Lower back pain will affect 80% of the population at some point throughout their lives. Often back pain is acute, meaning the pain has developed as a result of damage to the tissues, perhaps due to injury or poor posture. However, often pain continues beyond the expected healing time of 3-6 months, or has developed slowly and continued, in which case, we call this type of pain, chronic or persistent pain. Persistent pain, in it’s truest form, is actually a disruption of the nervous system and how our brains processes that pain (check out my previous blog, ‘Chronic Pain: Is it all in my head? for more information on persistent pain). However, pain that doesn’t get better with treatment is not always a case of “disrupted wiring” or ‘central sensitisation’ as we call it.

 

The missing link.

Often I see clients in my clinic who have had pain in the lower back for years and have been severely affected by it. They arrive deconditioned, frustrated and exhausted. In my experience, people do not arrive at this point from ‘lack of trying’. In fact, they have often seen various physios, chiro’s and exercise physiologists. They have tried the medication and the creams, resting versus exercising, and nothing seems to be making this “pain in the bum’ budge. So what if I said… “perhaps… the driver for this pain is not your lower back…”.

 

The Pelvis.

This brings me to the topic of this blog: The pelvis.The pelvis is basically a platform that our upper body balances on and transfers loads through, and the lower body connects to for movement and function. This platform that is the pelvis has a series of ‘scaffolding’, ‘ropes’, ‘electrical cables’ and ‘machinery’ connected to it that enable the platform (and everything balancing on it) to be functional and to work correctly. Of course I am using these terms as an analogy for the joints, nerves, muscles and ligaments that attach to our pelvic complex.

 

So take a moment to imagine a building based around a platform such as this. If there is an imbalance on this platform, perhaps it is rotated one way or another, perhaps the ropes have become stretched on one side etc, then the rest of the building may be affected. To the naked eye, it may seem like the building has just got a lean or is a bit old and damaged. However, on closer inspection, it may be the unbalanced platform that is affecting the rest of the system. So in conclusion, you can fix the bricks and straighten up the building, but without fixing the platform, it may end up returning to it’s original lean.  

 

The lower back, legs and even the upper back and shoulders will depend on a balanced pelvic system to optimally function (as the song goes… the hip bone connects to the…- well you know the rest!). If an imbalance of the pelvis, weather that be joints, muscles, nerves or ligaments, is actually driving pain in another area of the body, then treatment to the symptomatic area may not necessarily help. You may experience short term relief, or have strategies to manage that pain, however if you feel you always end up back at the same place with your pain, then perhaps the driver for that pain has been missed.

 

How do I know if my pelvis is driving my pain?

It can be extremely difficult to tell if the pelvis is driving your pain. There may be hints in your history, such as a traumatic pregnancy or childbirth, pain in the feet as well as the lower back or difficulty with bladder and bowel dysfunction. A qualified physiotherapist with a special interest in pelvic health may help in determining if your pelvis is one of the suspects driving your pain. They will ask you questions about your history, your bladder and bowel health and other areas of your body that feel pain. They will assess your pelvic and spinal posture and check what happens to one if you change the other. They will assess joints, muscles and what happens to them as you move. They will look at your breathing pattern and see what happens to your breathing when you shift the pelvis position (e.g. does it get easier?, can you expand your ribs more?). A real time ultrasound assessment will give you information about the pelvic floor muscles and weather they are functioning well to help provide you with core stability. These are just some of the pieces that should be checked to solve the extremely complex puzzle that is the working pelvis and lumbar spine.

 

This line of enquiry may help you with your pain, or it may eliminate the possibility of the pelvis being the driver of the pain. I know that long term pain is frustrating and awful, but is it possible that something has been missed? As I said, the pelvis is a very powerful piece of the puzzle, and should be checked and rechecked for anyone with pain of the spine or lower limbs that has been unresponsive to treatment.

 

Coming up…

Do you  or someone you care about suffer from pelvis or back pain? For a limited time Calm & Connection are offering pelvis screenings with a qualified physiotherapist for only $20. Reclaim your movement and your life! Book your pelvis check-up with Calm & Connection Physiotherapy by getting in touch online, or phoning 0497 098 881.

Until then…

 

Be kind to yourself,

Julia Berger
Physiotherapist