It is not uncommon for a patient to come into the clinic and say they were told by a medical provider that they have unstable hips (generally referencing their pelvis). This is often followed by a laundry list of movements they “should not do”, possibly ever, to avoid making their pain worse. These patients often report frequent visits to have their body worked on and “put back together” in order to go through life without constant pain or joints “going out.”
Sometimes these patients haven’t seen any medical providers at all, but describe their pain as if something is unstable, slipping, shifting, etc. Perhaps they googled it and this is the best way they could find to verbalize the sensations they felt.
What this shows is a widespread assumption that our back/pelvis/hips can suddenly shift and change position and are “unstable”. Look at all these strong and beautiful ligaments. The strength of these is so great, could bad posture or lifting something in a “bad” way really cause that much movement?
Research shows that we are unable to accurately palpate (feel with our hands) if a joint position is “out of place” or moving in an “unstable” way. The linked systematic study found that “current clinical methods utilizing palpation for diagnosing SIJ pathology have been found to be unreliable and invalid in the literature and may have limited clinical utility.” Through research, we know that the SIJ can move on average about 2 degrees or 3-4 mm. That is such a small amount, I challenge the notion that we can actually feel that with our hands- through skin and fat and muscles.
So why do some people believe that our hips and pelvis are all willy-nilly and unstable?
As humans, we relate to stories. However, pain is not something that is easily understandable for everyone and may not have a concrete explanation- particularly when one has been in pain for years and it affects their daily life. Humans want a WHY. An easier explanation is that your SI joint is painful because of instability and movement at the joint. This seems relatable to folks because it might FEEL just like that- like it’s moving too much.
While explaining pain in this way can be helpful in some respects, the problem is that it snow balls into the “things I can’t do” list because if my pelvis is unstable, then I probably shouldn’t workout and DEFINITELY shouldn’t run. But one thing that we DO have research supporting is exercise to decrease chronic pain and improve quality of life.
So if you have pain, don’t panic! Go MOVE. If you need guidance for where to start, find providers that will encourage you to be active and strategically help you return to the activities you love. (Pro tip: This rarely entails the word “never." As in “you should never lift weights or “you should never run."). Let us know if we can help you!
Thanks for reading,
Dr. Jackie, PT, DPT, OCS, CSCS
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.