Pelvic dysfunctions are most common cause for pains in back and legs. Yet doctors almost never even consider that choise as a source of problems.
Tom LeBlanc, PT
Symptoms of an Upslip
Do you feel as if you are walking on uneven ground, even though you know the floor is level? Does it hurt to sit too long? Do you sometimes misjudge distance, while walking through an open door, and bang your shoulder into the door jamb? Do you feel off balance and frequently have to catch yourself to keep from falling? Have you noticed yourself ârunning out of steamâ much earlier in the day since having an accident or a fall? If you answered yes to any of these questions, you may be suffering from an upslip.
What is an Upslip?
An upslip, or superior ilium, is a condition where one ilium (pelvis bone) is slightly higher than the ilium on the opposite side.
Wayne E. Rasmussen, MS, PT, ATC
"The pelvic ring dysfunction presented two alignment changes. The left side of Nichole's pelvis was rotated posterior and elevated. The elevation is called an 'Up Slip', where one seat bone was higher than the other."
Upslips and Downslips: Ilio-Sacral Shears
"I want to introduce to you an IS pattern with which most of you probably are unfamiliar. The ilium can shear vertically on the sacrum; this is called an upslip or downslip. When this occurs is critical, because shears are nonphysiological patterns, rather than rotations within the joint's normal planes of motion. In this shear, the ilium has ridden superior or inferior on the sacrum, losing its normal relationship. Once you know how to assess for IS shears, they become obvious, and relatively easy to correct."
"Symmetry in your pelvis is very important to prevent pain problems and allow all your muscles to work as effeciently as possible. Your pelvis has many muscles that attach to it and it takes a lot of punishment from our work, sports and accidents. Subtle asymmetries can create lasting painful problems. Common assymetries are an upslip and/or a torsion. This is where one half of the pelvis shifts up or rotates forward or backward relative to the other side. It can happen in varying degrees, from a subtle muscle imbalance to a severe accident ramming one bone out of place."
Richard DonTigny, PT, Advisory board, World Congress on Low Back Pain and the Pelvis (1992-2002)
"Because of the variation of the angles of the front part of the SIJ and the back part of the SIJ, after the back part of the SIJ gets stuck, the front part of the SIJ can still move up or down. When the front part of the SIJ moves up, the leg on that side gets shorter and it looks like a posterior rotation or an upslip, but this can only happen after it rotates anteriorly. Many therapists or chiros will try to correct a 'posterior dysfunction'"
"When the innominate rotates anteriorly on the sacrum, when it goes 'out', it subluxates (partially dislocates) by moving up and out on the S3 segment so I refer to it as an S3 subluxation. Because of the unique variance in the angulations of the joint surfaces, when the S3 segment subluxates, the S1 segment is opened slightly. The thing that has been overlooked by essentially all practitioners is that once the S3 subluxation occurs, the innominate may move up or down at the S1 segment giving the appearance of many different kinds of dysfunction."
"The most common subluxation occurs when one ilium moves upward or downward. If the situation remains for more than a few days, the ilium on the other side will usually move in the opposite direction because of the instability produced by the first subluxation. The situation in which both ilia move either upward or downward is uncommon, although it does occur and can often make diagnosis very difficult unless the physician is aware of its possibility."
Dr. Einas Al-Eisa et. all.
â Asymmetry in lumbar lateral flexion and axial rotation effectively distinguishes between healthy individuals and patients with unilateral mechanical LBP.
â Asymmetry in lumbar movement is highly associated with pelvic asymmetry in both asymptomatic and LBP populations. http://me.queensu.ca/people/deluzio/public
"The Malalignment Syndrome describes a recently defined syndrome that is present in many people and which can affect everyday activities and may result in injury. It is now recognised that the malalignment syndrome is frequently a predisposing factor in sports injuries. It may also underlie biomechanical problems in less active members of the population."
"The symptoms are extensive and can be different in each individual. Because of the attachment to the spine and the legs, complaints may be neck or back pain, hip pain, muscle spasm, ITT band tightness, groin strain or even heel pain.A person may experience this discomfort and think he/she has injured a muscle or joint when it is really a result of the distortion of the pelvic ring"
Kim D. Christensen, DC, DACRB, CCSP
Much more common in the pelvis is a biomechanical source of pelvic unleveling, with sacroiliac joint subluxations. This condition can be caused by work postures, recreational habits, or just a broken-down chair at home. Muscle imbalances are frequently part of this syndrome, with weakness of the hip extensor muscles being most common. Tightness of a psoas muscle, or shortening of the hamstrings from excessive sitting can also contribute to pelvic unleveling. An "antalgic" posture in response to acute pain and inflammation of the lower spinal joints often results in a difference in height of the iliac crests.
