Treatment for Pelvic Rotation and Low Back Pain

Do you have a patient with chronic low back pain, pelvic pain or lateral hip pain? The problem could be an oft-overlooked Anterior Innominate Lesion, commonly referred to as Anterior Iliac Rotation. This malalignment is hard to identify unless the clinician is specifically evaluating for body alignment.

Simply described, anterior innominate is anterior / inferior rotation of the ASIS when compared to the contralateral ASIS. This unilateral rotational movement of is often a result repetitive movement patterns. Repetitive movement results in hypertonicity of hip flexors (primarily the rectus femoris and TFL), hypotonicity of the abdominals, hamstrings, and glutes, as well as increased laxity of the sacrotuberous ligament. The force coupling caused by the hyper/hypotonic structures yields the unilateral rotary movement of the pelvis.

The result is a chronic, dull achy pain that is unrelenting at times. Pain is typically felt across the entire low back. Focal tenderness upon palpation is commonly unremarkable. The patient may also have complaints of thoracic pain, lateral hip pain and potentially groin. Pain maybe exacerbated with athletic activity, or static postures such as prolonged sitting and standing.

As with many postural disorders, treatment for anterior rotation is best served through the use of manual therapy techniques. In my experience, there are two quick and easy treatments: muscle energy techniques (MET) and spray and stretch. Spray and stretch technique is a nice way to inhibit and elongate tonic musculature. Ischemic pressure massage to active trigger points of involved muscles followed the application of a vapocoolant spray, during a passive stretch works well. Although both treatment forms are effective, I prefer MET, as it is fast, effective, and incorporate a semi-functional component through contraction and relaxation of muscle.

When it comes to MET (or most manual therapy techniques for that matter) I often refer to anything by Leon Chaitow’s methods. In this particular instance, I have provided a video clip of a MET that can help both anterior and posterior pelvic rotation in one treatment session. I think the physiotherapists across the Atlantic do a great job of manual therapy, thus I chose a video that was made in the UK.

It is not uncommon to relieve patient pain with just one application of MET. For patients with significant malalignment this treatment may need to be performed twice daily for several weeks in conjunction with traditional functional rehabilitation designed to enhance neuromuscular efficiency.

So, if you have been a patient complaining of low back pain, be sure to observe for postural malalignment. You might find anterior innominate rotation. If so, you can utilize these techniques to resolve the problem quickly and restore optimal function.

32 thoughts on “Treatment for Pelvic Rotation and Low Back Pain

  1. elizabeth hood

    Is there a surgurical correction if all these techniques fail, to keep the pelvis from moving thus causing a pelvic tilt every time stand or sit. Had accident 8 yrs ago and have acute pain every day since. Did the manual releases and pilates as pt for 2 yrs. Didn’t help. Use tens unit. Didn’t help.

    Reply
    1. Josh Stone, MA, ATC, NASM-CPT, CES, PES, FNS

      Surgery is always an option, but rehab is the much safer route and oftentimes provides better outcomes. Surgery may not improve anything. In complex cases – like the one you describe – it is often necessary to have manual therapy 1 or 2 times daily immediately followed by a focused (1 on 1) and very specific rehabilitation program, and then immediately followed by another manual therapy session. Too often I have worked with clients where manual therapy was not done enough, or rehab was not specific. This led to poor outcomes and no relief for the patient.

      Good luck

      Reply
      1. elizabeth hood

        I had extensively manual physical therapy for 2 and a half yrs, every day for 4 hrs a day including pilates to build up my core strength. Problem is that I tore whatever muscles join the 2 hemisheres of female pubis and seriously injured my Si joint. I am also a massage therapist and work on myself several times a day on pressure pts and deep tissue massage. As soon as I stand and especially when I sit, my whole right hip/pelvis moves up and down with each step and rises higher and higher as day goes on unless spend whole day laying down. Was on opiates for past 8 yrs, now I am not, just Tramadol. It doesn’t cut all the pain. Need some kind of surgery to fuse the pubic and/or the Si joint. Is there such surgery? What type dr. Does it?

