Miserable malalignment can be fixed quickly!

Ever hear of the medical diagnosis “miserable malalignment?” Neither had I, until a client of mine who’s a physical therapist told me she had once been diagnosed with the condition (I still have trouble believing it’s a real diagnosis because it sounds so mean-spirited).

What is it? Well, it’s when a bunch of things in your leg and into your hip joint are misaligned. Your knee rotates in, your lower leg rotates out, and your arch collapses.  But according to the medical community, there is an easy fix!  What is it?

According to this website, it’s a screw/bolt looking thing.  It looks like this:

HyProCure's bolt (from

Now, yes, it does look like it can be had from Home Depot for 25 cents in the bottom drawer of aisle 17.  But what in the world would you do with that screw/bolt looking thing?

You would have it surgically implanted in your ankle!  Why? According to

realignment of the foot under the leg (elimination of excessive pronation, or flattening and turning out of the foot) is what is needed. The HyProCure® device is made to address this need.

So think about this.  Your hip joint gets out of alignment because of what’s happening at your ankle.  And apparently your ankle gets so under the influence of mysterious forces that you need a screw/bolt looking thing to stop it from getting out of line. Does that make sense?  At all?  Any?

That screw/bolt thing sounds like a quick fix to me (sort of…), but doesn’t it make more sense to be trying to reprogram the muscles of your body to align your bones better?  You know with some hard work, a little problem solving, some exercise?

That’s what I think.  That’s what my physical therapist client thinks.  But we are extremely biased.  And neither of us are trained surgeons, so take what we think with a grain of salt.

What do YOU think?

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17 Responses to Miserable malalignment can be fixed quickly!

  1. Trupti April 6, 2010 at 7:34 pm #

    I totally agree with the client and Matt! Physical therapists are supposed to help your body physically heal and function properly without suggesting to embed nuts and bolts in your body. My friend has about 3 screws in his ankle right now because he fractured/damaged/broke his ankle. I think that would be a good enough reason to have Home Depot-type fasteners in your ankle. However, if you are born with “miserable malalignment” (whatever that is!) don’t use a screw to fix yourself, have Matt help you! But if anyone ever chooses to use nails and screws, I’d suggest the Simpson Strong Tie brand. They are the number one fasteners used in wood construction!

  2. Kevin April 6, 2010 at 9:26 pm #

    I also agree with Matt and his physical therapist client. Matt’s knowledge and thoughtfulness to problem-solve are the best!

  3. rose April 19, 2011 at 8:23 pm #

    What types of exercises would be best for this condition to train the muscles if the bones are malaligned? What actually causes the pain associated with “miserable malalignment”?

  4. Matt Hsu, Certified Rolfer and Postural Therapist April 20, 2011 at 1:11 pm #

    Hi Rose,

    While I don’t know the particulars of your case, your best bet is to see someone who’s good at posture alignment therapy. Very likely, the supine groin progressive and the supine groin stretch are going to be extremely important exercises for you. Both are passive exercises that give your hip and leg muscles the opportunity to get used to proper alignment with gentle coaxing from gravity. The fix is not quick but the gradual approach means your body can actually handle and stabilize the change.

    Pain can come from a variety of sources, but the two common ones in dealing with chronic pain are too much friction (bone on bone or muscle across bone) and too much tension (within an overworked muscle). With miserable malalignment, depending on your specific situation, you’re probably dealing with both. Femur and tibia can’t articulate properly (excess friction), and the muscles that are creating this inefficient alignment are almost definitely doing work that is not ideal for their long term health.

    Hope this helps you on your quest. If anything was unclear, please don’t hesitate to ask for clarification!

    [Also, picture of the “bolt” has been updated as — the site originally referenced — has apparently been taken down.]

  5. ivy November 20, 2011 at 4:06 pm #

    Hi Matt,

    I am very excited to have found your site! Your philosophy is encouraging and you seem extremely knowledgeable and skilled. I so wish I lived in CA, so I could come directly to you, but alas, I live in NJ. Are you aware of anyone who does what you do (interdisciplinary combination of egoscue, rolfing, etc.) on the east coast (NJ/NYC preferably) area that you could recommend? I too have been diagnosed with miserable malalignment and am facing femoral and tibial osteotomies to fix it if I cannot improve through rehab. I have such intense, debilitating pain in my hips, knees and feet, I can barely walk, sit, stand or lie down without being in distress.

    • Matt Hsu, Certified Rolfer and Postural Therapist November 20, 2011 at 8:50 pm #

      Hi Ivy,

      Unfortunately I don’t know anyone in your neck of the woods who does combine these approaches. It’s not much solace to you in the short term, but in the long term we are working on putting together training programs to try spread the word and the practice around the country and the world.

      In the meantime, you could certainly seek out an Egoscue clinic or affiliate in NJ/NYC. There is a Westchester, NY clinic and a handful of affiliates out that way. I know there are also Rolfers around that area, though I do not have any in depth knowledge of how any of them approach things. Make sure you do a little screening by checking out websites and talking on the phone to see if they are the more structurally oriented Rolfers and don’t get too “out there” in terms of philosophy!

