Miserable malalignment can be fixed quickly! - Upright Health

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 hyprocuredoctors.com)

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 curemms.com:

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?

Leave a Reply 22 comments

Trupti - April 6, 2010 Reply

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!

Kevin - April 6, 2010 Reply

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

rose - April 19, 2011 Reply

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”?

Matt Hsu, Certified Rolfer and Postural Therapist - April 20, 2011 Reply

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 curemms.com — the site originally referenced — has apparently been taken down.]

ivy - November 20, 2011 Reply

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 - November 20, 2011 Reply

    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 - November 20, 2011 Reply

      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.

ivy - November 30, 2011 Reply

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 - November 30, 2011 Reply

    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.

ivy - December 1, 2011 Reply

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 😉

Matt Hsu - December 3, 2011 Reply

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!

Lisa - July 8, 2012 Reply

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…

Ivy - September 3, 2012 Reply

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. http://childrenshospital.org/about/Site1394/mainpageS1394P127.html

Ivy - September 3, 2012 Reply

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.

Diane - February 23, 2013 Reply

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!!

    Matt Hsu - February 25, 2013 Reply

    An email is on the way.

    Nivas - March 17, 2016 Reply

    Hi Diane, I am 25 years old right now, and I kind of have the same problem as your daughter is going through. I feel literally miserable for the tough times you & your daughter must be going through trying all possible solutions from different medical ‘experts’. In this journey, I realized one thing – popular doesn’t necessarily mean ‘perfect’. Long story short, your daughter’s over pronation is correctable, and

    I know it is 3 years since your message. I sincerely wish, she has already recovered from the pain. If not, please try the following:

    1) Change her to Vibram Five fingers shoes (preferably, the one with Velcros)
    2) Follow Egoscue. – they are the best.
    3) https://www.youtube.com/watch?v=lSaTJXJ_Maw – Check this video and try these exercises. If your daughter found any relief, Egoscue is the right platform for your daughter, and the best would be to consult an expert.

    I know it is 3 years since your message. I sincerely wish, she has already recovered from the pain. If not, please try the following:

Cathy - April 8, 2015 Reply

Hi Matt, looking for help with my daughter’s Miserable Malalignment case in Cincinnati. Already have been to several orthopedic docs, who say the same as in some of the cases above. A year of PT has not helped. Orthotics created knee pain, which will not go away, even now, after more than 6 months. My daughter was a highly competitive distance runner and is not even able to run a few steps without any knee pain. Also suffered season-ending shin splints in each leg. We are desperate for help, and looking into osteotomy, but would rather find less-invasive solutions. Please help! Thank you.

Janice - August 5, 2016 Reply

Hi Matt, unsure if this will get to you but my daughter was diagnosed with Miserable Malalignment late last year. This summer she joined a gym and has been working hard to gain strength and confidence. We went to an ortho doctor here who wanted to open her leg and shorten the bones, I refused. I was glad to here that exercise and gaining strength could help, because we have noticed that I her. We have tried sever brands of sneakers for running. Purchased braces and inserts. I was wondering if you knew of anyone in south Florida we could see to help her progress.

    Matt Hsu - August 9, 2016 Reply

    Hi Janice,

    Unfortunately I’m not familiar with anyone in south Florida. Keep on looking and do let us know if you find someone really good in your area!

Amber - August 25, 2016 Reply

Hi Matt! Are you familiar with anyone in the Raleigh/Durham, North Carolina area? My son, who is 12, was finally diagnosed just a week ago. I say “finally” only because I noticed the issue when he was about 3 years old and continuedo to bring it up in doctor appointments to no avail until this August, when is pediatrician finally said “ok, I’ll send you to an otho and see what they say.” I literally cried when I was told “he definitely has some deformity of his legs.” Fast forward to last week, we were seen at UNC and the doctor said that he needed inserts and unfortunately they haven’t seen good results from knees braces and physical therapy, so he will need surgery when he stops growing. So for we just deal with the pain. My son just started travel baseball, something he has been asking to to do for YEARS. After speed and agility class last night, he was in so much pain that he was nauseous and is not able to go to school today. I’m looking for any option that will help him stay out if this much pain ever again! And waiting until he stops growing to “fix” the problem just seems cruel! I know there’s no quick fix, but something has to help! Thanks for your time!

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