        Reply
      2. Alice

        I had a injury in August 2011 and I have a right posterior left anterior issue. It causes me a lot of right rib cage issues. My QL is tight I my right side as well as right side abs and hamstring. My right foot seems to be longer now on that side. Any recommendations since all MRI’s show that I am fine and hip MRIs look good too. I have good disc space and have never had scoliosis but sure feel like I am trying to get it from This injury due to muscles feeling unbalanced from pelvis issue. Help!!!!

        Reply
      3. Melly

        Hi for how long should manual therapy b done once or twice a day ? Are there clinics that do this kinda thing and how are they called. Our daughter has had this problem for a number of years already n has bin in to have it adjusted but it never lasts and causes her a lot of pain , she is 21 already an we are getting desperate for help !!

        Reply
        1. Willette

          I struggle with this as well, I get my pelvis adjusted and then the other side rotates, I say I have a wonky pelvis. One thing you may want to try, that has helped me, is a sacral cranial massage, I went to a lady recently and she was able to break up some of the issues and tightness in the area. I was told that possible adhesions could be preventing my pelvis from staying put. Good luck to you, it sucks to be so young and in pain.

          Reply
    2. Tabby

      I am in the same boat. Did you ever get an answer?

      I am a 27 yr old female and my back was injured when I was 14. I was body slammed onto a brick fire pit to where my low spine/sacral area hit directly cebter of the brick wall. I was in physical therapy for many months and was able to deal with it. When i was 19 and pregnant it went down hill again. My pt said pregnancy and difficult delivery probably damaged the already weak ligaments. After thousands of dollars of pt, mri, xrays, traction, and countless dr visits, i have not gotten relief at all. I have however, been treated with disrespect, judgement, and like a hypochondriac. My primary doc seemed to care but not know what to do. My pain management and spine specialist act as if a young female is incapable of having pain. I have shown them that leg discrepancy is approx 2 inches (left appears longer) and my butt-crack is even crooked from the rotation – but I still dont get their attention. They say it shouldn’t cause pain like I “say” I have. I have shown the damaged capillaries clise to the skin on my lower back that I have ruined with a heating pad (I know this is bad but it gives temporary relief). They just dont seem to get it or care. I have seen people go in obvious fakes and get treated like they are dying simply because they are 10-20 years older. My back is so bad that having a second child is not possible because of the pain. They dont seem to get that is a big deal. How is it that this pain cant be caused by rotation or pelvic tilt if having limb length discrepancy can cause it?

      Sorry to rant. Please let me know if you found an answer.

      And dr. If you check here… is it possible to have a constant pain from this issue? Thanks in advance.

      Reply
      1. Josh Stone, MA, ATC, NASM-CPT, CES, PES, FNS

        Thank you for the comment Tabby.

        Unfortunately your story is common. Too often people in pain become part of the system and fail to get the attention they need and deserve. Most of my clients have this same problem. Insurance expires, PT is not focused and the doctors just give drugs to shut you up.

        I really couldn’t say for certain if constant pain is from this or not. But I could say it is a very strong possibility.

        Reply
  2. Ronda Boji

    I have been suffering for 7 years now. I have NO idea what caused this crippling problem. I am DESPERATE for help. You are the first person I have found (besides Dr. Marc Heller in Oregon) who seems to have an intimate understanding of this disability. I
    The first problem I noticed was a burning pain deep in my buttock. I went to PM&R doc who immediately told me it was SI Joint. Gave me a shot. It went away. 8-9 mos later, I had increasingly bad pain in my leg, which over time became unbearable…I limped…could not drive more than 10 minutes (Right leg)…could not climb stairs (Had to go up using only one leg),,,could not even kick my shoe off. Finally went to PM&R doc and immediately diagnosed me with Hip Bursitis. I went to regular PT for 2 mos. Only 50% better. 6 mos later, I was back in PT just as bad as I had been. This time I went to Orthopedic Manual PT. I will never go to any other type! He cured my pain FINALLY! I thought I would be in that pain forever. When we finished, however, he asked me, “Then why are you still limping?” I said I didn’t know…?? I had been suffering with lower back pain this entire time, but never tied it in. After having to go back to PM&R doc for what I now know very well as SI Joint pain and received epidural shot (which took my pain away within 2 days) I began reading up on the SI Joint and realized that all the severe back pain I had been having was all tied-in to the SI Joint, as was the Hip Bursitis, the limp, the lower pelvic pain, the inability to sit long, stand long, etc. I went to a Chiropractor and he noticed my inverted hip (my leg actually turns in) and worked on me for six mos at the same time as a new Manual PT. To no avail.
    I now live for an epidural every 4 mos. that only gives me relief for 1.5 mos. I suffer unbearably for the next 2.5 mos until I can get another epidural. I am depressed and upset and beyond DESPERATE for help. I run a business and am there 55 hrs per week. This makes it very hard to “find” a professional who can fix this. Any help is appreciated. My give-up choice will have to be surgery. I am a 53 yr. old female with bulging, slipped disks, etc. that do not bother me ANY WHERE NEAR as much as this SI Joint problem does. HELP!