      Don’t let yourself get too distressed. With some stubbornness and perseverance, you’ll get where you want to go. Best of luck to you!

      • Matt Hsu, Certified Rolfer and Postural Therapist November 20, 2011 at 8:54 pm #

        Also, if you find a particularly good corrective exercise specialist, you might be in luck. It really is about getting muscles working properly again, and it definitely takes some time and perseverance.

  6. ivy November 30, 2011 at 12:20 pm #

    Hi Matt,

    Thank you so much for responding! Even though you do not know of anyone specifically, you have given me hope that my body may be able to improve without surgery. After all, I made it 40 w/out my body breaking down — surely it can “re-accomodate”. I did check out the Egoscue clinic in Westchester and will definitely go there. But I think what I really need is a more integrated approach that pulls from multiple disciplines. I guess I will have to be my own “coach” and put together a coherent, multidisciplinary “team” from different areas to work with me. Really wish there were more individuals like you though.

    In your experience, have you been able to help people with miserable malalignment (a bony anatomical condition) get better through working on their muscles?

    Thanks again,

    • Matt Hsu, Certified Rolfer and Postural Therapist November 30, 2011 at 12:56 pm #

      Hi Ivy,

      Be careful thinking of it as a bony anatomical condition. It’s generally just misalignment of bones, not full fledged abnormal growth of the bones. Misalignment can change, absolutely (and yes I’ve helped people do it!).

      Keep us posted on how it goes. A little stubbornness and faith will get you a long way.

  7. ivy December 1, 2011 at 7:43 am #

    Hi Matt — I’m confused… when you say “Misalignment can change”, are you suggesting that excessive anteversion and tibial torsion can be corrected through the right corrective exercise…?

    I will absolutely keep you posted on how things go. If I have to, will come out to San Diego for a couple of weeks to see you personally 😉

  8. Matt Hsu, Certified Rolfer and Postural Therapist December 3, 2011 at 9:26 am #

    Absolutely. The biggest thing that determines the position of your bones is what the muscles and connective tissues are doing to them. The bones don’t move themselves!

    Come on out to San Diego any time! Just not this month as I’m doing a lot of traveling!

  9. Lisa July 8, 2012 at 2:33 am #

    Matt, my daughter is 19 and her right leg is turned outwards almost at a ninety degree angle, her knee is practically on the outside of her leg and her hips hurt horribly as does her back, knee and the rest of her leg of course. I am also concerned now too about the other leg as well. She has been diagnosed with Miserable Malalignemnt but we are having a very hard time finding concrete help for her. I am totally terrified for my child!!! She has been recommended to PT but cannot do the excercises and is terribly depressed, refusing to see a therapist as well. Do you know of any help in the Boston area? I am afraid that surgery is her only help at this point. If your technique might help her, do you know anywhere I can look for someone to help her here? I too am disabled and on low income. We truly need help desperately PLEASE!!!, Worried Mom, Lisa Livant. Thank you, Please get back to me…

  10. Ivy September 3, 2012 at 7:44 am #

    Lisa — get your daughter an appt at Boston Children’s Hospital – they have programs to assist low income familes and have a stellar reputation for helping with complex orthopedic issues.

  11. Ivy September 3, 2012 at 7:46 am #

    Lisa – just adding that they wil not jump to a surgical solution — they are quite conservative and will recommend/guide you towards alternative treatments whenever possible.

  12. Diane February 23, 2013 at 6:56 am #

    Hi Matt, I cannot believe I have finally come across your page. My daughter is an amazing 10 year old girl who has been active her whole life. A few years ago we noticed that when she walks her feet pronate causing flats to literally go flat on the inside and I can barely look at the back of her heels. We then noticed her knees pointing inward and her hips rotating in so therefore it is like her butt sticks out. Telling her to rotate her pelvis forward has not helped. We had tried to buy stability shoes for her to have more support. Seven weeks ago while running she felt a pain in the back of her heel. One orthopedic said it is achilles tendonitis and just rest. Three weeks later still no relief and a different ortho said based on her bone structure she is just going to have to learn to deal with pain and prescribed her naproxyn and said don’t rest it, go and play. Also prescribed orthotics which we had her fitted for and are still waiting for them to be finished. The past two weeks the pain has also come in her lower back. We took her to Rush yesterday in Chicago to see another orthopedic and she again said the orthotics will help. Said it is miserable alignment. Nothing we can do. Take meds and play in pain and that in a few years her knees will probably be the problem. Prescribed physical therapy to help back and heel. She said kids don’t get back pain and then felt her back and said oh yes, she is very tight. I have not been able to swallow this. She plays travel softball which she absolutely loves and has not been able to for two months now. She just wants to feel normal. We were walking yesterday and she told me to slow down that she couldn’t keep up because her heel and back felt so bad. I am literally consumed by helping her and really don’t know where else to go or what else to do. I called an egoscue clinic in chicago yesterday and have been really thinking of taking her here to see if they can help. I just keep thinking that her structure needs help going into the right position and no one seems to be addressing that unless it really can’t be helped. Could you please provide me with more information or help. We would do anything for our daughter especially to help her while she is young in an effort to help her future!! Thank you!!

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