Twisted Pelvic Torsion Diagnosis & Treatment

Twisted Pelvic Torsion Diagnosis & Treatment

About Pelvic pain:
The pelvis consists of two ilia (the hips), the sacrum (the triangular bone) and the coccyx (the bone at the bottom of your spine). In the centre at the front, the two pubic bones are joined by cartilage known as the pubic symphysis or symphysis pubis1. There are many ligaments that bind the joints very tightly1, which maintain stability of the pelvic girdle.
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Learn everything you need to know about pelvis torsion and the twisted pelvis in this useful guide
The way people sit often causes issues with the pelvis and this translates into pain when people are sitting. Clients often complain of pain in their lower back or pelvis, which can easily be addressed by getting them to sit correctly. One of the common complaints when sitting is pain, but this comes in many forms from pain when sitting, pain when getting up and stiffness into the lower back, pelvis and sacrum regions.  These are relatively easy to correct as it involves teaching people to sit correctly, which they often aren’t aware of because no one has mentioned this.

Osteopaths and other manual therapists assess the pelvis for complaints of lower back pain, lower limb discomfort or for localised pain felt directly over the pelvic region. Pelvic pain is usually associated with unilateral low back pain and/or buttock pain, which could potentially radiate down the leg, or sometimes it can even be felt in the ankle or the foot2. Other types of pelvic pain can be due to body changes during pregnancy, concerns with the gynaecological system (females), trauma or muscle imbalance affecting the biomechanics of joints in the pelvis or the lumbar spine. Not sitting correctly can ultimately be a cause and effect of a twisted pelvis so a simple way to help them massively is to advise people on the correct chairs to use and how to use them. An easy way to fix this is to sit correctly, your muscles may be weak so they need retraining before this an happen.

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What is it ‘a twisted pelvis’?

Pelvic torsion means that one side of the hip is more rotated than the other. It can either be rotated forwards or backwards in relation to each other. Symptoms include low back pain that is localised, buttock pain on one side, back pain that shoots into the ankle or the foot, a more exaggerated spinal curve (scoliosis), which will affect the posture, and there will often be a leg length difference. The side where the pelvis rotates forward is more likely to have the shortened leg.
Pelvic torsion is known to associate with either the left or right innominate bones (ilia) (see the diagram below) that rotate in an opposite direction around a horizontal axis. This axis runs through a landmark called the symphisis pubis shown by Pitkin and Pheasant in 19362. A study many years later by Friberg suggested that 50% of the population who hadn’t noted any symptoms had an anatomical leg length inequality and this therefore is a possible cause.

Twisted Pelvic Torsion Diagnosis & Treatment

A picture of the pelvic girdle showing the lower lumbar spine: the ilia, sacrum and the coccyx.
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Taken from http://www.vancouveryoga.com/anatomy_sacroilliac.html. [Accessed on 01/01/20113].

Help to rehabilitate your twisted pelvis

What if you could help to rehabilitate your twisted pelvis, without having to visit a specialist? Well – you can! And it’s as simple as sitting comfortably…
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There are many products out there also which can help you if you are suffering from a twisted pelvis and want to help yourself.  Here are a few ideas of what you could look at and how much you should pay for them.  Find the products here

One of these products is the back app chair.  Designed for any home or office environment and approved by Harley Street specialists, the chair helps to combat common complaints, especially twisted pelvis and lower back pain. Your improved posture will help to rehabilitate these problems. The seat design puts your hips in an open and relaxed position, so you automatically get a more naturally curved spinal column. Because of this sitting position, your vertebrae and intervertebral discs receive optimal conditioning. The Back App is not just a chair; it is a training apparatus, as it strengthens the core and pelvic muscles around your spinal column and pelvis. The adjustable back seat ridge, together with the high sitting position and open hip angle reinforces the back’s natural lumbar curve, and help to rehabilitate and strengthen your pelvis.




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Causes of a twisted pelvis

 Relevant related injuries that predispose pelvic torsions include:

  • a leg length discrepancy of half an inch or 1.27cm, which is found to be clinically significant
  • disc degeneration
  • degenerative hip disorder
  • anterior cruciate ligament (ACL)
  • medial collateral ligament (MCL)
  • posterior cruciate ligament (PCL)
  • meniscal tears
  • chondral defects (defect to the cartilage)
  • patellar dislocation
  • ankle sprains
  • stress fracture
  • plantar fasciitis
  • peroneus longus strain 1.

Treatment for a twisted pelvis

One treatment modality that could be considered when treating this condition is myofascial manipulation. The procedure involves assessment of the skin and underlying fascia, and understanding the movement to find areas that are restricted. The fascia can then be pulled rapidly against the resisted direction. Therapists should begin on the superficial layers and progress deeper if required1.  Using a foam roller on a regular basis can be useful to help with stretching out those tight areas and myofascial structures which often become problematic with a twisted pelvis (Click here for our FREE advice about foam rolling)

How does therapy for a twisted pelvis work?

Sensory receptors in the superficial skin layers are stimulated by the technique. This sensation would travel into the spinal cord and then take a specific nerve channel, which is known as an autonomic pathway. Positive change is the result1.
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Other treatments for a twisted pelvis include:

Osteopathy can greatly benefit pelvic torsions in the following ways:
  • manipulating the sacroiliac joint (the client may hear a click)
  • mobilising the joint
  • mobilising or manipulating the lumbar spine
  • soft tissue application to overused muscles
  • exercise prescription i.e. rehabilitation of muscles (for strength) above and below the sacral iliac joint itself
  • sitting on the correct chair can help retrain muscles for correcting a twisted pelvis naturally (Best chair for back and pelvic retraining)

Upper body muscles to consider:

  • Transverse Abdominus
  • Internal Oblique
  • External Oblique
  • Erector Spinae
  • Quadratus Lumborum
  • Latissimus Dorsi 2

Lower body muscles to consider:

  • Gluteus Maximus
  • Gluteus Medius
  • Gluteus Minimus
  • Bicep Femoris
  • Rectus Femoris
  • Adductor Longus 2
A surgical procedure, known as the iliac screw technique, can be used as a last resort if all other treatment modalities fail. There are four types of screw technique. Using double screws is the better option, especially if the surgical procedure is required bilaterally (on both sides). The reason for this is because the single screws have been reported to break 4.

In conclusion, there are many treatment modalities available to treat a pelvic torsion. Osteopathy is an important route to explore as rehabilitation of the muscles would soon ease any pain and leave a client ready to challenge the world!

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References
  1. Vachet, T. (2010) Pelvic torsion or pelvic imbalance with a functional leg length discrepancy: a sports performance prospective. Alan Aragon’s Research Review. P. 1–10.
  2. Cooperstein, R., Lew, M. (2009) The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. Journal of Chiropractic Medicine. Vol. 8, p. 107–118.
  3. A picture of the pelvic girdle showing the lower lumbar spine, the ilia, sacrum and the coccyx. Taken from http://www.vancouveryoga.com/anatomy_sacroilliac.html [Accessed on 01/01/2011].

  1. Yu, B.S., Zhuang, Xin-M. et al. (2010) Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct.Eur Spine Journal. Vol. 19, ed. 7, p. 1121–1128.
Therapies that might help with a twisted pelvis or the pain associated with them are;