Hey everyone,
Here’s a post I’ve been meaning to write for a while, cause it seems to keep coming up lately!
As you may know, when the SI joint is out of alignment, it means that the ilium (the top part of the hip bone) isn’t in the right place, relative to the sacrum (or base of the spine).
When the SI joint goes out of alignment, we are only talking about a difference of a few millimeters, so it isn’t necessarily something that doctors can easily diagnose, or will show up on an x-ray.
However, when you’re working with a medical professional who’s had the right training, they can assess and treat these patterns of misalignment through hands-on methods. In my perspective, an experienced physical therapist is the best option. (We talk about why this is, and how to identify someone with the right experience, in my coaching program).
In today’s post, I’m going to talk about one specific pattern of misalignment, which is called an upslip.
What is an upslip?
When we talk about an upslip, what we are referring to is the fact that the ilium (hip bone) has shifted upwards in relation to the sacrum.
This is different from some of the other patterns of misalignment you can have, such as an anterior or posterior rotation (those happen in a front-to-back motion).
With an upslip, the hip bone has actually shifted straight upwards, as shown in the diagram below:
As with any form of misalignment, we are really only talking about the hip bone being out of place by a few millimeters.
However, like anything in the body, the SI joints were designed to work a certain way. Once the hip bone moves upward, even by a few millimeters, it can end up creating wide-ranging effects throughout the body.
Why does an upslip occur?
Generally speaking, anytime the SI joint moves out of alignment, it’s because the muscles and ligaments which are supposed to hold it in place are not adequately doing their job.
Sometimes this can happen due to a sharp upward force to one of the SI joints, since it is directly pushing that leg and hip bone upwards.
However, speaking from my own personal experience, I’ve always found that it also helps to think of things more globally.
If you’ve had an injury to your SI joints, chances are the ligaments have been sprained. Although my original injury didn’t involve the classic “upward” force in the type that would traditionally be thought of as causing an upslip, once my ligaments had been sprained, the alignment of my SI joints ended up depending on the activity of my muscles.
Muscle imbalance and upslips
What I’ve learned from my various PT mentors is that in people without that one clear traumatic injury, an upslip often occurs when a muscle called the quadratus lumborum goes into spasm and pulls the hip bone upwards.
The quadratus lumborum is shown here in dark red:
As you can see, this muscle runs along the side of the spine and attaches to the ilium, which is another word for the top of the hip bone. So, when it spasms, it has the ability to pull the ilium upwards.
(And remember, when we are talking about SI joint dysfunction, we are really only talking about the hip bones moving by a few millimeters. Unfortunately, though, that’s all it really takes to start causing issues).
However, it’s best to think about the larger picture
Why does the quadratus lumborum (or QL, for short) go into spasm? And why does that hip bone move so easily?
If we sort of “zoom out” and focus on everything else that’s happening, the issue is not just necessarily that the QL went into spasm.
It also may be that some of the other muscles around the pelvis that oppose the QL are actually not strong enough to do their job.
What I’ve learned from some of my PT mentors (shout-out to Muldowney Physical Therapy!) is that the main muscle groups that oppose the QL, and help prevent an upslip, are
- the glutes
- the transverse abdominis (a very important core muscle)
So by strengthening these muscle groups, you can help to balance out the QL so that there are other, equally strong muscles to support the area and help keep the hip bone in place, even if the QL does pull on it.
However, if you already have an upslip, you will need to correct it.
For more on SI joint alignment, be sure to check out my Correcting Your Alignment page, where I talk about all the different patterns you can have.
See you there!
My Sacroiliac Joint Saga 
Christy,
For what it’s worth I have some additional info about what may cause upslips in a small percentage of people who experience them. I have been researching this long and hard. I, apparently was born with a lumbo-sacral transitional vertabrae at my lowest lumbar section (so this is congenital condition). Essentially my S1 is lumbarized rather than fused to the sacrum. I have a pseudo joint on the right side, so the transverse process is actually touching the sacrum (this is the side that always upslips). I also have elongated TP on the left side that has only 5 mm of space between it and the sacrum. This has created an imbalance in my spine that over the years has caused SI ligaments to stretch/sprain (#1 cause of my upslips) but #2 cause of my upslips is because S1 is not supposed to move (but mine does) everytime I twist or bend it creates a pull on my SI joint. The pseudo joint itself causes pain because there is no cushion or synovial fluid so everytime it moves (which is pretty much everytime I move) it is bone against bone. I found all this out by way of a consult with Jenkins Neurospine in NYC thanks to info from the Bertolotti’s Syndrome FB Education group.
This all makes alot of sense to me. I am still pursuing conservative treatment. Right now getting prolozone injections into SI ligaments, multifidus muscles and the LSTVs to see if we can strengthen and stabilize that whole area.
