We’re sure there are many of us who have visited a physiotherapist, chiropractor or osteopath and have heard the words: 'Your pelvis is twisted', 'You have one hip higher than the other', or 'one leg's longer than the other'.
All potentially alarming words when you have no idea of anatomy. But you know your back hurts and you ask, 'can you put it right?'. First it is important to understand what is going on in terms of basic anatomy.
What are the sacroiliac joints?
Below is a diagram showing the sacroiliac joints, sometimes referred to as SI joints. These can easily be seen as two dimples when looking at someone from behind.
Image credit: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2).
It is a strong weight-bearing joint in the pelvis, connecting the pelvis with a triangular shaped bone called the sacrum. It is a very stable joint due to being surrounded by the biggest ligaments in the body, which help provide stabilisation and shock absorption for the spine. The ridges in the joint of either side act as a lock and key, much like if you put your knuckles together. These strong ligaments, together with the surrounding muscles, ligaments and fascia, control continuous distraction and compression forces around the pelvis in many directions as we perform our daily activities.
What are the symptoms of an SI joint issue?
When the joints become inflamed, pain is commonly felt on one side of the lower back.
The joint can move very slightly hence the term 'twisted pelvis'. You may experience pain into the hip, groin, buttocks and into the back of the leg. It is really important to get an accurate diagnosis from your physiotherapist as the symptoms can be very similar to other issues, such as prolapsed discs.
When you consider the complexity of the anatomy in the pelvic region, there are a mass of major nerves that pass in front of the joint from the spine and many anatomists believe that there are usually other factors involved in causing your pain as well as the sacroiliac joint itself.
If you look at the construction of the spine and legs that locate into your pelvis, there is a complex integration of movement and control required by many joints and muscles.
What can you do about it?
There are many options available when treating this and other spinal issues. Various physiotherapy treatments are available, which include manual therapy to more invasive ones such as a local injection.
Our approach at Ashleigh Clinic is always about movement, so we tend to base our approach on restoring normal function by adding simple functional exercises to your programme.
Here's an idea of some exercises:
Single leg to chest - lie on your back and as you draw one knee up to your chest, exhale. Flattening your spine to the floor and keeping your chin down to straighten the whole spine. Repeat with the other leg. Now repeat the exercise pulling both knees to your chest.
Knee folds - again lie on your back. Bend your knees with your feet on the floor. Place your hands in a crucifix position and gently move your knees from side to side.
The Cobra is an exercise many of you may know. Lying face down, place your hands by your shoulders and push up into a half press up position whilst breathing out, keeping your pelvis and legs on the ground. If this is too much, then keep your forearms on the floor for Half Cobra.
Child's Pose (pictured below) is a simple exercise where you start on your hands and knees with your knees apart. Then slowly breathe out and sit backwards onto your feet with your arms stretched out in front of you.
All of these exercises should be repeated 5-10 times and aim for a 5 second hold when relaxing and breathing out.
If you are in doubt, it is important you seek a consultation before performing these exercises. As we mentioned earlier, there could be many different reasons for your problem and it is important to target your particular issues.