My “Out of Alignment” Hips Don’t Lie or Do They?
One of the most common statements we encounter is, “my hips feel out of alignment,” and sometimes people include their spine. While this discussion is in no way discrediting the symptoms that you are feeling, but we hope, this helps you get change your mindset about your hip/SIJ being out of alignment.
Everyone loves an origin story
Like most things in the medical field, advancements in technology and research help drive out old information. But, where did this information come from? Most of these forms of diagnoses and classifications of pain come from clinicians and research determining this Sacro-Ilac joint having movement, observing leg length discrepancies, or point tenderness in the low back region of the PSIS (posterior superior ischial spine). From there, terms such as, “innominate mal-alignment,” “nutation,” and “counter nutation.” were formed and used to give subsequent treatment rationale. While the SIJ does move, more so when women are pregnant – due to chemicals and hormones; research has found this to be only about 5-6 degrees with active LOADED movement, and even less with passive movement. This means that even if it did move… We probably wouldn’t even feel it.
What we know about being out of alignment now
Alignment diagnoses are based on the palpation (touch) and observation skills of the provider in regards to a person’s bony landmarks/leg length discrepancies. More and more findings today are refuting the notion that palpation is the gold standard tool for clinical decision making. This is because numerous studies have found that intra-rater reliability of palpation is noted as “okay-good,” and inter-rater reliability as, “inconclusive – poor.” But what does that mean? “Intra-rater” means the same professional can repeat the same finding multiple times, whereas “inter-rater,” involves multiple clinicians. Basing a finding or a conclusion on a skill that cannot be reproduced accurately by multiple people is not evidence based or research supported medicine. Another issue lies in the terminology associated with being – “out of alignment.”
To have your joints out of place would actually require more force than a person can create, most times. This would result in dislocations – having increased sharp pain, bold limbs, altered sensations, unable to bear weight through a limb, etc. The nomenclature also promotes fear in a patient; we have come across plenty of people who avoid doing an exercise or activity because it will throw, “WXYZ out of place/whack.” This isn’t helpful in getting people back to what they love.
“But, I still feel it here. (points to SIJ region)”
While the location may be super specific and feel like it is, “right there.” More than likely it is a low back structure or a hip issue. This is not saying that the SIJ cannot be painful. Research just supports that this region is normally not your pain generator. No amount of popping or cracking can fix low back pain or move your SIJ enough to create a permanent change. Don’t forget as we age the SIJ starts out as being bound by loose cartilage and then solidifies in order to provide the support you need to be a robust and strong individual – crushing your goals and workouts.
There’s always exceptions… Pregnancy
Just like any musculoskeletal conditions, there are exceptions and changes and new research. While we just discussed how the SIJ more than likely is not the culprit of your pain, it sometimes can be. Those who are pregnant and postpartum can have issues with their SIJ – not to the extent of being out of place – but can be a pain producer! This is due to all the hormonal and morphological changes your body goes through and how these affect their joints. But, remember a good clinician should use multiple tests and assessments to confirm this for you! Treating the SIJ and the low back should look different for you.
So How Do I Get The Help Thank I Need?
Thanks for following along with the first topic in our myth busting series! If you have any questions, low back pain, hip pain, or SIJ pain that has not gone away… Feel free to reach out to us for a free phone consultation or visit our website www.p3physio.com. We want to help you live the best life possible WITHOUT PAIN! Stay tuned for our next topic (those SNAP, CRACKLE, and POPS) as well and see if we can solve some riddles with issues that have been troubling you.