Hip Misalignment Led to Saddle Sores and Decreasing Power

TLDR: Hip misalignment (off of the bike) resulted in one leg being effectively shorter than the other, caused saddle sores, and resulted in decreasing power output as noted by numerous failed workouts. Remedies have included a temporary heel insert to make the legs even, additional stretches, and a couple of visits to a chiropractor.

I’m posting this in case others have similar symptoms. It took me quite a while to realize that all of my seemingly separate issues were due to my hips being out of alignment. I’m only two weeks into an expected eight-week treatment plan and will periodically post updates.

Symptom 1 - saddle sores. I’ve been battling saddle sores for the last three months. I originally thought it was due to switching from Shimano to Look cleats since the stack height and location where the spindle crosses the cleat are different. I did ultimately lower my saddle 4mm and that helped, but the saddle sore returned.

Symptom 2 - bike tilt. I have a homemade rocker plate for my trainer. Over the last couple of months I started noticing that I was not sitting vertically on the bike. It was tilted to the left.

Symptom 3 - uneven peak power phase. I have a dual sided power meter and left / right balance was never worse than 48/52%. However, there is a larger discrepancy between peak power phase start. I tend to end my peak power phase at the same angle on each leg but my left leg starts the peak power phase more than 5 degrees sooner than the right leg. YMMV but, in hindsight, this was another data point that I missed.

Symptom 4 - lower back pain / fatigued muscle. The internal / external lower oblique muscles on the right side are working extra hard to try to compensate for the misaligned hips.

Symptom 5 - curved spine, hips bones not even. When looking at myself in a mirror my hip bones were not parallel. The right side was noticeably higher. Likewise, I also noticed a small left / right curvature in my lower spine.

Diagnosis. I finally went to the chiropractor. After reading my medical history and describing the hip / spine symptoms he had a good idea of what the problem was. However, to verify, he had me lie face down on a table and examined the length of my legs. As seen below, the right leg was effectively shorter than the left. He then had me ‘curl up’ my lower legs while keeping my thighs on the table. The right leg became longer than the left due to the hip misalignment.

Treatment. The chiropractor adjusted my hips during that first visit. There was a little movement but not too much. I’m going back every 1-2 weeks.

He also gave me a heel insert to balance the distribution of weight across both legs. While I can’t see a difference in hip alignment right now I can feel that the insert is working because my right leg feels longer than the left with the insert in my shoes. The legs felt even when I first got the insert. I’ll ask for a smaller insert during my next visit.

He also has me doing stretches. I can’t find an image / video online right now but lie on your back. Cross one leg over the other with the ankle resting just above the knee cap, making the shape of a number 4 with your legs. Extend the other leg and reach through to grab the hamstring of the extended leg, and pull. The stretch can also be done with someone pushing on your legs instead of pulling yourself.

Hopefully no one else has similar problems but, if so, I hope this helps. However, if you have had similar experiences, I’m interested in what else worked for you. Thanks!

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I had everything you say, solved it with a rehab programme, a slight lowering of saddle with more setback. I have a minor physical leg length discrepancy and scoliosis (side curve spine) resulting in left shoulder sitting noticeable further forward - diagnosed by a physio and confirmed by consultant. Manifested on bike predominantly as lower back pain.

I am very wary of chiropractors, have seen people pay for years of ‘treatment’ which does not work to eradicate the issue but instead treats symptoms. Great business model but not the best medical approach.

That photo looks to be taken at an angle (see edge of bed), if it was taken barefoot perpendicular to the bed with a set protocol to ensure you were laying evenly (which I have had a physio / bike fitter do) it might look very different. The cynic in me would ask if they have used an image to sell you a service.

A leg length discrepancy would IMHO, unless severe - in which case permanent corrective orthotics are likely necessary for all activities, only likely to make you sit off centre if the saddle is too high or extremely low, I would try dropping the saddle further in the first instance.

You don’t mention rest of fit but it could be out of, or to the extremes of, your tolerances, or bike setup out of alignment (bars off or not straight). Also the saddle could be set out of position for you or simply not suitable.

All of that would contribute too to ‘uneven peak power phase’, the 5% isn’t something that would worry me at all, neither 48/54 split.

The lower back working hard usually points to key fit issues or suggests weight too far forwards (usually then caused by reach too far or low, or insufficient saddle setback).

Spinal curvature is not something a figure 4 stretch is going to sort, that’s usually for hip flexors.
These are the sorts of exercises (plus more and advanced versions) I was set to do in this case:

Also deadbugs for core, glute bridges (next step on from pelvic tilt - first 2 legs then onto one), and plank sets (front then side, starting short position and over time working up to long, then again over time working to planks with destabilisation).

I hope you have found the answer but personally I would be taking another path.

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I was ‘blessed’ with this scenario last fall after I wasn’t able to walk comfortably and went to a chiropractor. Turns out the wing of my right hip flares in and up creating an imbalance with respect to length. Like you, I am visiting the doc weekly for and adjustment with daily stretching (to include a variation of the stretch you describe) and the change has been dramatic over time!

My comfort is improved, saddle sores have effectively disappeared and my pedal stroke / power is smoother.

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When I was younger I suffered from a ‘clicky hip’ after a ride and sore rotator cuff sometimes on it the latter would be quickly aggravated by a failing BB causing a few mm more of travel. Perhaps related my right calf was noticeably larger than my left. Then I had a retul which identified a leg length discrepancy, funny once pointed out it was obvious. Over time after using shims to correct it, the ‘clicky’ hip and sore rotator cuff seem to have disappeared and the right/left calf sizes are more even. It seems to have got me a more steady power output.

However, thats when my problem with saddle sores and wearing out bibs/saddles and pedal noses on the right hand side started. Touchwood that might have been related to what was growing inside me or it may have just been the process of balancing up and since my op/ fully balancing up I haven’t had any further problems with saddle sores or uneven wear.

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@Boombang, thanks for the detailed response. Based on the health insurance plan I have there is no “selling of services” and I feel that the diagnosis tracks with the symptoms I’ve been feeling. I’m willing to give it eight weeks to see if it continues to improve. If not then I’ll move on to something else.

I probably didn’t describe the stretch very well because I definitely feel it in all of the areas that are out of alignment.

I do need to tweak my bike fit. I bought it used from a guy 2-3 inches taller than me. I think the cranks and stem are a little too long. I’m going to try MyVeloFit once my hips are back in alignment, then hopefully get an in-person fit.

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@rkoswald giving is 8 weeks sounds a fair approach, you never know.

That said the final bit in the post above I would challenge - changing a fit after ‘hips are back in alignment’ sounds illogical if the fit isn’t right and you are riding in the meantime.

Why not fit now then fit again? A pro fitter should offer a follow up in ~3 months so even if you paid out you would likely get tweaks. Cranks and stem being too long on a bike that’s too big could alone give the symptoms you describe.

Sounds like extended pigeon pose. One of my favorites

That’s a good point. I have some vacation time coming up and for the MyVeloFit mid price point plan maybe I’ll do that.