Levels of pathology: how some forms of misalignment are more serious than others

Hey everyone,

A reader commented on my last post, asking if certain patterns of misalignment are more likely to cause nerve irritation than others. This actually really dovetailed nicely into what I planned to say next.

What I’ve learned from my various PT mentors is that there are basically different levels of pathology when it comes to the joints of the pelvis being out of alignment.

When I pass info on to you guys, I try to be very clear about where it came from. If it came from one particular physical therapist or researcher, I note that. If it came from a scientific article, I note that.

What I’m about to tell you guys has basically come from all of the physical therapists I’ve met with in person, who I truly feel are knowledgeable about the SI joints. It’s somewhat anecdotal, as I don’t have an exact article to link to (which is precisely why I’m trying to put this info out there!).

However, these are all people who’ve taken advanced courses in the SI joint and pelvis, and they all seem to say the same thing, which is why I’m sharing it with you here.

(And if you need a refresher what I’m talking about with patterns of misalignment, check out my post on why correcting your alignment can be the missing piece of the puzzle!).

An upslip is basically the most serious of the misalignments

If you have an upslip (I talked about why that might happen in my last post) it will basically pull everything else in your pelvis that’s prone to go out of alignment into a bad position, as well.

So, if you sometimes get an upslip and you sometimes get a posterior rotation of one of your hip bones, if you walk into your PT office and she sees you have an upslip, she will also assume that you’ve got the posterior rotation again that day, too.

It basically has to do with the pelvic mechanics, and how much one specific imbalance can affect the other joints of the pelvis.

An upslip really has a dramatic effect on your overall alignment and can compromise any of the other areas that have a tendency to be unstable.

Technically, the same is true of a downslip, which I haven’t yet talked about on this blog, however all of my PT mentors also agree that these are extremely, extremely rare (I’ve had plenty of upslips, but I’ve never had a downslip).

On the other hand, the most “limited” of the pelvic misaligments is actually a sacral torsion.

According to my sources, a sacral torsion (that is, your sacrum being rotated) is sort of at the opposite end of the spectrum from the upslip. It’s basically its own thing– the sacrum can rotate in relation to the base of the spine, without necessarily pulling anything else out of alignment.

However, because the sacrum is basically the “cornerstone” of your pelvis, if you’re prone to sacral torsions and you have any other misalignments, your PT will know your sacrum is likely rotated on that day, too.

Then there are the “middle level” of misalignments.

By this I’m referring to the anterior and posterior rotation of the hip bones, as well as the patterns known as “inflare” and “outflare.”

These are not as serious as an upslip, in terms of their effect on your overall pelvic biomechanics. (And, thankfully, they are not that difficult to treat with the Muscle Energy Technique, once you know how!).

These patterns of misalignment, on their own, won’t necessarily pull you into a more serious level of misalignment, (aka the upslip or downslip). In my experience, they certainly can make it more difficult for you to move around and eventually make it more likely that your quadratus lumborum muscle will spasm up and pull you into an upslip.

However, this is not quite the same thing as the way the upslip itself can pull everything else out of alignment in 2 seconds flat.

But because they are the middle level, they can certainly trigger the patterns of misalignment that fall underneath them, aka the sacral torsions.

So let’s lay it all out here:

• Most serious: upslip/downslip
• Middle level: Anterior/posterior rotation, outflare/inflare
• Fundamental level: Sacral torsion

I decided to refer to the sacral torsion as “fundamental” rather than less serious, because the latter would be an inaccurate term. All of these forms of balance are important to correct– for example, if your PT corrects only the upslip, but leaves everything else out of alignment, it will be that much easier for your upslip to come back.

Many people, in fact, refer to the sacrum as the “cornerstone” of the whole pelvis, so I definitely don’t want to imply that it’s a minor thing!

So let’s circle back to that original reader question: which of these are more likely to cause nerve irritation?

Thankfully, when nerve irritation happens at the SI joints, it’s different from when it happens at the spine, as the nerve isn’t actually being compressed (this is a great article from SI-Bone that explains more).

Instead, it has to do with the inflammation at the joint, and the muscles surrounding the joint, which then affects the sciatic nerve.

So, if we were going to be technical about this, I would say that in a sense, it’s still actually the upslip that would be the most likely to cause pain and irritation, because the upslip itself is going to trigger any other misalignments that you are prone to.

Okay, I think that’s just about all for this post!

This post was a little bit more textbook-y than some of my other posts, but I think it’s really important to get this information out there!

And again, please remember that the information on my blog isn’t meant to be taken as a substitute for medical advice.

It is, however, meant to help you along your journey and get you to a better place in less time than it took me.

If you have any questions, or are wondering how these patters of misalignment may be affecting you, please consider booking a coaching call with me– I would be happy to delve into all this with you, and help you figure out your next steps!

I’ll be discussing more about some of the corrections for an upslip and other patterns of misalignment in the future.

Stay tuned!