Introduction
Overall, the pelvis represents the connection between the spine and the legs and is of great importance for the overall stability and posture of the human body. Often the pelvis is not completely symmetrical in the horizontal axis, which is called pelvic obliquity. Studies show that this is the case in the majority of people, but usually the obliquity is only slightly pronounced and does not cause any further discomfort.
If, on the other hand, pain or other complaints occur, this is called pathological pelvic obliquity. A distinction is made between two forms, functional and structural pelvic obliquity. – In structural pelvic obliquity there is usually a difference in leg length, which means that the legs are of different lengths. – The functional pelvic obliquity, on the other hand, is caused by muscular tension, incorrect posture or even diseases such as scoliosis (i.e. a curvature of the spine).
What causes the pelvic obliquity?
Many factors can be considered as causes for pelvic obliquity. – A structural pelvic obliquity, for example, is usually caused by a difference in leg length, which is usually inherent. In order to still be able to maintain a straight and upright posture, the body adapts to this situation by tilting in the hip.
- However, legs of different lengths are not always pathological. Only when the difference exceeds a certain value does it usually lead to complaints. A few millimetres usually do not cause problems, but from a difference of about six to seven millimetres or more this should be clarified more precisely in order to prevent long-term incorrect loading at an early stage.
- However, the leg length difference can also only be acquired in the course of life, for example through an accident, prostheses or other illnesses such as arthrosis in large joints. – A functional pelvic obliquity is more likely to result from the dysbalanced interaction of muscles and ligamentous apparatus, which ultimately causes a poor posture. – Frequently, one-sided tension of the muscles in the buttocks or in the lumbar spine area leads to a malposition of the pelvis.
Factors that favour this are very long periods of sitting, lack of movement and poor posture, such as at the computer. Once the tensions are released or eliminated, the pelvic obliquity usually disappears. – Another cause of functional pelvic obliquity can also be scoliosis. On the one hand, it can cause a pelvic obliquity, but it is also possible that a pelvic obliquity can lead to scoliosis in the long term due to the associated malposition of the spinal column.
What are the symptoms of pelvic obliquity?
The pelvic obliquity clearly has an effect on the muscle groups of the lumbar spine and can cause muscle tension there. The more pronounced the pelvic obliquity is, the more the weight of the abdominal organs shifts to the rear abdominal wall. This means that the bones and muscles of the lumbar spine are subjected to greater load bearing capacity.
It is a cause for concern that muscle tension and pelvic obliquity are mutually dependent and worsen each other, which is why therapeutic intervention must be carried out at an early stage. The leading symptom of clinically relevant pelvic obliquity is pain. The primary symptom is usually back pain.
These in turn often lead to incorrect posture and incorrect weight bearing, which in the long term can then also affect other parts of the body. For example, in addition to the original back pain, affected persons complain of neck and shoulder pain with frequent resulting tension headaches. In some cases, however, patients also experience pain in the legs, for example in the knee or ankle joint.
The pain symptomatology usually occurs after long periods of sitting or standing and is primarily an expression of wear and tear on the joint structures. In the long term, this means that the pain does not get better or even disappear in the untreated state; it is usually only made worse by long-term stress. A common consequence of pelvic obliquity is pain in the sacroiliac joint.
The ISG – also called sacroiliac joint – is the connection between the lower spine and the pelvic ring. Congenital malpositions, chronic poor posture and muscle weakness lead to painful muscle tension and relieving posture. In particular, pelvic obliquity causes an imbalance of the muscles and the associated incorrect loads on the hips.
Among other things, this can lead to irritation of the joint capsule with subsequent inflammation. After a long period of malalignment, the development of an ISG blockade can be promoted – a painful functional restriction of the ISG, which can be counteracted preventively with muscle training. The gluteal muscles are responsible for the physiological position of the pelvis.
Thus, on the one hand, weakness in the gluteal muscles can cause the pelvis to become crooked. On the other hand, a pelvic obliquity can cause a painful imbalance of the gluteal muscles. In the long term, this has the consequence that mobility in the hip is restricted.
A slipped disc can be a dreaded complication. Here, too, the circulation must be interrupted by muscle building to ensure stability in the hip joint. The pelvic obliquity leads to uneven load in the legs and muscular imbalance.
As in all parts of the body, an imbalance in the muscular structure also leads to tension in the legs and to the resulting relieving posture. Chronically, this incorrect load causes accelerated wear and tear of the joints, especially in the knees, with an increased risk of arthrosis. Physiologically, the hip, knee and foot should lie in an anatomically measurable axis to each other.
Since this axis is disturbed in the case of pelvic obliquity, incorrect loading and pain occur in all three areas. Groin pain can be a common symptom of pelvic obliquity. In principle, a hernia, muscular tension in the hip region and hip joint arthrosis should be considered in the differential diagnosis of groin pain.
The inguinal hernia – the protrusion of abdominal viscera due to a connective tissue weakness in the groin region – can be excluded simply by ultrasound. Since many muscles are involved in the area of the inguinal ligament, pain can easily occur here as well in the case of incorrect loading in the case of pelvic obliquity. Here, the pain often radiates into the equilateral leg and getting up from a sitting position causes many problems for the patient. Additional pain radiating into the groin can be caused by hip joint arthrosis, which in turn can be the result of many years of incorrect loading in the case of pelvic obliquity.
