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.