20 questions about
pelvis instability
|
20 Questions on pelvis instability
1. What is your pelvis?
The pelvis is the link between your upper body and your legs. The pelvis
consists of several bones that are thoroughly connected by muscles and
tendons. The lower two dorsal vertebrae are a functional component in this.
Usually, play in your pelvis is limited but just enough to be able to move
smoothly. All forces between spine and legs are transferred through your
pelvis. There are several muscles pulling the pelvis: not only your
abdominal and back muscles, but also your buttock and leg muscles. The
pelvis is movable by nature. It can tilt forward and backward but turn to
the sides as well. All movements concerning your posture are working on your
pelvis. If all is well everything is balanced and you do not notice you have
a pelvis.
2. What is pelvis instability?
Pelvis instability is a medical complaint that is common to pregnant women.
During pregnancy, hormones cause the pelvis to become more movable. Pelvis
tendons become weaker so the bones get more play. This extra play is
necessary so that the unborn child will have enough space to work its way
out. It is not clear why one woman gets complaints and the other one does
not. It seems that insufficient rest and the combination of work and family
carry an increased risk. Also there seems to be a relation between the way
of walking and the amount of rotation, swaying, one uses. Pelvis instability
is seen with app. five percent of pregnant women. Complaints rise when the
different parts of pelvis start to move in regard to each other and muscles
are not strong enough to stabilize it all.
3. So how long does pelvis instability take to heal?
The "more movable" pelvis during pregnancy exists first in preparation of
birth. By month six, most women start to "walk like a duck". Usually, the
situation has returned to normal within one and a half month after birth.
Having tough luck, it takes more than a year for complaints to disappear.
4. Are (ex) pregnant women the only persons who can experience these
complaints?
No. Pelvis instability can also occur without pregnancy but in that case it
is not hormonal.
5. So what could cause it then?
An accident could be responsible (e.g. during cycle racing or horse riding)
but also overloading by running long distances. So it is not only women who
suffer from pelvis instability, men can have these medical complaints.
6. When do problems surface with runners?
Runners with extreme tilt and twist of the pelvis and insufficient strength
in the surrounding muscles can develop problems. Speed walkers also run an
increased risk. This can be explained by the way they walk, in which the
pelvis is tilt strongly. Complaints can occur within a few miles. Limits are
individual and are defined by the pressure on the body (e.g. speed and
walking surface) and the degree of training. Usually, complaints disappear
within 36 hours of the training session. Whenever this is not the case,
extra measures should be taken.
7. Which is the largest group of risk?
I believe (ex) pregnant runners. But also people who suffer from weak
tendons by nature.
8. What are the complaints on pelvis instability?
At first, complaints only start during or after heavy training. Gradually,
complaints also rise on standing for a long period of time and in the end
also on sitting down.
Complaints on pelvis instability are vague to stinging pains in the pubic
region, groin and in the lower back between sacrum and bowel bones. Pains
can radiate to one or both buttocks and legs. Also muscle complaints around
the pelvis can exist due to extra efforts of muscles and tendons to
stabilize the pelvis. Lying down is more comfortable sitting posture. The
endurance sportsman will experience tiredness in the pelvis region sooner.
Sometimes an aversion to doing sports could evolve. Typically for pelvis
instability is the changing pattern of complaints. And movements that do not
cause any trouble today but do cause them next week and the other way round.
9. Which movements are best avoided?
Movements that will cause pain are among others standing, walking and
sitting but especially unexpected turning movements. Also jolting movements
like running are notorious.
10. What could one do to avoid pelvis instability?
The only effective prevention is to prevent pregnancy. This is of course a
very theoretical solution.
Pelvis instability due to hormonal cause cannot be prevented. The "free
pelvis" just comes with pregnancy. Complaints can be limited though, by
keeping enough rest. Housekeeping should be managed. Managing means getting
others to do things for you. Pelvis instability caused by overexercising can
be avoided by responding well to the signs prompted by the body and to
choose a variable movement pattern.
11. Should I visit a doctor when suffering from pelvis instability?
Yes, firstly a doctor should determine if it really is pelvis instability
and if it is painkillers can be prescribed to provide a quick relief. In
pelvis instability due to pregnancy the obstetrician could play a role of
significance.
12. How can pelvis instability be determined?
Most of the times the pattern of complaints is clear enough and no further
investigation is needed. In cases of doubt, it may be necessary to take
pictures (CT-scans) in stork position (on one leg). Sometimes research to
exclude other diseases is needed as well.
13. Does physiotherapy work?
Physiotherapy can mean an improvement sometimes, as do therapeutic forms
like Mensendieck and Caesar. Learning these exercises under supervision is
advisable.
14. Which physical aids are there?
Pregnant patients can benefit by a pelvis band. This works like a brace that
encloses the backside and the pelvis. The pelvis band is not intended to
help increase training. Other aids for extreme complaints are walking stick
and crutches.
15. Do you have to quit doing sports?
No, usually not. It is wise though, to adapt the forms of training to the
situation. Training within pain levels remains well possible. Sometimes it
is temporarily needed to look for alternative training methods.
16. Which alternative training methods are there?
As an alternative, cycling and swimming would do very well. Cycling often
goes easier than walking and in swimming one does not have to carry any
weight. Also aqua jogging can provide good service as training method.
Should legs and pelvis really resist cooperating, training the upper body is
all that remains. In fitness centres the possibilities are well enough. But
also in the swimming pool one can, with the aid of floating devices, run for
miles on arm power. Especially variation in the exercising form and a
sufficient amount of rest are important. A modern way of walking that is
sometimes possible is called Nordic Walking. In this, you use "skiing
sticks" while walking, so the arms take on some of the work and one has a
little bit of extra support.
17. Is there any good in massage and warmth?
Both can provide relief. One cannot take away the cause, but tension in the
muscles can be positively influenced. Sauna could give good relaxation, too.
Cold baths and cold showers are best avoided and, in prevention of
unexpected moves, one should also take extra care on wet (slippery) floors.
18. Could I do any extra exercises to restore balance in the muscles when
needed?
Attention should be paid especially to the abdominal and bottom muscles.
When doing this it is very important to find the balance between pressure
and endurance. The exercises are needed to bring power to the muscles but
training should not be an extra load on the pelvis tendons because otherwise
complaints will increase. On pelvis instability caused by pregnancy,
strengthening exercises should only be started 4 or 6 weeks after delivery.
19. What should I do if it does not go better?
Except for being patient and getting regular check-ups by your physician and
physiotherapist there are only a few possibilities. There is no ultimate
solution. In extremely severe cases surgery is possible. Connecting the
bones with plates and screws will by any doctor only be advised in utter
need.
20. Do you have any universal advice?
Yes, listen to your body, that is your best advisor.
Arie Meijboom
Sportmassagepraktijk Meijboom,
Castricum
http://www.blessure-aanwijzer.nl
15 oktober 2004
Translation by Maaike de Wijs
