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.

Live Long and Prosper!