Anterior Rotation

An anterior rotation of half of the pelvis is an extremely common injury for athletes. It involves half of the pelvis (usually the right side) rotating forward relative to the opposing side. This has a ripple effect on the rest of the lower body. It can change leg length, place a stretch on specific muscles, and provide an altered neurological feedback loop. All of this will impact you or your athlete’s ability to run, jump, land, compete, and stay injury free.

How does it happen?

Most athletes and active individuals have no idea that they are rotated and how it happened. It can happen for a variety of reason. Here are some typical things that lead to a rotation:

Playing on an uneven surface – If an athlete is playing on an unpredictable surface, they will have difficulty knowing where to place their foot to avoid holes or high spots. We see this a lot younger athletes or recreational athletes who compete a lot of fields which aren’t well maintained. Any sudden, unexpected set will have a tendency to forcefully drive one leg up, causing a hip to rotate one way or the other.
Running on one side of the road – City streets have a crown to them, which allows the rainwater to flow into the gutter on the sides of the road. If an athletes is constantly running one direction on a road, they are striking on an uneven surface, thus we tend to see small, repetitive rotations which may eventually turn into a significant rotation.
Anatomical Leg Length Inequality – The research shows that 90% of the general population have legs of different lengths. If an athlete has even a small leg length inequality, their pelvis will have have a tendency to rotate and shorten or lengthen one limb to make up for the difference.
Scoliosis – The unnatural lateral curvature of the spine will definitely have an impact on the entire spine and pelvis due to the limited lateral flexion on one side and tendency to load more on one leg than the other.
Falling hard on one hip – Depending upon the sport, athletes may fall or get knocked down hard, landing on one hip, forcing it into an acute, sudden rotated position.
Repetitive jumping on a single leg – Sports such as basketball and volleyball will predispose athletes to anterior rotations because of their repetitive jumping and landing on a single leg. Many of these athletes will tend to be more dominant on one leg than the other, thus they will usually use that leg and will place unnatural shear forces on that side of the pelvis.

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Characteristics

An athlete who has an anterior rotation will present with pain and irritation, usually in the lower extremity and/or low back, and usually only present on one side of the body. Many clinicians get frustrated by “chronic” lower extremity injuries because they never get to the true cause of the problem when they stay focused on the actual site of pain. This shows a lack of understanding of biomechanics.

While it would be nice to be able to always associate one or two symptoms with lumbopelvic dysfunction, it is just too complex of an injury to do that. Every athlete will present differently as their body finds the path of least resistance. The old saying holds true to that you are only as strong as your weakest link. That’s why there is such a broad spectrum of injuries that are associated with lumbopelvic dysfunction. Whenever the body is not symmetrical and one limb is functioning different than the other, there will be a tendency for the body to break down. When it does, it is always the weakest link or somewhere in the path of least resistance.

Evaluation

The rotation is assessed by properly putting pelvis in it’s current “neutral” position. For more information on evaluating for lumbopelvic dysfunction, click here.

The anterior rotation typically has the following characteristics while lying supine:
The vast majority of rotations occur on the right side of the pelvis
The Anterior Superior Iliac Spine (ASIS) of the pelvis is even or lower on the affected side compared to the opposing side (pictured).
The Iliac Crest of the pelvis is even when compared bilaterally.
The Posterior Superior Iliac Spine (PSIS) of the pelvis is even or higher on the affected side compared to the opposing side.
Without the presence of an anatomical leg length discrepancy, an anterior rotation will cause a functional leg length descrepency

Most rotations will cause a shortening of the leg on the affected side, due
Figure 9: Leg Length Descrepency

to the posterior placement of the Acetabulum of the hip. So, as half of the pelvis rotates anteriorly the leg shortens as the posterior portion of the pelvis rises.
There is, however, a small portion of the population who will actually lengthen the leg on the affected side, because their Acetabulum is placed in a more anterior position than most of the population. These people will lengthen the leg when the pelvis rotates because the anterior placement of the Acetabulum will push down on the affected leg (pictured).
For more information on leg length inequality, visit our pages of information about functional or anatomical leg length inequality.

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Treatment

The treatment of choice for an Anterior Rotation is a good pelvic joint mobilization. This is a pretty specialized area of expertise that calls for advanced training. It is beyond the scope of a website discussion and should be left to those who have been educated in this area and have taken the time to perfect such techniques.

If you are an athlete in need of such a treatment, or a clinician who does not possess the skills to correct such an injury, we invite you to contact us to schedule an onsite educational seminar to learn the techniques to correct lumbopelvic dysfunction.

Other options that you want to explore is contacting a local Doctor of Osteopathy (D.O.), Chiropractor, Athletic Trainer, or Physical therapist who may possess the manual skills necessary to fix such an injury

Other treatment options include muscle energy techniques. These techniques use specific muscles of the hip to push and pull the pelvis back to a neutral position. These techniques can often be performed by the athlete themselves and rely on small, incremental changes to the hip positioning to correct the problem. The drawback is that while they can be effective for creating small changes, sometimes those small changes are significant enough for the body to maintain for very long. So, in rather severe or long term cases, they can be a little futile.

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