What is pelvic instability?
Pelvic instability can present at any age, but tends to decline with aging, due to stiffening of ligamentous tissues. Our pelvic bones bear the weight of our upper body and distribute it through the hips and legs. The pelvis consists of the hip, sacrum and pubic bones all held together by ligaments. If ligaments are injured or overstretched, the pelvis loses its stability and begins to move excessively with physical activities.
Pelvic instability often presents in young females who are involved in sport that requires a high degree of mobility (such as dance or gymnastics). It can also present during pregnancy or post-partum, especially whilst still breastfeeding as the hormone, relaxin (which relaxes the pelvic ligaments in preparation for childbirth) is still circulating in the system.
There may or may not be a history of injury that causes the pain. Often pain will commence insidiously and be associated with prolonged postures rather than moving or physical activity. The underlying cause of pain is deformation of structures in the spine and pelvis (joint and ligaments) due to excessive range of motion without the necessary muscular control. The joints are held at or near their end range of motion, which stresses and stretches the retaining ligaments.
Symptoms include pain in the sacral-iliac joints, lower lumbar spine and pubic pain. There may be radiation of pain to the groin or hip. Pain when rolling over in bed, climbing stairs, and getting out of the bath are highly suggestive of the condition.
As with most chronic pain conditions, a conservative approach for patients is recommended. Patients may be advised to wear a brace for a period of time until their muscles are strong enough to hold the pelvis in place. Simple analgesia, taping and exercises may also help manage the pain. If conservative therapies are unsuccessful, prolotherapy may be an option. Prolotherapy, an injection based therapy which has been used for over 60 years, works by prompting the body’s natural repair mechanisms to heal injured or weakened joints, ligaments and tendons. 1
Most studies on prolotherapy were carried out for low back pain in general, with inconsistent findings 2-5. However, there is good evidence supporting the specific use of prolotherapy around the sacroiliac joint, with one study reporting a functional improvement in 78% of treated patients. 6
At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain management, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. Our treatment pathway involves exploring our comprehensive array of available conservative and interventional treatment options. Our goal is to reduce your pain and improve your quality of life, enabling you to Live Better.
- Hackett GS. Joint stabilization through induced ligament sclerosis. Ohio.Med 1953;49:877-84.
- Klein RG, Eek BC, Delong WB et al. A randomized double-blind trial of dextroseglycerinephenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.
- Dechow E, Davies RK, Carr AJ et al. A randomized, double-blind, placebocontrolled trial of sclerosing injections in patients with chronic low back pain. Rheumatofogy (Oxford) 1999;38:1255-9.
- Ongley MJ, Klein RG, Dorman TA et al. A new approach to the treatment of chronic low back pain. Lancet 1987;2:143-6.
- Yelland MJ, Glasziou PP, Bogduk N et al. Prototherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9-16.
- Cusi M, Saunders J, Hungerford 8 et al. The use of prolotherapy in the sacroiliac joint. Br.J Sports Med 2010;44:100-4.
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