Some people may be surprised to realize that the pelvic region is composed of several bones and many muscles.
The bones that make up the pelvis are:
- the sacrum (at the base of the spine)
- the coccyx (commonly known as the tailbone)
- and the two hip bones, anatomically named the innominate bones, that are composed of three closely joined but separate bones:
- the ilium (what you feel when you place your hands on your hips)
- the ischium (the bones you feel in your bottom if you sit on a particularly hard surface)
- and the pubic bone (located a few inches below the navel)
The true pelvic joints are the lumbosacral joint between the spine and sacrum, the sacroiliac (SI) joint between the sacrum and ilium bone, and the hip joint between the pelvis and femur (leg bone). Between the two pubic bones there is a joint made of cartilage called the pubic symphysis holding the two innominate bones together.
If you look at the pelvis from the side you can see two bony protrusions that are important to your massage therapist, physiotherapist, chiropractor and other body workers. They are called the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). By assessing the levels of these bony protrusions, your therapist can tell if your pelvis is in a neutral anatomical position. Though some variation occurs, the angle between these protrusions should be between about 5-10 degrees. Any more or less than that means the pelvis is rotated out of neutral position.
Anterior rotation of the hips is very common, especially in people who sit a lot. This posture is marked by the pelvis being tilted downward and the sacrum and posterior ilium being tilted upward, causing excessive curvature in the low back (see D and E in the drawing at left). Usually if someone has anterior rotation they will have short, tight quadricep (in the front of the thigh) and low back muscles, and weak abdominals, glutes, and hamstring (in the back of the thigh) muscles, or some combination thereof.
Posterior rotation of the hips is often caused by poor posture such as slouching or by an injury. The pelvis is tilted upwards and the sacrum and posterior ilium are lower than usual (see B in the drawing at left). The pattern of short, tight muscles versus weak muscles is the opposite of anterior rotation. The abdominals, glutes, and hamstrings are more likely to be short and tight while the quadriceps and low back muscles are more likely be overly long and weak.
To complicate things further, some people may find that they only have rotation of the hip on one side. This could happen if a person has an injury to one side of the pelvis such as slipping on ice and falling on one side, or stepping too hard off a curb and jarring the hip.
Hip hiking is when one of the innominate bones sits higher than the other. This could be caused by always placing one’s weight on one side, or always sitting on a thick wallet placed in the back pocket. When looking at the picture at right, the person’s back would have shorter, tighter muscles in the back on their right side and in their buttocks and leg on the left, with weaker, longer muscles on their buttocks on the right side, and on their back on the left.
Standing with one hip thrust out will create other misalignment issues for the pelvis. Often when standing we let one hip swing out to the side, and as you can see from the photo at left, this can cause over-stretch and weakness in some of the gluteal muscles, notably the gluteus medius on the side that drops.
Problems that can Accompany Pelvic Misalignment
Pelvic misalignment can have serious full-body effects. This can manifest as low back, buttock, or hip pain, stiffness and decreased mobility, joint irritation including joint pain, hypo- or hyper-mobility, ligament laxity, increased pressure on the spinal discs that could cause disc degeneration and eventually herniation, muscle pain, trigger points, or sciatica. When the position of the pelvis changes, often the position of the legs or spine can change, causing postural pain in other areas of the body.
Assessing and Treating Pelvic Misalignment and Pain
Worrying about pelvic misalignment and pain can be overwhelming and concerning. Luckily, massage therapists and other body workers are trained to assess posture, range of motion, muscle length and strength, and joint mobility. These assessments allow us to understand where individual people’s muscles, bones, and joints have come out of anatomical position. From there we can use a variety of neuromuscular, joint mobilization, fascial, and stretching techniques to realign the body and decrease or stop the pain and dysfunction that can arise from pelvic misalignment. We can also help teach our clients bodily and postural awareness, as well as stretching and strengthening exercises to ensure the relief that occurs from massage treatment lasts.
(1) Blausen.com staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. – Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27796968
(2) This work has been released into the public domain by its author, ru:User:V-Ugnivenko. This applies worldwide.In some countries this may not be legally possible; if so, ru:User:V-Ugnivenko grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law. – Russian Wikipedia, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5206236
Hip Hike and Hip Drop images are property of Body Poets Massage Therapy