it has to do with a tight pec muscle. I do not overwork them and stretching my pecs has little to no effect on my shoulder performance.

  • As I have experimented with my movement patterns in the past few months it feels as if the muscles of my left side are being tugged into where my hip inserts. Here it feels like something is out of place. On my right side in this area it feels like the muscle is acting in a â??convexâ?? fashion supporting lengthening. On the left side it feels â??concaveâ?? and like itâ??s drawing all the muscles inward.
    It actually feels like if I can â??popâ?? this development back into place I can get rid of most of my issues.

Things that seem to begin to help:

  • Traction on both left arm and leg at the same time
  • Overhead tricep single arm cable press, very controlled form seems to help lengthen, and loosen the lats & lower traps
  • Sitting in a leg press and performing a calf stretch one at a time (immense stretch on left side). Again, feel a tug at both ends in left side of my lower back.
  • Thoracic spine stretches
  • â??Pigeonâ?? yoga pose
  • Rolling a baseball/lacrosse ball into my shoulder blade and lower back

Things that make it worse:

  • Forced form squats. Forcing perfect form in my squatting stance puts a large amount of pressure on my left knee and it feels like muscle strands from my glutes to knee are â??jumping overâ?? eachother.
  • Bending over while deadlifting, left hamstrings incredibly tight and again feels like knee is going to pop if I push it.
  • Basically any regular lifting movements. It is a constant battle to have good posture first to perform a movement with a challenging weight.

#3

And some pictures for reference. There seems to be this depression in my left side that isn’t apparent on my right.


#4

While I am not/ can not diagnosing you, what you describe sounds very, very, VERY much like a common pattern of asymmetry known as a Left AIC – or possibly a Left AIC/ Right BC – which can be identified and treated by physical therapists who are certified by the Postural Restoration Institute.

Without getting into too much detail, essentially what happens with a Left AIC pattern is that the left half of the pelvis becomes anteriorly tilted, abducted, and rightwardly rotated due to changes that have occurred to the length-tension relationship of a variety of muscles across the hip and knee. This can lead to changes in trunk orientation and issues at the scapula and shoulder. Literally every symptom you describe is a symptom of this pattern.

Identification of this/ these patterns requires a series of assessments that can be performed in a single visit. Treatment is typically centered around non-manual techniques that place an emphasis on respiratory mechanics and the nervous system in order to inhibit and facilitate the proper muscles in the proper order. Full resolution can take between 5 and 15 visits with a physical therapist, spaced 1-3 weeks apart. You’d be responsible for completing the prescribed exercises 1-3 x daily for the duration of treatment. That said, most people can expect partial resolution of their symptoms or at least changes in their mobility and movement after the first visit.

You can search for a Postural Restoration Institute Certified physical therapist on the Postural Restoration Institute website, or I can refer you to a therapist near you if you tell me your location. I can not emphasize strongly enough that you require a PRI Certified therapist. Other therapists and healthcare professionals are unlikely to be able to provide you with anything more than partial and temporary relief of these symptoms.


#5

[quote]TrevorLPT wrote:
While I am not/ can not diagnosing you, what you describe sounds very, very, VERY much like a common pattern of asymmetry known as a Left AIC – or possibly a Left AIC/ Right BC – which can be identified and treated by physical therapists who are certified by the Postural Restoration Institute.

Without getting into too much detail, essentially what happens with a Left AIC pattern is that the left half of the pelvis becomes anteriorly tilted, abducted, and rightwardly rotated due to changes that have occurred to the length-tension relationship of a variety of muscles across the hip and knee. This can lead to changes in trunk orientation and issues at the scapula and shoulder. Literally every symptom you describe is a symptom of this pattern.

Identification of this/ these patterns requires a series of assessments that can be performed in a single visit. Treatment is typically centered around non-manual techniques that place an emphasis on respiratory mechanics and the nervous system in order to inhibit and facilitate the proper muscles in the proper order. Full resolution can take between 5 and 15 visits with a physical therapist, spaced 1-3 weeks apart. You’d be responsible for completing the prescribed exercises 1-3 x daily for the duration of treatment. That said, most people can expect partial resolution of their symptoms or at least changes in their mobility and movement after the first visit.

