Diagnosis of a pelvic obliquity
For the diagnosis of a pelvic obliquity, an orthopaedic examination is first carried out by the attending doctor. He will assess the spinal column and the pelvic bones and can determine, for example by palpation, whether there are any curvatures, asymmetries or other deviations from normal findings. Even a trained eye can already detect muscle tension or subtle signs of malposition by simply looking at them.
If a difference in leg length is suspected, both legs are measured to quantify the difference exactly. Furthermore, there are imaging procedures that allow a more precise assessment for further clarification. On the one hand, an X-ray examination can, for example, easily detect a structural pelvic obliquity.
Another method is the so-called 3D spinal column measurement. With this method, the doctor can use light rays projected onto the patient’s back and pelvis to produce a very detailed, three-dimensional image on the computer. The biggest advantage of this method is certainly that it completely dispenses with X-rays. This makes it particularly suitable for children and for frequent follow-up examinations.
Treatment of a pelvic obliquity
The treatment of a pelvic obliquity can look very different. In principle, however, it is only treated if the pelvic obliquity actually causes complaints or if it is so great that the spinal column is curved to compensate. In order to choose the appropriate therapeutic approach, the exact cause must first be clarified in advance.
If, for example, it is a structural pelvic obliquity due to a difference in leg length, the primary goal of treatment is to compensate for this difference. If the difference is only a few millimeters to a maximum of about one centimeter, this can usually be easily compensated by orthopedically customized insoles. After the insoles have been applied, however, a follow-up should be carried out to check whether the insoles really fit well and lead to the desired goal.
If this is not the case, the orthopedist has the possibility to make adjustments at any time and thus exclude artificially generated false loads. However, if the difference in leg length is somewhat greater and amounts to up to three centimeters, the orthopedist usually advises increasing the heel or sole of the shoe. If the difference in leg length is even greater, the possibility of a corrective operation should be considered.
However, this is a very lengthy treatment concept, which is why this option should only be considered if the symptoms are correspondingly severe. If, on the other hand, it is a functional pelvic obliquity, the treatment concept is completely different. Muscle tensions are often the cause, which are usually localised on one side.
These can be relieved with the help of targeted physiotherapy and occupational therapy. In addition, important muscle groups of the opposite side can be trained by specific training, thus achieving an upright, stable posture in the long term. Then the pelvic obliquity and the corresponding consequences usually disappear again by themselves.
Movements in everyday life are also trained in order to avoid chronic incorrect strain. And last but not least, relaxation exercises such as yoga can also help in this. If the functional pelvic obliquity exists due to scoliosis, it should be treated first.
Possible therapy approaches for this would be, on the one hand, wearing a spinal corset, but physiotherapy with physiotherapeutic exercises to strengthen the muscles are also very important. The treatment concept for scoliosis also depends on the age of the person affected and the severity of the curvature itself. As the very last option, there is also the possibility of surgery.
However, this is usually only performed in cases of very pronounced curvature of the spine. Another form of pelvic obliquity can be caused by a mechanical blockage, also known as dislocation. By definition, this is also a functional pelvic obliquity.
However, this can be treated relatively easily with manual therapy. This should be carried out by an experienced person, who can then reposition the affected joint with a special handle. The surrounding musculature, which may have been tense due to the blockage, usually relaxes by itself and the pelvic obliquity is in most cases completely corrected.
Insoles or shoe sole elevations should always be used if there is a symptomatic difference in leg length. In most cases, this can create a compensation in which the previously caused pelvic obliquity disappears. Chronic incorrect strain with increased signs of wear and tear can also be prevented relatively easily and early on.
However, the insoles should always be individually prescribed by an orthopaedic surgeon and adjusted if necessary during the course of a check-up. In order to counteract a worsening of the pelvic obliquity and its effects, there are simple physical exercises that should be performed regularly. As a basis for the training, the orthopaedist’s diagnosis is indispensable and in the best case, compensatory measures for the malposition have already been started.
These can be for example insoles or a dislocation. Ideally, these exercises are carried out in conjunction with physiotherapeutic treatment and regular medical check-ups. In principle, most pelvic obliquities are not genetically determined, which is why muscular training can often help to counteract the malposition.
- A very practical exercise that can be integrated into everyday life for the shorter, weaker leg is the one-legged stand, for example when brushing your teeth. – In addition, the relaxation of the hip joints is important, for example by stretching the muscle groups. To do this, you can place the shorter leg on the floor from the four-footed position at a 90 degree angle to the front, with the knee facing outwards.
The other leg is stretched straight backwards and the upper body tilted forward, so that a noticeable stretching takes place. – You can also bend one leg backwards while standing, grasp the ankle with your hand and push the pelvis forward to stretch. Basically, the osteopathic approach can be divided into three major areas which merge into each other at many points and which focus on therapeutic intervention with targeted hand movements by the osteopath.
The three areas are divided into “cranio-sacral therapy“, visceral and parietal therapy. With regard to pelvic obliquity, “Cranio-Sacral Therapy” deals with the effects of the malposition on the head and nervous system. Since patients often experience tension headaches or tinnitus due to neck malposition, relief can be achieved by treating the neck muscles, among other things.
Visceral therapy focuses on the internal organs that are affected by the malposition. Parietal osteopathy as a third approach focuses on the musculoskeletal system. Here, the examiner mainly deals with pressure and pulling movements of his hands, which are intended to release joint blockages and muscular tension.
As with many therapeutic approaches, the success of osteopathy depends on the individual physical condition and the extent of the malposition. In rare cases, surgery can be considered to treat pelvic obliquity. In this operation, a growth plate is artificially drilled into the femur of the shorter leg in order to force bone growth at this point by applying lag screws.
The screws are placed directly into the bone to fix it and to exert slight traction. This system is also known as an automated internal fixator, as this built-in system can be adjusted from the outside with the help of a suitable program. In most cases, patients can leave the hospital a few weeks after the operation and only have to go to an orthopaedic surgeon for check-ups, who will then adjust the system again and again. Overall, however, this type of therapy can last for several years.
