Your pelvis is made up of several bones that are “fused” together. There is a group on the left side and a group on the right side. They come together in the middle and there is cartilage in the very front called joining them together. This is your pubic symphysis and it is located just above your penis or clitoris. Feel it, this bone is hard and easy to find. Each side, each collection of grouping of bones, is called an innominate. Though I’ve known several physicians to dispute this in the past, your innominates can move. When this happens, you are considered “out of alignment”. A lot of people are familiar with chiropractors correcting their alignment, but guess what, physical therapists do it too. My goal for this post is to teach you how to do this at home.
If your pelvic alignment is off, then the entire foundation that your pelvic floor muscles, nerves and ligaments are lying on is off. For those with pelvic pain, I think this is a problem and I think it needs to be corrected. I remember hearing in a course once that “Sometimes people are just out of alignment and that’s how they are. If it’s not broke, don’t fix it.” I agree to an extent. If you’re my grandma and for fun I decide to check your alignment and you’re misaligned, but you’ve got not pelvic issues, I’m not going to fix you for kicks. But, if you’re my patient with pelvic floor problems then I’m considering it “broke” and I’m going to fix it. How irresponsible for someone to tell pelvic floor therapists not to correct pelvic alignment on their patients. Why would we throw orthopedic care out the window? This is a personal pet-peeve of mine, as you can clearly see.
I like to correct my patient’s pelvic alignment in treatment, but I also need to teach my patient’s how to do this independently at home. You really do need someone to help you with this, so often times I even have my patient’s friend or partner come in for a pelvic alignment crash course.
Here is your crash course, but please note, this only works if your legs are the same length. If they are different lengths, you might need a heel lift.
- Lie on your back and bend both knees. Lift your hips up like you’re doing a bridge and immediately put them back down. Have someone pull both your legs straight. This “resets” the pelvis so you can get an accurate picture of what is going on.
- Place your hands high on your waist like you are an angry mother scolding a child. Get a good firm grip of your sides and slide your hands down until you feel a bone on both sides. This is called the iliac crest. I call this the “top of the sides of the pelvis”. So, go ahead and check the top of the sides of the pelvis to see if one side is higher than the other. “Higher” means close to your head. “Lower” means closer your feet. The relationship is to each other – the left and the right side. Check the front of the boney parts of the pelvis to see if one side is higher than the other.
- If one side is higher, have someone gently pull the leg on that side at the ankle for a few slow, gentle tugs.
- Recheck to see if the pelvis has been aligned by bending your knees and doing a bridge while someone pulls your legs straight. Recheck the top of the sides of the pelvis to see if they are level. If they are not, try the leg pull technique again.
- Steps 1 and 2 can be repeated as many times as necessary until your iliac crests are aligned. But, I’d say after 3-5 attempts to correct this, if it’s not corrected, it could be that you need some muscle or connective tissue work done first and then your alignment will more easily be corrected.
- Next step is to find the anterior superior iliac spine. Also called the ASIS. Also called “the front of the boney parts of the pelvis”. So, have you ever seen a picture of a really skinny girl (or boy) in really low cut jeans? These bones are the ones that jut out like spikes on skinny people. Heavy people, you have these too, but they are not quite “spikes”, more like a rock under a pillow. That’s okay too. Just want to let you know what to look for. So…check the front of the boney parts of the pelvis to see if one side is higher than the other. Again, “higher” means closer to your head and “lower” means closer to your feet.
- If one side is higher, bend the knee on that side and flex the hip to 90 degrees. Take your hand and try to push your knee away from you while your knee pushes into your hand. Do this for 8 seconds and repeat 3x. Recheck to see if your pelvis is aligned by doing step 1.
- If one side is lower, bend the knee on that side and flex the hip to 90 degrees. Try to bring your leg down straight while someone else resists you at your hamstrings. Do this for 8 seconds and repeat 3x. Recheck to see if your pelvis is aligned by doing the first step 1.
You’re always going to try to correct the side that hurts. None of this should increase your pain. It should all feel pretty good. But, if you do these corrections and you end up with more pain, just do the opposite of what you just did and you will reverse your correction.
Why do you keep going out of alignment? Some people go out of alignment every few hours, some go out of alignment every few days, some never go out of alignment again. If you are someone that goes out of alignment a lot, it’s important to look at what you are doing. Do you sit with your legs crossed the same way all the time? Do you sleep with one hip flexed and one straight all the time? Do you stand with your weight shifted on the same leg? Do you hang out on the couch leaning more onto one hip? Look at the way you move your body and the positions you lounge in. The key is to make things symmetrical. Shift how you cross your legs. Sleep with the other hip flexed and the other leg straight (if you can). Shift your weight onto the other leg when standing or don’t stand with your weight shifted at all. Get the point? Don’t let one side do all the work, either make your movements centered or make sure your other half gets in on the action.
