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.

18 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.

    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

      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?

    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.

      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.

  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!

    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.

  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

  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

      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

  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

  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.


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