Are you aligned?

Managing Malalignment – Clinical Tips Part 1

Very few active people make it through an entire season without experiencing some form of injury associated with weakness and/or with what physios refer to as malalignment.  Malalignment is a common condition referring to the alignment of the pelvis with respect to the rest of the body.  It can affect participants in sports that require significant rotational and diagonal forces, like tennis, hockey, soccer, and golf.  It can also affect people who engage in prolonged sitting at work or driving.  Pelvic malalignment can be a primary or contributing cause of over 50% of those with back and limb pain. The aim of this blog is to create an awareness of the most common malalignment presentations seen in the clinic.

Most sports require symmetrical strength and flexibility for optimum agility, mobility, speed, acceleration and deceleration control. But swinging sports are often asymmetrical in nature and can put a torque on the body, leading to an imbalance in length and strength of muscles and tendons. In the healthy body, we are able to withstand these forces. However, with repeated torsion over a period of time, your body’s ability to adapt is overwhelmed; this can cause asymmetries of muscle tension, strength, weight-bearing and joint ranges of motion leading to poor performance, dysfunction, pain and injury.


What does malalignment feel like?

Does your body ever feel like it is crooked or twisted? Do you ever feel as though one foot is scuffing the ground more than the other foot? Do you feel stronger on your mountain bike with one foot forward vs the other?  Do you get knee pain with running that seems to have developed out of nowhere? If feelings such as these are accompanied by pain or stiffness in the lower back, groin, buttocks, hamstring or elsewhere this could be due to malalignment syndrome.


Common Risk Factors for Malalignment:

·       Playing asymmetrical sports that require a lunging and/or rotation action such as tennis and other swinging racquet sports such as golf, baseball, hockey or cricket

·       Repeatedly landing from a jump with one leg first as in a tennis serve, volleyball, cricket bowling or skiing

·       Training on a camber (sloped surface, like the side of the road)

·       Inadequate core stability

·       Inadequate muscle control, strength and endurance

·       Inadequate hip flexibility

·       Driving for long distances (reaching for the gas pedal)

Assessment of Malalignment:

Your physiotherapist is trained to assess the pelvis and it’s alignment with respect to the rest of your body and in relation to your reported symptoms.  It is very possible that your knee pain may be caused by the malalignment of your pelvis, lumbar spine, thorax and/or a combination of these.  There are a number of simple checks that help us to decide through a combination of strength and flexibility testing as well as a visual and hands-on postural alignment assessment.

It is not possible to cover all of the different presentations and biomechanical changes that are associated with malalignment in the confines of this blog. Different presentations can occur and will present differently in each individual.  Determining the root cause of your pain and functional limitations is where physiotherapists excel.


As primary health care providers we avoid looking at an injury in isolation and ensure we examine the spine, pelvis and entire kinetic chain for signs of malalignment. The intention with this short blog was to create an awareness of pelvic malalignment, the malalignment syndrome and the type of problems these can create for active individuals.  Over time patients can learn to recognize the subtle changes that may occur upon recurrence of malalignment, such as a change in walking or running gait, changes in ease of multi-directional movement, or abnormal tension in the myofascial tissues. Early recognition of malalignment allows for earlier treatment, correction, and ideally an avoidance of the discomfort and associated problems.


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