If I ever were to need surgery the recommendation is NOT to fuse the SI joints but to fuse the pseudo joint and left side TP to sacrum as well thereby making that S1 fused as it should have been developmentally.
Don’t know that too many other people on your SI Joint Saga forum have LSTVs or Bertolotti’s Syndrome but I think it is well worth educating people about since it apparently can cause things such as the upslips and pain I experience. I am so grateful for all the info I have gleaned from your FB group as well as Temmy Radcliffe’s Bertolotti’s group.
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This is such great info, Barbara. Thank you for sharing– your experience and knowledge really add to the post. I know there will be people who stumble across it who needed to hear exactly what you said. Sending you positive thoughts as you to continue to sort this all out ❤
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Barbara,
I have a pseudo-articulating LSTV on my left L5 and upslip of that side. I was wondering if it might be related so thank you very much for adding this to the post, it helped me tremendously. It sounds like yours is lumbarization where mine is sacralization, but did Dr. Jenkins mention the possibility of removing the extended LSTV?
Angelica
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In my case Dr Jenkins would opt to fuse rather than remove, partly because sometimes with removal it grows back. Also since mine is a lumbarized vertebra that is supposed to NOT move, fusing makes more sense. The good news is that since I got the prolozone injections I have only had one upslip and one rotation (in more than 2 years) and not much pain so for me the need for surgery currently is low. Good luck with your situation
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Hi Christy,
Again, I marvel how you can explain everything on SIJ so beautifully! The one new word I will be using when I explain to people about my situation is to use use the word “sprain”
“ …. chances are the ligaments have been sprained.”
Most people would think sprain belongs to the ankles, but, yes it’s also applies to the SI joint…
Eureka!!! ❤️
Laura
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Exactly! People usually don’t think about ligaments when it comes to the pelvis, but that’s exactly what’s going on.
So glad the post was helpful!
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Hi Christy,
Do you think this misalignment causes foot drop ?
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Hi Katya, that’s a good question. Foot drop is caused by an issue affecting the nerves that control the muscles in the front of the foot. Generally an upslip wouldn’t be able to cause that type of significant pathology.
However, it can certainly alter your movement patterns and give you the sensation of being uncoordinated.
Hope that helps!!
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Hi Christy. I’m glad you are talking about upslips. Thanks for explaining it with drawings and diagrams. I have one suggestion for how you can have an upslip. Being hit by a car as a pedestrian is how I got my 3cm upslip on my right hip. It went untreated for almost 8 years and caused me a lot of pain. My PT knew that my left leg appeared to be 3 cm shorter than my right leg when measured from the same hip protrusion but he couldn’t figure out why. He gave me many exercises to do that didn’t fix it. I finally got treated by an osteopath that manually put it back into the glide zone and my terrible pain is gone. I wish I had known what I had. My right foot was very painful and as soon as the hip went back in the foot pain stopped! My fifth metatarsals were pulled out of place and I couldn’t comfortably do stairs for all that time. Such a long time to be in great pain.
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Hi Kathryn, I’m so sorry to hear about what you went through– that is a really long time to be in pain. I’m so glad you finally found the right person to figure this out.
Unfortunately, there are still a lot of PT’s and other medical professionals who don’t understand the concept of alignment. That’s why I’m doing my best to raise awareness on my site, so people dealing with situations like yours can start to learn about it and seek out the kind of treatments they need.
Having an upslip or other misalignment at the pelvis can absolutely wreak havoc throughout the entire body. I’m so, so glad you are doing better now.
Thank you for sharing your story!
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Christy, Ryan Whelton a physical therapist from Florida states that the root cause of sacroiliac dysfunction is an upward slippage and/or eruption of the ilium on the side of pain. He has successfully treated hundreds of patients with his protocol. What is your opinion about this?
https://www.practicalpainmanagement.com/pain/spine/root-cause-sacroiliac-joint-dysfunction-four-step-exercise-protocol
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Well! This is GREAT information to take to your PT in case they re unfamiliar with SIJ issues!!! ( or they THINK they know!). I need to print this out and save it for when I ll need to see one!!!
Thank you SO much for sharing! Whoo HOO! I m so lucky to have you around!
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Hey,
Two years ago, I wound up getting bilateral sciatica or at least something like it. My spine is normal. However, the day after the sciatica my ql was very painful and that leg is now shorter than the other. The opposite si joint according to PT, is always getting stuck. I still have all these issues today cause nobody can figure it out. I think you helped though…maybe. You mentioned if you have a upslip already which I think I have, you have to correct it. How do you so that? Just strengthen the glutes and that other muscle or something else? I will bring this to a PT and see what they say.
Thank you
Andrew
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