One of the more stable joints of the body is our hip joint. Specifically called a “Ball and socket” joint there are several movements that should occur at the hip to allow for normal every day function. To be very specific, there are 6 movements: Flexion, Extension, Abduction, Adduction, Internal Rotation & External rotation. However, if we look at the entire function of the pelvic joint, you will understand that you are also relying on a normal functioning of the pelvis with the hip joint. Our pelvic joint or sacroiliac joint is also reliant on normal movement patterns which can create an issue for the hip if there is too much of a tilt or rotation, usually from an out flare in the sacrum. This is the first joint that I look at if there is a patient coming to me for back, hip, knee, foot and even shoulder pain! Why? If the hip and pelvic joints are not functioning correctly, there is a domino effect. Literally, the entire body is thrown off balance. I stand firm in my statement that over half of back surgeries could have been prevented if the pelvis was aligned and functioning appropriately. I’ll even add in that many knee and ankle surgeries could have been prevented as well.
Back problems are one of the most misdiagnosed issues I have seen in my career. Have you wondered why 50% of lumbar fusions fail? It’s because the problem was ALWAYS in the sacroiliac joint, never in the back. With that said, there are times where surgery is indicated, specifically, if reflexes are diminished and weakness is present along specific patterns (PTs are trained to look for weakness in these areas-myotomes) during an initial evaluation and should refer out if present. The surgery is primarily to avoid permanent weakness, often times seen as drop foot. Pain should never be a driving factor in determining a surgery, but often times it is the single force that leads people to agree to surgery. Many times, the pain is alleviated for a period of time, but then, it rears its ugly head again, and sometimes worse.
The point of this is not to scare people, but to educate them into making better decisions. Especially for those who have already had a surgery (there are probably imbalances that still need to be corrected to avoid future surgeries). If you suspect you could have an alignment issue in your hips (easy way to tell, do you consistently stand with one foot in front and lean to be comfortable)? This is for you. A lot of postural abnormalities can also be acquired over time, and it is our job to correct those abnormalities through manual therapy, exercises to balance out the body & education on postural habits.
Amanda Worley PT, DPT, CMTPT
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