    Reply
    1. Jennifer

      I really feel for you and all the patients on here. I just returned from an osteopath who has given up on me. Doesn’t understand why I’m in pain, thinks I’m exaggerating. But I can’t drive for very long, can’t lie on my own bed because it doesn’t support my hips. I sleep on the couch away from my partner and child to support one leg up. I have chronic upslip and rotation in right illium that creates sciatica like nerve problems in my thigh, calf and ankle. Numbing, and aching. I pull my hip down into place ten times a day and its not enough. Thank u Stone for your insistence on pt more often. I don’t know how I’m going to permanently solve how loose my joint is.

      Reply
  3. Pingback: Pelvic Upslip and Rotation: Evaluation and Treatment | Stone Athletic Medicine

  4. Dr. Tim Speicher

    I see about 10 patients per week for SI joint dysfunction- I am manual therapist that specializes in neurogic release and i am also a biomechanist. Several things to consider in addition to what has been mentioned is the need for a dynamic high speed biomechanical analysis which often reveals neuromuscular and structural compensations that are not visible to the human eye. Additionally many patients have neurochemical binding of tissues that requires specific and targeted release with such techniques as Positional Release Therapy or Facilitated PRT. Once tissue hypertonicity has been addressed along biomechanical loading issues- then and only then is rehab often effective and lasting

    Reply
    1. Jennifer

      That makes total sense! I couldn’t figure out a way to tell my general practitioner and PT how things keep being missed upon clinical evaluation. I’ve a persistant downslip on my right hip/leg that simply won’t settle in the correct position. MET and stretching is only temporary for myself as I do these things 60+ times a day… thankyou again

      Reply
  5. Wendy Thomson

    Dear Josh Stone thank you for your timely expertise in this complex complaint. Would you kindly tell me where the you tube video was shot in the UK – I would like to make a referral. Kindest regards Wendy Thomson

    Reply
      1. Wendy Thomson

        Hi Josh I,m a spent remedial gymnast physiotherapist ( now doing research) ! So when a great friend reported chronic disabling pain I decided enough was enough of pain killers, chiropractors etc. and wanted to look at alternatives for him. So I,m fascinated by your drilling down approach. I don’t think I could apply the technique as shown in ‘you tube’ ( which I think would be a demonstrated so admirably by a RG with a Scottish pedigree?) – because I haven’t got a plinth etc.
        But & his objective approach is so objective & realistic.! – The times I see ,so called, therapists applying regimes which are to me totally inappropriate have called into question my training & makes me wonder if my training was right ?
        Now I need to source someone similar in the UK & if possible take my friend by the scruff of his neck to the therapist who did the demonstration on YouTube ! So thank you so much for your work and your tenacity – kindest regards Wendy

        Reply
  6. Kathy

    I have a twisted pelvis and my Chiro does it totally different and I stay sore and in pain for at least 3 weeks after, what should I do? Thanks

    Reply
  7. Rebecca

    my pelvis was hyper mobile for 10 years on the left side. I had the si jointed fused 6 months ago I can walk, elliptical and swim without my pelvics rotating and sticking. I fought for this surgery for years. I knew what I was wrong with me but and I found a manual physical therapist to advocate for me with Sonoran Spine in Arizona. I have ongoing nerve damage that I believe would not exist had someone listened to me years ago. Keep fighting to find the right doctor, surgeon or physical therapist to advocate for you. Before the surgery I had stopped all cardio even walking because my pelvis twisted and would stick. My manual therapist was wonderful but after a year even he knew I needed the si fused.

