Don't Get It Twisted

11 minutes ago

7 min read

Your pelvis is an extraordinary structure, and we think it deserves a little more appreciation. Designed to support the weight of your upper body, transfer force through your legs, protect vital organs, and allow us to walk, run, bend, twist, and move in just about every direction, the pelvis is more than just the epicenter of dynamic movement. It is also associated with our sense of grounding, stability, creativity, and the natural flow of energy throughout the body.

Yet, we tend to take it for granted. Until something starts hurting...

The pelvis is not a stationary structure. For women, it undergoes remarkable changes during pregnancy and labor. The joints and ligaments surrounding the pelvis work in tandem with hormonal signals to adapt and accommodate childbirth. It's a remarkable physiological process that deserves far greater recognition than it generally receives.

Unfortunately, the pelvis doesn't always return to its previous patterns of movement and stability on its own after giving birth. But the good news is that there are specialists who can help restore strength, coordination, and function to the muscles and structures involved. Sometimes, getting everything working together again requires a little professional guidance.

But here's where things get interesting: the pelvis is incredibly dependent on the muscles surrounding it, and some of them you've probably never even heard of.

Meet the muscles you didn't know you had.

Let's start with the usual suspects.

Pectineus: A small but mighty muscle located deep in the upper inner thigh. It helps flex and adduct the hip, meaning it helps bring your leg forward and toward the midline of your body. When it's irritated or overworked, you may notice discomfort deep in the groin or inner hip.

Iliacus: This muscle lives inside the bowl of your pelvis and joins the psoas to form the iliopsoas. Together, these muscles are major players in hip flexion. Every time you lift your knee, climb stairs, or bring your leg forward, they're involved.

Psoas: This one deserves its own conversation. The psoas connects the lumbar spine to the femur and plays an important role in hip flexion and trunk stability. When it's overworked or restricted, discomfort can show up in the front of the hip, groin, or lower back.

Piriformis: A small muscle tucked deep in the buttock, beneath the gluteus maximus. It helps rotate and stabilize the hip. Its close relationship with the sciatic nerve makes it particularly interesting when someone complains of deep buttock pain, tingling, or discomfort traveling down the leg.

These muscles work together with the glutes, deep rotators, abdominal muscles, and pelvic floor to keep the pelvis moving and functioning properly. When one area isn't pulling its weight, another area often has to compensate.

And that's when things get twisted.

The domino effect: When one hip isn't playing fair.

Have you ever looked in the mirror and noticed that one hip sits higher than the other?

Maybe one side of your waistband always seems to slide down. Perhaps one shoulder looks higher, or you notice that one side of your lower back feels tighter than the other.

These observations can sometimes point toward differences in pelvic positioning, muscle tension, strength, or movement patterns.

When one side of the pelvis is elevated and the other is depressed, the spine may adapt to keep your head and eyes level. Your shoulders can compensate, your neck may become involved, and muscles throughout the body can begin working overtime.

And here's something we see all the time: cross patterns.

Left hip, right shoulder.
Right shoulder, left pectoral.
Right knee, left hip.
One tight side of the lower back, opposite-side shoulder discomfort.

Why does this happen?

Because your body isn't one-dimensional. It's a connected system of muscles, joints, fascia, and nerves that work together to create movement.

Your body is designed to twist! That's part of what makes walking, running, reaching, and rotating possible. Opposite-side arm and leg movement is a fundamental part of normal gait.

But when one area becomes restricted, weak, or overcompensates, the effects can travel through these connected movement patterns.

In our previous newsletter, we talked about how dysfunction in the ankles and feet can influence everything above them. Now let's consider the other side of that conversation.

What happens when those compensations settle into the hips and linger there? Suddenly, everyday activities become uncomfortable. Running hurts. Driving becomes unbearable. Sitting for too long makes you want to crawl out of your chair. You stand up, shake your legs, stretch a little, and somehow your foot is STILL numb. That's when we need to look beyond the obvious source of discomfort.

Piriformis Syndrome, Sciatica, and the nerve of it all.

These two terms are often used interchangeably, but they aren't quite the same thing. Sciatica describes pain, tingling, or numbness that travels along the sciatic nerve, usually from irritation or compression somewhere along its pathway. Piriformis syndrome is one possible source of those symptoms, occurring when the piriformis muscle or surrounding structures irritate the sciatic nerve.

The tricky part? Both can create discomfort that travels from the buttock down the leg, making it difficult to determine where the problem actually begins. This is why understanding the source of the irritation matters. Sometimes the answer isn't simply stretching a tight muscle. It may require a little more investigation and the right combination of professional care and at-home support.

