pelvis out of alignment on both sides

[caz]

My physio has told me that my pelvis is twisted on both sides - the right side has slipped forwards and the left side has slipped backwards. I was just wondering how common this is, and also any idea what might have caused this to happen? Was it caused by an accident (I ride horses and have had many falls over the years), or is it just the way my body has developed? (I am 39 but I reckon I have had this since I was a teenager)

I also have other imbalances - right leg longer than the left, scoliosis with head off-centre etc. I'm assuming these are all connected, but I don't know which came first!

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[neuromuscular]

My physio has told me that my pelvis is twisted on both sides - the right side has slipped forwards and the left side has slipped backwards. I was just wondering how common this is, and also any idea what might have caused this to happen? Was it caused by an accident (I ride horses and have had many falls over the years), or is it just the way my body has developed? (I am 39 but I reckon I have had this since I was a teenager)

I also have other imbalances - right leg longer than the left, scoliosis with head off-centre etc. I'm assuming these are all connected, but I don't know which came first!

u

Dear Caz:

In your other post you mentioned that you have scoliosis. From my research, it has often been that people with two different pelvic angles such as you are describing have scoliosis.

As the acetabulum is not in the center of rotation for the innominate bone of the pelvis, the rotation causes a functional differring of leg lengths. This puts the body on a slant or slope. Which, in turn, causes compensations which lead to scoliotic patterning.

Hope that you find this helpful.

Best regards,

Neuromuscular

[caz]

Many thanks for taking the time to reply - what you say makes perfect sense. I think I've got more information from this site than I have from the health professionals I've seen to date! I had one GP who refused to believe I had a problem and just told me I 'looked quite straight' (without examining me of course!). My own GP recognises I have scoliosis but doesn't seem to think this could cause me pain so is unsympathetic about my situation. The 3 physios I've seen have been lovely, but have all dismissed me after a couple of months, saying they can't do anything for me.

I don't even know what is causing the pain - the physios seemed to think it was the twisted pelvis causing the pain, whereas another doctor I saw said it might be a problem with a disc.

I find it quite distressing at times, although I do my best to get on and make the best of things - I'm not the sort of person to sit around complaining and I'm doing everything I can to help myself - I do pilates and yoga, I have joined a gym to improve my general fitness and I take Alexander Technique lessons to help with my posture. But unfortunately I'm still in pain, with a GP who thinks I'm a hypochondriac, and I don't know where to turn next. I'm not sure if it is worth trying a private physio, or whether I should just accept that nothing can be done...

Anyway, many thanks for your interest in my case - it is most appreciated.

[neuromuscular]

Many thanks for taking the time to reply - what you say makes perfect sense. I think I've got more information from this site than I have from the health professionals I've seen to date! I had one GP who refused to believe I had a problem and just told me I 'looked quite straight' (without examining me of course!). My own GP recognises I have scoliosis but doesn't seem to think this could cause me pain so is unsympathetic about my situation. The 3 physios I've seen have been lovely, but have all dismissed me after a couple of months, saying they can't do anything for me.

I don't even know what is causing the pain - the physios seemed to think it was the twisted pelvis causing the pain, whereas another doctor I saw said it might be a problem with a disc.

I find it quite distressing at times, although I do my best to get on and make the best of things - I'm not the sort of person to sit around complaining and I'm doing everything I can to help myself - I do pilates and yoga, I have joined a gym to improve my general fitness and I take Alexander Technique lessons to help with my posture. But unfortunately I'm still in pain, with a GP who thinks I'm a hypochondriac, and I don't know where to turn next. I'm not sure if it is worth trying a private physio, or whether I should just accept that nothing can be done...

Anyway, many thanks for your interest in my case - it is most appreciated.

Dear caz:

It must be very frustrating. I was told that I needed asurgery or would be in a wheel chair in ten years - that was over 30 years ago.

However, contact a physio or other professional who will take the time to do a pelvic assessment from all four sides and with hip abduction.

Then the most common treatment that I have seen to work well with what you describe is to treat the adductor longus and adductor magnus on the left and the psoas on the right. If you have someone who can do this see what effect it has on your pelvis and scoliosis.

The usual is that the pelvis levels and the scoliosis is moderated.

There is much more to do than just this, but it would probably make you much happier.

Best regards,

Neuromuscular.

[caz]

Thanks again - so it sounds like it is worth giving physio another go. All I need to do now is find a good physio who has a good understanding of these issues...

I'll let you know how I get on.

[caz]

Sorry to come back with yet more questions!

