ARE YOU OUT?

How many times I’ve heard a client say: “I have one leg shorter than the other,” I can’t count.

Or there’s, “my hips are out and the therapist tugs on my leg to fix it.”

What exactly are us therapists doing when we pull your leg? What we’re up to is actually a form of manipulation that’s supposed to target the sacroiliac joint (SIJ), where the tailbone (sacrum) meets the pelvis, wing-like bones (innominants). 

I will admit this was a technique I used frequently to help correct my client’s pelvis misalignments. 

I’ve even had it done to my own. The trouble with this is when clients tell me they need to keep having it done, because it keeps going out. 

WHY ARE YOU OUT? 

The pelvis (sacrum or tailbone and the pelvic bones or innominants) has two forms of stability. 

1. STATIC STABILITY, which comes from the shape of the bones and how snugly they fit together as well as the tough ligaments like duct tape holding them firmly in place.

2. DYNAMIC STABILITY, which comes from the muscles and how they pull on the pelvic bones. 

WHAT MUSCLES?

Muscles can have an effect on your pelvis including the muscles at the front of the thigh (quadriceps, tensor fascia lata), the inner thigh muscles, the back of the thigh muscles (hamstrings), the buttock or gluteal muscles, the back muscles, and even some of the shoulder muscles (the lattissimus dorsi, which is a huge muscle coming from the front of the shoulder down into the lower back). 

CHECKING THE PELVIS

I check the alignment of the pelvis on most of my clients who come in for an assessment. 

I had one client who came in for a calf strain as she was training for a half-marathon.  After releasing the calf tightness and following the line of muscle tension up the hamstring to the pelvis, I soon discovered she had significant muscle tightness and stiffness in the left upper thoracic spine (mid-back between the shoulder blades). 

The stiffness was one-sided, so I asked if she had ever been in a car accident (one where because of the shoulder strap crossing over one shoulder only, there may have been a twisting trauma). 

In fact, she had…20 years ago. 

IS THE PELVIS STUCK OR IS IT JUST MUSCLE?

One of the things I learnt from physiotherapist Dianne Lee http://dianelee.ca/ (be sure to check her website for more educational information) is how to better determine what muscles might be contributing to the problem at the pelvis.

Why are you out? This is the question I ask myself. So, I feel how the joint itself is sliding and gliding. Sometimes I feel a stiffness like I am pushing against a brick wall (the joint itself is stuck). Other times (which is actually most of the time) I feel a resistance that resembles trying to push against a mattress spring. This to me is indicative of a tense muscle causing the joint to lose its mobility. In any case, the treatment technique is different. 

With the stiff joint, I will manipulate it (which might be tugging on your leg). With restriction from muscles, I use Intramuscular Stimulation (IMS) http://istop.org/.

COMMON TRAINING ERRORS

One of the biggest training mistakes I see is over-working of the quadriceps (front thigh muscles).  People run, bike, play hockey, then go to the gym and blast the quadriceps more with squats, squat jumps and lunges. 

Tension in the quadriceps builds and has the tendency to pull the pelvis bone (wing innominant) forwards. This then puts strain on the back opposite (antagonistic) muscles, the hamstrings, which can then contribute to a hamstring strain or pull. 

You can see what I’m getting at. It’s all about muscle balance.

DO I NEED STABILITY EXERCISES?

In my honest opinion, everyone can benefit from exercises that focus on stability around the pelvis. It connects the lower half to the upper half. 

There are people who have injured the strong ligaments (after childbirth is one example) that support the pelvis and need to work on regaining the muscle stability. 

There are specific tests we can do to determine if you will benefit from these exercises and if you need extra support (core shorts are what I use).  

When retraining the pelvic muscles, PT Dianne Lee distinguishes the inner core from the outer core. 

Hold tight for more on this in my next blog entry.

So for now, if you are someone who continually needs to have his/her leg tugged on to re-align the pelvis, it’s time to look at whether the SIJ is too loose and needing extra stability or whether it’s a matter of muscle imbalances around the hip and pelvis (or up at the shoulder) that need to be released and stretched. 

It’s time to look for the why (see my earlier blog on our “bullies”) rather than treating the symptom (victim).

IF YOU’RE MOTIVATED:

Read more from physiotherapist Dianne Lee: http://dianelee.ca/

Find out more about IMS: www.istop.org/

Read Wendy’s earlier blog on discovering our bullies: http://bit.ly/qjUCY0

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.