Can anything help pelvic/spine joint problems?

[lesleyfx]

Hi there, I'm hoping someone can suggest ideas for self-help and hope for the future.

March 2007 I had a right THR. I had been using a walking stick in left hand for a full year prior to this and walking less with more pain despite strong painkillers.
After my op the hip was suddenly painfree. While on crutches I was over the moon, painfree, walking a couple of miles a day and loving it. As soon as the crutches were taken away I came down to earth with a bump. very low back pain and trying to walk further than 100 yards causing my pelvis to tilt further and further out behind me. Felt like something was knotting up tighter and tighter. Standard THR physio didn't help. Then found I also have OA of lumbar spine, but that's a higher level. Physio for lumbar spine didn't help lower pain either... told it's illiac joint pain due to pelvis being out of allignment? Eventually told right leg is now longer than left leg so that's agravating the pain. Got a heel raise.... I've now been using the heel raise for 9 months and still no improvement in the illiac joint pain. Still the pelvis tilts gradually further out to the back as I walk further. To walk round a supermarket I NEED to lean on a trolley.
I'm only 49 and really want to find something to improve this? I still do physio exercises... core strengthening, including pelvic tilts concentrating on the lower abdo muscles, hip and leg muscle strengthening (standard post THR type), I also do lots of pelvic tilt exercises while sat at desk at work (discreetly, no-one notices, while working). I'm fed-up with living on Tramadol simply to continue half-normal life. More importantly........ I really really miss being able to walk round a park or along a beach.
Can anyone suggest anything that could help? Or give me hope that my pelvis will eventually straighten up? Or anything? Please?

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[neuromuscular]

Dear Lesliefx:

Have yopu been assesed for pelvic angle difference?

Try this simple test.
Place your fingers on the right and left ASIS. Stand with foot position at 30 cm. Then increase the foot width using hip abduction directly lateral.. As you increase the foot width to 60 cm, then 90 cm note if the one ASIS moves inferior to the other. if you do your problem may be associated with pelvic bone problems or pressure to the bones by a muscular problem.

Once you have done this please contact me.

Best regards,

Neuromuscular

[lesleyfx]

Thanks for replying neuromuscular
No I haven't been assessed for angle as far as I know.
I've just tried what I think you meant (layperson interpretation?)
For a start, to stand feet 30cm apart without my heel raise my weight is thrown completely onto my left leg. Trying to pull the weight back to the centre uses a lot of muscles and tension. Stood like that the right ASIS is higher. As I move my feet apart, still keeping the weight centred, my right ASIS drops most until at 90cm apart it's dropped below the left ASIS. Having just tried the same exercise with my shoes on (heel raise in), they start level, and as my legs widen the right drops slightly more but unsure how well I'm centering my weight here? I think I have a learned tendency to put more weight on the left now? Hardly suprising (RTHR and leg length difference).
The thing I notice too...... You know how you can drop the hip out to side to take all the weight on that leg? my left hip will go out to the side very normally... if I try the same with my right hip it a] feels awkward to do and takes concentration and muscle power to hold, b] instead of going out to the right it goes backwards too? sticking my buttock out and up? This is similar to the problem I have walking... as this gradually causes tightness and knots around both iliac and lumbar. Even though I walk tall with weight centred and hips held in straight, not with hip swing. I should add here that I'm very overweight which won't help. To be able to walk round a full supermarket I have to lean on a trolley.. if I try walking it unaided but with heel raise in I end up with backward curl on lumbar spine, muscle knotted, pain. This, even when I concentrate on lower abdo muscles pulling pelvis forward the whole time.
Does any of this make sense?
Last point.. for comfort sitting, the left corner of my sofa works like magic. With my back shoved hard against the back, left leg curled on seat, right leg up and straight on seat, with left foot against it, left arm resting on sofa-arm.... is the one position that will ease my back pain. (a fact no-one else has been interested in, but I'm sure should be valid?)
Thanks

[neuromuscular]

Dear lesliefx,

Wth information you supplied, it would appear that you have a mucscular imbalance causing pelvic bone imbalance as I often see. I call it APAS. The research paper on it will be out in a little while.

Have a practitioner palpate the adductor longus on the left. If this is very tender, this will be a start. The imbalance of the pelvic bones has been one of the most overlooked problems.

The next step will be to assess the right psoas.

Your position of comfort also indicates pressure on the pelvic bones.

Have your practitioner contact me.

If your practitioner cannot make sense of the test, then you may contact me again.

Best regards,

Neuromuscular.

[lesleyfx]

I don't have a 'practitioner' now (assuming I'm rightly reading physiotherapist)
NHS only supplies short-term help and I've not seen a physio for over a year now. I still do the exercises I was given, on my own at home. I don't see my Orthopaedic surgeon til next March 2009.
Are you suggesting I need to find a private physio? Or are there things I can do for myself?