Can Pelvic Misalignment Cause Back Pain? Your Diagnosis

Q: Can Pelvic Misalignment Cause Back Pain? Your Diagnosis

Hello： Pelvic tilt is a symptom rather than a diagnosis, although some practitioners, particularly within the chiropractic field, may consider it a diagnosis. <br>In treatment, we generally emphasize addressing the underlying cause rather than just treating the symptoms. <br>Trad

Can the pelvis become misaligned?

Dear Doctor: I previously injured my lower back while lifting heavy items at work, resulting in weakness.
After receiving massage therapy, I felt better.
A traditional Chinese medicine practitioner mentioned that my pelvis was misaligned, leading to poor muscle condition, which caused my back muscles to fail under the strain of heavy lifting.
Eventually, I improved with treatment.
However, after moving to a new location, I sought medical attention at a hospital.
Before any imaging was done, the doctor diagnosed me with a herniated disc.
An X-ray was taken, which showed that my bones appeared normal.
An MRI was then performed, and the doctor indicated that everything looked fine, but some areas seemed too close together, potentially compressing a nerve.
The doctor firmly concluded that I had a herniated disc.
When I mentioned the previous diagnosis of pelvic misalignment, the doctor was dismissive, stating that there is no such thing as a misaligned pelvis and that it was just misinformation from the massage therapist.
He insisted on lumbar traction treatment.
However, due to the hospital's poor service, I stopped seeking treatment.
Recently, the pain has returned, and I visited another hospital where a different physician stated that my pelvis was indeed misaligned.
Can the pelvis actually be misaligned? I feel that the symptoms described by the traditional Chinese medicine practitioner and the third Western physician align more closely with my experience.
However, the second physician had imaging results, which I do not fully understand.
Which professional should I trust? I experience lower back soreness after standing for long periods, and bending forward provides some relief, but prolonged bending also leads to pain upon standing.
My legs feel somewhat weak on both sides, with no specific side being more painful than the other.
Both sides of my buttocks are also quite sore.
I kindly request your response, Doctor.

ellen, 20~29 year old female. Ask Date: 2004/08/28

Dr. Guan Zaoxiang reply Rehabilitation

Hello: Pelvic tilt is a symptom rather than a diagnosis, although some practitioners, particularly within the chiropractic field, may consider it a diagnosis.
In treatment, we generally emphasize addressing the underlying cause rather than just treating the symptoms.
Traditional Chinese medicine primarily focuses on symptom-based descriptions for diagnosis.
Your first physician is a traditional Chinese medicine practitioner who provided you with a diagnosis based on symptoms; the second physician, a Western medicine practitioner, conducted examinations and inferred that a herniated disc might be the underlying cause of your condition; the third physician may have aligned their diagnosis with your own description or may belong to a chiropractic approach.
There is no right or wrong among these three perspectives, and you can accept all of them.
The key is whether the inferred underlying cause, based on symptoms and examinations, has sufficient objective evidence (by this standard, the second physician's examination was the most detailed, but I did not see you describe the physical examinations from the other physicians, so I will refrain from making assumptions), as well as the treatment recommendations based on that.
The second physician likely disagreed with you using "pelvic tilt" as a diagnosis for the reasons mentioned above, and you need not feel confused by this.
Furthermore, based on your description, a herniated disc is a possibility, as is chronic muscle strain in the lower back; these two possibilities are more significant.
Other issues (including congenital, acquired, neurological, musculoskeletal, vascular, etc.) are less likely.
I would consider your "pelvic tilt" (I suspect you have a slight scoliosis) as a symptom.
Therefore, in treatment, I would first recommend lumbar traction for at least several weeks (generally, herniated discs begin to show improvement within the first to second week).
Manual therapy may help with muscle symptoms, but if your underlying cause is indeed a herniated disc, this will only alleviate symptoms and not treat the underlying cause.
Based on the above explanation, I suggest you choose a rehabilitation specialty hospital or clinic close to your home for initial treatment.

Reply Date: 2004/08/28

More Info

Pelvic misalignment can indeed contribute to back pain, and understanding your diagnosis requires a comprehensive approach that considers both structural and functional aspects of your body. Your experience highlights the complexity of diagnosing musculoskeletal issues, particularly when different healthcare providers offer varying opinions.

Firstly, let's clarify what pelvic misalignment means. The pelvis is a critical structure in the body that supports the spine and is involved in weight distribution during movement. When the pelvis is misaligned, it can lead to an imbalance in the muscles and ligaments that support the spine, potentially causing pain in the lower back, hips, and even down the legs. This misalignment can result from various factors, including injury, poor posture, repetitive strain, or even anatomical variations.

In your case, it seems that your initial injury from lifting heavy objects may have set off a chain reaction affecting your pelvic alignment and, subsequently, your spinal health. The fact that you experienced relief after manipulation suggests that there may have been some muscular or joint dysfunction that was temporarily corrected. However, the return of pain after moving and seeking care from different providers indicates that the underlying issue may not have been fully addressed.

Regarding the differing opinions between your healthcare providers, it's essential to recognize that the interpretation of diagnostic imaging (like X-rays and MRIs) can vary. While one physician may focus on the presence of a herniated disc, another might emphasize the importance of pelvic alignment. Both perspectives can be valid, as they address different aspects of your condition. A herniated disc can indeed cause nerve compression and pain, but if your pelvis is misaligned, it can exacerbate the situation by placing additional stress on the spine.

The symptoms you describe—such as lower back pain that improves with bending and worsens with prolonged standing—are common in cases of both pelvic misalignment and disc issues. The discomfort in your legs and buttocks could also indicate that the nerves are being affected, possibly due to the herniated disc or muscle tension resulting from pelvic misalignment.

To address your concerns, here are some recommendations:
1. Seek a Comprehensive Evaluation: Consider visiting a specialist who can perform a thorough physical examination, including assessing your posture, pelvic alignment, and spinal function. A physical therapist or a chiropractor with experience in pelvic alignment may provide valuable insights.

2. Diagnostic Imaging: If you haven't already, obtaining a detailed MRI of your lumbar spine can help clarify the status of your discs and any potential nerve involvement. This imaging should be interpreted in conjunction with a physical examination.

3. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles that support your pelvis and spine. A therapist can also teach you exercises to improve your posture and alignment, which may alleviate pain.

4. Pain Management: If pain persists, discussing pain management options with your healthcare provider may be beneficial. This could include medications, injections, or alternative therapies like acupuncture.

5. Lifestyle Modifications: Pay attention to your body mechanics during daily activities. Avoid heavy lifting and practice good posture to minimize strain on your back and pelvis.

6. Consider a Multidisciplinary Approach: Sometimes, a combination of treatments from different disciplines (orthopedics, physical therapy, chiropractic care) can yield the best results.
Ultimately, trust your instincts and seek care from professionals who listen to your concerns and provide a clear explanation of their findings. It may take time to find the right approach, but with persistence and the right support, you can work towards alleviating your pain and improving your quality of life.

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