    Reply
  8. will

    I have read the pelvic bones can’t rotate much independently. If one moves forward then the other one moves forward. I believe the range of motion at the SI joint is around 3 degrees. Instead, if you had one side that was tight, it would cause a “lateral” rotation to that side NOT and anterior rotation. This lateral roation/ pelvic obliquity would cause twisting of the pelvis and therefore twisting of the spine. Twisting of the spine is accompanied with lateral flexion of the spine. This lateral twisting of the pelvis is what causes the leg to appear short, NOT the anterior rotation of once side. Regardless, your technique obviously works and that is the most important part.

    Reply
  9. Willette Burback

    I was told I have a pelvic upslip on the left side and then when that is corrected my pelvis rotates usually on the right side. I go to PT and they do active release and it helps for a time, but then rotates again. I try to do the exercises to strengthen the area, but it still rotates. I have pain in lower back, mid back, hips, sometimes even knees and ankles. I was told it’s not my SI joint, but could it all be connected. Also any ideas how to stop the pelvis from rotating? This has been going on for 10 months for me, I’ve been to chiro, PT, Athletic Therapist, Oesteopath, and I’m 42 years old.

    Reply
    1. Joshua Stone Post author

      Without performing a full assessment I wouldn’t be able to give an accurate answer. Obrien thing that is very important is corrective exercise. Make you the corrective exercise you are doing are being done consistently (4+ days per week) and with absolute perfection. Most people don’t do them perfectly unless they are being supervised.

      Reply
    2. Jennifer

      I have the same issue and my story is very similar to yours. Ten months of pt, adjustments, exercise, stretches, and massage to loosen persistent tension in pelvis, spine, and lower back. Get an MRI, because what i learned is that my l5-s1 has been degenerated for years now after it herniated, then with wear my l4-5 began to change as well. In fact my whole spine slowly showed deterioration all originating from that initial injury to my l5-s1. That’s where the instability is for my pelvis and si joints. And omg in the process of writing this I just got the call approving a hybrid surgery! This has been a ten year long process of diagnosing, conservative treatment, waiting, and fighting for intervention. Get an MRI. See a surgeon who does ADR. Start doing research. Good luck to you!

      Reply
    3. Rob Rich

      Hi Willette,
      Find an Ortho-Bionomy practitioner in your area. One issue that is often not addressed by poeple who focus on muscles is why the muscles contract to start with. The QLs are recruited when the lumbar spine is unstable usually due to a rotational movement (the ribcage has 32 degrees of rotation the lumbar spine has 5 degrees, so if the ribcage is jammed – feel for a protruding rib then you will be recruiting into the lumbar when you rotate). I use QL tension as an indicator of lumbar spine stability, work with the spine and you can see the pelvic rotation and upslip self correct.

      Reply
  10. Lorraine

    Hi, I was just wondering if one’side is elevated ( in this case my right) can it make the other side ( hip and surrounding regions) miserable as well? I have suffered right sided hip instability for years and it has been for the most part greatly helped by my chiro, as in getting the hip back down to a reasonable level. But recently I have been experiencing terrible pain and tightness on the opposite side as well when the right side goes out! Almost like a very hard pinching and bad tightness under the butt A ND resulting piriformis misery, as well as pain on the outside of the hip. Rally bad stiffness. When the right side is adjusted it eases off…a bit. What causes this misery on the other side? Thanks in advance for your reply!

    Reply
  11. LORETTA MILES

    My low back on the left side hurts terribly. The pain also goes down my left leg on the outside. The chiropracter says it is pelvic rotation and is treating me for it, but any relief is only temporary……maybe 1/2 hr. Excruciating pain is there all the time.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *