Medical Questions > Conditions and Diseases > Back Pain Forum

hip problem , faciliation at the L4/5 , pelvic rotation ???

Hi my name's Jo. I'm a 22yr old female.

I have had pain in my right hip for over 4 years but it has been getting a lot worse lately.

I went to see my doctors back in February 2006 with this problem, but my hip was very clicky and it sometimes hurt a little. The locum doctor there couldn't say there was anything wrong, but it could be a connective tissue disorder as the muscles around my right hip were very tight. He said for me to get some exercise, but I'm practically on my feet most of the time at work, for around 6-7 hours if I miss out the breaks and times when I do sit down, and I'm petite and very slim for my age, so it can't be that.

Anyway, I carried on with things, but in February this year, I was on holiday with my partner in London, and we were walking around. I suddenly felt a sharp stabbing pain in my right abdominal area and right hip area, right over the crest. I just thought it was a normal stitch, but it was making me feel stiff when I was walking and so I had to stop.
This happened around the 27th/28th of February. I took note of this, and through all of the 4 months the pain around my hip and tummy area HAS come back and has been hassling me a lot.
I was starting to wonder if it could be my menstrual cycle as I start around the 4th-8th. But I didn't want to jump to any conclusions so I just let it be.

One morning in May this year, my right hip had been hurting a lot more, and the pain was so severe it woke me up an hour before I had to get up. I got up because I was in so much pain, went to stand, and my right leg couldn't even support my weight, and it actually gave way underneath me. I was also feeling very stiff. I made an appointment that day to see a doctor, who was a locum doctor also, and he made no diagnosis as he seemed to think everything was ok. Even though he said everything seemed normal, he referred me to an osteopath, but because they weren't on the NHS, I had to pay to go private.
I was in so much pain and I just wanted it sorted out, so I went with a practise which was just up the road from where I lived.

I saw an osteopath that day, which was quite good, and he became immediately aware that my spine had been extended. I wasn't sure what he meant, but he carried on to say that I was hypermobile and because of my slim build, was very bendy.
He did a range of palpation techniques on me and suggested I take up Pilates to help strengthen my back.

For 2 months I took up Pilates privately and I saw the osteopath every 2 weeks, but my hip was still causing me problems.

2 weeks ago I saw a female osteopath and she had a feel around where I said the pain was felt. She told me that my pelvis was quite twisted.
That was when I started to panic, but she simply said she can only treat me so much for it, but if I'm in any more pain and if she seems to think it isn't musculoskeletal at all, then I should go back to my doctor.

She sent a letter to my doctors and sent a copy to me. I just wondered if what I have is anything specific because there are so many big words in it!

She writes that " a general hypermobility was noted with faciliation at the L4/5 level seen. A pelvic rotation (anterior on the right) was observed with hypertonia through the right psoas muscle palpated."

Does anyone know what this means and is it anything I should be really worried about? I'm very confused by what she wrote and I want to know if anyone out there has any idea what it is. Please help!!

Thanks

Jo
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replied February 12th, 2009
Err...
I never understand why it's necessary to point out when a doctor, pilot, etc. is female. To be consistent, you should point out that the other doctors are male.
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replied February 12th, 2009
It means...
It means that your muscles are extra stretchy in that spot. The doctor noticed pelvic rotation when the muscles were pressed because of it. The only treatments I have ever encountered for hypermobility are a) prolotherapy and b) strengthening/resistance (not stretching) exercises. Look up "sacroiliac joint dysfunction." Many do SJID resistance exercises.

If a doc clears you, try this: wedge a bent leg between a stability ball and a table while you sit on a chair. Push up against the table with your knee - then push in the ball with your knee. Repeat. Listen for the clicks in your joints and feel for sacral iliac muscle tension. Remember no stretching, just strengthening.
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replied February 13th, 2009
Active User, very eHealthy
"She writes that " a general hypermobility was noted with faciliation at the L4/5 level seen. A pelvic rotation (anterior on the right) was observed with hypertonia through the right psoas muscle palpated"


hypermobility means your joints have an abnormally large range of mobility, this is usually due to laxity of the ligaments, and the soft tissues that hold the joints together.


I don't know what she means by "with facilitation at the L4/5 level seen"

Facilitation is a word that can have many slightly different meanings, generally it means something that assists or makes easier some action or process. L4-L5 is the second bottom joint in your spine.

Osteopathes, chiropractors, and sometimes physios use the term pelvic rotation to describe an abnormal twisting of the pelvis.


The pelvis is made up of three bones with two mobile joints called sacroiliac joints on each side of the sacrum which is the bone in the middle of the pelvis that the spine sits on. The ilia are the two large pelvic bones on each side that the femurs (thigh bone) connect to, and form the hip joint.

A pelvic rotation is when one ilia tips forward, and the other one tips backward resulting in an imbalance of the sacroiliac joints, and an unleveling of the sacrum, which usually will cause some degree of scoliosis (a sideways bending of the spine) as the spine now sits on a tilting base of support.


The psoas muscle is a large powerful muscle that is attached to the lower five vertebra, and courses through the pelvis, and attaches to the femur it causes the leg to flex (raise the knee) when it is contracted. Hypertonia is a condition marked by an abnormal increase in muscle tension, and a reduced ability of a muscle to stretch.


Good luck Krystal1985
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replied September 15th, 2009
Hip clicking/giving way,etc maybe Femoral-Acetabular Impingement
Krystal- google on Femoral-Acetabular Impingement (FAI). Your hip should NOT be "clicky." Your hip should NOT give way. These are two tell-tales of FAI. So are pelvic issues resulting from the torsional rotational forces when the hip is catching and sticking. The world's leading surgeon in the FAI arena is Dr Marc Phillipon, Steadman-Hawkins Clinic, Vail CO. Several dozen surgeons have studied under him and are practicing around the U.S. All this within the last 5-6 years, so you're not going to learn anything helpful about FAI from your local orthopedic surgeon (mine said the hip was too good, and I was too young, to replace with an artificial hip- that's all the medical profession had to offer until recently.) My point is that you may be best off if you research and learn enough about FAI yourself so you can find one of the few knowledgeable surgeons. At least see an orthopedic surgeon to discuss your case and I'd take some printouts off the internet on FAI in case they're not familiar with it. Best of wishes with this and pursue this aggressively- it's up to us as individual patients to advocate for ourselves when the Dr can't identify the problem. Paul
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replied March 16th, 2017
I have the exact problem. L4 continuously rotating and the right pelvis rotating. I also have herniated discs, advanced DDD, and POTS.

Get evaluated for Ehlers Danlos Syndrome. I was recently diagnosed. I do a good PT routine and get put back into place regularly. It's chronic pain, bit you'll get through it if you keep strong. I used to do yoga and I think yoga made me worse, probably how I herniated discs.

You're on the right path, but there are different versions of hypermobility and some should be ruled out. They'll check your Aorta and eyes, because connective tissue disorder doesn't only impact your bones! I have stretchy veins (pots) and a stretchy colon (ibs) so it's good to know so you can prevent the can catastrophes!
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