Upslip
An Upslip of half of the pelvis is an extremely common injury for
athletes. It involves half of the pelvis (usually the left side) moving
upward relative to the opposing side. This has a ripple effect on the
rest of the lower body. It can change leg length, place a stretch on
specific muscles, and provide an altered neurological feedback loop. All
of this will impact you or your athlete's ability to run, jump, land, compete, and stay injury
free.
How does it happen?
Most athletes and active individuals have no idea that they are Upslipped and
how it happened. It can happen for a variety of reason. Here are
some typical things that lead to an upslip:
- Playing on an uneven surface - If an athlete is playing
on an unpredictable surface, they will have difficulty knowing where to
place their foot to avoid holes or high spots. We see this a lot younger
athletes or recreational athletes who compete a lot of fields which aren't
well maintained. Any sudden, unexpected set will have a tendency to
forcefully drive one leg upward.
- Running on one side of the road - City streets have a
crown to them, which allows the rainwater to flow into the gutter on the
sides of the road. If an athletes is constantly running one direction
on a road, they are striking on an uneven surface, thus we tend to see
small, repetitive changes which may eventually turn into a significant
upslip.
-
Anatomical Leg Length Inequality - The research shows that 90%
of the general population have legs of different lengths. If an
athlete has even a small leg length inequality, their pelvis will have have
a tendency to Upslip and shorten one limb to make up for the
difference.
- Scoliosis - The unnatural lateral curvature of the
spine will definitely have an impact on the entire spine and pelvis due to
the limited lateral flexion on one side and tendency to load more on one leg
than the other.
- Falling hard on one hip - Depending upon the sport,
athletes may fall or get knocked down hard, landing on one hip, forcing it
into an acute, sudden upslipped position.
- Repetitive jumping on a single leg - Sports such as
basketball and volleyball will predispose athletes to upslips
because of their repetitive jumping and landing on a single leg. Many
of these athletes will tend to be more dominant on one leg than the other,
thus they will usually use that leg and will place unnatural shear forces on
that side of the pelvis.
Characteristics
An athlete who has an upslip will present with pain and
irritation, usually in the lower extremity and/or low back, and usually only
present on one side of the body. Many clinicians get frustrated by
"chronic" lower extremity injuries because they never get to the true cause of
the problem when they stay focused on the actual site of pain. This shows
a lack of understanding of biomechanics.
While it would be nice to be able to always associate one or two symptoms
with
lumbopelvic dysfunction, it is just too complex of an injury to do that.
Every athlete will present differently as their body finds the path of least
resistance. The old saying holds true to that you are only as strong as
your weakest link. That's why there is such a broad spectrum of injuries
that are associated with
lumbopelvic dysfunction. Whenever the body is not symmetrical and one
limb is functioning different than the other, there will be a tendency for the
body to break down. When it does, it is always the weakest link or
somewhere in the path of least resistance.
Evaluation
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The Upslip is assessed by properly putting pelvis in it's current "neutral"
position. For more information on evaluating for
lumbopelvic dysfunction, click here.
The Upslip typically has the following characteristics while lying
supine:
- The vast majority of Uslips occur on the left side of the pelvis
- The Anterior Superior Iliac Spine (ASIS) of the pelvis is higher
on the affected side compared to the opposing side (pictured).
- The Iliac Crest of the pelvis is higher on the affected side (Pictured).
- The Posterior Superior Iliac Spine (PSIS) of the pelvis is higher on the
affected side compared to the opposing side.
- Without the presence of an
anatomical leg length discrepancy, an
Upslip will cause a
functional leg length descrepency
- Upslips will always shorten the affected leg. So, if you see
an upslip on the left
side, the left leg will always be shortened because the entire half of
the pelvis is elevated (pictured).
- For more information on leg length inequality, visit our pages of
information about
functional or
anatomical leg length inequality.
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Treatment
The treatment of choice for an Upslip is a good pelvic joint
mobilization. This is a pretty specialized area of expertise that calls
for advanced training. It is beyond the scope of a website discussion and
should be left to those who have been educated in this area and have taken the
time to perfect such techniques.
If you are an athlete in need of such a treatment, or a clinician who does
not possess the skills to correct such an injury, we invite you to
contact us
to schedule an onsite educational seminar to learn the techniques to correct lumbopelvic dysfunction.
Other options that you want to explore is contacting a local Doctor of
Osteopathy (D.O.), Chiropractor, Athletic Trainer, or Physical therapist who may
possess the manual skills necessary to fix such an injury
Other treatment options include using a short term heel lift. If a 1/4"
thick wedge is placed under the longer of the two legs, many times you can
successfully change the mechanics at the pelvis over the course of 3-7 days
enough to correct the upslip.
Many clinicians make the mistake of placing a lift under the short leg,
thinking that an
anatomical leg length discrepancy exists because they either don't
understand the biomechanical kinetic chain or don't take the time to look at the
pelvis. If you put the lift under the short leg of an athlete with an
upslip, you only cement the problem and make symptoms worse and harder to fix.
Keep in mind, though, that you don't want to cause more problems than were
originally present. Thus, if you leave a heel lift in too long, you will
see either an increase in symptoms, or create symptoms that weren't present at
the start. So, use a lift as a tool in the overall treatment plan.
It is merely a means to an end.
Other things which may be affecting an athlete's
lumbopelvic dysfunction include:
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