Hip, SI joint, and low back is often chalked up to be due to malalignment of the pelvis. Some medical professionals will swear this is a thing while others will tell you it's nonsense. 

In this article, I want to share with you my take on this. When you feel like your hips or pelvis is 'out of alignment"  what is actually going on. And then what can you do to correct the issue?

First of all, it is important to note that both the ball and socket hip joint and the SI joints (where your low back meets the pelvis) are VERY STABLE. I have only seen a few true dislocations in my career and they were the result of traumatic injuries involving airborne operations, falls from  a steep height or motor vehicle accidents. 

So while your hips and pelvis are not likely 'moving out of place',  we can get stuck in movement patterns where we load one hip more than the other or rotate one side more and then we can start to feel 'unbalanced', or like things are out of alignment. 

As this happens, extra movement and load may be directed at one side of the pelvis causing the joints and muscles to become 'overworked' while the other side gets stiff and rigid from not enough movement. 

Pain can then manifest on either side- the overworked hip and SI joint or the underworked side. 

*Certain populations may be more prone to this such as those with hypermobility and then pregnant women. For both of these populations, the ligaments and connective tissue has more give which allows for more movement in the pelvis. Sometimes this extra movement can increase feelings of 'getting out of balance' or 'out of alignment'. 

Treatment for this condition may vary depending on which type of rehab provider you see.

Chiropractors will likely recommendation an adjustment where  a high velocity thrust force is transmitted through the pelvis with the intention to get the joints to move. 

And Physical Therapists are likely to treat you with some sort of mobility/stability exercise work (some may also do adjustments). 

Clinically, what I have found is that for acute onset of SI joint pain, adjustments followed by simple range of motion exercises can be very effective. This is often the case after a trip and fall landing on the hip/buttock where one side of the pelvis gets 'jammed up'. 

For chronic hip/SI joint pain, I think an exercise approach is the best solution. If things have been going on for months/years you have certainly developed movement patterns that are likely compensatory and dysfunctional.

A targeted movement and exercise program is the best way to create lasting changes in how your body moves, how your brain communicates with your body, and then finally how your joints, muscles, and connective tissue tolerate movement and load. 

From an exercise perspective we want to initially focus on restoring movement. 

SI joints are surrounded by really dense ligaments and connective tissue so they don't have a ton of movement, but they should still get some mobility. This is done by targeting work to the low back which moves the sacrum (S part of SI joint) or by targeting mobility to the ilium (I part of the SI joint). 

Most people will find imbalances in their body when we start isolating mobility work to the pelvis. This is due to the movement patterns we develop over time based on our hobbies, lifestyle, pain etc... 

We also want to restore movement to the hip joint. This is focused primarily on the hips ability to rotate and then the ability to hinge the hip. These two movements are crucial for improving health of the hips and SI joint.

Many of my physical therapy clients initially have trouble separating hip movement from low back movement. This is another compensatory movement pattern that can develop over time but can present numerous problems. 

Once movement and mobility has been restored, we want to start loading the hips and pelvis. In a nutshell- we want to add resistance to improve the strength and endurance of the muscles that attach to the pelvis and support the hips and SI joints. 

This includes the small rotational muscles that lie deep in the hip, the often stretched by never strengthened hip flexors and adductors, the notoriously weak hip abductors, and then finally your large powerhouse glute max muscles. 

We want to train these muscles in isolation and as co-contractions with functional movements. Additionally, we want to train them in a variety of positions and then ensure that we are providing enough of a training stimulus (AKA move past the easy band exercises!). 

And then the last phase of rehab (which is the most fun IMO) involves retraining the hips to absorb impact forces and produce power. 

Your hips are meant to be a power house. They should decelerate you as you slow down, change direction, land a jump etc... They should also be able to produce an enormous amount of power from an athletic standpoint. Often times, after years of pain and dysfunctional movement your hips forget how to do their job. Our final phase of rehab is to retrain them how :)

So are you hips 'out of alignment' or 'out of place'? Not likely. BUT you very likely may feel unbalanced and lack symmetrical movement.

If this has been going on for awhile, a comprehensive exercise program is your best approach. Keep in mind, this is not a quick fix type of solution.

Instead, a proper exercise based rehab program should give you the opportunity to take a deep dive into how your body moves. Where are you lacking mobility? Where are you lacking stability? Do you have compensatory movement patterns? The answers to these questions go hand in hand with the long term solution. 

If you you have been dealing with nagging hip/SI joint issues and constantly feel like you are 'out of alignment', make sure to check out my Performance Hip Program. 

This self-paced 5-Phase Program gives you a structured exercise plan to follow. We begin my restoring movement and mobility to the hips/pelvis and correct underlying movement dysfunction. From there we follow a progressive strengthening regimen targeting all the surrounding muscles. And by the last phase of the program we retrain the hips to absorb impact and produce power. 

You will have exact blueprint that I use in the clinic with my physical therapy clients. My goal is to teach you how to heal your body and correct the issue. 

Click HERE to learn more or get started. 

Feel free to reach out at [email protected] if you have any questions. 

Yours in health, 

Jamie 'Doc Mraz'