She trained smart. She stretched religiously. She ran through the pain—until she couldn’t. The same hip would seize up again and again, derailing months of preparation. Her physio blamed her glutes. Her coach blamed her cadence. Nobody asked if her pelvis might be rotated.
This scenario plays out every day—not just in recreational runners, but in elite athletes. And yet few people—runners or rehab professionals—are familiar with the concept that could finally explain it.

Malalignment Syndrome

The term was coined by the late Dr. Wolfgang Schamberger, a physician, author, and lifelong runner who spent the better part of his career challenging the orthopedic and rehab community to rethink what injury really is—and where it begins.

What Is Malalignment Syndrome?

Dr. Schamberger discovered the hard way—through personal injury—that some problems don’t stem from weakness, tightness, or overuse. They come from how the body is built and aligned.

Subtle structural asymmetries in the pelvis, spine, and limbs can shift the way force travels through the body. The result? Chronic, one-sided injuries that seem to defy logic.
His books, The Malalignment Syndrome and Read My Hips!, laid out a rigorous framework for understanding how mechanical imbalances can quietly derail even the most robust athletes.

Studies suggest that over 80 per cent of chronic running injuries occur on one side of the body, strongly implicating hidden mechanical imbalances rather than global dysfunction.
And runners are particularly vulnerable—not because running is inherently dangerous, but because it is relentlessly repetitive. If your structure is even slightly off, you’re repeating that “offness” thousands of times per week.

What You Need to Know

1. Malalignment is often invisible to the untrained eye.
   You won’t spot it on an MRI. You won’t foam-roll it away. These patterns involve joint orientation, limb length asymmetry, and compensation strategies that only become visible through specific alignment-focused assessments.
2. Strength training won’t fix what alignment throws off.
   Yes, strength matters. But if your foundation is skewed, you’re just reinforcing dysfunction. A misaligned runner becomes a strong—but unstable—runner. And when your body finally hits its compensation limit, the resulting injury tends to be worse—because now you’re generating more force through a flawed foundation.
   It’s like putting a bigger engine in a car with a wheel alignment problem. The more force you generate, the bigger the eventual disaster.
3. You can’t stretch your way out of a rotated pelvis.
   Tightness is often a symptom, not a cause. Stretching might bring temporary relief, but those same tissues will tighten back up if your body’s alignment is still off. Position doesn’t just matter more than flexibility—it helps define the parameters of your mobility. If your structure is off, your range of motion will always be fighting against built-in restrictions.
4. Pain isn’t always where the problem is.
   That sore knee might be compensating for a rotated femur. That angry Achilles could be working overtime to make up for a misfiring hip. In a misaligned system, pain shows up at the weakest link—not necessarily at the root cause.
5. Alignment is measurable—and correctable.
   Professionals trained in alignment-based assessment can detect these patterns using posture grids, pelvic balance tests, gait evaluation, and manual palpation. What you uncover may surprise you—and it may change the way you train forever.

So, What Can You Do?

You don’t need to become a biomechanical detective. You just need to stop guessing—and start testing. A good clinician can guide you. But you can also begin on your own.

Runner’s Alignment Self-Check
Try these three at-home cues:

• Stand barefoot in front of a mirror. Do your kneecaps and feet point straight ahead—equally on both sides? They should. Even slight asymmetries may suggest underlying alignment issues worth exploring.
• Lie on your back and bend your knees. Do they appear even, or does one sit higher than the other?
• Perform a slow bodyweight squat. Do you favor one leg, even subtly?

If so, your body may be compensating for an underlying alignment issue.

The good news: you’re not powerless.

Dr. Schamberger believed deeply in manual therapy—especially osteopathic techniques like Muscle Energy Technique—to correct alignment. These are effective, but often require ongoing visits to a practitioner.

Fortunately, many alignment issues can be addressed through targeted corrective exercise at home. While complex cases may need professional support, most runners can begin restoring balance—without a lifetime of clinic visits.

If you’re stuck foam rolling the same tight spot or stretching a muscle that won’t release, it may be time to look upstream.