I spoke to my GP about this, and he discussed the full report from the last physio I saw. The physio had tried to correct the pelvic alignment but came to the conclusion that this could not be corrected because it was a 'long standing' problem, and was associated with scoliosis. The implication was that the structural changes are permanent so it cannot be corrected. I think she is right that I have been like this for a long time - I am 39 now and I remember back in my early teens there were signs that my body was out of alignment (even though I thought nothing of it at the time, and it didn't give me any pain so it wasn't investigated).

So if I have been like this since I was a teenager, is there any chance it can be corrected, now that everything else seems to have gone out of alignment to compensate?

My GP has said nothing more can be done, so I'll not get any more treatment from the NHS physios. I would be prepared to pay privately if it would help, but there is no point going down that road if it is the case that it is too late to correct my alignment.

I'd be interested to hear what you think....

[opihiman]

what are your pain behaviors like....When does it hurt more, and when does it hurt less?

OPI

[neuromuscular]

Dear caz:

I guess that I am of a different opinion.

*I cannot see that a pelvic misailignment as permanent unless there is physical damage or neurological causes or some other factor that is a medical condition.* I have treaterd several people with long standing misaligmemnts with resolution of the misalignment in the majority that lasts unless there are ergonomic factors wich produce RSI or trauma injuries.

Many feel that idiopathic scoliosis is permanent, but opinions change as more research is done.* I am treating a paitnet with idiopathic scoliosis of forty years ago and with the new research we are getting very pronounced changes that will be confirmed by an MRI in late December.

The assessment of the pelvis using the four sided test with landmarks and hip abduction give the necessary information to treat these type of problems.
Hope that this is of benefit to you.
Sorry that I am in* another country as your case would be of interest in the research project.
Best regards,Neuromuscular.

[caz]

Neuromuscular - yes, from what I've read about this, there seem to be very different opinions about the causes and treatment of scoliosis. I wonder if the UK is a bit behind in this idea that scoliosis (certainly as an adult) is permanent. So what I need to do is try to find an enlightenend physio who has done some of the research you've done and is prepared to try to fix the problem, rather than just deal with the symptoms. Yes, what a shame you are so far away - you seem to have a very good grasp of the problems and what can be done to help!

Opihiman - I have a continuous low level ache in my lower back and right hip -its never a sharp pain, its more like toothache - a deep, throbbing kind of ache. But sitting causes me the most pain, and I also find standing still is painful - in fact I just don't stand still, I tend to wiggle my hips and move from side to side, which helps a bit. Movement in general seems to help - so I am constantly changing position. The most comfortable position for me is lying on the floor with my feet on a chair.

So I have no idea what all that means - I'd be interested to hear your opinion!

[opihiman]

Does Lateral flexion stretching help or hurt more

OPI

[caz]

Bending to the right makes no difference, but bending to the left makes the pain worse.

Some further information, in case that helps you work out what is happening - I have no problem bending forwards, in fact since I've been doing my hamstring stretches, I can now touch the ground without difficulty although I do sometimes get pain when I straighten up again.

My movement leaning backwards is more restricted, and does cause me pain (across my lower back, but worse on the right side)

Thanks for your continued interest

[opihiman]

I would beg to differ on bending forward being OK. Sitting which is the flexed position held over a longer duration, and your HS stretching both cause you more pain. which would be an indication of and overall bad direction.

Lateral flex R on the other hand sounds like a possibility...try stretch out you lateral flex R. and see what impact it has on your other movements.

Good luck.

Bending to the right makes no difference, but bending to the left makes the pain worse.

Some further information, in case that helps you work out what is happening - I have no problem bending forwards, in fact since I've been doing my hamstring stretches, I can now touch the ground without difficulty although I do sometimes get pain when I straighten up again.

My movement leaning backwards is more restricted, and does cause me pain (across my lower back, but worse on the right side)

Thanks for your continued interest

[Canuck Physio]

Dear Caz,

Hi I became very interested after reading your case, the issue being that pain usually is a sign that there is some form of manifested dysfunction in the body that is telling us that something needs to be done to rectify it. Even if you have scoliosis True, there is no reason why you can't be placed into the best alignment against gravity for your current situation. The common fallacy these days is the belief that we can not change long term problems. Although it is quite obvious that these long term problems are exactly what we need to rectify;

a visual example to make point:



On the other hand, could you help us out by answering:

- When did your problem begin?
- What incident caused it? Trauma/Insidious Onset
- What happened initially, what did you do? Pain?
- Who did you contact/see? What did you do?
- Where did you go  admitted?
- What Rx did you receive – how did you feel? How did it affect you?
- What investigations did you have? What happened next?
- How were you before this incident?
- How have you been since?

