Overcoming Chronic Neck Pain

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Fix the Posture–Upper & Lower Body

   –5 Posture Types in Profile

   –Left-Right Asymmetry

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Left-Right Asymmetry

1. Handedness posture characteristics
2. One-sided pain from handedness posture
 3. Correcting Left-Right Asymmetry—Goals
4. Exercises for uneven hips or shoulder heights, head tilt, malrotated hips etc.

Complicating any of the faulty postures in profile (e.g. flat back, swayback, kyphotic-lordotic etc.) may be differences between left and right halves of the body. Commonly, when the pattern of asymmetries is associated with being left or right handed, this is called "handedness posture."

1. Handedness posture characteristics: right-handed people may have one or more of the following asymmetries (left-handers have the opposite):
— lower right shoulder,
— head tilt to the right (or if not tilted, a greater distance between neck and right shoulder with over-stretched right upper trapezius)
— deviation of the thoracic spine toward the left in a "C"-shaped curve,
— a higher right hip that sways to the right, resulting in overstretched and weaker right gluteus medius,
— a prominent right pelvic ilium that has rotated toward the front, closer to the umbilicus (belly button)
— a lower left hip with tighter, shorter, lateral hip muscle and fascia (tensor fasciae latae and Iliotibial band)
— a recessed left pelvic ilium that has rotated toward the back
— the right leg appears longer than the left leg (pant legs rise higher on the right than left leg). [Of course there really may be a structural leg length discrepancy that accounts for uneven hip height and leg length — see an orthopedist for evaluation.]

Right handedness posture may be worsened by the following habits (left handers have opposite habits):
— standing with more weight on the right leg with the right hip higher and shifted to the right (I stood like this all the time without realizing – see illustration below);
— sitting with left leg and foot folded under the butt;
— lying on one's left side, propped up by the left elbow;
— holding a baby exclusively on the right hip.


2. One-sided pain from handedness posture:
     Examples of one-sided pain in right-handedness posture include:
— the left side of the neck, when head tilts to the right. Left lateral neck muscles are over-worked trying to keep the had from falling further to the left;
— the right hip because of stretched gluteal hip muscles and destabilization of the hip joint;
— the left side of the knee because of tight left lateral hip muscles that pull on the iliotibial band, which attaches to and helps stabilize the knee cap.
— the right side of the back because of shortening of right side torso muscles that are compressed between the low right shoulder and raised right hip; shortened torso muscles are more prone to spasm during turning or twisting in daily activities.

What causes left-right asymmetry? Perhaps an acute one-sided spasm of the lower back: "With a back spasm, the pull will be so strong and abrupt the body has to drop the shoulder and lean the head away. ...as [an unconscious] protective mechanism" (Carey, 2005, p.75). But maybe one-sided short, tight back muscles were already present from handedness posture, and any sudden twisting movement would have triggered one-sided back spasm. People are either right or left handed and use one side more than the other. This results is differences in muscle size and length between right and left... arms, legs, shoulders and torso muscles. The tendency that many people have of habitually shifting their weight to the same hip and leg, probably stems from handedness preferences. And are the result of long term habits in standing, sitting, lying and playing sports such as tennis or golf that exaggerate handedness asymmetries.

Because of the low right shoulder, you'd think the neck and head would tilt down to the right, but often the brain prefers the eyes to be level; so the neck will tilt left—in the opposite direction—to keep the head upright and eyes level; but this also widens the space between shoulder and neck (see illustration below: Asymmetric Upper Body-A), overstretching the right upper trapezius, which may cause pain.

Sometimes the brain easily compensates for uneven eye height, allowing the head and neck to follow the low right shoulder in tilting down to the right, which can result in pain and tightness of the left lateral neck muscles, which are under increased stress as they try to support the off-balance head and keep it from falling further to the right (see Asymmetric Upper Body-B). In left-handed persons, the opposite asymmetry—low left shoulder; short, tight left side; and raised left hip—may be present.