A few tools worth having in your self-care toolbox:

1. Stretching

Gentle hip flexor, gluteal, and piriformis stretches can help improve comfort and mobility. The goal isn't to force your body into a position it doesn't want to be in. It's to gradually restore comfortable movement.

2. A massage ball

A massage ball can be useful for working on the glutes and surrounding hip musculature. Gentle, controlled pressure can help ease muscular tension. Avoid rolling directly over the sciatic nerve, bony structures, or areas that produce tingling or radiating symptoms.

3. Nerve flossing

Nerve flossing, sometimes called nerve gliding, uses gentle movements to help a nerve move relative to surrounding tissues. Unlike a traditional stretch, the goal isn't to pull the nerve as far as possible. It's about controlled movement without provoking symptoms. This is particularly useful when prescribed or demonstrated by a physical therapist.

4. Hip release tools

Tools like the Hip Hook are designed to apply targeted pressure to muscles around the pelvis, particularly the psoas and iliacus region. They can be useful for some people, but more pressure doesn't mean better results. The psoas is a deep muscle, and aggressive pressure into the abdomen or groin isn't something to experiment with.

Remember: discomfort isn't a competition. If a technique creates numbness, tingling, sharp pain, or symptoms that linger afterward, stop.

Sometimes you need a little outside help.

Massage is wonderful, but it's not the answer to everything. We like to operate within our scope of practice and refer you to the professionals who excel at what they do. Sometimes, we'll even send you with what we think you've got going on (and usually, we're on the right track).

Pelvic Floor Specialists

For women experiencing postpartum discomfort, pelvic pressure, incontinence, painful intercourse, or a feeling of instability through the pelvis, a pelvic floor physical therapist can be an incredible resource.

Pregnancy and childbirth can affect the pelvic floor, abdominal wall, connective tissues, and the coordination of muscles surrounding the pelvis. A pelvic floor specialist can assess these structures and help restore strength, coordination, and functional movement.

It's not simply about putting everything back where it was. It's about helping your body learn how to work together again.

Chiropractors

Chiropractors can assess spinal and pelvic mechanics, joint mobility, and movement restrictions. Depending on the individual, treatment may include joint mobilization, manipulation, and movement recommendations.

The goal is to improve comfortable movement and function, not necessarily to force the pelvis into a perfectly symmetrical position. Some asymmetry is completely normal!

Simple Hip Flexor Exercises

You don't need an elaborate gym routine to start paying attention to your hips.

Try incorporating gentle movements like:

Standing marches: Slowly lift one knee at a time while maintaining an upright posture.
Controlled standing hip flexion: Hold a countertop for balance and slowly bring one knee forward.
Seated leg raise: Sit with your legs stretched out in front of you. Carefully, raise a straight leg up and over a kettlebell or something similar.

Start with comfortable ranges of motion. Consistency matters much more than intensity.

What happens when you get on our massage table?

Now we're getting to our favorite part.

At Rally and Revive, we approach hip discomfort with the understanding that the area you're feeling pain isn't necessarily the area that needs the most attention.

Our job is to assess, listen, and work with your body's limitations rather than against them.

Here are a few ways we approach the hips and pelvis:

Gentle Touch

Sometimes the best thing we can do is take a step back.

When muscles are already irritated or inflamed, digging into them with aggressive pressure isn't necessarily going to help. In fact, it can make things worse.

Gentle touch allows us to assess tissue sensitivity, reduce guarding, and introduce movement and pressure at a pace your body can tolerate.

Deep Tissue vs. Deep Pressure

These are NOT the same thing.

Deep tissue massage is about understanding the layers of tissue, identifying restrictions, and working with the underlying structures. Deep pressure simply describes how much force is being applied.

Knowing when to use either is an art form.

Sometimes a muscle needs focused, sustained work. Other times, it needs a lighter approach that allows it to relax without fighting back. The goal isn't to see how much pressure you can tolerate. It's to create meaningful change without aggravating the tissue.

Passive Stretching

This is where we get to take you through the motions.

Passive stretching allows us to move your leg through different ranges while your muscles remain as relaxed as possible. It gives us an opportunity to assess where movement feels restricted, where your body is guarding, and where one side behaves differently from the other.

We pay attention to the quality of movement, your comfort, the available range, and the sensations you experience along the way. Sometimes we notice a restriction before you even realize it's there. Sometimes we find that one direction of movement feels completely different from the other. We don't force the issue. We respect the limitation, work within your comfort level, and gradually explore what your body will allow.

Because the goal isn't to win an argument with your muscles. It's to get them working with you again.