ADJUSTMENTS TO THE PELVIS. People usually complain of low back pain, pain when bending forward, sciatic pain, painful legs and feet, knee problems, and other back problems that may be further up the body.

1. PELVIC TWIST

Person lies facing up. Check that the person is straight and relaxed.

  1. Let your hands be receptive to what the person’s body is asking: have the attitude that you are helping them to find the best position for their joints and muscles.
  2. Find the points at the ends of the iliac crest (either side of the belly) : (Anterior Superior Iliac Spine - A.S.I.S.)
  3. Ask the person to put their hands on the points.
  4. Together, look to see if there is a twist (one side higher).
  5. Discuss your findings and look at a model of the spine.
  6. Adjust by one of you lifting the lower side as the person breathes out. This adjusts the pelvis on the lower spine.
  7. Person relaxes with knees up and feet on the bed.

2. PELVIC TILT.

Person lies facing up. Gently pull both legs from the ankles and compare the apparent leg length.

  1. Measure the leg length on the ankle bones.
  2. Measure the top of the hips (top of iliac crest) this should coincide with your finding on the ankles.
  3. Explain what you find and show the model spine.
  4. Adjust by pulling the ‘shorter’ leg and pushing the ‘longer’ as the person breathes out , or
  5. By pushing the hip that is higher, towards the person’s feet.
  6. Person then rests with knees up.

If it is painful for the person to lie down, try to do the best measurement assessments you can in whatever position they are most comfortable, and then do the appropriate adjustments. It is difficult when someone has been in pain for any length of time as the muscles fight to protect the joint. Work to adjust the obvious. Tell the person your findings, what can be done for them and why they are in pain. This is important as they then start to realise that it can go away. Very often they don’t believe it is possible; reassurance is vital. Unfortunately, the full effect may take several days and they need to know this. Arnica (homeopathic remedy for bruising) and rest can be helpful at this point. After the work, it can be good to drink water as many of the systems of the body may have been slightly disturbed.

Very often you find that the twist adjustment puts the tilt right so that both adjustments are not necessary.

If relief is not felt or the body seems to be resisting, check the Pubic Bones as well – see notes later on.

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MORE WORK WITH THE PELVIS.

Work with the pelvic twist and tilt (as above) is often is all that is needed for low back pain. When the person walks about a bit, they can feel a difference in the quality of the pain; sometimes it is completely better.

We discuss what they are probably doing in their life that might be causing the problem, like standing with their weight on one leg only or sitting twisted at work. To alleviate the problem they can sit on a level surface for a while, or sit on a book the side that needs lifting up; this raises the ischium on that side. The fact that they understand why they have the problem is helpful so that they can do something about it.

If there is still pain, there may be other adjustments that could be needed. Always go on the person’s pain and only ever do adjustments that they themselves feel would be helpful or that they are willing to try. We can always return a bone to its preferred position if it should feel more uncomfortable in the new position.

Person lies facing down or sits up.Make sure they are straight and relaxed.

  1. Measure the ridge of the iliac crest - top - see if one side is higher (towards the person’s head)
  2. Adjust downwards (towards the person’s feet). If this is difficult, push up on the lower pelvic bone (ischium) on the opposite side or just below the Posterior Superior Iliac Spine (P.S.I.S.) on the opposite side (the ends of the iliac crest).
  3. Measure the ends of the iliac crest (PSIS) next to the sacrum - see if they are level with the bed or stool.
  4. Adjust by easing down while lifting the other side of the pelvis upwards from underneath. (Sometimes it is easier to do this measurement when the person is sitting but often it is easier to adjust when they are lying down.)
  5. Measure the distance between the 2 PSIS and the spinous process of the sacrum.
  6. To adjust, move the iliac crest inwards, outwards or diagonally. If any of these movements are needed, there will usually be pain in the centre of the buttock or on top of the hip. Always check how it is feeling to the person and ask them if they think it should be moved further or not. They soon become aware of what they would like and tell you.
  7. Sometimes it helps to ease both PSIS’s apart a fraction.

 

 

MORE WORK ON THE PELVIS - PUBIC BONES.

This is not always needed, but if you have done all the other pelvic checks and the patient is still not comfortable, check this too. This should always be checked if the person has pain in the groin or around the pubic area. Sometimes adjustments to the pubic bones can alleviate incontinence which is a great boon to many people.

Person lies facing up, either with the knees down or up. 1. Measure the pubic bones (highest points) to see if they are level with the bed; if not, the pelvis is twisted.

  1. Adjust by pressing down gently the side that is higher while lifting up the ischium on the other side; this is easier if they have that knee up.
  2. Measure the pubic bone – top – to see if one side is nearer the patient’s waist – if it is, the pelvis is tilted.
  3. Adjust by pushing the side that is nearer the patient’s waist, towards the feet. If necessary, push up on the other side too, underneath the pubic bone.
  4. This can also be checked and adjusted sitting up.

These adjustments can be a bit painful so be as gentle as possible. Occasionally adjustments to the pubic bones relieves pain in the low back. People may prefer to do the adjustments themselves. Ask them to move with you as the adjustment is done.

SACRUM. In children, this is a series of joints; in adults, they have fused, except for the coccyx.

Person lies facing down or sits up. 1. Test each centre joint with the person by touch (spinous processes); they will generally feel the difference between those that are right and those that are not.
  1. Measure either side of the spinous processes.
  2. See if one side stands proud (for a twist).
  3. Adjust by easing in the side that is proud.
  4. Check each time to see how it feels.
  5. Measure each of the 5 joints as they can vary.
  6. Measure the tilt - with the holes or ridges.
  7. Adjust from the base to give more room.
  8. Check the whole sacrum: it may be pushed in or out.
  9. Adjust accordingly.
To test if the sacrum is more in line, when the person is lying face down, lift one foot slowly till the lower leg is at right angles to the bed. The person will tell you if the pain in the sacrum has eased or not. This is a useful indicator for you both to see if more adjustments are needed.

COCCYX.

People generally know when this bone needs adjusting. If there is pain or extra sensitivity : measure it for tilt and twist, in or out, or a strange angle. Adjust accordingly.

  AFTER PELVIC ADJUSTMENTS. Ask the person to stand and walk about; then ask them to bend forward if they feel they can – this should now be possible to do very gently. When people come in pain, often as a last resort, you need to realise that their muscles are tight so that adjustments are more difficult. Although you might want to work on the muscles first, the muscles themselves are painful and will resist you; also they are not usually the original cause of the pain. They are protecting the mis-aligned joint and they are deliberately adding to the pain. The point of this ‘behaviour’ on behalf of the muscles is that the person simply has to rest - and ultimately seek help. I find that checking the joints, explaining my findings and doing the adjustments with the person is the quickest way of relieving the pain, even though it might be tempting to massage the muscles first. It can be helpful if the person has taken pain-killers before- hand so that they are not in acute pain. Checking the pelvis is really essential at the start of any examination because if it is crooked there are likely to be problems all over the body : the legs, knees, feet, the back, the neck and shoulders, the head, neck and even the arms; ( the nerves going down the arms to the hands, come through the neck.) So if someone comes with a problem as far removed as tinitus (buzzing in the ear), for example, it is still advisable to check the pelvis.