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.
Good job Josh! SIJ dysfunction is often overlooked or not detected.
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.
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
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?
If your pelvis is/has been that unstable you should have had surgery on day one. But I am not your physician, nor do I really know the extent of your injury, nor did i ever evaluate you. So take my comment as it is. It wouldn’t hurt to get looked at again.