Dec 24, 20204 min read

WARNING: here's what every back pain sufferer needs to know about the pelvis

You must remember that classic song of 'the hip bone is connected to the...' In this article I will highlight the influence and significance the pelvis has upon your spinal alignment and how it may be the origin of your back stress, tension and pain.

Common Symptoms

- Low back pain (a.k.a. lumbago) - Sciatica - Joint stiffness and soreness

- Muscle stiffness and soreness - Hip pain - Motor weakness - Numbness and tingling to the hips, legs and/or feet

Anatomy of The Pelvis

The pelvis is comprised of two coxal (hip) bones that connect through the pubic symphysis ligaments on the anterior and through the sacrum and its related ligaments on the posterior. There are numerous muscles that cross over, or arise from , or connect to, the pelvis from the femur, ribcage and spine. Only one of the muscles arises from the pelvis to the humerus bone of the upper arm - the latissimus dorsi.

In essence, these muscles help control the range of motion that is available at the pelvis. These movements include anterior and posterior tilt, lateral tilt and inflare/outflare of the each of the coxal bones.

The pelvis is the centre point of the body, the very foundation of the spinal column, and its alignment and health is critical to the alignment and health of your entire body. It also forms a basin within which the lower abdominal organs are contained and protected.

Creating Happy Hips

1. Pelvic immobility

This is the most common pelvic issue that I see in my clinic. Simply, the lack of movement and coordination of recruiting the muscles to control the pelvic alignment coupled with the inability to move the pelvis in its normal ranges. The cause for this is what I allude to in my new book - The 15-Step Playbook for Pain Relief - postural debt. This refers to the number of hours that we spend in a bad alignment throughout our typical day and how our lack of movement and stretching to pay off this daily debt, leads to stress, tension and pain. This is also known as a slow-motion injury, that progressively over the course of numerous weeks, months or years our body manifests pain without any known cause.

2. Pelvic Alignment

Naturally from pelvic immobility and lack of control, your pelvic alignment gets altered and deceptively appears to get comfortable in these faulty positions. It can be challenging to understand your own pelvic alignment and having this tested with a therapist is a worthwhile investment. I've discussed this in a previous article available here: What you don't know about pelvic pain could hurt you!

Image source: Women in skiing - Lower Spine Alignment by Kristen Heard

The three common misalignments that I measure are: a) Excessive anterior tilt

This is the appearance of a forward tilt of the pelvis which can be often seen with a hyperlordosis in the lower back (an excessive inward curvature). Immediately, this takes your spine out of neutral position and also creates an inward rotation of the legs, altering the mechanics of your gait and all other movement patterns. Common causes include hypertonicity of the hip flexor and spinal erector muscles, hypotonicity of the lower abdominals and hamstrings, and hypermobility of the spinal column.

b) Excessive posterior tilt

This is the appearance of a backward tilt of the pelvis which can be often seen with a flattening in the lower back. Immediately, this takes your spine out of neutral position and also creates an outward rotation of the legs, altering the mechanics of your gait and all other movement patterns. Common causes include improper sitting ergonomics, hypertonicity of the hamstrings, and hypotonicity of the hip flexors and lumbar erectors. If left unaddressed for an extended period of time, this is a very common trigger for lumbar disc herniations.

c) Excessive lateral tilt

This is the appearance of a hip 'hiking' on one side, common causes include standing on one leg more than the other, or sitting on one hip more than the other with the knees up and body twisted.

3. Anatomical differences

There are instances whereby a patient has a measurable discrepancy between each coxal bone - assessed and measured through x-ray film. The first image to the left illustrates an anatomical difference between a patient's left and right coxal bone. Commonly, patients with this discrepancy will have more pain when seated than when standing and moving. The correction would be to use a hip lift (the thickness of which correlates to the measured discrepancy) whilst seated to help realign the pelvis and spine.

A second discrepancy can also be evaluated with x-ray, and this is known as an anatomical leg length discrepancy. Literally, one femur or tibia bone is anatomically shorter on one side relative to the other. Clinically, I've measured differences of up to 18-mm (0.7"). This second image to the left, illustrates a leg length discrepancy in a patient. Note the height difference between their left hip, right hip and the horizontal green line. The correction would be to use a shoe lift to realign the body (the thickness of which correlates to the measured discrepancy).

Restoring Balance in 5-Steps

Move - increase your body temperature and blood flow to all your muscles.
Massage- using a partner, lacrosse ball or foam roller to agitate the muscles.
MOBILIZE - move the joints in their full range of motion.
Stretch - focus on lengthening the short-tight (hypertonic) muscles.
Strengthen - focus on strengthening the (hypotonic) long-weak muscles.

This week I shared one of the simplest and fastest way to mobilize your pelvis, anytime and anyplace.

My prescription is to perform this mobilization often to help pay down your postural debt due to overuse of some muscles and inactivation of others. Remember intensity is the shortcut to results. In this case, the intensity comes from the frequency of repetitions throughout your day.

I suggest the following: MAJOR SYMPTOMS - Mobilize 3+ times per day.

MINOR SYMPTOMS - Mobilize daily.

NO SYMPTOMS - Mobilize at least 3 times per week.