In pelvic obliquity, the pelvis is not in its natural, horizontal position, but is tilted toward one side of the body. Pelvic misalignment can lead to severe discomfort and, over time, cause postural problems. However, depending on the severity of the misalignment, conservative or even surgical therapies offer good prospects for recovery.
What is pelvic misalignment?
The pelvis is the link between the spine and the legs and is therefore of great anatomical importance to the human body. It is usually in a horizontal position and thereby stabilizes and regulates the posture of the body. If the pelvis is not horizontal, but tilted to one side of the body, this is called pelvic obliquity in medicine. Depending on its severity, this can lead to serious orthopedic problems and damage the entire postural and musculoskeletal system. In particular, the spine is usually gradually deformed by a pelvic obliquity, and those affected suffer from increasing discomfort. Basically, two forms can be distinguished in medicine: the structural and the functional pelvic obliquity. Structural pelvic obliquity is usually caused by a difference in leg length. If one leg is significantly shorter than the other, the pelvis tilts to one side when standing upright. This form of pelvic obliquity is thus caused by anatomical conditions and leads to a severe misloading of the spine in those affected. A functional pelvic obliquity, on the other hand, has no anatomical causes. In this case, it is usually muscular imbalances or tension that trigger the malposition. The tense muscle cords shorten and pull the pelvis from its original horizontal position into a tilted position. According to estimates, about two-thirds of all people in Western industrialized nations suffer from pelvic obliquity, but in many cases it goes unnoticed by those affected for years or even decades. Young people are particularly often affected by the malposition, here it is caused by irregular growth spurts and is therefore usually only temporary.
Causes
The causes of a pelvic obliquity can either be congenital or result from incorrect posture and stress during life. One of the main causes of a tilted pelvis is uneven distributions in the muscular system. Naturally, the right and left sides of the body differ in each person, and usually the muscles are better developed on one than the other. However, this can be aggravated by incorrect or insufficient stress in everyday life. If, for example, one half of the body is loaded primarily during sports, this leads to an uneven distribution in the body’s own muscle system. The same is the case with a lack of movement due to a lot of sitting or lying down. Over time, these so-called muscle imbalances lead to poor posture and can promote the formation of a pelvic obliquity. Moreover, muscle tension in combination with a lack of exercise also leads to postural weaknesses. In particular, people who spend a lot of time sitting (for example, in front of the computer or in the car) often suffer from tense back muscles. The tension causes a shortening of the muscle – if this happens mainly on one side of the body, a pelvic obliquity can be the result in the long term. Another cause of pelvic obliquity can be congenital leg length differences. If one leg is significantly shorter than the other (about a few centimeters), this results in a pelvic obliquity. This has a negative effect on the spine – a scoliosis forms. However, this can also be congenital and in turn cause the pelvic obliquity.
Symptoms, complaints and signs
In the case of pelvic obliquity, the back makes an effort to compensate for it so that there is no restriction of movement. A mild pelvic obliquity can usually be effortlessly compensated by the spine and causes no or only mild discomfort to the affected person. A massive pelvic obliquity, however, results in a severe curvature of the spine, which is also known as scoliosis. Scoliosis usually causes discomfort only after a longer period of time and with increasing age; these then occur mainly after prolonged standing, lying or sitting. The typical symptoms include first and foremost back pain, which is felt by those affected as stabbing, tearing or cramping.In addition, the pelvic obliquity leads in most cases to pain in the shoulder and neck area, since the incorrect posture triggers a cramping of the muscles here. Headaches are also part of the symptoms, and in some cases the pain also radiates to the knees or ankles. Due to the pelvic obliquity, the spine is permanently curved to one side and thus shows premature signs of wear. This in turn leads to an intensification of the symptoms, especially the back pain usually increases steadily with age.
