Gluteal Asymmetry: it means something !
Two photos above, toggle the red bar on the right. What do you see ?
Here is a case of a young football star we saw last night. He came in with a fresh right mid-belly quadriceps strain. This is a simple case if you know what the visuals are telling you. Just be sure you test your visuals (which are ASSUMPTIONS !), in other words, prove or disprove your hunches. What you SEE is not always what is present as the problem.
You can see clearly that in a prone position this chap has significant right gluteal underdevelopment compared to his left. This is a “quick peak” method of screening that i do on every patient when they turn over prone on the table as he is positioned.
There are many nuiances to this case, but here is what i was thinking the moment he told me about the injury…. “Doc, we were doing short 40 sprints, and my right quad just seized up?”.
I thought, hummmm….. i wonder if he was anchoring his thigh into his glutes and abdominals. Lets test his glutes first. If the glute is weak then i can assume he is quadriceps dominant and not anchoring the limb into the pelvis and core correctly. If he is gluteal inhibited, that means he will have underdeveloped glute if it has been there long enough. And if so, the glute cannot power hip extension so that range will be deficient. Sagittal extension will occur the next level above (lumbar spine) and inhibit the lower abdominals on the right. The hamstrings can also be called in to drive hip extension (welcome to the world of chronic hamstring issues in athletes). And if hip extension is limited, then internal rotation is likely somewhat limited. And if internal hip rotation and hip extension are limited then ankle dorsiflexion (“ankle rocker”) will be impaired and limited during midstance thus creating early heel rise during push off thus forcing the calf muscles to create more body mass lift than forward propulsion.
I put him on the table……saw the atrophied right gluteal……and proceeded to confirm all of the above. Treatment is based on figuring out who started this whole mess and reversing the functional pathologies in the pattern that makes sense to that patient’s neurologic system. It can be different for each person. You cannot “cook book” good manual medicine.
Prove or disprove your differential diagnoses or hunches……. make sure your direction is the right one. We all know what ASSUMING lead us to ……. it makes a donkey out of all of us.
We are….. The Gait Guys……. just a couple of donkeys.