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.
I will be explaining how to correct an upslip, and some of the different schools of thought around this, in my next post.
See you there!