Part 1 – My ‘Pelvis is out’, why you are wrong and why you may need to find a new therapist!
Jul 19, 2017
Have you or someone you know ever been told that your pelvis is ‘out’?
It is a fairly common phrase used by many practitioners and immediately gives you (the patient) the impression that something is not-aligned and that it needs to be put back ‘in’ it’s rightful place. Fortunately for you and me our body is not a Jenga tower waiting to fall in a heap and often things do not “go out of place” unless a car accident or fall from a severely high height is involved.
Comments like this breed a degree of fear in a persons body and create a sense of reliance on the therapist to then ‘fix’ or ‘maintain’ the pelvis in the correct position which occurs through regular and indefinite ‘re-alignment’ sessions. I want to challenge this belief by explaining how structurally robust it truly is and to help empower you to think differently about your body.
Why you’ve got it wrong when it comes to your pelvis being “out”.
Conceptually, for something to be ‘out of place’ there needs to be the presence of a bony joint which allows one part to actually move in relation to the other. At the pelvis the joint that is often referred to as being out is the Sacro-Iliac Joint (SIJ). As the name infers the joint in comprised of the Sacrum which is the continuation of your spine and the Left and Right Ilium which is the broad pelvic bone on either side of your body.
The SIJ is inherently extremely stable is designed to tolerate high loads experienced with activities such as running and jumping. It has a complex and very comprehensive amount of ligamentous support (Figure 1) which is designed to tolerate ligaments are bone-to-bone connectors and are the intrinsic glue that holds joints together. In order for your pelvis to be ‘out’ there would need to be trauma to these ligaments which have been stretched or torn allowing the SIJ to become unstable.
Let’s compare that to your ankle. You may know that typically when you severely roll your ankle you have the potential to tear or stretch the ligaments on the the outside of your ankle (see figure). For example, imagine you jumped during a game of basketball and then landed on another player’s foot which made you you suddenly roll your ankle. Subsequent damage to those ligaments was therefore due to a significant and rapid amount of force applied to them which overcame their capacity.
So if we return to our pelvis, if you look only at the bony and ligamentous structure of the joint you will notice that it is much thicker, stronger and more resilient than the outside of the ankle. So if it takes a significant roll of the ankle to damage these ligaments what does it take to do similar damage to the pelvis? Think high speed car accident or falling from a significant height. Essentially, It takes a lot of force and doesn’t just ‘slip’ out during the course of your everyday activities.
What you should take away from this
If you are being told that your pelvis is ‘out’ and that it regularly becomes ‘out of alignment’ you probably need to consider finding a new therapist who is genuinely interested in progressing you to long term self management and empowering you believe your pelvis and SIJ is in fact incredibly structurally robust.
You may be asking yourself what about the loud ‘crack’ I hear when it gets manipulated? Please stay tuned for ‘part 2’ next week which which discusses in detail that there is no evidence that a ‘pop’ or ‘crack’ is in fact not re-positioning anything at all! We will also talk about the lack of reliability and accuracy of testing and assessment of the pelvis and how It is most commonly related to postural muscular imbalances from the muscles that cross hip and spine.
What do the Physiotherapists and Osteopaths at the Injury Rehab Centre in Cheltenham do?
At the Injury Rehab Centre We specialise in assessment and collecting actionable data using the latest technology previously only found in elite sporting institutions when dealing with lower back and pelvis pain patients. This includes:
- M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify the risk factors of low back pain.
- Slow Motion Video Analysis of fundamental lifting techniques such as squats, deadlifts and presses TO FIND BAD HABITS that can cause injury to areas such as the lower back.
- Strength Testing to identify any strength discrepancies that have a huge role in injury risk.
- Force Plate Technology to put a number on differences in the power you can generate through each leg that can lead to compensations and can cause repetitive stress injuries such as those activities that contribute to back pain.
- Traditional Physiotherapy and Osteopathy examinations to identify dysfunction.
Next our treatment process achieves pain relief in the shortest amount of time by using hands on Physiotherapy and Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques. This may include the use of the True Stretch system as well as Dry Needling and Taping techniques.
Finally your management plan will involve an individualised training plan to build your strength and capacity (muscle and tendon strength, stamina, specific flexibility) often to improve discrepancies from side to side that could be the true cause of your low back and pelvis pain and build confidence in your body.
If you suffer from low back pain and want to get off the treatment merry-go-round and back to feeling better, moving better and performing better contact the Injury Rehab Centre today on 95537024 or book online using the link at the top of the page.
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