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Pelvis

THE HIP BONE’S CONNECTED TO THE…

Pelvic girdle dysfunction is an extremely common problem which often goes undetected and untreated.  The signs can include: incontinence; uneven leg length; asymmetry along lower extremities, unilateral foot deformities; uneven pelvic alignment; back pain; knee pain; and hip pain.

By way of further explanation, here is a very brief anatomy overview.  The pelvis is built with 3 bones: two innominates (hip bones), with the sacrum (tail bone) in between the hip bones.  These three bones together create a solid ring or “girdle” that the entire trunk rests on.  These three important bones are not fused, allowing very slight (a few millimeters) movement.

Additionally, another extremely important structure is the coccyx bone.  The coccyx serves as the attachment for most of the pelvic floor muscles.  These structures are both key for control of the bladder sitting directly above as well as for the stability of the entire trunk by functioning as a base or foundation.

Frequently, due to an external force (trauma, tripping or missing a step, falling, childbirth, lifting) the pelvis can lose its alignment.  Without alignment, pelvic muscles cannot fire at full capacity and trunk stability is disturbed.  The results could include a wide range of symptoms such as the leakage of urine and trunk instability.

In addition altered trunk stability plays a role in nearly all back problems.  It also plays a big role in many problems and dysfunctions along the lower extremities, e.g., knee pain.  Again, it is a condition generally ignored by traditional medicine.  Neither X-rays nor MRI’s or other body scans reveal the underlying condition as trunk stability dysfunction.  Altered trunk stability is only a “functional dysfunction”.  Therefore tests that evaluate structure e.g. MRI but don’t evaluate function cannot reveal it.  When the system does not work efficiently and the “functional dysfunction” persists in the body, serious structural damage may occur over time.

The resultant damage can now be clearly visible on X-rays or MRI’s etc. but at this point, any dysfunction is much more difficult to treat and significantly improve.  Often the pelvic girdle dysfunction forces the body to compensate in other areas of the body, like the lower back.

Over time, compensatory mechanisms create damage like a disc herniation.  The disc herniation will receive the medical attention since it can be observed on an objective test like an MRI.  The problem is that quite often the disc problem keeps recurring after treatment since the symptom rather than the underlying cause of the problem has been addressed.

Pelvic girdle problems manifest in a number of ways.  For example, one side of the body could feel weaker or stiffer.  You might be told that you have a leg length discrepancy.  Often the feet become asymmetrical or there is repetitive knee pain or a pulled or painful hamstring.  The bottom line is that any unilateral, one-sided, or asymmetrical problem along lower extremities requires the investigation and examination of the pelvic girdle, and trunk functional performance.

The good news is that pelvic girdle problems can be successfully treated with functional manual therapy.  The Pelvic Health Program in which we all specialize at European Therapy Center especially addresses pelvic girdle realignment and balancing.  This program is made up of four distinct steps:

  1. Functional manual physical therapy applied to the appropriate dysfunctional structures help to move the structures back to their preferred efficient positions.  This allows the pelvic girdle'’s structure and musculature to work efficiently;
  2. Neuromuscular reeducation reminds the muscles about the coordinated work that they should perform;
  3. A proper exercise program is taught to reinforce the gains made during steps one and two.  Exercise alone without the first two parts of the treatment will result in a partial result.
  4. Individual and specific strategies are developed to reduce or prevent reinjury during your daily activities including sports.