pelvis out of alignment on both sides

[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