Hip Degeneration due to Category 2 Distortion Pattern

What is your frame of reference regarding pelvic rotation?

Where is the axis of rotation for the pelvis?

The description of various physical phenomena is relative to the perspective of the observer and the observed objects, especially regarding the nature and behavior of the physical body. Barring birth defect or traumatic injury as a cause, is the appearance of a “long” and “short” leg the result of an anatomical deficiency or rotation of the pelvis?

How does this affect Hip Degeneration?

Ilium Femur Axis of RotationPelvis Axis femur ilium

In anatomy, pelvic tilt is the orientation of the pelvis in respect to the femurs it rests upon and in space. It can tilt in four basic directions. Based on the perspective that the axis of rotation is the acetabulum and the femur.

  • Anterior pelvic tilt is when the front of the pelvis drops and the back of the pelvis rises. The hip flexors shorten and the hip extensors lengthen.
  • Posterior pelvic tilt is the opposite, when the front of the pelvis rises and the back of the pelvis drops. The hip flexors lengthen and the hip extensors shorten, particularly the gluteus maximus which is the primary hyperextensor of the hip.
  • Lateral pelvic tilt describes tilting toward either right or left and is associated with spinal curvatures or people who have legs of different length. It can also happen when one leg is bent while the other remains straight, in that case the bent side’s hip can follow the femur as knee lowers towards the ground.
    • Left pelvic tilt is when the right side of the pelvis is elevated higher than the left side.
    • Right pelvic tilt is when the left side of the pelvis is elevated higher than the right side.

The conventional causes are attributed to:

  • Anterior pelvic tilt is caused by increased lumbar lordosis and thoracic kyphosis, stretched abdominal muscles, tightened hip flexors.
  • Posterior pelvic tilt is caused by sway back and thoracic kyphosis, stretched flexors and lower abdominal muscles and tightened hamstrings.

Applying the Tenets of Treatment

Rotation Acetabulum

This begs the question is it the muscle attached to the pelvis, lumbar lordosis and thoracic kyphosis or is it a Category II distortion pattern? When viewed in through the lens of the Tenets of Treatment. “Everything the body does is defensive in nature.” All of the muscles listed above are contracted to defend the body. While the lordosis and kyphosis is a function of the R plus C Factor. However, the axis of rotation of the ileum relative to the sacrum does not occur at the junction of the acetabulum and femur.

Sacrum Ilium Axis of Rotation

Pelvis Axis sacrum ilium

The axis of rotation of the sacrum relative to the ilium occurs one body inch superior and one body inch posterior to the acetabulum. When the interdigitated grooves of the upper and lower boots of the sacroiliac are separated the ilium will counter-rotate the ilia relative to the sacrum. This creates the rotation associated with the Category 2 distortion pattern.

Rotation Ilium

The axis of rotation one body inch superior and posterior of the acetabulum leverages the acetabulum superior and inferiorly. This creates the appearance of a functional short and long leg. The muscles mentioned in the first section contract to prevent further rotation of the pelvis. The R plus C Factor is the lordosis and kyphosis also involving the muscles associated with a Category 2 Distortion pattern occurring from the tip of their toes to the top of their head. Not just at the sacroiliac joints. “No part of the body can be excluded from the whole.”

Hip Degeneration

Pelvis RotationIn a chronic Category 2 distortion pattern, the torsion in the pelvis will cause a tightening of the acetabular ligaments. This drives the femoral head into the acetabular socket. Restricting and reducing blood flow to the cartilage, ligaments and bone of the femoral head causing a degradation of the involved tissues. This would be exacerbated in conditions such as insulin resistance where red blood cells are prone to aggregation. Any vasoconstriction or compression of blood vessels would have red blood cell aggregation blocking the flow, dumping their oxygen causing increased free radical damage. For More Info on RBC Aggregation.

Blood supply to the head of the femur

Screenshot 2015-11-30 20.04.154 groups of arteries :

  • Extra-capsular arterial ring
    • Trochanteric anastomosis
    • Major contributions posteriorly from the horizontal branch of the medial femoral circumflex artery and anteriorly from ascending branch of the lateral femoral circumflex artery
  • Ascending cervical branches
    • Retinacular branches
    • Arise from extra-capsular arterial ring
    • Pass up beneath the synovial and capsular reflections
    • In their passage they give branches to the metaphysis of the femoral neck
    • There is a free intramedullary anastomosis between branches of the superior nutrient artery system, branches of the extra-capsular ring, branches of the ascending cervical branches and the subsynovial ring.
    • Form 4 groups; superior, inferior, medial and lateral
    • The lateral group supplies most of the blood to femoral head
    • At the margin of the articular cartilage, these vessels form a second ring the subsynovial intracapsular ring
  • Subsynovial intracapsular ring (Chung)
    • Circulus articuli vasculosis
    • This ring may be complete or incomplete (complete more often in males)
    • From this ring, epiphyseal branches arise that enter the femoral head
  • Artery of the ligamentum teres
    • From the lateral branch of the obturator artery
    • Supplies small area about the fovea

Cartilaginous Degeneration

Cartilage degeneration of the acetabulum usually precedes that the femoral head. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior portion of the weight bearing area. The acetabular cartilage degenerates faster as the patient’ activity increases with a loss of blood necessary for tissue health and repair. The appendix refers Vasomotor Viscerosomatic pain to the right acetabulum. For More Info on Vasomotor Viscerosomatic Referred Pain. The tissue destruction attacks macrophage to clean up the damaged tissues causing further degeneration and destruction.

Acetabular DegenerationAcetabular rim degeneration is a constant finding in the aged hip, which seems to be triggered by femoroacetabular impingement caused by a Category 2 distortion pattern. Cartlilage degeneration of the acetabulum usually precedes that the femoral head. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior portion of the weight bearing area.

 

Axis UMS

Axis LLL

The psoas muscle attaches to the lesser trochanter. The psoas/diaphragm complex are part of the muscle irradiation involved in a Category 2 distortion pattern. This contracture helps to further reduce the blood supply to the hip joint. With the psoas/diaphragm contracture, diaphragmatic excursion is diminished further reducing oxygen/carbon dioxide transfer. Further exacerbating the Category 2 distortion pattern which is prone to insulin resistance. Both of which have impaired blood flow and red blood cell aggregation resulting in Oxygen Deprivation Neuropathy. For More Info on RBC Aggregation.

Exercise is recommended for those with Insulin Resistance to break up RBC aggregations.

Exercise is recommended for those with Insulin Resistance to break up RBC aggregations.