Question
QUESTION: Hello David,
i am experiencing third case of SI misalignment since 2009. i never had lower back (or spine)problems in my life (i am 44). it only started lately after about 1,5 years of doing yoga regularly. before then i was always physically active. here is the recent story:
My chiropractor and I looked at my x-rays from previous misalignments and they are all very similar if not the same. What he tells me is that my left ilium is tilted forward and right ilium is tilted backward. When I had this problem second time, I got second opinion from another chiropractor. That one said he doesn抰 see misalignment from the x-rays, but found what he called degenerative disk (L5). However, he proceeded with the same manual adjustments as my chiropractor did (laying on the side and applying force to pelvis). I came back to my guy and asked him about the disk. He said, he won抰 call it degenerative. However, even I can see clearly on the x-rays that it is at least thinning (L5-S1) because it is quite a bit thinner than other disks. He also confirmed that my spine is tilted sideways (there is a slight curve at the base of the spine from left to right) because my left shoulder is higher a bit, although he won抰 call it scoliosis. Now, it started out differently from previous 2 times when it started with lower back pain; first one-sort of out of blue, second one-right at the yoga class. This time it was right hip joint pain in sitted cross-legged position or any position with lateral hip flexion. But only in sitted, not reclined. Then my right flexors tighten up like crazy and I got referred pain down my right knee and sometimes foot. I applied bunch of magnesium on that area and it worked wonders and released all tightness, and it was then when lower back pain started. Now, I don抰 know if we never fixed the problem at the first occurrence or it would get fixed and then come back every time. What抯 most frustrating to me is that I can抰 figure out the cause and so I don抰 know what to do or not to do to prevent it from further occurrence.  I do know, it is got to do with yoga.  I read all about SI misalignments at yoga-on-line and careful with my forward bends, wide-legged poses and twists. I抦 seeing my chiropractor for these 3 weeks 3 times a week and seeing no improvement. he tells me that my illium bones rotate back after adjustment, but can't explain why. He never performed any tests on me, just x-rays. So my questions to you are: what makes pelvic bones to rotate back to misaligned position; is my thinning L5S1 disk the origin of tilted pelvis (if so may be there should be a different approach to adjustment); I use a roll under my lower back lying on the floor to stretch the area - is that ok? I'm very much looking forward to your suggestions.
P.S. I have no hip or back pain when lying down in any position. Right hip pain is really bad when sitting. Walking is pretty much painless too unless it is over 45min and hip starts to act out.
Thank you so much, Yelena

ANSWER: ok, first off: the xray, assuming you have disc thinning. That can cause that radiating pain you had into your knee due to compression of the nerve by a thin disc, but it can also be caused by a mis aligned vertebrae in the spine.
I'm not clear on the description of the "base of the spine" being curved left to right??? that tells me you may have a slight (mild scoliosis) causing the problem with your misaligned pelvis. there is either a levoscoliosis (left curve; or concavity on right and convexity on left)   or there is a dextroscoliosis (with right curve; concavity on left and convex part of the curve on the right)
for a normal lay person this can be confusing. if you have a slight curve you need to find out why. it can be of unknown cause, or postural reasons, or biomechanical (meaning you have one leg shorter then the other , even if by a few millimeters) usually short leg is to the side of the curve , but not always.
if your xrays were taken standing then the top of the femur should be checked to see your legs are perfectly even. do not have someone check it by eye or check it by tape measure. only by xray standing.

second; i see many yoga injuries in my office.I am not fond of yoga. If you noticed these problems during yoga why would you continue yoga??? stop yoga and take up pilates (much better and it will help you build your core) if you like yoga for specific reasons take those specific things out of yoga and practice them by themself) for ex. i like the meditation and stretching of yoga. so i meditate and i stretch on my own safely.

third; have your chiropractor check your psoas muscle, the only way to get to that muscle is the the front between your anterior pelvis and your belly button.
the ilio-psoas is connected on lateral aspect of lumbar vertebrae and connects to the front or anterior aspect of the pelvis. this can cause both a mild lat. curve in base of spine and pelvis to mal-align chronically. its a tough muscle to stretch. have your chiro release it and teach you to stretch it.

David Kulla, DC
synergy wellness
new york chiropractor

---------- FOLLOW-UP ----------

QUESTION: thank a lot for your quick response.
It is a mild right curve(concavity on left and convex part of the curve on the right)when you look straight at the x-ray in front of you. Interestingly, it was my yoga teacher who told me i have slight scoliosis, that is my left shoulder is higher a bit and spine is tilted laterally (can't remember which side she said). my chiropractor never mentioned it until i asked; that indicates to me he probably didn't think it is important.
I did my x-rays in standing position, there never was a question of difference in leg length and he never checked it with a ruler on the x-ray, may be just by looking at it he determined it's not a problem. Would you suggest i find another chiropractor?
In terms of psoas muscle, i do stretches for it on the regular basis. i am more concern with the origin of the problem: Is it my mild scoliosis and tilting of the lumbar vertebrae pulls on illium bones or is it the other way around? my DC couldn't tell. As far as i understand it is also not typical for illium bones to be misaligned in opposite directions (at least not for yoga practitioners; with them it is more of the sacrum popping in and out of pelvis). So what i am trying to figure out is the mechanics that would result in such misalignment. Any thoughts on that one? And is there any difference in treating a single vertebrae first and then to address pelvis vs treating pelvis in hopes that misaligned vertebrae will go back to normal as the result? I mean, what is the proper order here?
Obviously, if after so many adjustments pelvis keeps coming back to misaligned position, there is some underlying factor for it. What is it? Why these ligaments keep pulling and twisting pelvic bones after adjustments? Thank you

Answer
you need to look at the marker on the xray and not go by the way it is hanging up on the viewbox. that will determine the side of scoliosis.
your yoga instructor is wrong, of course the pelvis (pelvis most often subluxates in different directions)and the sacrum can misalign too.  They are meant to move and its pretty common to see them come out of alignment, even if you are active.
i doubt you are really stretching your psoas muscle, because it is extremely difficult to stretch.
i know your concerned with the origin of the problem, which may be the yoga!
as far as the scoliosis , you need to have the top of the femur heads (leg bones) measured to make sure they are even length. if they are not then that could be the cause of these problems.
also, i would see your chiro at least 6-8 times and if you are not getting some relief (doesn't have to be 100%) then you may want to switch doctors.
where are you located?