Pelvis

It usually takes very large forces to cause a fracture of the pelvis. Common causes include falls, especially in the elderly, motor vehicle accidents or bike accidents. Stress fractures of the triangular lower back bone (sacrum) have been seen in underweight elite female distance runners, often due to low bone density and high repetitive loads. This can also occur across all age groups, in individuals who perform high-intensity exercise or in adolescents who may be undergoing growth spurts. In rare cases, bone cancers can occur that may be related to spreading of disease (metastatis), so any unusual pain or changes in function should be investigated.

If you have any of the following symptoms, consult your GP or physiotherapist and request an X-ray to confirm a pelvic fracture:

• tenderness or sharp pain anywhere around your pelvis and severe difficulty turning over in bed, or weight-bearing through one or both legs after a traumatic accident
• pain when you sit, stand, walk or use stairs
• pain, numbness or tingling into the groin, or thighs, associated with bladder habit changes
• pain that keeps you awake at night.

If the X-ray does not show a fracture but your symptoms persist, you may need a CT scan to investigate smaller fractures that may not have been identified on an ordinary X-ray. It is important to discuss these issues with your GP.

Usually, a pelvic fracture requires 6–8 weeks of non-weight bearing or on crutches to give the pelvic bones time to heal.

Muscle strengthening

Once this time has passed, your physiotherapist can design a comprehensive exercise program to regain lost muscle strength in the lower back pelvis and hip region. Research shows that six weeks of non-weight bearing results in widespread decreased activity of many muscles of the trunk. Therefore, rehabilitation of pelvic muscles with your physiotherapist is a vital part of getting back to full function for work, life and sport after a pelvic fracture.

Mobility

After a long period of modified or non-weight bearing, the skeletal system can also be affected, and joints in the hip, lumbar spine and lower limbs can become stiff and have decreased bone density. Initially, exercises in water to help regain movement and to re-establish walking will greatly assist recovery.

Physiotherapy cannot assist in the fracture healing process. However, when it is time for you to start weight-bearing and returning to previous activities, physiotherapy is a great way to do so safely. Physiotherapists can guide you through appropriate exercises that will strengthen your pelvic muscles and allow you to return to activities safely.

When you rest your body and don’t do normal activities, and when you have been in a lot of pain from a fracture, you can develop muscle tightness and spasm. Physiotherapists can provide various treatments to help decrease your muscle tightness and pain. Techniques that physiotherapists may use include massage, dry needling and joint mobilisations. These techniques help to relieve your pain, get your joints moving better and allow strength exercises to be performed more easily.

Depending on the location of your fracture within your pelvis, you may or not be able to put weight on your legs. Consult your physiotherapist regarding appropriate weight-bearing, use of crutches, and if there are any exercises that may help maintain muscle activity during the fracture healing stage.

Again, the location of your fracture will determine the healing time. Generally, the fracture will have good healing within 8–12 weeks, however, your pain should start to subside slowly after 2–4 weeks. It is important to strictly follow the weight-bearing guidelines given to you by your doctor to allow best healing to occur.

SIJ dysfunction is frequently caused by high-impact accidents, including car accidents and general trauma to the area following a fall, hard running, twisting or awkward lifting. Pregnancy, as well as repetitive loading, can also instigate issues throughout the area.

Common symptoms will include localised pain to the buttocks region. This will generally be on one side and will travel down the side of your tailbone. Pain can radiate from the buttocks and down the side of the leg (or into your pelvis, scrotum, labia or penis). Additionally, sufferers can experience spasm throughout their gluteal muscles, as well as pain across the base of their lower back.

Aggravating activities can include arching your back, twisting in bed, long car journeys, walking up hills and going down stairs. SIJ dysfunction is difficult to diagnose with more common forms of imaging such as MRI and X-ray. Currently, the most-effective method is a ‘SPECT’ CT scan, which has a high rate of clinical accuracy. This condition is most commonly found in women (68 per cent), as demonstrated in a study conducted by Arthritis Care in 2010, but can also occur in males.

A physiotherapist skilled in the area of lumbopelvic and hip pain can differentiate sacroiliac pain from other areas that can refer to the region, including the lower back and hip. Your physiotherapist can then design a comprehensive plan of manual therapy to the pelvis and surrounding joints and muscles as needed. This hands-on treatment will be supported with a comprehensive and progressive functional exercise program to build control and dynamic strength through the lumbar spine, pelvis and hips, for everyday life, work and sport.

Physiotherapy has been shown to be the most effective treatment for sacroiliac dysfunction. In a landmark research study based in Sydney, 1200 patients were diagnosed with SIJ incompetence both clinically and on CT scan (SPECT). Of these patients, 80 per cent went on to overcome their issues with a comprehensive physiotherapy program, without requiring further specialist injections or surgery. Further, research published in the British Journal of Sports Medicine in November 2012 showed that pelvic pain caused by SIJ dysfunction can be 95 per cent resolved by musculoskeletal physiotherapy.

Laying on your stomach with a pillow under the lumbar spine, and a hard-covered book under the pelvic bone, on the painful side, can often help alleviate the pain. This can be combined with ice on the painful joint if inflammation is present, or heat on the bottom muscles if they are tight and overactive. Gentle sit-to-stand exercises from a chair, stopping just before you sit on the chair, can help build the bottom muscles that support the sacroiliac joint. Bike and compression shorts or female contouring undergarments may also be useful for providing compression to the area for pain relief and control. 

Generally, SIJ dysfunction requires a change in biomechanical patterning and an increase in strength, particularly through the core and gluteals. This will take a minimum of 12 weeks to achieve. Patients can expect a prognosis between 12-24 weeks before symptoms completely disappear. Ongoing performance of strengthening exercises is required to prevent reoccurrence.