The current trend in rehab is to retrain movement—but if the foundation is off, that’s a dead end. You can’t cue your way out of structural imbalance. It’s like teaching a driver to steer better in a car with a bent wheel. The harder they try, the worse the wear.

While some pain-science experts question the importance of alignment, physics remains unchanged—and structure still governs function.
Maybe that’s the quiet revolution rehab needs. Not another trend. Not another cue. A return to fundamentals.

When the body is aligned, movement flows and pain fades. Ignore alignment, and you’re not fixing dysfunction—you’re just reshuffling it.
Pain speaks the language of imbalance. Malalignment is the message. You weren’t built to break. You were built to move.

Start moving that way again. 

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IMPACT Magazine Summer Outdoor Travel Issue 2025 featuring Shanda Hill, a Canadian Ultra Triathlete who is redefining the sport. Run on some epic trails in our own backyard or join a run club. Eat your way for Mental Clarity, fueling while travelling, seasonal eating and some kitchen must haves. Become strong and fit in only 20 minutes a day, and enjoy some tasty drinks guilt free and so much more.

As the deadline for the article draws near (it is midnight the night before the article is due), imagine the stress the writer must feel as he brews a pot of coffee and sets himself up for a couple of hours to research the topic, organize the information, create an outline, come up with a catchy opening line, write the article, rewrite the article, rewrite it again, print it out and rewrite it one more time. And, of course, the whole time he is beating himself up for waiting so long to start and telling himself he’s no good at writing anyway and the article will be junk.

This is procrastination in full, weedy flower. Delay. Broken promises and unfulfilled expectations. Feelings of inadequacy and low self-esteem. Worry. Fear. Stress. Overwork and probably not as good a product as the writer would have produced if he had tackled the job in a timely and reasonable manner.

Procrastination isn’t good for anyone, anytime. So why do so many do it? I’ve certainly done it , and I bet you have too! Not just around such matters as filing income tax and completing holiday shopping, but with everyday tasks such as doing the dishes, organizing the garage or starting a project at work.

The more difficult, inconvenient, or scary the task is perceived to be, the more procrastinators procrastinate. All too often semi-convincing self-talk makes the delay appear reasonable, but in the end it’s a self-defeating behaviour that causes all sorts of problems, not the least of which is stress.

Here are ten strategies to overcome procrastination:

1. Set Goals.
   Decide what you want and what needs to happen to get it. Be specific and create a realistic timetable.
2. Commit.
   Make a contract with yourself. Tell a friend, co-worker, or family member about your plan.
3. Set Priorities.
   Make a list of the things that need to be done in order of their importance.
4. Get Organized.
   Have the right tools and equipment to do the job. Make lists. Keep a schedule.
5. Think Small.
   Don’t let the entirety of the project overwhelm you. Stay in the present and chip away at the process.
6. Break Tasks into Bite-Sized Pieces.
   The “Swiss cheese” approach to getting any major project completed is to break it apart and work on one piece at a time.
7. Use Positive Self-Talk.
   Think “carrot” versus “stick”.
8. Replace Excuses with Rational, Realistic Thinking.
9. Remember There is No Such Thing as Perfection.
   Begin the thing knowing it can never be done perfectly. You’ll do your best.
10. Reward Yourself.
    Frequently and generously pat yourself on the back; enjoy your accomplishments.

Like many other self-defeating behaviours, procrastination can be overcome. The place to begin is exactly where you are and the time to start is now!

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Sciatica is essentially pain that starts in the lower back or buttock area and radiates down the leg. The pain is usually behind the leg and can go all the way to the foot. Like most pain problems, there is a wide range of intensities, but people with sciatica often describe having intense pain, numbness, or a tingling sensation along the back of the leg.

The sciatic nerve is the largest peripheral nerve in the body. It exits the pelvis in the buttock area and runs down the back of the thigh. Just above the knee, it divides into several branches, with some extending down into the foot. Sciatica refers to a set of symptoms that arise when the nerve is irritated or compressed.

Symptoms
When compressed or pinched, the sciatic nerve typically sends painful impulses down the back of the leg. Although it usually occurs on one side of the body, it is often quite painful and sometimes disabling. While some people experience one acute episode, more commonly others suffer from persistent or recurring attacks of sciatica.

