T Nation

Functional Problems- Pelvic Issue?


#1

Anyone here ever had to have treatment for some sort of pelvic dysfunction? Over a year ago, I started noticing things didn't seem quite right with my alignment, and I was very prone to injury in lower limbs (tibial stress fracture, IT band syndrome and chondromalacia patellae.)

For as long as I can remember I've had difficulty with rotation of my left leg (when seated, I can't drop it down outwards to floor,) and so for months and months have been working on improving hip motility and lower-body flexibility (everything from foam-rolling to motility drills to hour-long stretching sessions) but seem to have made little progress.

If I'm honest, things seem to have gotten worse- I can suffer from extreme lower back pain (right down near base of spine) and things seem to extend right through into the upper half of my body (issues with rotation/limited movement/uneven positioning of shoulders, insane muscle tightness.)

I've done a load of research to try and identify what the problem could be, but have been overwhelmed with the amount of different suggestions- everything from a rotated pelvis to sacroiliac joint dysfunction, to a leg-length discrepancy, to a malformation in the ankle. My work in the gym has suffered more and more- I can barely squat or deadlift anymore because I can't find a firm, balanced position, and benching has began to suffer (due to uneven shoulder blades.)

Some days I feel so off-balance, I can't walk in a straight line. After finally getting to see a doctor, the X-ray has come back clear (no abnormality) and I've no spinal curving, so have now been referred to a physiotherapist, orthapedic and neurologist, to try and identify the problem.

Has anyone ever had any similar problems? I know there's a lot that seems to be going on, but has anyone experienced serious issues with body alignment and managed to have it successfully treated, either through their own work or by a professional?


#2

i have the same problem as a result of leaving a shoulder injury to long. The whole of my right side now doesnt seem to "fire" properly and i have problems with my pelvis, groin, hamstring,abs (as a result of lower back not firing) and still the shoulder (my scap will just not stick to the back of my rib cage). i also have problems walking straight and feel unbalanced. i have tried allsorts of exercises to get it firing but nothing seems to work, so i guess im in a similar situation. any advice would be great .


#3

I've been battling almost identical issues since Jan 2010. I've seen dozens of doctors for an array of possible causes. I started feeling relief after going to a Certified Active-Isolated Stretch Therapist (popularly known as Mattes Method or also known thru another famous practicioner named Wharton). My first session lasted approx 3 hours and I felt +95% pain relief after the initial treatment. The therapist I went to see also recommended two books, which I HIGHLY suggest reading. "Healing Back Pain" by John Sarno and his other book "The Divided Mind". Hard to believe, but most of this pain (along with any back pain really) is all mental. Read the books and you WILL feel relief if you keep an open mind


#4

There is no research that shows a causitive relationship between pelvic alignment and pain. Research actually shows pelvic malalignment is more common that 'alignment.' Even if there is a malalignment there has never been one research article to show that manual therapy can 're-align' it. As for your hip issue, I would reckon you chose the wrong parents. Everyone's femoral-acetabular angles differ.

I would recommend you read anything BUT books that try to tie muscles/ligaments/joint/tendons/bones to pain. I would recommend "Explain Pain" and "Painful Yarns" These are based on current neuroscience and not false biomechanical explanations.

Remember, pain is an output from the brain, not an input from the body....PERIOD.


#5

Pain is an output from the brain based on input from the body.....

Pigeon holing pain into any one category is not wise. Which is why you treat from both angles. Poor biomechanics, leading to less than optimal structural integrity can and often DOES lead to pain.

Just as constant dark thoughts can lead to depression.

Keep an open mind about solutions, whether you choose to use neuroscience based rehab, biomechanic based or someone trained in both.


#6

mch,
I agree pain is impacted by input but somatosensory (tissues) components are minimal in this case. This started one year ago. Tissue healing has ceased at this time yet pain persists. Pain is less a symptom and becomes the disease.

if the brain does not perceive threat, there is not pain. Tissue damage and pain level are not linear. I can find many people with good biomechanics and lots of pain and those with poor biomchanics without pain.

OP,

Don't get too tied up in 'fixing your faults.' We all have them and many of us don't have pain and vica versa. Take the tasks that are difficult and ensure your technique is correct/modify as needed. Perform the exercises in a pain free manner initially. As tolerated, progress the range of motion and weight without triggering a pain response. You'll be back in no time.


#7

It's an interesting theory (one that I like) that the brain remembers the inital pain and continues with the pain and you have to reprogram it to a certain extent.

I've seen some guys use various techniques to help with this and participated in another thread where this idea was brought up using David Butler.

Not to nitpick more for discussion olifter (Sorry if I'm hijacing OP, but you can learn from this as well). What are your views with the idea of inadequate tissue repair, say too much fibrosis or chronic inflammation from a biomechanic issue that never healed. Just because it was initially a year ago doesn't mean that it can't still be receiving abherrant input from those tissues.