You can search for a Postural Restoration Institute Certified physical therapist on the Postural Restoration Institute website, or I can refer you to a therapist near you if you tell me your location. I can not emphasize strongly enough that you require a PRI Certified therapist. Other therapists and healthcare professionals are unlikely to be able to provide you with anything more than partial and temporary relief of these symptoms. [/quote]

Thank you very much for the thoughtful and constructive reply! I have done a bit of research just with google and am surprised how much of the literature overlaps with the things I have been experiencing.

I am also somewhat surprised/frustrated that none of the past doctors I have seen had even brought up the idea or concept before. I have already spent a lot of money up to this point but I found a couple practitioners in my area (based in the UK currently) and am looking to schedule a consultation if it ends up leading to a solution.

In the meantime is there any thing (stretches, movements) I can start doing today to improve my condition given the information above? (while still being able to exercise) Or should I put off everything until I see a PRI doctor first?
And yes, ultimately I understand you are not diagnosing or treating anything, I am looking for advice and direction under my own will and never would have gotten the Left AIC idea if I didn’t ask. So I still think it is valuable to post the information here in the meantime.

Also I will note a couple more observations in regards to my feet. When I lay down flat on the floor and extend both legs my left leg definitely twists outward and my left foot twists in such a way that the outside of the foot extends down and the inside of the foot pulls up into the leg. When I try and flatten my foot again my left knee wants to cave into the right leg. Looking at my foot at the back it’s like the left side is elevated 30 degrees.
Also looking at my shoes my right side is worn out more than my left. I am guessing because I place more weight on my right side.

Again, just adding more information just in case this helps anyone else.


#6

I understand your frustration completely. They did not think of/ mention the concept because they are unfamiliar with it themselves. It is not standard curriculum for any field, for reasons that I can’t comprehend. For instance, it is not uncommon for these asymmetries to show up on X-rays and MRIs, just to have doctors write them off as technician or patient error (i.e. They assume the patient just wasn’t laying straight). How you can do that consistently for years without wondering if there might be something else going on is beyond me.

I would avoid stretches, as they are unlikely to help and can potentially exacerbate your issues. For instance, you indicate that your left hamstring is tight. However, this is unlikely to be the case. It is more likely that your left hamstring is actually being stretched due to the position of your left hemipelvis. It feels “tight” because it is constantly being put on stretch, not because it is actually short. Stretching it further can actaully cause it to lengthen even more, which would feed your pattern. This is just one example of how stretching can backfire in your case. I will will include some exercises at the end of this post that MAY be helpful for you. However, this will in no way replace the advice of a PRI certified physical therapist (I’m not a physical therapist). I would make it a priority to start treatment with one of the providers you found ASAP if you want this problem fixed.

Your observations about your left leg rotation fits perfectly with the Left AIC hypothesis. Due to the rightward orientation of the pelvis, the left femur needs to externally rotate in order to keep you from tripping over your toes as you walk. Laying down partially neutralizes your pelvis, so the external rotation of the femur becomes more apparent. The uneven wear patterns on your shoes are also indicative of a Left AIC, although in a less direct way. It simply indicates that your pattern is effecting your gait mechanics, which is unavoidable.

Try these 3 exercises in this order for 3-5 sets of 5 reps/ breaths each. Pay close attention to the instructions, especially as it relates to breathing. The breath is a critical component of these exercises. Relaxed inhales through the nose, full exhales through the mouth:

(Will continue in the next post)


#7

#8

UPDATE:

So in the time since I have sought out a PRC provider close by and have done a consultation. He said that I definitely have symptoms of Left AIC according to them but again, is unsure of the exact cause of my symptoms.
I began treatment of the following exercises every day:

1 minute of deep breathing focusing on inhaling on my left side
12 reps/side lying hip shifts (pulling left hip then right hip down, vice versa)

4x:
12 reps cat/camel on all fours
12 reps all fours belly lift
12 reps, with a full slow breath at the top 90/90 Hip Lift w/medial hamstring
12 reps right sidelying left abductor respiratory pullback
12 reps/side glute extensions on all fours, one leg at a time

On a positive note what I have gotten out of treatment so far is learning how to hone in on trigger spots even further. Before I would try to rotate my whole trunk and hips slightly to offset my asymmetry but I have found isolating the region of my iliac crest on the back of my left side and imagining trying to shift it straight back, with some longitudinal rotation targets the mind muscle connection of my left kinetic chain better than before.