SI subluxation is a legitimate syndrome, separate from the type of low back pain associated with disc conditions, lumbago, or sciatica. 1-6 In fact, SI joint dysfunction has been implicated as a common cause of back pain in more than 30% of children. 3 Additionally, a study involving the correction of SI joint dysfunction in patients presenting to a chiropractic center over one day found an incidence of 57% for SI joint dysfunction. 7
1. DonTigney RL. A review. Physical Therapy 1985; 65(1):35-44.
2. Cox HH. Sacro-iliac subluxation as a cause of backache. Surg, Gynec & Obstet 1927; 45:637-648.
3. Mierau DR et al. Sacroiliac joint dysfunction and low back pain in school aged children. JMPT 1984; 7(2):81-84.
4. Jessen AR. The sacroiliac subluxation. ACA J of Chiro 1973; 7(s):65-72.
5. Cyriax E. Minor displacements of the sacro-iliac joints. Br J Phys Med 1934; 9:191-193.
6. Freiberg AH, Vinke TH. Sciatica and the sacro-iliac joint. J Bone & Foot Surg 1934; 16:126-136.
7. Gemmell HA, Heng BJ. Low force method of spinal correction and fixation of the sacroiliac joint. The Amer Chiro 1987; Nov:28-32.
Rehabilitation prescribed in coordination with prior chiropractic therapy as a treatment for sacroiliac subluxation in female distance runners. Grimston, S.K., Engsberg J.R., Shaw L, Vetane N.W. Chiropractic Sports Medicine, 1990;4: 2-9.
This is the story of a Canadian research team that included chiropractic care in the rehabilitation program of 16 injured female long distance runners. The runners recovered quickly and seven of them scored Ãpersonal bestÃ performances under chiropractic care.
Chiropractic effects on athletic ability. Lauro A. Mouch B. Chiropractic: The Journal of Chiropractic Research and Clinical Investigation. 1991; 6:84-87.
Fifty athletes involved in various activities including football, volleyball, track, cross-country running, weightlifting, body building, rugby and aerobic dancing were tested. They were divided into two groups.
One group received chiropractic adjustments, the other served as controls. Eleven tests were used to measure aspects of athletic ability including: agility, balance, kinesthetic perception, power, and reaction time. After 6 weeks, the control group and chiropractic group were examined.
The control group exhibited minor improvement in eight of the 11 tests (only two were statistically significant) while the chiropractic group improved significantly in all 11 tests (eight were statistically significant).
In a hand reaction test measuring the speed of reaction with the hand in response to a visual stimulus (reaction time), the control group exhibited less than a 1% response while the chiropractic group exhibited more than an 18% response after 6 weeks. After 12 weeks the chiropractic group exhibited more than 30% improvement in reaction time.
For example, a player is right arm-/left leg-dominant. The compensation pattern will show up with sacroiliac joint subluxation with pain on the dominant side. However, if the hip flexors are tight on the opposite side, then the compensation will pull to the nondominant side, due to a pelvic tilt and/or rotation. This dramatically affects the efficiency in athletic performance, even with just a little compensation. So, the key becomes to identify compensation patterns as quickly as possible and counterbalance them.
"Most manual therapists, however, be they physical therapists, chiropractors, or osteopaths, appear to believe that appreciable motion exists in the SIJ, that careful clinical testing can isolate SIJ dysfunction, and that specific treatment procedures can affect SIJ dysfunction. Sacroiliac joint dysfunction is variously termed subluxation, "upslip," "downslip," or posterior or, more frequently, anterior fixed innominate.[2-5]"
 Lee D. The Pelvic Girdle. New York, NY: Churchill Livingstone Inc; 1989.  DonTigny RL. Function and pathomechanics of the sacroiliac joint: a review. Phys Ther. 1985;65:35-44.  Nyberg R. Clinical studies of sacroiliac movement. In: International Federation of Orthopaedic manipulative Therapists Fifth International Conference, Vail, Colorado, June 1992. 1992:A90. Abstract.  Grieve EFM. Mechanical dysfunction of the sacro-iliac joint. Int Rehabil Med. 1983;5:46-52.
Spinal Manual Therapy: An Introduction to Soft Tissue Mobilization, Spinal Manipulation, Therapeutic and Home Exercise (Paperback)
by Howard W. Makofsky (Author)
On page 191: "Because the iliac upslip requires additional force to correct, a manual thrust rather than MET will he described subsequently."
Sacroiliac Joint Dysfunction in Athletes
"Next, determine if there is any leg length discrepancy. One should realize that true leg length discrepancies will generally cause asymmetry and pain, whereas a functional leg length discrepancy is usually the result of SI joint and/or pelvic dysfunction. Assess posture for increased lumbar lordosis, which can result from sacral torsions."
Sports Medicine & Rehabilitation
Doctor Taras V. Kochno MD
"Subluxations for the sacroiliac junctions are best done by chiropractic or osteopathic manipulation, and once the manipulation is successful, functional range of motion of the gluteal and lumbar muscles can be restored quickly through various myofascial release techniques."
The second most common site of injury is the low back, sacral, pelvic area. As the body is restrained with the legs extended, the impact is absorbed through the pelvic/sacral areas. Frequently, subluxation of the sacroiliac joints occur which directly affect the L4, L5 and S1 vertebral complexes.