How to correct an upslip

Hey everyone,

So in some of my recent posts I’ve been talking about what an upslip is. An upslip essentially the most “serious” of the different patterns of misalignment you can have, as it has the ability to pull other areas out of alignment when it occurs.

Although the long term fix for an upslip really involves strengthening, once you have an upslip, it’s really important for your overall movement patterns to get it back into place.

Unfortunately, in my experience, an upslip is really the hardest thing for patients to try to correct on their own, at home.

For this reason, I wanted to try to put together a post with some ideas.

Before I go on, please remember that the info on my blog is not meant as a substitute for medical advice! I am just putting some ideas out there, for the purpose of helping you find information and also to raise awareness of the fact that we need more help for these issues.

So, with that being said, there are several schools of thought for correcting an upslip.

The leg-pull

This is really the classic physical therapy approach for an upslip. The patient lies face up on the exercise table while the PT gently pulls downwards on the patient’s leg. This is also known as “tractioning” and the idea is that, as you pull the leg down, that pulling force travels through the whole leg and ends up pulling the hip bone back down into place, too.

I’ve definitely had PT’s do this for me, and it did fix the upslip. Like so many aspects of treatment for the SI joint, this approach is technically “correct,” and does work for many people.

However, there are a number of reasons why the leg pull isn’t a good idea for some patients, because of the stress it can place on all of the joints involved. After all, if the PT is pulling on your foot or lower leg, that force is also travelling through your ankle, knee, and hip joint before it gets to the SI joints.

Now that I’m aware that I am genetically hypermobile, I follow the advice of the specialists at Muldowney PT who say that this form of adjustment is a bad idea for people with connective tissue disorders. This kind of forceful adjustment, which applies force across multiple joints, is just not a good idea for us.

So what are some alternatives?

Releasing the quadratus lumborum muscle

As I explained in a recent post, upslips are generally caused when a muscle called the quadratus lumborum goes into spasm and pulls the hip bone upwards.

Quadratus lumborum

So, sometimes you can correct an upslip simply by releasing the spasm in the quadratus lumborum. This may not be quite enough to fix the upslip on its own, but it is worth a try. I’ve had a PT simply do a trigger point release on my QL before, and it was enough to fix the upslip that I had that day.

So, this is something a PT can do and, over time, potentially help teach you to do for yourself at home using self-massage tools.

Through running my blog, I’ve met people whose PT’s have taught them to release the QL by using even a tennis ball, when it applies pressure in just the right place.

It would be amazing if this could work for everyone. However, I’ve also been taught that sometimes an upslip may need a bit more help, in terms of a manual adjustment to nudge that hip bone back into place.

It’s also unfortunately the case that not everyone is in a position to get down on the floor and lie on top of a tennis ball. I know that, with my hypermobility condition, that is not something I would ever really love.

So let’s continue to look at some more options:

A more gentle form of adjustment: pushing down from above the hip

At Muldowney Physical Therapy, where they specialize in hypermobility, they’ve come up with a much more gentle form of adjustment. They have you lie down on your back, but instead of pulling downward on your leg, they perform a very, very gentle hand movement on your lower back, above the hip bone.

This correction essentially applies pressure to the quadratus lumborum muscle, to release it, and also pushes the hip bone back into place at the same time. It uses much less force than the leg pull, and it is only applying pressure to the SI joint, so it spares the ankle/knee/hip. That makes it much better for anyone with a connective tissue disorder, or other issue such as a labral tear in the hip.

Again, I know that not everyone reading this blog is in a position to travel to the same place, however I am putting this post out there in the hopes of raising awareness.

I looked around online to see if anyone else was doing this kind of adjustment, and I found this interesting video from Ryan Whelton, a PT in Florida, talking about his own method of adjusting an upslip by pulling down from above. In this case, his goal is to avoid manipulating the hip of someone who’s had hip surgery– rather than specifically to treat someone with a connective tissue disorder– so it isn’t exactly the same as the Muldowney method.

However, I’m really excited to see more practitioners developing an interest in SI joint dysfunction and thinking outside of the box, in terms of how to treat it, so I wanted to put this out there!

Muscle Energy Technique

Now, this is the one I really wish I could find more info on, because MET has helped me so much for other patterns of dysfunction (such as anterior and posterior rotation of the hip bone).

But all of the PT’s I’ve spoken with in person have pretty much said they aren’t aware of a specific MET that could correct an upslip.

With that said, I have heard from at least one reader of my blog that her PT was able to give her an MET technique for an upslip. From her description, it sounds as though she is lying face down on an exercise table and isometrically contracting her hip flexors against the mat, and that’s what’s pulling the hip bone back into place.

Hip flexors

Although I personally haven’t worked with a PT who knows about this, I am so curious to learn more about this technique, or to see if other people are using it, too.

Fascia release

So this is actually a fascinating topic that I really need to write about in its own right. For now, let me say that I believe fascia release to be a really promising new area of therapy.

Fascia is a form of connective tissue that essentially covers the muscles– hopefully this isn’t gross, but I think the best way to think of it is like the casing that surrounds a hot dog.

Many people, myself included, believe you can work with fascia to release it, similar to how you can massage a muscle.

This approach is somewhat controversial– there are, quite honestly, a lot of very smart people who I would agree with on many other things, who would say there isn’t enough evidence to back this up.

But I have personally experienced the benefits of fascia release, and learned about it from practitioners who I know, respect, and trust personally.

I was getting recurring upslips for a while, and was using the gentle “pushing down” style of adjustment to put it back into place.

Then I went to see my friend Natasha at Inspire Motion PT and she actually released some of the fascia around the area. It was insane how different I felt when I got up off of the treatment table.

In just a few sessions, she dramatically reduced the number of times my upslip came back– thanks to her (and combined with strengthening via the Muldowney method) it went from a weekly thing to once every few months.

Again, I will definitely be saying more about fascia release in the future. For now, I just wanted to start getting this info out there!

So this was a comprehensive look at all of the methods I’m aware of for correcting an upslip.

My hope is that by putting this sort of “brainstorming” post out there, I can help you understand some of the treatment options available.

I’m also hoping that PT’s/researchers/other medical professionals might stumble across this post and use this info as a springboard.

If you have any questions about this info, or want to go over your treatment plan, I offer coaching sessions by phone and video chat. I would love to speak with you!

I hope this helps!

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