So now your back hurts again. It seems to come on at different times maybe nothing consistent. Three is spasm and tightening and my butt is painful.

We looked before at the pronating runner and now we can realize that the chain of events need not stop at the knee. Excessive pronation is seen not only running, but also with walking and to different extents, right or left.

As the femur gets a little inward rotation from the pronation, it allows an anterior rotation of the right side of the pelvis, Gluteal muscle weakening by virtue of the pelvic girdle anatomic “shift” and consequent tightening of the back of the hip joint.

Very often, when the lumbar spine is presented to clinic and with accompanying reports of Piriformis pain this mechanical dysfunction is observed. Direct causality is hard to prove, but in most cases, success comes when the full lower extremity and its relationship to the pelvis and lumbar spine is seen, appreciated and properly managed.

Control of the spine from the lower extremities can be equated to the keel of a sailboat. You can float, but firm directional guidance will come from the keel. Proper forces will then minimize the variance of movement you are asking the spine to perform.