The malalignment syndrome—implications for medicine and sport:

Article Outline

• Copyright

Although this book was written by Wolf Schamberger, MD, with contributions by 2 physiotherapists, anyone reading it would think it was written by a chiropractor. There is little in this book that the chiropractic profession would consider new or revolutionary information. However, the book is so well written, referenced, and presented, it should be read by any practitioner who is regularly looking for malalignments.

The book starts with a historical perspective on how medicine has viewed malalignment to include simply the pelvis and spine. The diagnosis of malalignment syndrome is described as having the following characteristics: asymmetrical alignment of the pelvis, trunk, and extremities; compensatory curves of the spine; asymmetrical range of motion and weight bearing patterns; leg-length differences; and asymmetrical muscle strength testing. Although this is a newly defined syndrome to medicine, chiropractors have been studying, looking for, and discussing these characteristics for over 100 years.

Chapter 2 discusses sacroiliac joint biomechanics, axes of motion, and how they are involved in absorbing shock during gait. Spinal and pelvic stabilizing muscles are reviewed and described as inner and outer units. Common pelvic malalignment presentations, “clinical pearls,” and a whole battery of tools are provided to help the clinician identify and diagnose malalignment syndrome. All the tools discussed, such as palpation, static and dynamic posture evaluations, range of motion and muscle testing, and orthopedic tests, provide the foundation of a biomechanical examination, as taught at chiropractic colleges nationwide. It is refreshing to see the medical profession recognize and utilize what chiropractors have been teaching for a long time.

Chapter 3 discusses in detail how the malalignment syndrome is commonly associated with a rotational malalignment in the sagittal plane of 1 innominate relative to the other, in other words, what chiropractors often describe as a posterosuperior or anteroinferior ilium. This rotational malalignment is then associated with various concomitant asymmetries, such as sacroiliac joint mobility, spinal curvatures, or muscle and leg tightness.

Using a large collection of photographs, diagrams, and anatomical models, the reader is able to better visualize and understand how these assessment tools can aid in formulating an effective treatment intervention.

Chapters 4 and 5 will probably be new information for most chiropractors. These chapters discuss the implication of malalignment for various medical specialists, as well as its clinical correlation in various sports. The author attempts to educate medical specialist to think outside the box and to be aware that malalignment syndrome can be the source of their patient’s pain. Sport biomechanics and technique limitations due to malalignment are discussed in a variety of sports ranging from tennis, skiing, and an entire chapter on equestrian sports. Considerable detail and an obvious amount of time and research went into the formulation of these chapters. It is doubtful if such an exhaustive explanation of malalignment, as it relates to different sports, exists anywhere else in the literature.

Chapter 7 is entitled “A Comprehensive Treatment Approach” and includes information about mobilization, exercises, orthotics, and even various types of injections. One of the contributing authors, a physiotherapist, wrote an entire chapter on the topic of manual therapy and covered many different techniques, including the high-velocity, low-amplitude (HVLA) manipulation typically associated with chiropractic. Although not within the scope of this book, the author does attempt to discuss the theory behind why manual therapy works at correcting the malalignment syndrome. Perhaps in future editions of this book, the author could include contributions from chiropractors, who are considered by most to be experts at manipulation in the treatment of malalignment.

What the author has done exceptionally well is provide a detailed description of malalignment syndrome and how it can be identified and treated. Although malalignment has been recognized for over a century within the chiropractic profession, it is encouraging to see allopathic physicians recognize it as a syndrome and begin to assign criteria to aid in its diagnosis and treatment.

Dr Schamberger’s book is an excellent and highly recommended book that should be found on every practitioner’s shelf.