Complications
A severely pronounced and untreated pelvic obliquity leads in the course of life to a curvature of the spine, a so-called scoliosis. This, in turn, can cause massive postural deformities and severely limit the mobility of those affected. The curvature leads to one-sided overloading and premature signs of wear and tear. These are accompanied by tension in the shoulder and neck area and can sometimes be very painful for the patient. The misalignment of the pelvis also leads to an uneven load when walking and running, which can lead to premature wear and tear of the knee or ankle joint. A pelvic obliquity caused by a leg length difference can also lead to an undeveloped gait pattern and gait disorders in children. Even if the therapy of a pelvic obliquity is mostly successful, complications can occur, especially in the case of surgical leg lengthening. In the worst case, the bone growth expected by the treating physician may be very slow or may not occur at all. In this case, other underlying diseases are usually present.
When should you go to the doctor?
A pelvic misalignment often does not cause any symptoms at first when the patient is young and is therefore often not even noticed by those affected. In some cases, the misalignment is also diagnosed by a doctor at an early age, but is not considered worthy of treatment due to its minimal severity. A slight pelvic obliquity can remain unchanged and thus harmless for a lifetime, but the risk of a worsening of the condition increases, especially with increasing age. At the latest when the pelvic obliquity causes discomfort when walking, standing or lying down, a doctor should be consulted immediately. The same applies if the person affected experiences diffuse pain in the knees, back or shoulders and is unable to pinpoint it. Particular urgency is required if the spine is already beginning to curve due to the malposition. In the early stages, this is also rarely noticed by patients, but over time, severe back pain sets in, especially when sitting or standing upright. Since a spinal curvature (scoliosis) can lead to serious postural defects, the orthopedist should be consulted here already at the first signs.
Diagnosis
To diagnose a pelvic obliquity, the doctor usually does not need complex procedures. A pronounced misalignment can usually be detected by merely palpating the spine and pelvic bones. In this case, the doctor examines the pelvis from behind with the patient standing upright and checks whether the outer pelvic bones are at the same height. If this is not the case, the patient has a skewed pelvis. In order to obtain more detailed findings, an X-ray examination can also be performed. Here, it can also be assessed whether a leg length difference is the cause of the pelvic obliquity. A 3D spinal measurement is also one of the common diagnostic procedures when a pelvic misalignment is suspected and can provide further information about the misalignment. In this procedure, the body of the affected person is measured with light beams, with the help of which a three-dimensional image of the spine and pelvis can be generated on the computer. Since no X-rays are used in this process, the measurement can be repeated several times if necessary and is therefore particularly suitable as a diagnostic procedure for children.
Treatment and therapy
If the pelvic obliquity is only minimal (a few millimeters), therapy is usually unnecessary, since the body can compensate for this small irregularity itself. However, if it is a pronounced pelvic misalignment (several centimeters), therapy is medically indicated. Treatment essentially depends on the cause that brought about the pelvic obliquity.The age of the patient and the extent of the misalignment also play a significant role in the choice of the right therapy. If muscle imbalances or muscle tension are the cause of the misalignment, physiotherapeutic measures such as targeted strengthening exercises or special massages are often sufficient. Treatment is much more difficult if the pelvic obliquity is caused by a difference in leg length. If the difference between the leg lengths is only slight (about one centimeter), the affected person is usually prescribed special shoe inserts that raise the sole of the foot and thus compensate for the difference in length. However, shoe insoles are now considered obsolete for small differences. Today, orthopedic exercises are recommended to correct a slight pelvic obliquity or a slight leg length difference. However, this orthopedic measure can only be applied within certain limits – if the leg length difference exceeds three centimeters, it must be surgically corrected. In this case, the significantly shorter leg is artificially lengthened through several surgical interventions – this form of therapy is very lengthy and may well take several years, depending on the findings. In this procedure, the bone of the affected leg is drilled into, creating an artificial growth plate. A frame is then attached to the leg, which gently and steadily stretches the bone. This stimulates the growth of the bone until it reaches the desired length.
