My client has been confirmed by a specialist (consultant orthopaedic surgeon) has having muscular imbalances in his pelvic girdle, resulting from a sway back posture. However, with current exercise (basics first of all) this problem has appeared to worsen, specifically in the SIJ. He described the following as the most painful movements: "sitting with my legs stretched in front of me, sitting straight up into that position from lying on my back, sitting on a Swiss ball, getting out the car." As for occupation/lifestyle, he now sits on a Swiss ball at work rather than a chair and has a lumbar support in his car. He has been treated at physio for reoccurring piriformis tightness and is evidently tight in the lower extremity muscles associated with the sway back. However, while he is in pain, he is away from the gym and exercise, and the last time things flared up, he missed six weeks of training. The initial training after that time made him feel good and appeared to be doing good, but when the cold weather came, he appeared to be more immobile than usual. Could you assist me in some ideal ways to help my client loosen up in the morning as well as indicate any research/literature I can review?
Thank you so much for your question and client concern. To assist you in this situation, I will list some important definitions followed by ideas for you to try. As I’m sure you’re aware, it is impossible to give you a “black and white” answer to a dynamic, always changing client. Here’s how we will start: muscular imbalance in the pelvic girdle can mean anything and is most likely a result of something else. Sway back is another general term to describe a pelvic malalignment. However, these descriptions can give CLUES. The first clue I would expect with a sway back is a deceptively looking lordosed posture. This deceptively viewed posture differs from excessive lordosis in that the entire pelvis and top end of thighs are swayed forward in relation to the feet. To counteract the position of the pelvis, the upper body is swayed back. The key to this correction is to develop the functional strength throughout the kinetic chain (don’t disregard the rest of the body) to lift and maintain the torso UP and OFF the ligaments of the hips. Your exercise selection should be ground based (not seated, prone or supine) so the entire body is challenged to absorb and transfer force properly through the pelvis. Much research is now stating that isolated exercises for the pelvic girdle will exacerbate back problems, not help them. To give you exact movements (exercises) would be a complete guessing game because I don’t know your client's functional threshold. However, to learn more about functional anatomy and proper correction for your client (and many others), I strongly recommend Gary Gray’s Functional Video Digest Series on the Lumbar Spine and Hamstrings. It will be well worth your investment and will supply you with an array of new tools to assess and address this malalignment.