In a recent New York Times article, “Short-Track Speedskaters Are Lopsided,” the author notes and interviews several Olympic athletes that can tell they are “off” and out of “balance”–and they notice this more during regular activities of daily life than in their event. The article goes on to highlight these asymmetries are most commonly seen with speedskaters. According to the article, it is common to find that their thighs and glutes are typically larger on the right, while their lower-back muscles maybe more developed on the contralateral side. This finding is common with athletes that always train in one direction or play a sport, such as tennis, that requires unilateral domination.
After reading this article I asked myself: does asymmetry really matter? Is this highly trained Olympic athlete with musculoskeletal imbalances setting themselves up for an injury later in life? Skeletal asymmetries are common in patients we see every day. As physical therapists, we intuitively know that musculoskeletal balance is a “good thing.” The scientific literature does suggest that skeletal asymmetries can lead to a shift in load transfer and an alteration of distribution of forces, especially throughout the spinal column (Popovich, 2013). In fact, there are clinically-relevant biomechanical models that show a greater than 1 cm difference in leg length can alter peak stresses across the articular surfaces of the sacro-iliac joint and corresponding ligaments.
Spinal imbalances as noted in this article, and other regions of the musculoskeletal system, are addressed primarily in our (600/700) quadrant courses. We teach you when and if these asymmetries are clinically significant or when the asymmetry is irrelevant to the condition your patient presents with. Begin your journey toward mastering these techniques in our Lumbopelvic Spine I and II courses (which can be taken in any order). Here are a few coming up (click on link for more info and to access more manual therapy videos):
–Michael Lucido, PT, DPT, FAAOMPT
J.M. Popovich et al. / The Spine Journal – (2013) -The Lumbar facet joint and intervertebral disc loading during simulated pelvic obliquity
Kiapour, A. et al./ Leg Length Discrepancy and the Sacro-iliac Joint Biomechanics. JOURNAL OF ORTHOPAEDIC RESEARCH OCTOBER 2012