Pelvic problem

[maiaoz]

Hello to you!
Following the mishandling of the pelvis that I did myself, I am stuck. It is now six years I've lived with it. The left pelvis moved 10 cm to the right by turning inward.
I went to see some osteopaths but nothing to do. The last that I saw in 2007 handled me during 15 minutes and told me to wait several days before to comes back up but it never came up.
After that I have not insisted on physiotherapist and osteopath sceances because I know very well they can do nothing.
Until now surfing a little on the net, I found orthopedists.
I wanted to know if this kind of physician could surgically help me to replace it.
I have not yet ask advice from a physiotherapist or an osteopath on this one but given the importance of moving I think I must do something.
Thank you in advance for your answers.

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[SigMik]

Dear Maiaoz.

First of all, what do you mean by "mishandling" your own pelvis? Was it due to a trauma?

Secondly, just to clarify. It is literally STUCK in a position, it does not MOVE 10 cm?

Thirdly, 10 cm. is quite a lot. Who measured this? Was it eyeball estimation by a therapist or yourself? You mention both "turning inward" and "it never came up". In what direction is it misaligned and from what reference point (reference to leg length or from left ilium to spine/belly button)?

Fourth, what is your main activity restriction due to your misaligned pelvis? Is this mainly due to pain or stiffness? And where is the main area of pain or stiffness?

Lastly, if the pelvis is misaligned and stuck by 10 cm, then I am of the same opinion as you, I hardly see any physio or osteopath being able to correct this. A physiotherapist could provide management strategies to help you improve your activity restrictions but only in terms of exercise therapy. I would therefore, based on the information so far, advice you to seek an opinion from an orthopedic surgeon concerning the 10 cm. misalignment of your left pelvis.

Kind regards,
Sigurd Mikkelsen

[maiaoz]

Thank you for responding so quickly.
In fact if I put in a fixed position, standing and a x ray was made, a pelvic shift would be clearly visible. But in addition to this shift, with manipulation, for example if an osteopath and the fact that the pelvis is moving, it will see and feel a large left pelvic anteversion with his hand.

To answer your first question, my problem is not caused a car accident or a fall or a malformation, it is a "wrong move", I can't describe to you what I did it as manipulation because it does not have a name in technical terms so I would say it was a "wrong move", a left pelvic anteversion to be more accurate than I did with my hands. I manipulated my left pelvis. If you want to know why I did that I could you explain in detail later, but now it does not really matter, today it is severely blocked.

For your second question, my pelvis is indeed blocked in one position, but if I try to do an hip extension, hip flexion, the left pelvis will tend to have excessive anteversion coupled with internal rotation.

For the third question, 10 cm, it is a way of speaking to say that it's huge shift. It is an estimate made by eyeball.
"Turning Inward" was to say that the left pelvis perform an internal rotation and "it never cam up" to say that I could never put it back in its normal position.
The direction of alignment is in a plane transverse and slightly more frontal (anteversion, internal rotation).
The reference point is the left iliac bone, spine and navel.

For your fourth question, this problem prevents me from playing sports, running, to feel good about myself, I am often stressed, I feel stuck, it has already wasted six years of my life and if I can find no solution that will continue.
This is mainly due to stiffness, a severe blockage. I have very little pain. If there is pain I think it's mainly due to compensation caused by the blockage.
Sorry for my English. I'm French and I don't speak English well. I use a translator.

[SigMik]

Hi again, Maiaoz.

Thank you for additional helpful information and I think at least this makes three important issues clearer.

First of all, it seems to me that 10 cm. is a subjective reference to how misaligned your pelvis is. This was an important point to clarify, as a 10 cm. shift would potentially be a physical disadvantage.

Secondly, we have clarified that the main component causing you trouble is STIFFNESS, there is generally little pain, and you reason yourself that the pain associated with it could potentially be due to a compensation issue.

Thirdly, although this situation obviously seems to affect your quality of life, you report that it prevents you from playing sports and running - two relatively rigorous activities - physically speaking. I therefore carefully assume that you are able to sit and walk, sleep, get in and out of bed/car and similar activities with relatively little restriction.

I'll try to discuss some of these issues a bit more. When you describe your pelvic position, you refer to a X-ray that clearly shows a pelvic shift. The reference points when observing these kind of X-rays are first of all the height of your ilium (the two larger bones that articulates on each side of the sacrum, together making up the pelvis) and the obturator foramen (the two biggest circular rings) amongst others. I always say that diagnostic images shows no pain - with that I mean that even if there is observations of anomalies, they do not represent painful situations. Many people with no activity restrictions will show anomalies on such images. One should therefore be careful on concluding a causality when observing images, especially if there is no strong hypothesis of what kind of anomaly the observer is looking for.

