Have you ever gone on a long car ride where you sit for many hours? You get out of the car and you feel stiff and sore in the buttocks and lower back. Or, perhaps you went on one of those long overseas flights and you end up with a persistent ache in the backside that just will not go away. Or, maybe you slipped on some ice and had a bad fall, landing on your behind.
Some soreness would be considered normal in all of the above situations. However, when the soreness persists for weeks and months, you will probably begin to wonder if there is something wrong with your hip or lower back.
Rotation means trouble
There are many causes of pain in the lower back, buttocks and hips. One common problem involves a rotation of one side of your pelvis. It is often preceded by prolonged sitting, running or a fall. If you place your hands on your hips, your thumbs will rest just above your pelvic joints called the sacroiliac joints. There is one sacroiliac joint on each side and they are positioned at the upper part of your buttocks where the pelvis meets the lower back. If rotation occurs at the sacroiliac joint, either forwards or backwards, then it can cause many problems with the lower extremity on the affected side. This means you could end up with pain and weak hip muscles.
When the pelvis tilts forward, muscles in the front of the hip are forced to work in a shortened, tighter position. Muscles in the back (buttock and thigh) are pulled, also working in an abnormal position. When the pelvis is tilted backwards, the reverse pattern occurs. Muscles in the back are shortened and muscles in the front are pulled.
When muscles are forced to work in such an abnormal mechanical position, they will become sore and weaken over time. Often, the hip on the affected side becomes tight. Your practitioner will likely notice that one leg is longer than the other. With pelvic rotation, this is an artificial leg length difference. This means the leg length difference is temporary and correctable.
A common misdiagnosis
Pelvic rotation problems are more common in women. Unfortunately, it is an infrequently recognized problem and it is often misdiagnosed as another ailment. An improper diagnosis can lead to many unnecessary tests, including lower-back X-rays, which expose patients to a sizable amount of radiation. If your physician is not familiar with this problem, they can direct you to a practitioner who has experience in diagnosing musculoskeletal back and pelvic problems.
The right treatment
Until the pelvis is realigned, the pain and weakness symptoms will persist. Medication, massage, acupuncture and other therapies may provide short-term pain relief, but until the rotation in the pelvis is corrected, the symptoms will continue. Once diagnosed, realignment is best performed by a manual physiotherapist or a chiropractor. Strengthening exercises for weakened hip muscles and pelvic muscles are also recommended. In some cases, the pelvis will continue to shift back to the abnormal position. A sacroiliac belt is one method used to try to gain more stability in pelvis. Some patients will even try injections of a sugary solution (a treatment known as prolotherapy) to the sacroiliac joints in a last effort to gain pelvis stability.
Do not let an achy behind slow you down. If you are having persistent lower back, buttock or hip pain, make sure an alignment problem in your pelvis is not to blame. It is a treatable condition. Ask your practitioner about abnormal rotation in the pelvis. If your symptoms could be the result of another problem in the same area, your practitioner can review the different possibilities with you.
Dr. Maureen Kennedy MD, CCFP, FCFP, MSc, PhD(c)Kinesiology, Dip. Sport Med., is a sport and exercise medicine physician at Pan Am Sport Medicine in Winnipeg.
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