Twisted pelvis/lower back pain

[bridwyer]

Coach Rip,

For the last 5 weeks or so I have been suffering from some pretty bad pain centering in my right side lower back. I got a couple deep tissue massages to try to work out some of the tightness in my hamstrings, glutes and lats which has been helped a little, but I was told by the therapist that my pelvis had become twisted. In doing my own research I believe one of the major culprits may be tightness in the hip flexors...the reason I suspect this is that prior to attending your CF Barbell Cert a couple months ago I had had a couple hip flexor injuries in the past year from squating with poor form (feet too close, among other things). Have you had any experience with this - the twisted pelvis? My current squat form looks and feels good (all pain goes away temporarily when I am loose from a workout), and I'm trying to figure out if I can work through this and the problem will go away, or if its something I need to see a medical professional about. If you have any advice or can steer me in the right direction it would be greatly appreciated.

Thanks in advance

[Mark Rippetoe]

I may be the wrong guy to ask about this because I seem to have the same symptoms, have had them for 3 weeks, and have no idea what the hell is going on. I'm curious too. But I doubt my pelvis is "twisted".

[Ian Kovtunovich]

Keep in mind that massage therapists are not actually doctors. Meaning they are susceptible to wrongheaded ideas about things like the ability of one's pelvis to become twisted, for example.

[JaredLLL]

Here is my short answer, If you have an old injury in your hip somewhere other muscles may be tightened around that scar tissue causing the pain. Your body is smart and if this is the case do not suspect a single muscle to be the cause, it may just be the straw that broke the camels back, but rather suspect that every muscle that can help to protect that hip is to blame.

The longer answer:
For me, I had piriformis syndrome, but virtually every muscle from the psoas, hamstring, glutes, obliques, the spinal erector and quadratus laborum all on my left side had tightened and stayed that way. Even the abductors on my right leg had tightened. EVERY muscle was playing its part, not just one. All that tightness caused my pelvis to tilt upwards on the left side, which, coupled with the right side abductor tightness caused my pelvis to become twisted. Left side was twisted backwards and the right side was forwards. That setup my spine, along with all the tightness to bend out into the right plane of my body forming a tight little "C.' Which was easily visible just by looking at my back. Also, all these muscles as a result have become stronger then their counterparts. I can feel a size difference between my left and right spinal erectors just by putting my hand on my back and feeling around, and I'm still having problems trying to get them evened out today.

After seeing a good ART he was able to diagnose all this on my first visit, and I was almost 100% after we were done.

Or if you rather not, like I said before, if its muscles a laying tight against a nerve and causing pain, suspect every muscle, rather then just one, and do your best to stretch them out.

Also you could illicit the help of a mirror and a discerning eye to see if you have one side of your pelvis higher then the other. Have you ever been screened for leg length equality? If it does turn out that you are unsymmetrical then it could be structural, or in my case it was my muscles pulling in all directions messing up my pelvis and spine.

One more question, when does it hurt the most? during a workout or a few hours afterwards? or on odd occasion? Hope this helps.

[Spud]

"Keep in mind that massage therapists are not actually doctors. Meaning they are susceptible to wrongheaded ideas about things like the ability of one's pelvis to become twisted, for example."

Of course Ian has never been "wrongheaded" about anything in his life so therefore he can assume that a mere massage therapist can be.
BUT! your therapist may just be right It all depends on what was meant by "twisted" .:eek: and the use of the therapist terminology
As a massage therapist of over ten years in practice I have never seen a perfect or symetrical pelvis, so if the pelvis is asymetrical could it be twisted? If you have a SI joint problem (which is the first thing I would check in this case and refer accordingly) could that be deemed as twisted. If the client is lying on their back and the right asis is higher than the left could the pelvis be twisted? Could there be a twist (rotation) in the vertabra, being caused by the cronically tight hip flexors, which may very well fire off the piriformis and cause other spasmodic muscles.
There could also be a leg length descrepency, functional or anatomical causing what appears to be a pelvic tilt (twist) so all these things need to be checked as well. I would also like to check the QL's
What were you doing within the previous 24hrs before the symptoms came on, that may give you a clue as to what the problem is.
But WTF do I know Im just a massage therapist that has studied his arse of for 10 years because I love what I do. Go see a good Chiro or Osteo and get checked, to be fair your massage therapist should of suggested this. hope this helps some cheers Spud;)

[JM3]

As a massage therapist of 14 years I second the above.
I deal with a lot of athletes and tell them to take any assesment with a block of salt. I stay studiosly "dumb" to the issues and simply make sure I get every single origin/insertion as thoroughly as I can. Even when I have some idea of whats going wrong I try to let the therapy work w/out a lot of explanation- It's too easy to be wrong, even when getting good results.
Functional assesment is possible by MTs - I got a cert in it. but only if they put serious time in beyond what most schools teach in order to get your paper. Anyone that says "twisted pelvis" as an assesment is being overly facile- they should name the muscles that are deconditioned as well as the ones that are short- thats begets a rehab protocol. If he is legit in his assesment; youll notice is that the massage and stretching will be un-balanced- working certain muscles far more than others, and not neccesarily where the complaint is- if he does everything equally to all sides then he has no protocol in mind.
In my experience, it's pretty rare to have a pelvis that has perfect joint angles. and nearly everyone has tight hip flexors due to sedentary nature of work.
Improvements in form will often resolve issues over time- because everything your'e doing is systemic - and more so as form improves.

[JM3]

Oh and Mr Rippetoe- it isnt your pelvis thats twisted....

[bridwyer]

Well I've gone about my business as usual, with a lot of extra stretching, and the mystery "twist" appears to be going away (and new squat and bench PR's have come). The pain and tightness have mostly gone away - Running/Sprinting/Over-strides seemed to help a lot to loosen up my hips. I hope you're also doing well with the back and the shoulder, Rip.


Thanks