You then describe that the osteopath could see and feel a pelvic anteversion. These abilities, (to see and feel), are a matter of ongoing discussion, mainly concerning REPRODUCIBILITY (can I consistently see and feel the same situation on several occasions, and would my colleague observe the same if he tried to see and feel the same situation?) and VALIDITY (do these observations really mean anything?). People within the same profession does not agree on this, and even less, the different professions generally have very mixed opinions about this. In fact, this topic is probably one of the subjects that will cause the most emotional loaded discussions too.

My initial advice on seeing an orthopedic surgeon was solely based on a 10 cm. misalignment of your left pelvis as you initially described, as this was also your main question of concern. I feel both you and I have clarified that this is not true, and the answer to how misaligned your pelvis is, are a bit more subjective than what initially thought.

Further on, the references to how much or in which direction your pelvis is misaligned, are largely based on observations on which I have discussed, namely X-ray and "see-and-feel" issues. I can therefore no longer justify my initial advice, and am at this point NOT of the impression that you need to see an orthopedic surgeon. The misinterpretation from my part, are not unusual when discussing complex health issues on these types of fora, and highlights the importance of good communication when a person seeks advice in regards to health issues. This concerns the detail of information you might give in these types of fora, but especially also a reminder to myself on what advice to give based on what information.

In order to better achieve this level of communication, I therefore believe that you need to discuss your concerns with a health care professional in-real-life, before one can start to untangle the physical and/or emotional components that represents barriers to your recovery.

I am truly regretful that I can not be of any more help at this point, but ask you to keep in faith.

Kind regards,
Sigurd Mikkelsen

[maiaoz]

It is true that my problem requires some tests and consultations.
And this with real health professionals.
I think I'll go see my GP soon to go do some x rays, and finally finish with an orthopedist.
I have not made any x rays or extensive examinations.
But my mind is rather oriented toward the surgery.
About surgical orthopaedic procedures, they are multiple I think. I'd like to know roughly if it's if the surgeon could adapt a surgical procedure, according to its competence and according to the problem of the person or what it's imposed procedures that he has learned during his studies and he can't do otherwise?
If you also brief or detailed information on surgical procedures for replacing a pelvic can you give me this information?
This is just to have a personal opinion to see if it could help me.
Thank you in advance.

[SigMik]

Dear Maiaoz,

in general, the most common surgeries would involve reconstruction of the pelvis because of fractures following trauma, and in some cases surgical fusion of the joint when PAIN is thought to emanate from the joint itself. However, reviews from postoperative outcomes report that up to 50% still have pain after a fusion of the SIJ. This is because the pain is often caused by the heavily innervated soft tissues around the joint, rather than within the joint. Also, surgical procedures will often be the last intervention to try, after other conservative approaches have failed. This is because any surgery involves a risk in itself - the patient is not guaranteed that a surgical procedure will help. And I have personally never heard or read any reports of cases where there has been done a surgery to replace a pelvis.

I understand that you've tried some therapies without success, but my mainstay on this is that the focus from any therapist should look at you in a more functional perspective and analyze if there are any other possible explanations to why you feel this stiffness. Such a consultation should include an evaluation of whether the lumbar spine, the hip joint or the leg muscles contributes to your perception of stiffness.

If you have not been examined thoroughly by a specialist within the neuromusculoskeletal field, I would advice you to do this at some point in between consulting your GP and the orthopedic surgeon. If for nothing more than a second opinion in terms of identifying possible ways you can improve your way of moving, help yourself and in preparation for whatever opinion the GP or orthopedic surgeon would have in regards to your situation.

Have you considered other explanations to why you feel stiff, other than the pelvis being out of place?

Did you feel that the pelvis was out of place, before the osteopath told you?

Who took the X-ray and who told you that the pelvis was out of place, based on the X-ray?

Kind regards,
Sigurd Mikkelsen

[maiaoz]

No. Because there are six years that I was very athletic. I manipulated my pelvis to January 1, 2005, I was 19. And now I have 24. I was very athletic in my adolescence I was doing all kinds of physical activities, athletics, swimming. I was comfortable in my movements, that's why I did not ask further questions, I've never had any blockage before.

My pelvic was in place during my adolescence until that accidental manipulation.The osteopaths, it was to resolve this pelvic shift. Since this manipulation, I became aware of this blockage. It's not an osteopath who told me so.

I have not still made any x ray. But I don't need this to know that my pelvic is moved. If I make one, it's only if a therapist asks me for reasons of justifications of pelvic displacement for medical principle.

[SigMik]

Dear Maiaoz,

apologies for my delayed reply. And thanks for answering the questions I had for you. Again, I misinterpreted the information you gave me - I thought you HAD done an X-ray... I think this highlights even more my previous comment about the importance of good communication in regards to such important matters as health. As neither of us has english as our first language, it puts an even stronger emphasis on my suggestion of you seeing a therapist in real life and communicate in your own language so messages don't get misinterpreted again.

Sorry I couldn't be of anymore help, but wish you well.

Kind regards,
Sigurd Mikkelsen