3. How to Correct Handedness asymmetries, including low shoulder, uneven and/or rotated hips etc. :

                           "Usually, shoulder correction tends to follow correction of lateral pelvic tilt..." (Kendall et al.)


— Lengthen compressed torso muscles on the side of the low shoulder, and shorten elongated torso muscle on the side of the higher shoulder.

— Equalize shoulder heights.

— Reduce head tilt.

— Shorten and strengthen stretched hip stabilizer muscles on the side of the higher, more prominent hip.

— Stretch over-tight lateral hip and leg muscles on the side of the lower hip and reduce postural leg length differences.

— Correct malrotation (inflare and outblare) of pelvis

— Frequently remind oneself to stand with weight evenly distributed between both legs, to sit with both feet flat on the floor, not to favor one side over another when holding children or carrying heavy items on the hip or in the arms, and not to prop yourself up on the same elbow in bed when reading (I lie on my back in bed to read with book on my chest and with knees supported by a pillow).


4. Exercises:

1) Lateral Side Bend and Shoulder Shrug Up
[Lengthens compressed torso muscles on the side of low shoulder, shortens elongated torso muscles on the side of higher shoulder, equalizes shoulder and hip heights.]
 A. For right handers: Stretch right lateral trunk muscles with side bends to the left, and shorten right upper trapezius with shrug-ups of right shoulder:
   a. Steady the body by placing the left hand, palm down on a low countertop for support.
   b. Shrug the right shoulder up high toward ears and hold, (helps stretch area between right arm and hips too)
   c. At the same time, bend the torso to the left (side bend) over the support arm—bending the elbow to accommodate—until a gentle stretch is  felt along the right side.
   d. Hold for several seconds (working up to 20 seconds if no pain).
   e. At the end of the stretch, return to vertical posture by pushing up with the left arm. This avoids tightening/strengthening the right side or  straining the back.
   f. Optional—Upper trapezius strengthening: Shrug-ups using dumbbell weight on right side until shoulder height is equalized, then shrugs on both sides. Restrict the shrug to upper range of motion and don't allow the weights to pull the shoulder down further. Avoid carrying around heavy weights and letting them pull down on the shoulder joint. Keep upper trapezius strong to avoid overstretching.

  B. Left-handers do the opposite: Stretch the left side of torso with lateral bend to the right and shorten left upper trapezius with shrug up of left shoulder.

3. The Hip area: (See image of hip muscles below)

— To address weakness around joint of the higher hip.

Squats and sit-to-stands (sit in a chair and stand up with body weight more towards the heel of the foot; eventually hold dumbells to chest to increase difficulty). When body weight becomes easy try using dumbbells. See these videos for more gluteus medius strengthening and hip stabilization exercises for the higher hip.

— To address tightness around joint of the lower hip.

b.) For the side with the lower hip: Stretch the lateral hip muscles, (Tensor fasciae latae or TFL) and fascia (iliotibial tract or IT band). A tight, shortened lateral hip muscle, the tensor fascia latae, contributes to a short-appearing leg (recommendations from Kendal et al.):
          - For stretching the Tensor fasciae latae/TFL) and fascia (iliotibial tract/IT band) of the short-appearing leg of the lower hip, see this AthleanX.com video: IT Band Syndrome and Knee Pain (HOW TO FIX IT!).
         - As an alternate stretch of tight lateral hip muscles and fascia: I used the opposite of right-handedness posture as a stretch. I assumed a left-handedness posture, pushing my left hip out to the left and lowering my left shoulder. At first I held the stretch for a good 10 seconds but not not long at all. [Precaution: Unfortunately, the first time I did this stretch, I stretched a little too forcefully and my left hip was painful for a week. This is why it's very important to be gentle with any stretch. But in time, I was able to continue the stretch and my leg length discrepancy is no longer noticeable. Currently, I don't do this stretch more than twice a week as part of my usual stretching routine after a workout.}
[Precaution: Once the correction is done, avoid doing this stretch frequently because of the risk of the same overstretching and hip destabilization that was a problem with the other side. If you've done this stretch a couple weeks and the leg-length differences hasn't improved, you may have an anatomical-based (bone structure) difference in leg length. Consult an orthopedist.]

