I have a 27 year old client who has had a compacted spine in L5-S1 for 14 years and has developed a bump in that area. She has also had a triple pelvic osteotomy in the right hip two years ago. Her left leg is bigger than the right as a result of compensation, but she has a massive adductor magnus muscle in the right leg. She also gets tingling and numbness in the right peroneals and tib anterior. Her right hip is only posteriorly rotated. Both hamstrings are tight, and when she lunges with the right leg (sagittal, frontal, transverse) and reaches to the ground with her arms, her low back arches and she struggles to get back to standing. I have trigger pointed her piriformis to release the sciatic problem, but do I stretch her hamstrings and right adductor, or is it a defense mechanism because of her back problems? Any help would be much appreciated.
It sounds like your client’s pelvic position, tightness and increased muscle mass is a result of a common compensation (albeit an extreme one) from an actual leg length difference.
The body is attempting to equal the leg lengths by posteriorly rotating the right pelvic bone (and possibly flattening the right foot). This may also start to explain the compacted spine (L5-S1) as the spine laterally flexes to the side of the longer leg. The increased adductor mass (and biceps femoris tightness) may be due to lack of glute strength (synergistic dominance) on the right.
The left leg appears larger as it is carrying more weight as a result of a weight shift to the shorter side, coupled with a common neural preference to stabilize with the left leg (vestibular dominance).
The numbness and tingling in the right peroneals and tibialis anterior may be a result of neural impingement. The common peroneal nerve that innervates these muscles originates from the L4-S2 area. So this could be a result of the compacted spine or some other problem such as a bulging disc, spondylolisthesis, etc.
With all of this in mind, before you prescribe any kind of exercise program for this client, you should refer her to a specialist. This way, it covers you professionally as this is a little outside of a personal trainer’s realm, and a specialist will be able to diagnose what is really going on far more effectively and safely with the use of digital imaging.
Once the specialist has diagnosed the problem, you can work alongside him/her to strengthen your client safely with the knowledge that you are not going to do her any harm.