What can correcting alignment help with? Theoretically, it should help with any SI joint pain (this is pain more around the center of the butt cheek on either side), some low back pain and really most pelvic floor dysfunctions. This doesn’t mean correcting alignment resolves these problems 100%, it just helps improve them. It’s a big claim to say it helps with most pelvic floor dysfunctions, but it’s true. Like I said above, we are correcting the foundation that everything in the pelvic floor lies on.
Who shouldn’t correct their own alignment? I think that you should really see a professional if you have had surgery, spinal cord issues, or any other larger condition more than just run of the mill back pain or “just” chronic pelvic pain. What I’m saying is, if you’ve been diagnosed as just having back or pelvic pain, then it’s probably okay to correct your own alignment, but if something larger is going on, then consult your doctor or physical therapist first.
What if you go out of alignment all the time? If you go out of alignment easily, I suggest that you make sure your pelvis is in alignment before working out and stretching. If you go out of alignment really, really easily, like with just the transition from sitting to standing, then you might want to get a belt to apply pressure to your pelvis. These belts are called SI belts. SI stands for sacroiliac. Some pregnant women wear these to keep their pelvis stable and to take the belly weight off the pelvis just a bit. Others who are not pregnant can use it as needed. Some need it 24 hours a day, even while sleeping. Others need it just when they are being active or running.
How can you tell if an SI belt is right for you? I will correct someone’s alignment and have them walk thinking about their pelvic pain levels. Then, I’ll put them in an SI belt and have them walk thinking about their pelvic pain levels. If there is an obvious and instant reduction in their pelvic pain, then the belt is a good option. If they put the belt on and walk for a bit and cock their head to the side and say “Umm, it’s a little better…I think.” – Then I don’t suggest the belt. I personally feel that the belt is best when there is a marked and obvious improvement in pain and movement. Think about this too – if there isn’t an obvious improvement when you put the belt on, then you probably aren’t going to wear it very much anyways. One note about the belt – it can be a little uncomfortable if you sit a lot because the edge of the belt might dig into your hips and thighs.
What if you put the SI belt on and it makes your pain worse? Then you probably put it on when you were out of alignment. Re-check and correct your pelvic alignment and put the SI belt back on. It should typically feel better.
Does this really help in the long run? I get asked about the efficacy of the SI belt a lot. People want to know if the belt just helps to reduce pain at that moment, or if it helps their pelvis in the long run. I’ve heard different therapists say different things about this. Some therapists say that the SI belt is a band-aid, it just helps reduce pain in the moment that you’re having pain. They say that the SI belt keeps you from using your own muscles to stabilize your pelvis and therefore is probably hurting you in the long run.
The other camp says that the SI belt is not only helpful in reducing pain, but it helps improve the health of the pelvis. The ligaments that keep your pelvis aligned can become injured or too lax and that is why someone who goes out of alignment easily goes out of alignment so easily. It takes almost a full year for these ligaments to regrow more appropriate tissue and you want this tissue to grow at the right angle to keep you from going out of alignment all over again. Because of this, some therapists want you to wear your SI belt all the time for a year. I sit in this camp. The only thing is, I don’t know any patient that has actually done this. Wearing an SI belt is kind of awkward and when you want to look good in a nice outfit, it might show a bit. While I don’t think anyone will wear their SI belt constantly for a year, I do tell people to wear it all the time for as long as they can. If they can align their pelvis as often as it goes out, even if they aren’t wearing their SI belt, then their ligaments will heal and regrow at an appropriate angle.
Correcting your own alignment is huge in helping to reduce your pelvic pain. However, this in itself doesn’t replace the professional help of a physical therapist. Your alignment may be stuck. You may try and try to use the suggestions I’ve given, but your alignment doesn’t improve. You might need some work done by a therapist before your pelvis is ready to work with you. In addition, like I said before, if your legs are different lengths, it’s very possible that you need a therapist to help you determine if you need a heel lift. Lastly, something I’m not teaching in this post is how to correct an issue with the sacrum – which is the little cupped part of the pelvis on your backside. This is half of what we call the sacroiliac joint – better known as the SI joint. Only a skilled clinician can really address this, I do not think this is something that a post can or should teach because it’s not that cut and dry.
If you have any questions, please email me at [email protected] or leave them in the comment section below.