Can an Uneven Pelvis Create Chaos?
Scoliosis is a condition that can affect any area of the spine and the pelvis position plays an important role in determining treatment options. Scoliosis ultimately leads to compensations and posture changes in the entire body, with muscles, ligaments and nerves all affected There is research growing trying to identify the causes of scoliosis but even if the causes are ultimately narrowed down, it will always be true that the body will react to pressure over time. It can do this in a multitude of ways, including but not limited to muscle hypertension, ligament laxity and joint instability.
The Forces on the Body Can Change the Shape of Bones!
It may surprise you to know that the forces being placed on the body as scoliosis evolves are strong enough over time to actually change the shape of bone. This happens all throughout the life of a patient with scoliosis but is especially true at critical times of bone growth, which includes puberty and later in life as bones grow weaker and degeneration takes place.
The Pelvis and Lumbar Spine Are Closely Linked
Let’s focus on one common issue that I see with a majority of patients with scoliosis: the relationship between lumbar scoliosis and the pelvis. Pelvic obliquity, with or without significant deformity, can affect anyone with scoliosis but is especially important in primary lumbar scoliosis. This means that even though they may have other curves in their spines, the lumbar is the more severe and often quite rigid. This is also more common in an adult onset of scoliosis; a type known as De-novo Degenerative Scoliosis. It’s important to remember that pelvic obliquity can occur for many reasons, including but not limited to sacral deformity, ischial deformity and leg length discrepancy. We will explore this more shortly. Find out exactly what is going on in the pelvis is going to be crucial to patient management of scoliosis. When the pelvis is not level, it’s hard to reach scoliosis treatment goals! .
Which Comes First – Scoliosis or Pelvic Obliquity?
Either can be first. Truthfully, even if you diagnose a case of scoliosis in a teenager or even younger, it may not matter which was there first. The proper course of action is to treat both the scoliosis and the pelvic distortions and in doing so, you will achieve the best outcomes.
The harder part of these considerations, both as a parent or patient, is that if left untreated or treated incorrectly it can lead to pain and discomfort later in life and also increase the risk of scoliosis progressing.
3 Causes of Pelvic Obliquity
Each of the 3 potential causes of pelvic obliquity can present their own set of problems and there is not always a solution. However, the presence of small pressure over time will lead to change and must be considered during treatment.
1. Scoliosis and Bone Growth Rates
Scoliosis creates abnormal forces on the spine that can actually prohibit equal bone growth in the spine itself. This is sometimes referred to as wedging of the vertebrae. The sooner scoliosis is treated the less likely this is to happen. The same applies to the areas within the pelvic bones, sacrum and even the legs See below: Mild L5 wedging.
2. Bony Deformity
This can be a congenital of traumatic deformity of the tailbone (sacrum) or extra bony growth between L5, the bottom vertebrae of your spine, and the tailbone. This is clinically called lumbarization or sacralization, depending on the location. See below: lumbarization of S1 sacral segment.
3. Leg length
Perhaps, the one you will hear the most often and the example I use below is leg length differences. One leg can certainly be longer than the other. However, this needs to be properly evaluated to see if this is a true difference in the long bones of the legs or more so the reaction of the pelvis to those differing leg lengths. See below: 5.2mm leg length discrepancy.
Evaluation
The 3 listed above are certainly the ones I see most often and they can all be evaluated correctly with proper x-ray analysis.. The caveat is that it needs to be taken correctly but if done so can actually lead to simple solutions that will make a huge difference for patients, regardless of symptoms.
The particular X-ray is called a Modified Ferguson’s view. If you have scoliosis and you have not had a proper pelvic X-ray or evaluation from a scoliosis trained professional, reach out to talk with us at ScoliCare Louisville and ask about our free x-ray review or how to get your new x-rays at our clinic.
Case Review
Adult male patient with chronic lower back and hip pain. He has known about his scoliosis most his life and was told there is not much to be done. What is the cause though? Hint: If you have lumbar scoliosis you need to have your pelvis properly evaluated.
The patient never had his pelvis correctly imaged. A congenital defect in his femoral head formation led to an extreme difference right to left in his leg lengths. In the 2nd image you can see how unlevel the entire pelvis is due to this leg length, likely the direct cause of his scoliosis and resulting in his chronic low back pain and hip pain.
How did we fix it?
A simple solution to a lifelong problem was to balance the pelvis and rehabilitate the spine using a non-surgical approach. This last X-ray is taken with a foot lift in that was prescribed after the Modified Ferguson’s X-ray was completed and analyzed. A $60 solution that almost immediately took away the patient’s low back pain. The hip pain is still present due to the congenital deformity of the femur heads but the patient is still improving.
Non-Surgical Scoliosis Treatments in Louisville
At ScoliCare Louisville, we specialize in non-surgical scoliosis treatments designed to improve posture, reduce pain, and enhance quality of life. Our approach includes the innovative ScoliBrace®, a custom-fitted brace that helps correct spinal curvature, and ScoliBalance®, a targeted exercise program that focuses on strengthening and stabilizing the muscles around the spine. These treatments are tailored to each individual, providing effective solutions that support long-term spinal health without the need for invasive procedures.
Taking Control of Your Scoliosis
Taking a proactive approach to seeking treatment can help address scoliosis early and prevent further spinal degeneration, reducing the need for invasive treatments later.
If you notice changes in yourself or a loved one, don’t wait until symptoms worsen. Take action today and contact our team to explore your treatment options. You can also call us on 502-384-3205 or schedule an initial appointment here.