#8

mch,

When I read the OP I hear a patient with so many thought processes and falsely informed cognitions that his nervous system begins to adapt in a protective manner; i.e. resistance training hurts. The OP suggests that he 'feels' off balance yet no image can support this contention. Listen to the terminology: suffer, overwhelmed, serious issues with body alignment, etc. These are not physical, they are cognitive and emotional changes that lead to immuno-endocrine changes within the body leading to a more sensitive state. I would assume the tissue tolerance has decreased over this period of time (possibly due to initial injury?). If the OP continues utilizing a load that is over his new tissue tolerance, then yes an inflammatory state may occur, further sensitizing the nervous system and decreasing the overall work capacity.

You mentioned David Butler; are you a healthcare practicioner?


#9

As of now I'm a corrective exercise specialist. I'm finishing up my Chiropractic doctorate.


#10

With regards to pain etc., there is no sense of constant, consistant pain. In general, it's only when doing certain things that pain flares up; I've had sciatic-type pain from deadlifts/squats (around my left S.I. joint) and impingement-type pain in my left shoulder. Progression has become difficult in the weightroom, and have seen myself regressing down to low weights with perfect technique, but still subject to pain.

I'm not in a frame of mind of "This is going to hurt" when I step up to deadlift, because most of the time, prior to it, I'll actually feel no pain and be thinking "Hey, this is going to be okay today," before the pain starts to kick in once I lift. There are visible discrepancies between the two sides of my torso; the top picture in this link (http://ncefptsupport.com/posture.html) provides a pretty much identical example of how I look- typically like a case of scoliosis, but my spine is straight.


#11

Do you have pain when doing single lg work? While I don't discount olifters thoughts of ides based pain...

I would look at lat recruitment, lower trap recruitment. I have seen some issues with problematic lats causing hip pain.

Things to try now is to look up nerve flossing, single leg work, and possibly discuss mental cues for pain. I recommend finding a chiro who is fluent in muscle activation. BBB maybe able to refer someone in UK


#12

Single leg work I have tried, but found difficult; machine-based leg work (Single leg-press) really irks on my left S.I. joint. Free-weight lunges or split squats are awkward... When doing them, usually one side can be done okay, but when it comes to doing the other side difficulties arise because it feel like my pelvis 'twists' in on itself, or the supporting hip doesn't drop like it's supposed to.

I've actually tried the nerve flossing before, on my left side. It did seem to loosen things up a touch, but only very briefly. I've not had any luck with it since.


#13

Hmm.. Try for the chiro and see what happens


#14

I was referred by my doctor to an orthopedic specialist, with who I have an appointment the week after next. I just want to get a proper diagnosis on this; from all the reading I've done over the past year, I've tried to find something particular which I could just look at and thin "That's it!" but haven't been able to identify any 'one' thing. There seems to be so much correllation between different conditions, so how the hell can a single one be pinpointed?

My best guess is that it's some form of pelvic obliquity, and functional leg-length discrepancy/scoliosis. Things that I note are that my left hip just does not seem to be able to rotate fully outwards, and my left foot often seems to have a different type of pronation to that of the right (which leads me to wonder if the issue stems from the ankle, rather than the hip.)

I also don't know if worth mentioning that when younger, I had a really bad fall on my neck- I never got anything checked up, but to this day my cervical verterbrae still crackle worse than a bowl of Rice Krispies.


#15

The body is a massive structure of connections so usually everything is related. I won't speculate too much on your cervicals without examining them.

IMO most complicated movement patterns are better assesed by an outside eye. my guess is that unless you have an operable patjology or iussue the orthopedic will refer you to PT. Hopefully that PT can recognize the issues and understands how to treat them, and not goes through the motions.

SI dysnfuntion isn't best self treated.


#16

OP,

If the PT or chiro attemptes to 'correct' your 'pelvic obliquity' move on. They obviously have no idea what the current pain science says. There has NEVER been evidence for any lasting change in physical structure with manual therapy or manipulation. This is why I urge you look beyond the 'physical dysfunctions' that are present in people without pain (my right PSIS is an inch lower than my left). There may not be a physical "IT" causing your pain.

Something to show you what I mean:

How can someone without a leg have pain and burning in their toe?


#17

OP,

A presentation from one of the leading researchers in pain science

Enjoy


#18

I fully appreciate what you're saying, and accept the possibility that any pain I feel may be psychological rather than physiological. However, I find it impossible to deny that there is something physically not quite right, and it seems to stem from the hip/ankle of my left side. The pain for me isn't the issue, it comes and goes, but what bothers me is what seems to be the inability to function properly. Asides from my weightlifting, I'm very capable in cardio activities (I'm more naturally geared towards them) but have had to all but give up running, as well as turn down an opportunity to receive cycling coaching; my capabilities seem to be dwindling as a result of this whole thing.


#19

Watermelon,

Did you watch the video or just read the title?

I am not saying YOUR pain is psychological or physiological. In pain, the two CANNOT be separated. Pain is multidimensional. Our cognitions (thoughts), emotions and afferent sensory input all play a role in the pain experience, none more important than the other.