Causes
There are several causes of sciatica, including pressure on one of the nerve roots which blend together to form the sciatic nerve. These nerve roots can be pressed on by a bulging or herniated disc or by unwanted bony formations at the spine. Another common cause is when the piriformis muscle in the buttock tightens excessively. This is called piriformis syndrome. The sciatic nerve and the piriformis muscle exit from the inside to the outside of the pelvis through the same notch, so they are very related. Approximately 10-20 percent of people have the sciatic nerve passing through—not beside—the piriformis. If you are one of the “lucky” ones to have this anatomical characteristic, you are certainly more prone to this version of sciatica than the average person.

The discs in the spine act as shock absorbers and provide space for the nerves to exit the spine. However, the nerve roots exiting the spine can be pressed on by either bulging or herniated discs. If there is sufficient compression of the disc, it is simply squeezed outward from between the vertebrae, like the gooey center of an OREO cookie.

Sometimes the discs are damaged during acute injury or deteriorate due to decades of dysfunctional pressures. A herniation occurs when the outer wall of the disc gives way and allows the jelly-like interior material to leak out. This disc material can come in contact with a nerve root that is part of the source of the sciatic nerve and cause pain.

Diagnosis
To diagnose sciatica, a primary care provider (medical doctor, chiropractor, or physical therapist) can obtain a medical history and perform a physical exam. A neurological assessment can be conducted to determine the location of the primary lesion. In some cases, a CT scan or MRI may be necessary to pinpoint the exact cause and source of the symptoms. For complex cases, a neurologist may perform a nerve conduction study to evaluate nerve function, assess the severity of nerve damage, and precisely identify and differentiate the location of the affected nerve.

Treatment
Most physicians will initially recommend conservative treatments for sciatica. Although a few days of rest and prescription pain pills will sometimes decrease the acute nature of the symptoms, it almost never results in lasting relief. If conservative care doesn’t result in a solution, your physician is likely to want to talk about steroid injections, laser ablation, or surgery, all of which come with their own list of cautions, from being unreliable methods of sustainable relief to lacking enough thorough research.

Posture Re-Education: An Effective Solution
One of the most effective, lasting, and non-invasive solutions for sciatica is posture re-education. By addressing the underlying biomechanical issues and misalignments, you can significantly reduce or even eliminate sciatic pain. Studies have shown that corrective exercises focusing on posture improvement lead to substantial pain relief and functional improvement in patients with sciatica. Another study highlighted the effectiveness of specific corrective exercises for postural improvement in alleviating sciatic symptoms.

Get an expert assessment to identify the source of your sciatica. Once you understand the nature of your sciatica, the path to a solution becomes more obvious. Nobody can solve a problem they don’t understand. Sciatica should not be a source of worry; it can be solved by releasing the dysfunctional stresses that are the root cause of the problem. Get smart, then get healthy. 

This article has been edited for length and republished with permission from alignmentfirst.ca.

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Featuring Canadian Taekwondo Olympian, Skylar Park. Must-visit adventure destinations across Canada. Your best trail running season ever with FAQs and threshold training plans. How (and why) gravel biking can rule your summer. Essential preparation to stay injury-free during hikes. Zero-waste your hiking and camping trips like a pro. Treat yourself with a Rustic Strawberry Chocolate Tart or Dairy-Free Vanilla Ice Cream, and so much more.

What’s a stretch?

A muscle stretch takes place when the overlapping protein fibres of the muscle cells slide past each other to elongate the muscle. Static stretches are best for this kind of result. Dynamic stretches are exercises done to warm up the body in preparation for training or performance. A lot of confusion surrounding stretching might have been avoided if this class of exercise had been called something else.

Why stretch?

We need to stretch to maintain adequate muscle length and avoid the malalignment problems that can predispose us to injurr and/or chronic pain. Adaptive shortening is an insidious process that affects everyone and occurs if we do not consistently ask the joints of our body to move through a full range of motion. As we get older it becomes ever more valuable for us to maintain a daily regimen of appropriate mobility exercises to maintain good structural alignment and full joint range of motion. Find stretching boring? Nothing is more boring than waiting for an injury to heal. Or worse, laying in a hospital bed waiting for your turn under the knife.