Despite doing these exercises every day for the last 2 weeks though I am still feeling quite tight on my left side. I started back with using the bar and light dumbbells only for my workouts but then started to develop a stiff shoulder again that feels as if the kinetic chain was cut just below my shoulder bones on my left side, the shoulder slid forward and puffy inflammation filled the space. The doctor said I have developed bursitis because my shoulder is still out of alignment so I�¢??m also trying to deal with the inflammation.

While I can feel a load of benefits for mobility on my right side (which is about a 7-8) my left shoulder has been a 3 at best and is about a 2 now. As I do the exercises for the left AIC and try to ever so slightly push my shoulder back into proper positioning I am still met with a lot of resistance. I still can�¢??t recruit my scapula to pull my shoulder back.

You can see some of the asymmetrical behavior in the pictures. I increased the contrast only to make it easier to see the lines.

Comparison 1: http://i66.tinypic.com/aax6xg.jpg
Comparison 2: http://i67.tinypic.com/2hmlx6e.jpg

FURTHER OBSERVATIONS

Things that �¢??feel�¢?? better:

  • having someone behind me pull my left shoulder up, around and down my back. This really pulls on the muscles of the left side of my neck though. I try to achieve a similar effect in the gym by lying on a bench with shoulders back and down and sliding up on the bench (when gym is empty).
  • Tried incorporating some Ã?¢??leg flossingÃ?¢??. While sitting and extending a leg at a time I notice pinching in my left hip flexor as well as a click at the hip and knee.
  • Trying to attempt to force my left shoulder in a less slumped, better posture position always sends shoots of pain down my whole arm like I am pinching nerves trying to Ã?¢??put it backÃ?¢??
  • When attempting pushups my right side works fine, however on left side my scapula is Ã?¢??stuckÃ?¢?? and my left shoulder rolls forward and my trap engages to lower me down.
  • Taking a plank or all fours position my right arm feels longer and supports most of my bodyweight as my left feels shorter because it is slid forward.

SUMMARY

Anyways, just wanted to give an update to others who might be experiencing similar issues. No clear working method just yet. Weights down to a minimum and taking anti inflammatory medicine for my shoulder. Continuing prescribed exercises though as well as some stationary bike to keep up my fitness. If the inflammation in my shoulder subsides I will try to post some more specific pics/videos of my current movement patterns.


#9

Another photo for reference.

Let me know if you guys need any more info or have more questions.

I wish Tnation had a sticky about this topic as I’m looking through the forum history and there seems to be people sharing the same issues.

EDIT - Sorry the pictures came out so large this time.


#10

Which exercises did your therapist recommend to you? I find it strange that he said you had “symptoms” of a Left AIC. That can be determined by a relatively simple test which gives you a clear yes or no answer. Odd.

Can you post a picture of the front of you rib cage?


#11

Apologies if I missed it, but what do you do for work or sport? A lot of times if you spend all day doing one movement it will generate imbalances that are furthered when weight training gets involved. In my case, I would play 80 baseball games a year plus practices, and spend all summer holding a nail gun in my right hand. Naturally this meant an excess of rotation in one direction, and poor scapular position on the right side. Once I had the imbalance any training I did, even if it was symmetrical with good form, would just further the problem. Over time and with assistance work I’ve corrected it for the most part, but I think a lot of time the most crucial part of addressing this kind of issue gets missed. You literally have to be conscious of it at every point of the day.

Correcting it will mean trying to force yourself into proper position while at work, sitting, walking, sitting on the toilet and even breathing. My best guess is something that you did daily created an imbalance in your pelvis and over time caused your body to make adjustments up and down the kinetic chain, resulting in your scapular issues, knee issues and I’m assuming some tightness in the left lat as well. If you want to discuss it further throw me a PM and we can chat about some of the things that worked for me personally, two of them were already listed by members above.