A hip that is prominent and larger than its fellow is of frequent
occurrence. It may not be necessarily conducive to a defect in
posture, but it often is. The female is more frequently afflicted with
this anatomical irregularity than the male. In the first place, the
female pelvis is not so stable and rugged as the male pelvis, i. e.,
a mechanical wrench or fall will more easily displace the relative
position of the tissues in the female. Then, in the second place, the
dress of the woman accentuates irregularities of the figure, so that
possibly in some instances the defect, from a diseased or deformed
point of view, is more apparent than real. But of still more importance
is the fact that many cases of a prominent hip are due to a lateral
curvature of the lumbar spinal column. Lumbar curvatures are of common
occurrence in the woman; first, the spinal column is not so strong as
in man, simply on account of the physique not being so robust; second,
modern dress constricts the waist by the use of corsets and many
waist bands, and the weight of heavy skirts upon the waist, hips and
abdomen; and, third, severe strains from childbirth. Care should be
taken that there is no congenital abnormalities of the lumbar spine, or
that congenital asymmetry of one-half of body, or trunk or leg is not
present.
Thus the principal =cause= of a prominent hip is the lateral lumbar
curvature. This, through compensatory action, renders the hip on the
concave side prominent and high, while the hip on the convex side is
depressed and less pronounced in appearance. Dressmakers and tailors
are all too familiar with this feature of the irregularly outlined
figure, and, consequently, have to resort to “padding” to round
out the symmetry of the body. The mere irregularity of the figure,
unfortunately, is by far the less serious part of the defect. Many
ailments and diseases can be readily and directly traced to this. Not
that the prominent hip itself necessarily always plays a leading part,
but rather the lumbar curvature is the cause of very much suffering
and misery. To enumerate the many disorders that arise from malaligned
lumbar vertebræ may be unnecessary but a few will be given. A point to
be emphasized is that the prominent hip often plays the role of a sign
or symptom, or an effect, that an ailment or disease may be elsewhere.
In the female one of the most common causes, if not the most common
cause by far, of disorders of menstruation, whether painful, profuse,
or irregular, is irritation or obstruction of the lumbar spinal
nerves due to lumbar curvatures. It is well known the lumbar spinal
nerves control, to a large extent, the pelvic organs; consequently
the osteopath pays particular attention to this area. Then certain
intestinal disorders, such as appendicitis, typhoid fever, dysentery,
rectal diseases, owe their origin to predisposing lesions here; also,
bladder ailments, and sexual diseases of men, and many affections of
the legs, as sciatica, varicose veins, etc.
In a number of instances the prominent hip will be due to a displaced
innominatum. Then a lumbar curvature will result as a compensatory
condition. This reverses the compensatory act as heretofore referred
to; the prominent hip, in this instance, is the cause and not the
effect. To diagnose which is cause and which is effect will frequently
require considerable technical knowledge and experience. The slipped
innominatum then produces symptoms and disorders directly from its
changed anatomical relations; the points of diagnosis are given in the
chapter on Diagnosis. The prominent hip can easily be detected when the
subject sits down upon an even, firm surface, or stands up, and the
one side is compared with the other. In some cases where the prominent
hip is due to a lumbar curvature, and the prominence is a secondary
feature, the legs will be found uneven in length, but not always, for
the lumbar curvature may straighten out when the patient lies flat upon
the back. To diagnose the cause from effect and to differentiate the
maze of signs and symptoms that may be present is not always easy even
for the skilled practitioner.
The =correction= of a prominent hip is not ordinarily a difficult
matter. In the cases where lumbar vertebræ are principally at
fault, and these include the greater number, the problem is one of
correcting the spinal curvature. Lumbar curvatures are the easiest of
any of the curvatures to correct, for one is not hampered by the rib
articulations, and the lumbar section presents an area where a leverage
can readily be obtained. Where the innominatum is primarily at fault it
is simply a matter of readjusting this, with probably some attention
to the lumbar region. Care should be taken that the prominent hip is
not caused by a tubercular sacro-iliac disease, by hip-joint disease,
by a dislocated hip, or by an overlapping of thigh or leg bones from
fracture.
Standing erect will, of course, be a valuable help, for standing with
the weight on one foot will tend to make the hip on that side more
prominent. But generally the reason why one favors a certain side is
because the other side is weaker; a weak back, a slipped innominatum,
or an injured leg are common causes. There are many cases where the
skirts will have to be considerably altered after the hips have been
made symmetrical.