Outlook and prognosis
The prognosis depends largely on the extent of the pelvic obliquity and, more importantly, its cause. The patient’s age also plays a role and can positively or negatively influence the healing process. If the body of the affected person is still growing (children or adolescents), the misalignment can often regulate itself. Since most people’s bones grow at different rates, minimal leg length discrepancies can occur until the end of the growth phase, which will correct themselves over time. In adults, self-regulation of the pelvic obliquity can no longer take place. In this case, the chances of recovery depend greatly on the cause. If the deformity is caused by a minor leg length difference, conservative therapy with special heel inserts can usually provide relief. However, this form of treatment often initially causes discomfort when walking/running, as the body only slowly gets used to the foreign body in the shoe and the new type of stress. In this case, the patient usually has to be patient and often the orthotist has to readjust the insoles several times. If the deformity is severe, surgical intervention is usually necessary. In this case, the patient must plan for a lengthy treatment, which, however, in many cases is free of complications. The chances of recovery are usually very good if the pelvic obliquity is caused by muscular imbalances or tension, since this is only a temporary malposition. As soon as the muscle imbalances or cramps are compensated or released by specific physiotherapeutic exercises, massages and sports, the pelvis moves back to its original position.
Prevention
Since pelvic obliquity can be triggered by congenital anatomical irregularities such as a leg length discrepancy, it can only be prevented to a limited extent. Only in the case of a pelvic obliquity favored by postural deformities and incorrect stresses do sports and a healthy lifestyle offer themselves as preventive measures. In particular, people who spend a lot of time sitting down should specifically train their muscles and integrate sufficient exercise in the fresh air into their daily routine. It is often sufficient to take the bicycle instead of the car for the daily commute and to use the stairs more often instead of the elevator. An extended walk during the lunch break also provides sufficient oxygen supply and relieves tension in the back and shoulder muscles. Endurance sports such as swimming or jogging are particularly recommended, as they move all muscle groups. In addition, pelvic obliquity can also be prevented by sufficient rest. In particular, people who are under a lot of stress at work suffer more quickly from muscle tension, back pain and postural deformities, which in the worst case can lead to pelvic obliquity in the long term.Depending on the cause, pelvic obliquity is corrected in different ways. Aftercare adjusts to the method used to correct the pelvic obliquity.
Aftercare
Surgical measures require more intensive aftercare than manual therapies. With balancing measures, orthotics, heel cushions, or heel raises can correct the pelvic misalignment. When leg joints and pelvis receive appropriate treatment, pelvic obliquity, the leg length discrepancy that causes it, and pelvic tilt disappear. Follow-up care is still important, however. After surgical leg length correction, pelvic obliquity often reappears. The therapy-induced pelvic obliquity can occur immediately after the end of therapy or later. If regular follow-up care is not performed after treatment, the new pelvic obliquity remains unnoticed. During follow-up care, an examination is performed to determine whether unilaterally tense gluteal muscles are the cause of the new pelvic obliquity. Untreated pelvic obliquity ensures that the spine cannot straighten. Scoliosis can be the result. With timely correction of the obliquity through orthotics or temporary heel elevation, the problem can be corrected during follow-up care. The gluteal muscles can relax again and the pelvic obliquity disappears. The doctor will determine how long this will take in further follow-up examinations.
What you can do yourself
If the cause of the pelvic obliquity is not congenital, but results from the consequences of poor posture, incorrect loads and lack of exercise, the affected person can strengthen his back muscles himself through sports and targeted exercises and thus counteract a misalignment. In this way, muscle imbalances can be corrected and an upright and healthy posture can be promoted. It is important to train not only the back muscles, but also the abdominal, buttock and thigh muscles. Sports such as yoga or Pilates are particularly suitable for this, as they also contain many stretching elements and thus loosen and stretch tense and shortened muscles. If a deformity is already present, sports such as jogging, soccer, etc. should be avoided, as they put a lot of strain on the back and pelvis. Swimming or aqua aerobics are more suitable, as is light walking or hiking. In addition, if you have a pelvic obliquity, you should pay more attention to your own body weight – if it is too high, the spine is unnecessarily stressed. A healthy and balanced diet is recommended, and any excess weight should be reduced. In addition, patients should not sleep on mattresses that are too soft. These give way during the night under the body weight, the spine is unnecessarily bent during sleep and thus stressed. Many patients therefore experience severe back pain during the night or the next morning. Better suited are high-quality mattresses with firm material, which additionally stabilizes the back.
