Question
I am three weeks post acetabular labral repair. Prior to surgery my pelvis was tilted resulting in left hip problem. I can still feel the trochanter is higher than the right side and sticks out more. A lot of left back pain, groin, thigh pain. The hip joint is no longer catching, but the underlying issue of alighnment had not been solved. I was a runner before this and am an RN on my feet. Really want to know if chiropratic and physical therapy together can help with alignment.

Thanks for your help.

Answer
Hi Danielle,

If you took 100 people and x-rayed their spines, you'd find disc and joint degeneration, scoliosis and segment misalignment in a significant number of them.   However, there is very little correlation between what is seen and where the pain is coming from.  Some people with degenerated discs and bone spurs (both are notable on x-rays) have no pain.    Some people with discs bulging against nerves (as seen on MRI...you cannot see the disc or nerve on x-ray) will say they feel fine.    Some people with perfectly normal x-rays (and MRI's) are in miserable pain.  You cannot go by the x-ray in most cases to determine what part of your spine is causing your pain.  Likewise, the palpatory and visual assumption that a pelvis is misaligned also has not cut the clinical muster.  Even if you had 10 doctors agree that your left SI looks lower than your right, there is no correlation between that and your pain.  Further, there is no proof that manipulation or exercise will change the alignment.   The concept of bones being out of place has been disproven years ago and all modern, evidence-based practitioners are well aware of this.   Forget about "correction."   Think first about pain relief and regaining your functioning.   There are two basic perspectives on pain: 1) histologic/pathology model.   This is where there is a tissue that is diseased or damaged and is the cause of the pain.  This would be the case if you had a disc protruded against your nerve and it correlated with your symptoms and objective signs/tests.  The other model: 2) functional/kinetic model.  This is where there is no evidence of tissue disease or damage, but there are signs of bodily dysfunction, e.g. things aren't working well.  Your providers must focus on #2 if there is no evidence to support #1.   Orthopedists are well trained to look for #1: disease/pathology, e.g. your torn hip labrum.  PT's are supposed to be good at dealing with #2: re-habilitate what doesn't work well (assuming you have a good PT).   DC's are supposed to be good at #1 and #2 unless they have not been keeping up with the clinical literature or coursework over the last 15 years.    I would suggest finding a chiropractor that has a variety of modalities at their disposal: joint manipulation, distractive manipulaion, exercise training, soft tissue procedures, etc.  Seek out someone via www.grastontechnique.com  or Active Release Technique (.com).    Also keep in mind that about 30% of your body is composed of fascia.   There is no justification in "alinging your bones."  That's not what joint manipulation does.  You need to ask your provider about these things.   If you cannot get a straight forward and logical answer, then you need to find a new provider.  

1.   Schneider, M., et al., Spinal palpation for lumbar segmental mobility and pain provocation: an interexaminer reliability study. J Manipulative Physiol Ther, 2008. 31(6): p. 465-73.
2.   Binkley, J., P.W. Stratford, and C. Gill, Interrater reliability of lumbar accessory motion mobility testing. Phys Ther, 1995. 75(9): p. 786-92; discussion 793-5.

'Hope this was helpful,

Scott

www.drgillman.com