"2 months ago I fell off my horse onto my left side.  The side of my hip was bruised but the X-ray didn’t show a break. The bruising is now almost gone.   About 2 weeks later my lower back and hip started aching and has got worse in the last week. For the last 4 days my balance hasn’t been quite right.  Are they linked and can you help?"

Ms McC, Croyde age 26




This sounds like an injury to your Sacro-Iliac Ligaments (SIJ). This group of very thick, strong ligamentous tissue between the Sacrum and the Ilia, hold the back of pelvis together.  It usually takes an awful lot of force to damage an SIJ.  Nasty falls, falls off horses, road traffic accidents, rugby, football, child birth and industrial injuries are commonly associated with SIJ lesions.  They hurt often in the lower back, hip and into the backside and almost always on one side.  Tears can range from a complete tear to the more common partial tear.  Ligaments are not visible on X-rays.

If present, the damage to one side of the main weight bearing structure of the pelvis results in an "S" shaped distortion of the spine.  To prevent this distortion, the body responds with a contraction of muscles to maintain the straight resting posture of the spine. Of the muscles primary linked with this compensation pattern are the Latissumus dorsi, the Trapezius group, Iliopsoas and Piriformis, and the Temporalis.  These are the large muscles in the back from the pelvis to the shoulders, the muscles around the hip and the muscle on the side of the head (known as the temples).  Of these muscles the Piriformis, Upper Trapezius and Temporalis are known to be involved in the balance system.

To balance, your brain co-ordinates information from three main sources, the eyes, the inner ear canals and the muscles.  The latter, known as proprioception, is how your brain interprets where your arms, legs and importantly, your spine are at any time. 

If the SIJ lesion is sufficient, or the muscles are weak or weakened, they will shorten and may spasm.  Either way, they start to distort the signal of proprioception from the muscles to the brain.  I can usually see this on a patient as one shoulder is higher from a spasm in the Trapezius muscle.  However, the patient will say it is the opposite shoulder that feels higher. It's this "false information" that throws your balance system off.

Simply put, the body compensates for the trauma to the SIJ and this interferes with your balance.

Dealing with SIJ lesions and the complex compensations associated with this type of trauma accounts for at least a third of any Chiropractor's day.  Balancing the muscles spasms to allow the SIJ to heal usually occurs over a course of treatments. I find that six to eight sessions over a three month period resolves the more serious cases and a support belt helps.  The less torn the tissue, the quicker it heals.  If the pain has worsened over a period of more than 6 weeks, examination and treatment is recommended promptly.

Julien Barker