Are my hips out?

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I feel like I need to start this off with a very simple answer, no they aren’t. If you are able to walk around and bear weight through your legs with or without discomfort, and are uncertain of the alignment of your hip joint, I can reassure you now that nothing is ‘out of place’.

If the most stable joint in the human body was somehow able to dislocate from its socket, I’d imagine that you might have been hit by a train and you’d most likely be in an agonising state of pain, I would also advise that you should be heading to the local hospital instead of reading this.

Now if you are referring to your hips being ‘out’ in the sense that one of your hips feels higher than the other, or that your pelvis is anteriorly (forwards) tilted, posteriorly (backwards) tilted, or that it feels ‘twisted’ we encourage you to read on, because there are some important things you need to know.

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Hip posture and position

If you have been told that your bad posture, scoliosis, or the fact you have one leg shorter than the other is the reason you have pain and discomfort, it might be worth heading on over here to have a read about the importance of ‘good’ or ‘bad’ posture.

As a short summary, having minor differences in symmetry between one leg and the other, is not a reliable predictor of current or future issues of pain or discomfort (Grundy, 1984, & Needham, 2012). The same is to be said for having a pelvis that is either more anteriorly rotated or posteriorly rotated in comparison to the person that lives across the road from you.

Many people believe that having an anteriorly tilted pelvis (one where certain bony points of the pelvis are rotated lower at the front compared to the ones at the back) causes certain muscles like the hip flexors to shorten on one side, and other muscles like the hamstrings to be put on tension and stretched out on the other side. This is thought to cause an imbalance of muscle activity and poor posture that has an effect on the lumbar spine and joints of our lower back which cause problems of pain and discomfort.

If you feel this relates to you, or if you have been told these things before – fear not! In fact, there have been countless studies that show how asymmetries are completely common and normal findings in healthy pain free people (Vogler, 1984) and that the angle of someone’s pelvic tilt has no correlation on the curve of your lower back! (Heino, 1990).

This all makes sense right? Think about how one foot might be a half-size bigger than the other, put your palms together and you’ll notice that one of your fingers is probably longer than the same finger on the opposite hand. As living organisms we are perfectly asymmetrical. And to top that all off, due to the variance in everyone’s body shapes and sizes, it makes it almost impossible to obtain a consistent, reliable and accurate measurement of how tilted someone’s pelvis is (Preece, 2008).

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But when I have my hips adjusted or manipulated, that really helps!

These techniques done by a therapist can certainly cause a reduction in pain or discomfort, but it is certainly not because your hip joint is being put back into place or readjusted by a few millimetres! If you have read our blog on the effects of heat and ice for injuries, then you’ll appreciate that treatment techniques like this cause stimulus to the body which in turn has an effect on how you perceive your symptoms and pain. The funny thing about the human body is that it is made up of structures that are capable of withstanding tremendous amounts of force! As an example, if you have ever ridden a roller coaster, your bodies is put under almost 4-5’Gs of force. That is essentially equal to 5 times our body weight, and amazingly nothing gets misshapen or deformed when we step out of the ride.

If it was possible for the joints and structures within our body to be so easily changed with a level of force that another human is capable of manually producing - last time I checked I couldn’t squeeze a handheld dynamometer (for measuring grip strength) the equivalent of even 60% of my body weight - then we would be constantly altering the structure of our body with simple movements like running (which puts almost eight times the force of our body weight through our calves), jumping, hopping or even sneezing!Thankfully we have evolved to be much more resilient and robust than this.

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So if my hips are normal, why do I have pain?

Great question - but unfortunately the answer for this isn’t so simple. There are many factors that could be contributing to your symptoms and presentation - they could be related to; load and exercise (either too much or too little), tissue damage or the perceived threat of damage, or even stress and the fear of doing something that will cause harm. (Read this if you want to know more about pain)

One thing you can be assured of however, is understanding that our bodies and especially our hip joints are resilient and strong. You should be able to move with confidence knowing the next time you do something that usually causes concern for you, your hips aren’t going out of alignment, and you especially do not need someone to ‘fix you’ and ‘put them back in’.

If you are concerned about your hips, and have been told that you are ‘out of whack’, or if your symptoms are getting in the way of your life and your goals, our highly qualified allied health team can help you out.

References

Grundy PF, Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet. 1984;2(8397):256-258.doi:10.1016/s0140-6736(84)90300-3

Heino JG, Godges JJ, Carter CL. Relationship between HipExtension Range of Motion and Postural Alignment. J Orthop Sports PhysTher. 1990;12(6):243-247. doi:10.2519/jospt.1990.12.6.243

Needham R, Chockalingam N, Dunning D, Healy A, Ahmed EB, WardA. The effect of leg length discrepancy on pelvis and spine kinematics during gait. Stud Health Technol Inform. 2012;176:104-107.

Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L,Bowker P. Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J Man Manip Ther. 2008;16(2):113-117.doi:10.1179/106698108790818459

Vogler JB 3rd, Brown WH, Helms CA, Genant HK. The normal sacroiliac joint: a CT study of asymptomatic patients. Radiology.1984;151(2):433-437. doi:10.1148/radiology.151.2.6709915

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