The Clinic
About Massage
Common Disorders
- Upper limb
- Shoulder
- Back & neck
- Pelvis & hip
- Knee
- Foot & ankle
© Donald Budge 2001
PELVIS AND HIP
THE PELVIC GIRDLE
The Pelvic Girdle comprises the sacrum (base of spine), coccyx, two innominate bones (pelvis) and two hip joints. The sacrum comprises five naturally fused vertebrae and the innominate comprises three naturally fused ILIUM, PUBIS and ISCHIUM bones. The articulation of the lumbar spine, pelvis and hip joints combine to form a complex range of movements. The pelvis has three joints, two Sacro-iliac joints and the pubic symphisis (where the right and left innominate bones join at the front). These joints are required to support upper body weight plus any additional loads being supported. Muscles and ligaments provide the stability, alignment and equilibrium of this structure. Muscular imbalance leading to joint misalignment will impact on posture and gait. This condition, if not treated, may then lead to secondary problems associated with knee and ankle joints and/or upper spine and to the shoulder complex. It is therefore essential that the pelvis is adjusted so that it provides a level and stable platform to support the body weight before attempting to correct other specific conditions which may indicate pain at the time.
SACRO-ILIAC JOINTS
The sacrum is located at the base of the spine and supports the body weight. Forces are transmitted through the SACRO- ILIAC joints to the right and left ILIUM. As such, sacral distortions, accompanied by innominate and/or pubic distortions are not uncommon. The ILIUM is the wing shaped bone which forms part of the innominate bone. These joints should always be mobile. Remedial Massage Therapy employs techniques to free these joints. In some cases Manipulative Therapy, Osteopathy or Chiropractic may be required.
POSTERIOR/ANTERIOR Innominate rotation.
Refers to a condition where one of the innominate bones has moved backwards or forwards, relative to the sacrum, and is locked in that position. Remedial Massage Therapy employ techniques to free these joints.
PUBIC DISTORTIONS
The pubic symphysis is a fibrous joint and is always affected in distortions of the innominate bones. It is often "misplaced" as a result of childbirth and should be checked and corrected post delivery.
MUSCLE SPASM and the PELVIC GIRDLE
There are several very powerful muscles attached to the Lumbar Spine and Pelvic Girdle complex - Hamstrings, Gluteus (buttocks), Psoas, Piriformis, Adductors, Rectus Abdominus (six-pack). In addition, there is a strong fibrous band (Ilio-tibial-tract) connecting the Ilium to the Tibia (shin bone). Spasm in any of these muscles can create an imbalance and cause or maintain the pelvic girdle to distort. Remedial Massage Therapy employs techniques to release or relax muscles to avoid or remedy this condition. If joints are not exercised to their full limits, muscles will shorten and increase the risk of muscle strain (tear) if sudden demands are asked of them.
TENDINITIS
Tendinitis may affect any of the muscle tendons. Tendinitis of Rectus Femoris, the quad muscle which flexes the hip is not uncommon amongst sports people.
BURSITIS.
A bursa is a small sac containing synovial fluid which provides lubrication between bones and soft tissue e.g. it prevents wear and degeneration of tendons and skin tissue. If traumatised by overuse, injury or muscle imbalance, the bursa will become inflamed. This is known as bursitis. The most significant in the Pelvic region include; Trochanteric bursitis (bony protuberance at hip joint- painful to touch); Ischial Bursitis - results in pain over bony part when seated particularly on hard surface; Iliopectineal Bursitis - pain felt in groin when walking; Psoas Bursitis - pain at front area of hip joint and deep into groin area. Treatment will usually consist of ice, ultrasound with soft tissue work on the appropriate muscle.
ROTATIONAL DISTORTIONS at the HIP.
Anterior/Posterior Femoral Heads are sometimes used to describe a condition where the head of the femur (thigh bone) is held in such a way as to rotate the leg inwards (medially) or outwards (laterally). Charlie Chaplin and Ballet dancers display a serious "lateral" rotation in both hip joints. The "John Wayne walk" indicates a medial rotation of the hip joint. Remedial therapeutic massage is normally very successful in restoring the correct alignment.
LATERAL FEMORAL HEAD.
This condition is quite common and is describes the femoral head partly dislocating in the hip joint such that it is held up and outwards in the socket. Remedial Massage Therapy can be used to restore the joint to its normal position. Post treatment soft tissue therapy is essential to avoid re-occurrence.
OSTEO-ARTHRITIS.
Osteo-arthritis is characterised by the degeneration of the hyaline cartilage covering the articulating surfaces of the joint or by the formation of bony outgrowths called osteophytes. Overuse, over-weight, misalignment of the joint or diet can be contributory factors. Pain is usually felt in the groin area and spreads to the lumbar region, the front of the thigh and to the knee. Sitting becomes more uncomfortable and hip flexion more restricted. Remedial Massage Therapy can help arrest the degeneration and restore greater movement, but in severe cases, replacement hip surgery is the only remaining course of action.