How is:
- General Health
- Any previous similar injuries, surgeries, fractures?

Also this helps:

Bending to the right makes no difference, but bending to the left makes the pain worse. Great! a clue!

Some further information, in case that helps you work out what is happening - I have no problem bending forwards, in fact since I've been doing my hamstring stretches, I can now touch the ground without difficulty although I do sometimes get pain when I straighten up again. Pain! Where?

My movement leaning backwards is more restricted, and does cause me pain (across my lower back, but worse on the right side)Would be great to have a body chart about now ...

Can you describe the pain more spefically
- where is it,
- is it constant or intermittent
- Is there any time its not there,
- How bad is it at worst, how good at best?
- Is it improving, the same, or getting worse generally
- You mentioned some things that make it worse, any movements that make it better?

Also, if you can paste a body chart of your problems that would help a million.

Regards

[caz]

Thanks very much for replying. I'll attempt to answer your questions to see if that sheds any light on the situation! This makes it a very long post, so apologies for that!


I have had back pain on and off probably for about 10-15 years - but it was only occasionally to start with, and was just a niggling ache as opposed to anything that I felt needed attention. However over the years it has got progressively worse (both in terms of how often I get the pain, and the intensity of the pain).

When the pain started to interfere with my daily life eg preventing me from sleeping (this was about 2 and a half years ago), I went to a private physio first, who gave me some exercises and did some manipulation, but this didn't help so I gave up on that after a few months. I then went to my GP, who prescribed anti-inflammatories. Again, this didn't really help so I went back to him, and he then put me on the waiting list for an NHS physio.

In the meantime, I thought I would try a chiropractor - he was the one who first diagnosed the scoliosis and twisted pelvis. Again though, I gave up on this treatment after seeing him for a few months because I felt it wasn't helping.

After about 6 months I got an appointment with an NHS physio, who thought the main source of my pain was the twisted pelvis. She tried to fix the pelvic alignment, but it didn't 'hold' so she gave up on that and gave me acupuncture for pain relief. I found the acupuncture helped for a few days, but of course this didn't solve the problem. This physio discharged me after a few months, saying she couldn't do anything more to help. I was also sent to an NHS pilates class around that time, and I have continued to keep this up myself.

So, it was back to the GP again, who this time referred me to an Orthopedic Triage Clinic. The doctor I saw there told me I didn't have scoliosis and my pelvis was level and that my pain was probably caused by bad posture. However, he made this announcement without even examining me, so I was not at all impressed with his medical opinion! And I've been taking lessons in the Alexander Technique for almost a year, so I am very conscious of my posture... Anyway, this doctor referred me for yet more NHS physio.

The second NHS physio I saw examined me and came to the same conclusion as the other physio and the chiropractor ie I have a twisted pelvis and scoliosis. Again, she seemed to think it was the pelvis causing most of the pain, so she tried to realign the pelvis. But again, this didn't hold and it kept going back to the way it was. She then asked her more experienced colleague to assess me, and she confirmed the problems with the pelvis, scoliosis and associated imbalances - one shoulder higher than the other, head off-centre etc. Her analysis was that because it was a long standing problem (probably since I was a teenager), the changes were permanent and nothing could be done. So I've been told now its just a case of pain management.

My general health is very good - I don't have any medical problems, I don't drink, smoke etc. I try to keep as fit as I can and work out at the gym 5 times a week, and do pilates and yoga type stretches every day.

One thing I should point out, that may or may not be relevant - I have ridden horses pretty much all my life, and have had lots of falls over the years. My worst one was when I was 16 and fell from a galloping horse onto the road - I broke my left shoulder and wrist. I've had other falls which haven't resulted in serious injury but which have left me sore for a few days. One of the physios I saw wondered whether the pelvic misalignment could have been caused by a fall years ago...



The pain is across my lower back/top of the pelvis - it feels sometimes like there is a tight band around my lower back. Although the pain affects both sides of my lower back, it is worse on the right side - around where the sacroiliac joint is. I also get pain in my right hip - its hard to describe the exact area, but it could be anywhere around the hip bone, right buttock, or sometimes into the right groin with a vague ache in the right thigh. Very occasionally I will get a sharp pain in the right side of my back when I'm walking quickly and I turn the corner -its as if something 'catches' - but this is rare and its usually just an ache rather than a sharp pain.