Which muscles should I stretch?

A stretching program needs to be designed around individual needs to be effective. Going by feel can be misleading as muscles that feel tight are often being pulled taut by another muscle and are unlikely to benefit from being stretched more. Eliminating that tight feeling is more likely to occur by stretching the shortened muscles that are pulling the target muscle. The most common example of this phenomenon is chronically tight hamstrings. When someone complains that their hamstrings are tight, check their pelvic position. More often than not, that person’s pelvis is rotated too far forward. This results in the hamstrings being placed under perpetual stretch tension. The usual suspects are the muscles of the low back, quadriceps and inner thighs. Creating more length in these muscles will help return the pelvis to a more neutral position and often, almost magically, solve the tight hamstrings mystery.

How long should I hold a stretch?

Research is inconclusive on the optimal time for holding a stretch. I ask my patients to hold their stretches for 60 seconds. I have found that most people will stretch as aggressively as their pain threshold will allow. However, there is this thing called the stretch reflex, a natural defence mechanism that occurs in response to either a very sudden or strong pull on the muscle. If you stretch too aggressively the reflex contraction will counteract your stretch, typically resulting in post-exercise soreness but no added length. All pain, no gain. A 60-second stretch discourages you from stretching too aggressively for the simple reason it usually causes pain in less than 60 seconds. If you can hold the stretch for 60 seconds without creating pain, you are almost certainly not stretching too aggressively.

When should I stretch?

Many studies have proven that static stretching results in temporary strength decreases in the muscles being stretched. So don’t do a lot of static stretching right before you need to perform, whether in competition or training. It will hinder your performance. Dynamic stretching is best for pre-event preparation. Save your static stretching for post-event and for your rest and recovery days.

There are lots of possible reasons you might have back pain, but some causes are far more important than others. Here are six things that are often blamed but are rarely the key cause of lower back pain.

1. 1. You’re not Young Anymore: But that doesn’t mean age causes back pain. Some teenagers suffer from back pain and some 80 year-olds don’t. With back pain the amount of time your spine has been misaligned is much more important than how old you are.
   2. It’s Genetics: Some genetic conditions can predispose you to developing lower back pain. The most common one is scoliosis. But the biggest back pain cause passed down from our parents is behaviour. From childhood, we copy our parents’ habits. Bad posture and movement habits are often passed down like family heirlooms. Thankfully posture and movement patterns can be retrained.
   3. One Leg is Shorter Than The Other: It’s common for your pelvis not to be perfectly square, which can cause a slight difference in the length of your legs. More often than not, this crookedness is due to faulty alignment of bones, not a difference in bone length. Straighten the pelvis, your legs are no longer different lengths and voila, your back feels better.
   4. You Don’t Move Around Much: It is popular to blame sitting as the cause of back pain, the explanation being that prolonged sitting causes our hip flexor muscles to shorten, putting pressure on the back. I’ve seen thousands of back pain cases and know chronic hip flexion is the cause of a tiny percentage of such cases. Hyperextension of the hips is more common than chronic hip flexion. Sitting all day isn’t healthy, but correlation is not causation.
   5. You Have Weak Abs: There is a seed of truth behind this myth. Since your abs connect the ribcage to the pelvis, they need to be balanced with the muscles of your back to keep your ribcage and pelvis vertically aligned. This does not, however, mean abdominal crunches are the secret to a pain-free low back. Sometimes a diet of crunches is setting you up for herniated discs and a date with your surgeon.
   6. Your Glutes Aren’t Working: Sometimes the gluteus medius doesn’t work as it should, but it is rarely the cause of lower back pain. When the pelvis is misaligned it interrupts your body’s ability to activate many of the muscles in the middle of your body. Straighten the pelvis and your glutes magically start working again. Trying to strengthen these muscles without first straightening your pelvis and/or hips is like swimming upstream.

There is a hierarchy of importance in any rehab situation. Begin with minimizing misalignment. Then turn your attention to mobility. Movement quality (motor control), stability, strength and finally endurance. Respect that natural order and you are on the right path. Misunderstand the root cause of your pain and you are guaranteeing yourself a long and frustrating journey.