A PROVEN APPROACH TO TREATING MALALIGNMENT
Realignment of the pelvis is possible in most and the chances of eventually staying in alignment are increased by following a progressive treatment programme that includes:
GETTING THE RIGHT HELP
Your recovery program should be supervised by a qualified manual therapist: an osteopath, chiropractor, or other professional who has done the extra training to become proficient in using this treatment approach. The therapist may choose to add complementary techniques to improve your chances of maintaining realignment; for example:
- acupuncture, massage, and/or intramuscular stimulation (IMS), to settle down ongoing pain and muscle tension
- prolotherapy injections of a joint capsule and ligaments, to help stabilize that joint
- Learn to do a self-assessment for alignment, to spot recurrences of malalignment early on and seek treatment before they cause problems
- Carry out some simple self-corrective manoeuvres that may allow you to temporarily achieve partial or complete realignment (Fig. 16); this can prove particularly valuable when you are out on the road and away from any help, so you can prevent or minimize any sacroiliac (SI) joint instability and the development of pain until can see your therapist
BECOMING INVOLVED ON A DAY-TO-DAY BASIS
STRENGTHENING THE CORE STABILIZING MUSCLES
Regaining the stability of your pelvis and spine is essential for carrying out all actions in a controlled way (e.g., mounting a bike; throwing a ball). When SI joint instability is present, a sacroiliac belt may be helpful initially to decrease recurrences of malalignment until core muscle strength has improved (Fig. 17).
RE-ESTABLISHING NORMAL BODY MOVEMENT PATTERNS AND BALANCE
This can be achieved by starting a proven approach, such as Pilates, once you have built up core strength and are maintaining realignment for longer periods of time.
AVOIDING RECURRENCES OF MALALIGNMENT
OR TRIGGERING SYMPTOMS
Athletes are advised to play it safe. Only once the core muscles have been strengthened and you are starting to maintain alignment should you consider a graduated return to your sport. A common mistake is to start up or accelerate the training program too quickly, or subject specific areas of your body to increased forces that you are not yet ready to cope with by:
- Exceeding your current physical capabilities in the course of training or competition
- Changing equipment or terrain; for example, including terrain with sloped surfaces or suddenly adding up- and downhill components to a previously all-flat workout
REEVALUATING ORTHOTICS AND SHOES
Orthotics that were provided prior to detection of the malalignment should be thrown away as they are likely to perpetuate the previous abnormal weight-bearing pattern and predispose to you going out of alignment again after correction. If still indicated, new orthotics should be cast immediately after realignment and with you weight-bearing (e.g., standing for a cast or walking over a computerized pad or treadmill surface). Shoes that show wear-pattern changes attributable to the malalignment (Figs. 12, 18) should be replaced with a pair appropriate for your true weight-bearing pattern – pronation, neutral, or supination – that becomes evident once realignment has been achieved.
RULING OUT ANY CO-EXISTING MEDICAL CONDITIONS
Symptoms associated with malalignment can overlap with those caused by a coexisting medical condition and end up hiding it. Alternately, one may aggravate the other to the point that it is hard to determine which condition is primarily responsible for an athlete’s problems. Further investigations and a change in the treatment protocol may be called for, especially when the athlete keeps going out of alignment despite a concerted treatment effort aimed at the malalignment. Failure to detect an underlying condition or failing to separate its effects from those of a coexisting malalignment problem can result in misdiagnosis, inappropriate (and sometimes harmful) investigations and treatment measures, physical and/or mental harm, and possibly medico-legal consequences.
- The pelvis, spine, or both are out of alignment in over 80% of the general population.
- Athletes are at increased risk of injury and/or experiencing abnormal sensations, discomfort, or outright pain in structures that are put under undue stress by the malalignment. Back, shoulder, hip, and knee pain are most common.
- The biomechanical changes seen with an upslip or rotational malalignment affect style, energy efficiency, and the chances of the athlete realizing their full potential.
- Realignment is possible in most. Recurrences despite ongoing treatment can be attributable to worn or inappropriate shoes, previously-provided orthotics, an unstable sacroiliac joint, or a coexisting medical condition.
- Following a progressive supervised treatment program that includes the athlete doing a day-by-day self-assessment and possibly self-corrections increases the chances of eventually staying in alignment.