Challenge Physical Therapy

What is a twisted pelvis and how does one end up with one? A “twisted pelvis” is athree dimensional mechanical dysfunction. It can happen as a result of trauma, pregnancy and delivery or simple muscle imbalance. It is a very common problem andis often the underlying cause of low back pain, mid back pain and neck pain. It can alsocause structural damage and degeneration throughout the spine.

When the pelvis twists out of normal alignment the right side of the pelvis, or rightinnominate, rotates forward or anteriorly, due to a tight, short iliopsoas muscle. The leftside of the pelvis (or innominate) rotates backwards, or posteriorly, as a result of a tight,short quadratus lumborum muscle. These rotations can also cause the pelvis to moveabnormally inward or outwardly. When the innominate rotates abnormally, theacetabulum, the cup portion of your hip joint, moves up or down (superiorly or inferiorly).When this happens, the head of the femur follows it and creates a short or long leg.The functional leg length discrepancy which can develop as a result of an unstable,twisted pelvis is frequently misdiagnosed as an actual leg length discrepancy. Onedoes not want to where a lift in ones shoe to correct this functional leg lengthdiscrepancy as it only helps to support and hold the pelvis in a dysfunctional position.

The Iliopsoas muscle

To treat the “twisted pelvis” the right iliopsoas and left quadratus lumboum musclesneed to be lengthened, stretched and released. Joint mobilization or manipulationshould be performed to align the innominates and sacrum. Strengthening exercisesshould be performed in order to balance andstrengthenthe muscles that hold the pelvisin normal alignment. Muscle energy balancing techniques are very helpful and can beused to align and mobilize the pelvis by yourself. This technique is very helpful todecrease pain. Modalities like hot packs, cold packs, ultrasound, electrical stimulation,etc. only treat the symptoms and give only temporary relief. In fact, hot packs and heatcan cause more instability if they are used over the sacroiliac ligaments, as theseligaments help hold the pelvis in normal alignment. Heat applied to these ligamentsincreases their plasticity and allows them to stretch and let the sacroiliac joint moveabnormally. It is always safer to use ice or cold packs in this area. Hot or cold packs do nothing to correct a twisted pelvis, the real cause of your neck or back pain.