Pelvic misalignment can take the form of tilting, tucking or rotation. Any of these conditions has the potential to create painful spinal symptoms. The pelvis is a troublesome region for many people, especially women, with chronic pelvic pain conditions being both widespread and debilitating. The pelvis therefore receives considerable attention in the modern healthcare sector, with some care providers specializing in this location and the pain syndromes that often affect it.
The pelvis is formed by several bones and many soft tissues. It is responsible for joining the hips and legs to the spine, as well as providing the supportive tissues for the genitals, perineum and lower internal organs. When babies are born, their pelvic bones (the ilium, ischium and pubis) are separate from one another and joined by flexible connective cartilage. As we age into adulthood, the bones naturally fuse to provide added strength and rigidity to our skeletons.
There are many pelvic pain syndromes that do not affect the back or spine. These are usually soft tissue pain problems that affect the pelvic floor and perineal areas. However, skeletal and connective tissue conditions that change the position of the pelvis are well known to be possible causes or contributors to lower back pain, as well as postural problems. This focused dialog focuses on the latter category of pelvis pain and the effects of a misaligned pelvis on the entire human organism.
A normal pelvis aligned is defined as being “neutral”. This means that the pelvis sits in an ideal position anatomically and does not feel or create postural stress. The optimal position of the pelvis demonstrates no rotation and only a very slight anterior tilt, meaning that the top of the pelvis is slightly farther forward than the bottom. Achieving a truly neutral pelvis is a common goal of many types of enlightened exercise, including yoga and Pilates.
A rotated pelvis is shifted towards one side or the other. It can be turned slightly to moderately left or slightly to moderately right. Pelvis rotation is well documented to be problematic, although the condition is certainly not inherently painful. Remember, the human anatomy has a wonderful ability to compensate for changes to typical structural and function. Pelvic rotation can be the cause of spinal issues or can be the result of them, as we will detail in the section on the causes of pelvis misalignment below.
An anteriorly-tilted pelvis might be straight in the side-to-side (Coronel) plane, but is not correctly positioned in the front-to-back (Sagittal) plane of the anatomy. Instead, the top of the pelvis is much farther forward than the bottom, which is pushed posteriorly. This creates a pelvis that seems to lean forward when observed from the side view.
In contrast, a tucked pelvis is the opposite of an anteriorly-tiled pelvis. Pelvic tuck means that the bottom of the pelvis is actually further forward than the top, making the pelvis appear to slant backwards when viewed from the side.
There are many possible reasons for pelvic misalignment concerns. Some of these sources are structurally-based, while others are developed functionally. Below, we detail many of the most often seen origins of pelvic alignment problems:
Sacroiliac joint degeneration and injury can be causes or effects of pelvis alignment problems. The sacroiliac joint is directly responsible for joining the sacrum of the lower spine to the pelvic ilium, making it fundamental to both pelvic structure and functionality.
Short leg syndrome can also be a cause or consequence of a misaligned pelvis. Short leg can be functional or structurally-motivated, further adding confusion to the diagnostic process.
Scoliosis in the lumbar spine will naturally tend to twist the sacrum and therefore the pelvis, as well. The resulting rotation and possible tilt of the pelvic girdle are some of the most pronounced when viewed using diagnostic imaging. Occasionally, minor scoliosis might be an effect of extreme pelvis rotation and/or tilt rather than its origin.
Muscular injury can cause any soft tissue to pull the pelvis out of alignment. Since there are muscles, tendons, ligaments and cartilage that attach to the various bones of the pelvis, the realm of possible causes is vast when it comes to muscular strain, pulls or tears.
Muscular imbalances can similarly affect the pelvis, often causing it to tilt from an unusually strong set dominating its antagonistic weaker set. Imbalances can also be consequences of structural pelvic alignment problems in addition to their cause.
Hypolordosis or hyperlordosis in the lumbar region is a common cause and a common effect of pelvic tilt or rotation. Lumbar hypolordosis tends to encourage a tucked pelvis, while lumbar hyperlordosis logically facilitates excessive anterior tilt of the pelvic girdle.
Pelvic structural concerns can take the form of bones that fused incorrectly or bones that did not fuse at all, creating a lack of general stability in the skeletal pelvis. Since there are several bones and many soft tissues that make up the pelvis and since these interact with the sacroiliac joints and other structures, the possible causes of anatomically-enacted pelvis pain problems numbers in the dozens.
Poor posture can encourage the pelvis to lose proper alignment over time. Similarly, it is virtually impossible to maintain ideal postural habits when a patient suffers from a moderate to severe pelvis alignment concern. Therefore, posture can also be both cause and effect of pelvic misalignment.
As you can clearly see in the section above, there are so many conditions that can be either the cause or effect of a pelvic alignment abnormality. This makes diagnostic processing extremely difficult and leaves abundant room for iatrogenic error in the form of misdiagnosis. When this fact is considered, it is no surprise that pelvic pain is one of the most difficult conditions to successfully treat. In our clinical experience, we see many patients who have clearly been misdiagnosed, sometimes completely and other times with simple cause and effect mix-up. Regardless, many of these patients have been in fruitless medical treatment for years, have suffered unnecessary surgeries or have literally exhausted all the alternative healthcare practices, without positive outcome.
We caution patients and care provides alike to always carefully consider the cause and effect scenarios that are inherently part of most pelvic alignment problems in order to maximize the accuracy of diagnostic evaluation and efficacy of subsequent treatment.
Consulting a specialist is a good way to get a truly expert opinion on any pelvic misalignment condition, while seeking evaluation from a general physical therapist, chiropractor or massage practitioner generally sets the ideal stage for misdiagnosis. To go one step further, we generally recommend seeking multiple diagnostic opinions from more than one type of care provider and then weighing all the evidence to find the explanation that makes the most sense and corresponds best to the clinical presentation of the condition. This extra effort will certainly help reduce the likelihood of misdiagnosis and the frustrating horrors that typically follow.