The pain is constant - its the first thing I'm aware of when I wake up, and its there all day - it usually gets worse at the day goes on. At its best it is a dull niggling ache, at its worst its a deep throbbing ache that makes it difficult to concentrate on anything else - I would describe it as like bad toothache!

I think the pain level has stabilised - it had been getting worse over a number of years, but has been about the same for the past couple of years.

General movement seems to help, rather than any specific movement. It definitely helps if I can change position frequently - so when I'm at the gym, I never do than 10 minutes on any machine because I get too sore, but I can do 10 minutes on the bike, then 10 minutes on the crosstrainer etc and manage this ok.

There are also some yoga stretches which are good for me eg the 'child's pose' - if I push my bum right back in this one, this feels great! Also the 'downward facing dog' one is good. I also find that squatting helps - don't know why any of these things work though! And another thing that helps, but I don't know why...my Alexander Technique teacher gets me to lie down with my left leg bent and foot resting on the table - he then takes holds my right foot and takes the full weight of my leg. Then he pulls my leg out and slightly to the side and this feels fantastic - which makes me think the pain must be related to something happening in the right leg/hip/SI joint...maybe?!

I'm afraid I don't have a body chart I can put up, but hopefully this will be enough for you to go on...

Thanks again for taking the time to read this essay

[Texasgal]

Caz, I am not even sure you will see this message but I was hunting around the internet trying to find out HOW to relieve my aching, aching hip pain when I cam across this forum. I was shocked to read how incredibly similar we are to each other! I am 42 and have ridden horses all my life and still do today with many bad accidents and I was diagnosed as a yound teen with scoliosis. I have the same symptoms as you have except mine are on the left side not the right side. I also have severe pain my cervical spine due to a bulging disc which may turn out to be a ruptured disc when I go in for an MRI on Monday. My symptoms have gotten a lot worse over the last several months and my nonstop horse riding and barrel racing, which is a rodeo event we do here in the states on our horses, does not help my spinal problems nor my pelvic problems. Anyway, I hope you see this message and you let me know what you found helped you in the last year or so. I am at my wits end with this pain! The docs in the US want to treat the symptoms not the problem. I do not want to live my life on pain meds or Cymbalta although the Cymbalta helped the pain quite a bit it made my mind fuzzy and I don't think taking meds the rest of my life will fix the problem. The chiropractor has helped me a little but the one person that has helped me the most and really figured out that my pelvis was twisted or out of alignment was my massage therapist!!! No MD has ever thought about this nor taken the time and now I need to know where to go from here??? Help??? Hopefully, we can get this all fixed before they decide to make drastic changes in our healthcare here in the US!!!

[Petra Karni]

Hi Caz
I am a physiotherapist, Alexander Technique Teacher and a craniosacral therapist.
I know form working with people and my own experience( I havn't fallen off horses but I grew up skiing and falling many times) that craniosacral therapy can help. Browse The Upleger Institute site and have a couple of craniosacral sessions to find out if that helps you. Good luck!

[caz]

Petra - sounds like you are ideally qualified to help me - I've found the Alexander Technique to be of help and I have found a fantastic physio who has done some craniosacral therapy and myofascial release, both of which have been some benefit.

Texasgal - I'm sorry to hear about your problems, it definitely sounds like we are two of a kind! There seems to be very little understanding of problems like ours - like you, I've pretty much been written off by the NHS, just told to take painkillers and get on with it! Easy to say, but not so easy to deal with when you are in pain all the time and it is interfering with every aspect of your life!

I still haven't found a magic solution to my problem - and I think I'm now resigned to accepting that there isn't one and that I will have to learn to live with the pain. But the good thing is that I feel I am managing it a bit better now - as I said, the Alexander Technique has been a godsend - it has improved my posture and has also helped me deal with the psychological effects of chronic pain. I feel a bit more in control of things now, rather than feeling the pain is controlling me. And I've found a great private physio, who uses a number of different techniques (mobilisation, myofascial release, craniosacral therapy, acupuncture, exercises) to help relieve my pain - this is only temporary, and only reduces the pain, rather than eliminates it, but its still something positive. She is the only physio who has really been able to help me though (and I've seen 4 others) so I think it does vary a lot between different practitioners. I've been very lucky to find such a good one!

I hope you can find something to make life more bearable - I know how horrible it is being in pain all the time, and it does drag you down. But don't give up the riding, whatever you do - I think us horsey people need this to keep our spirits up!!

[jonogunn]

I also have alignment problems due to my extremely unstable si joint. i'll keep an eye on this post.