Frequently standing with the same hip swayed to the same side causes stretched and weakened hip-stabilizing muscles. The main hip stabilizing muscle is the gluteus medius (see image on the left below) needs to be strengthened and shortened. On the opposite side the lateral hip and leg muscles and fascia, the tensor fasciae latae and the Iliotibial tract (IT band) become shortened and tight. (see image on the right).



— Pelvic Rotational Misalignment:

pelvic rotational misaligmentAsymmetry between right and left hip as result of rotation of the pelvis horizontally. The result is one forward, more prominent iliac crest of the pelvis and one recessed hip/iliac crest. The more prominent hip has a medial or internal hip rotation called inflare. The recessed hip has a lateral or external hip rotation called outflare.

pelvic rotationWhen the pelvis rotates, the spine, which is attached at the sacroiliac joints (SI joints), also rotates and takes the torso with it. So the torso would face toward the side. But we want to be able to walk straight ahead, not off at an angle. And we want to face forward to see directly ahead. And when we talk to someone, we want our eyes to face that person. To accomplish this, somewhere above the hips, the torso must twist back toward the front so the eyes face forward. The muscles that are able to twist the torso are called the abdominal obliques (internal and external), which have fibers that run diagonally from pelvic iliums to the lower ribs and along the front of the abdomen.

abdominal obliques

Exercise to Correct Pelvic Malrotation: Inflare and Outflare

Part 1 For right-side inflare: ilium prominent on right side and rotated toward umbilicus (belly button)

exercise-part1Lateral/External Hip Rotator Exercise:

   1. Lie on the back with knees up, feet flat on firm, padded surface.

   2. Bring right leg up to 90 degree angle and cross it over the left leg in a figure 4 position.


Exercise-part 2   3. Try to pull the right knee forward with both hands or use a belt around the knee to extend reach, but resist any movement with butt muscles (lateral hip rotators). This is an isometric exercise, no movement occurs. Be gentle; use 50% or less power to lessen risk of muscle strain.

   4. Hold for count of 5 - 10. The purpose is to strengthen butt muscles/lateral/external rotators in order to pull/rotate the right hip toward the rear.

exercise part 3 Part 2 for left-sided outflare: left ilium recessed and rotated away from umbilicus. [Always accompanies right-sided inflare]

Medial/Internal Hip Rotator Exercise

   1. Bring left leg up and cross over right leg in figure 4 position.

   2. Try to push left knee back with both hands against the knee, but resist any movement with inner thigh muscles.This is an isometric exercise; no motion occurs. Be gentle; use 50% or less of power to lessen risk of muscle strain and spasm of inner thigh/groin muscles which is very painful. (I’ve done it myself and couldn’t do hip adductor exercises for weeks.)

   3. Hold for count of 5. Do 3 or 4 times twice a day. The purpose is to strengthen inner thigh/medial hip rotators in order to pull or rotate the left hip towards the front.

Part 3 Torso rotation

[With right side inflare, the torso rotates to the right to counteract the pelvic rotation to the left, which results in shortened right abdominal obliques and psoas major, while on the left side there are correspondingly elongated torso muscles.]

Torso Rotation Exercise   1. Place left hand on left pelvic ilium to prevent the pelvis and lower body from moving.

   2. Keeping the ilium steady, twist the torso to the left.

   3. Hold for count of 5.

   4. Return to neutral position. Note that the right pelvic ilium has rotated significantly toward the back and away from the umbilicus.

For the opposite condition, left-side inflare and right-side outflare; do the opposite of the preceding instructions

And again it's very important to persist in standing with weight evenly distributed between both legs. This prevents further worsening of existing asymmetry, and once asymmetry is corrected, helps maintain the correction. Also important is to regularly self monitor the correction by checking in a mirror for uneven shoulders and head tilt, for instance. These asymmetries are difficult to "feel". They must be seen. Do not over-correct.

For pain, lack of improvement or worsening of pelvic malrotation seek professional help.



© 2017 Rochelle Cocco