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It is quite common to see structural conditions in our clients, such as knock-knees, overpronation, forward head posture, sway back, and a host of other physical alterations. However, these do not always cause our clients discomfort; in fact, people can go for years without ever having symptoms or pain. Alignment problems abound in the lower extremities and it is not uncommon for them to lead to soft-tissue pain. In many cases, biomechanical dysfunction in one area leads to issues in another, as in overpronation leading to patellar-tracking disorders. In more developed cases, dysfunction continues to move up or down the kinetic chain, causing pain in multiple regions of the lower extremity. Sadly, in some cases, and in particular with knee pain, clients may go years in pain and see a variety of health-care professionals, but still not have an explanation as to why the pain exists. For about 10 percent of the population, there are fundamental structural alterations in the lower extremity bones that produce a complex cascade of dysfunction in the lower extremities. This composite of problems is called miserable malalignment syndrome (MMS) and can produce compounded biomechanical issues that can generate pain. In this article, we discuss how to identify and assess six key conditions or components of this dysfunctional syndrome. In my next article, Part 2, we'll explore the main treatment protocols for MMS and the role massage can play as a helpful intervention. ASSESSING MMS In MMS, the tibia and femur bones play key roles in the dysfunction. In most cases of lower leg pain, it is the soft tissues and biomechanical alterations that are at fault and produce painful symptoms. The following conditions and structural components are often seen in the clinic, but typically not all at once. BROAD PELVIS Some clients who have MMS have a broad pelvis; that is, a pelvis that seems wider in proportion to the stature of the person. There is no commonly used standard by which to measure the broad pelvis, so it is more of a general visual perception. With a broader pelvis, the femoral heads are farther away from the midline of the body. The distal femurs, however, naturally angle in toward the midline of the body, and a broader pelvis produces even more of this angulation, making the femurs less vertical (Image 1). The weight of the body is most efficiently distributed when the femurs are closer to vertical, so this increased femoral angulation results in more of the soft tissues around the knee being engaged to absorb the load. Because women have a wider pelvis for childbearing, and because it broadens more during pregnancy, this component of MMS is seen more frequently in women than in men. 96 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 5 technique CLINICAL APPS Miserable Malalignment Syndrome, Part 1 By Whitney Lowe Miserable (appropriately named) malalignment syndrome can have detrimental effects throughout the body. Conditions that can manifest as a result include: plantar fasciitis, knee pain, arthritis in the joint, shin splints, iliotibial band syndrome, ligament sprains, patellar tracking disorders, bursitis in the hip, nerve impingement, stress fractures, and sacroiliac problems. 1 The broad pelvis. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved.

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