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!

Published by Christy Collins

Hi, I'm Christy! I'm a health coach who helps people overcome SI joint dysfunction and chronic pain.

8 thoughts on “Levels of pathology: how some forms of misalignment are more serious than others

  1. Hi again, Just a new resource I wanted to share and see if you’d known about. I watched some of Dr. Ryan Wheltons videos on YouTube and, while he seems pompous and has trouble getting to the point, his methods resonated. He developed and patented a 4-exercise series for SI joint dysfunction and I have to tell you — I’m getting more relief from this than from anything I’ve ever tried (and you know I have a decades-long history battling this stuff)!

    There’s not a lot of detail but it’s still worth a gander. I contacted Wheltons office and they put me in touch with a local physical therapist who has been trained in his methods. Unfortunately local in Alaska means she’s still 5 hours away so we haven’t been able to meet yet (I’m not quite ready to stay in a hotel during a pandemic), but I think she’s on to something of a breakthrough with my jacked-up SI joint and all the other imbalances it causes.

    Thought I’d share!


    Sent from my iPhone



    1. Hi Bethany, that’s great to hear! Yes I have heard of Ryan Whelton’s methods and I’m so glad you’re having relief! I know they have to do with releasing the fascia, which in general I think is an incredibly promising approach! I’ve actually started to get into fascia release myself and have been meaning to write about it here.

      I am SO excited for you– definitely keep me posted!

      Liked by 1 person

  2. Hello I have been reading your stuff for a year now very interesting. Quick question what do you mean be “releasing the fascia”
    Thank you kindly Randall Lee Weed Jt.

    Liked by 1 person

    1. Hi Randall, I have actually been meaning to write about fascia– there is a lot to say! The very short explanation is that fascia is a form of connective tissue that surrounds your muscles. This is still an emerging area of research, but many people (myself included) believe that you can develop restrictions in your fascia, similar to how you can develop trigger points in your muscles.

      However, the technique to release restrictions in fascia is different from massage techniques that target the muscles.

      I’ve had it done to me by a PT, and she actually taught me to do it to myself! I’ve found it can really help to increase range of motion in a way that’s different from traditional massage.

      I will definitely be writing about this more in the future! Hope this helps.

      Liked by 1 person

  3. Christy,
    You are so right! The initial cause of the dysfunction triggers a kinetic response. In my case an injury to my bum caused a pelvic tilt and si joint dysfunction which also affected the sciatic nerve from my heels to my neck. Alignment has been incredibly difficult but you are my hope that things will get better. Thank you.

    Liked by 1 person

  4. Christy,
    My life has been a living hell for the last two years. It seems the medical community doesn’t understand how painfully debillitating this condition can be. I have been in excruciating pain and the drugs only make me feel sleepy. My chiropractor seems to have a better understanding but the means used to help patients overcome this are rather primitive. Having knowledgeable experts are needed in this field and better treatment methods.

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s