Pelvis and Hip
Pelvis and Hip Pain?
The coccyx is a small bone (not much bigger than your fingernail) that sits at the end of the spine. It attaches to the larger sacrum, which is a triangular bone that sits in the
Unlike other spinal and pelvic bones, the coccyx is non-weight bearing. Injuries to the coccyx usually come from falling onto the base of the spine or sitting on hard surfaces.
Coccyx injuries often require:
- Ice to reduce inflammation
donutcushion to reduce direct pressure on the coccyx when sitting
- Careful chiropractic adjustments
- Pelvic floor soft tissue techniques and exercise
Osteitis pubis (OP) is an inflammatory condition that affects the joint formed between the two pubic bones at the front of the pelvis (pubic symphysis). This can cause pubic and groin pain, pain to the front of the hips or referred pain down the inside of the thigh to the knee. Symptoms are worse with weight-bearing activities.
Causes of OP include:
- Pregnancy and childbirth
- Repeated minor trauma – such as athletic activities
- Major trauma
- Inflammatory arthritis
- Pelvic surgery
PREGNANCY AND CHILDBIRTH OP
During the first trimester of pregnancy, the hormone relaxin is produced, which has the effect of softening the pubic symphysis in preparation for childbirth. Combined with the increased weight of pregnancy and stretching of the pubis during childbirth, this can result in tearing and inflammation of the pubic symphysis and eventual OP.
Specific chiropractic adjustments balance the pelvis, non-weight bearing exercise (such as swimming) and pelvic support belts may all be helpful.
This is a condition that is common among young athletes and can prevent full athletic activity for up 12 months in some cases.
Irritation on the pubic symphysis can come from adductor muscle (groin) contraction. This muscle is often used with kicking and changing direction while running. The abdominal muscles insert into the top of the pubis, so excessive sit-ups or similar activity may also be an aggravating factor.
Diagnosis is based on clinical findings but can be confirmed with X-ray, bone scan, CT scan or MRI.
Gentle care can be very useful in improving the pelvic balance.
It is very important that any activities that aggravate the condition are ceased. This really is a case of time being the best healer.
Rehabilitative exercise and even running coaching can be beneficial prior to return to sporting activity.
Pelvic Floor Weakness
The pelvic floor is made up of a group of muscles that run from the pubic bone at the front and the coccyx (tailbone) at the back. On each side, these muscles attach to the ischial tuberosities – bones you can feel if you place your hand underneath your buttocks when sitting.
Much has been said about the importance of these muscles in women, especially after giving birth. However, the pelvic floor also plays a role in core stability and is therefore considered important for both men and women.
In both sexes, the pelvic floor supports the bladder and bowel, and in women, it also supports the vagina and uterus.
A weakness in the floor of the pelvis can result from:
- Inactivity and de-conditioning
- Following pregnancy
- Chronic constipation
- Chronic coughing – such as a ‘Smoker’s cough’
- Heavy lifting
- The aging process
The result of weakness can lead to pelvic and low back pain, sexual dysfunction and stress incontinence (wetting yourself when you laugh, cough or sneeze).
The trochanteric bursa is a small, fluid-filled sac that sits on the outer aspect of the hip. It protects the iliotibial band (ITB) and gluteus medius muscle from rubbing against the outer aspect of the hip, known as the greater trochanter.
Trochanteric bursitis occurs when there is excessive rubbing of these muscles on the hip causing the bursa to become inflamed. This is usually the result of repetitive strain, rather than acute injury and is common with both athletes and non-athletes.
Symptoms of trochanteric bursitis include:
- Pain on the outside of the hip (may occur on both sides)
- Pain with hip movements
- Pain worse with walking, running or sitting long periods
- May be painful to lie on affected side or press onto area of bursa
You are more likely to experience trochanteric bursitis if you have:
- Poor biomechanics of the low back, hips and pelvis
- Tight ITB
- Weak gluteus medius
- Lack of pelvic stability
- A functional or structural short leg
- Recent increase in running/walking length or intensity
- Degenerative changes in hips or low back
- Ice 10min x3/day
- Avoid aggravating activity
- Soft tissue techniques to release trigger points – especially in the ITB and gluteus medius
- Heel lift on short leg side (if short leg is due to structural change)
- Chiropractic techniques for improve biomechanics
- Graduated return to activity
- Perform exercise that is less likely to aggravate bursa – eg straight kick swimming (freestyle and backstroke)
- Continue to ice after exercise if required
- Strengthening exercise for hip stabilizers
- Deep soft tissue techniques – foam roller and ‘spikey’ reflex ball helpful for self-massage of ITB and hip
- Chiropractic care to improve body balance
In some cases medical management may also be required which might include non-steroidal anti-inflammatory medication or cortisone injections.