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Pay attention to what you're NOT paying attention to avoid unnecessary hip replacement!!!

Updated: May 31

It is well known that when you have a problem distributing your body weight evenly to your feet from your upper body that you can have pain in your lower back and sacroiliac joints. What people are not paying attention to is what they do not feel.

When you have been told that your sacroiliac joints are not functioning properly because they are not moving, but they don't hurt, this does not mean you are in the clear. It's what your not paying attention to that can get you in a load of trouble.

When you watch people walk you will notice that their feet may not be facing forward, but pointing outward to the side or even on the inside. Maybe you thought this was normal and went about your life without thinking too much about it. However, you should pay attention to what your NOT paying attention to. Take a look at yourself and see which direction your feet are pointing when you walk.

Your sacroiliac joints in your lower back not only control how you distribute your body weight from above to below. They also control which direction your feet are pointing as well. You might say to yourself, okay so what? If I don't feel anything, meaning pain, I must be alright, right? No, unfortunately this is far from truth. When your sacroiliac joints are facing the wrong direction, the first thing you will notice is your feet may be facing outward or more inward from center. This can be further influenced by improper muscle balance in the pelvis as well.

When your feet have been facing the wrong direction for a long time, the femoral head, meaning the top of your leg that connects to your acetabulum, which is the socket where your leg attaches to your sacroiliac joint will start to wear unevenly and cause cartilage loss. Cartilage is the cushion on the inside of the socket where your leg attaches.

However, if you are of the mindset that if I don't feel any pain, I must be fine. You will have a day of reckoning. All the while, when your not feeling any pain, the cartilage continues to wear thin due to the imbalance of body weight caused by your sacroiliac joint facing the wrong direction. At some point, the cartilage will wear straight thru to the inside of the socket and there won't be any more cushion. When that happens you will start to feel constant aching in your hip socket(s). At this point, even if we were to re-align your sacroiliac joints, it would then be too late. You would be referred for a hip replacement surgery.

So, now your worried and aware that you should be paying attention to what you're NOT paying attention to. Now what should you do? The very first thing you should do if your concerned is to make an appointment to have your gait assessed with us. Dr. Lewis will take a close look at how your sacroiliac joints are functioning. We will give you guidance to avoid improper ergonomics which make this problem worse. We will then check to make sure your sacroiliacs are facing the right direction to avoid uneven wearing of the sockets. This is done by taking an x-ray of the lumbosacral region to visualize the sockets for uneven wear to see how much spacing is left in your socket before it wears thin and requires replacement. If you are already having pain in your sockets, make an appointment right away to determine if surgery is necessary.

Bad ergonomics such as a bad sleeping position with one leg crossing over the other when sleeping can cause torsion of the pelvis perpetuating imbalance. Driving long distances with the right leg turned to the outside can cause muscle spasm of the piriformis muscle which can cause the sacroiliac to rotate causing this issue as well. Even riding a motorcycle for long distances can cause this on both side due to the leg placement. Improper exercise when performing squats or other exercises can also create this problem. If you are concerned you may be doing something that is making your pelvis worse, please call us to discuss your individual concerns.

Below you will see examples of what your sacroiliac joints can look like when they're in the wrong position. Take a close look at the sacroiliac joint in the image below where the hip replacement was done. Compare it to the other side. Do you see how it appears larger than the one on the opposite side? This is because it is facing internally to the outside putting excessive pressure on the socket where the hip replacement was performed as well as the inferior sacrum. The inferior sacrum has a white chalky appearance when there is too much pressure on the bone. Ironically, this is likely the same position the sacroiliac was in which caused the arthritis which resulted in the need for the hip replacement in the first place. Unfortunately, the socket on the other side is also degenerated and will likely need to be replaced in the future due to the improper weight distribution which remains uncorrected.

right side hip replacement

You can avoid this happening to you by making sure your sacroiliac joints are facing the right direction. Often times, when your sacroiliac joints are facing the wrong direction you will have no pain at all. The only indication of dysfunction may be that your feet are facing in a direction that is not straight ahead.

All that is needed is to have your chiropractor or this office assess your gait and to x-ray your lumbosacral region to see if your sacroiliac joints are facing the right direction to see if your hip sockets have been adversely affected. You will also be able to see how much cartilage you have lost as well. If cartilage has been lost, you will not be able to replace it, however, by re-aligning your pelvis properly you can significantly extend the life of your sockets to avoid hip replacement.

Proper adjusting of the sacroiliacs are also important. Just simply moving the joint and hearing/feeling a sound is not helpful if it's not being moved in the right direction. Excessive rotation of the joint by twisting can cause the joint to become hypermobile which is also not beneficial. The sacroiliac joints can move anterior/posterior (forward/backward), or internally/externally. This information should be reviewed with the chiropractor or osteopath of your choice or you can have us manage this for you. Dr. Lewis has developed a tried and proven technique for dealing with these issues as it is done at Medspine on a daily basis.

Take a look at the image below. Look closely at the sockets on both sides. You will see a healthy space on each side. Now look at the sacroiliac joints and you will notice that one side still appears larger than the other, specifically what appears on the right side of the image. This one looks slightly larger. This patient may not have any pain at all and may still have future cartilage loss resulting from improper distribution of weight caused the slight rotation of the sacroiliac over time. This is why you should be paying attention to what your not paying attention to so you can avoid an unnecessary hip replacement down the road. If you still have questions, please call our office for an appointment at 702-530-2225 or send us an email at

normal pelvis

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