sacrum dysfunction and unstable hip

I've been seeing a physical therapist for si dysfunction/hypermobility.  My symptoms are pain in my left hip and right knee, sometimes alternating, and sometimes simultaneously.   Right now, my right knee has stabilized and all the pain is in my left hip.  I also have a length discrepancy - my left leg is sometimes 1/2 shorter, but after adjustment it leveled out.  My therapist has not been rechecking it and has not been continuing to try to adjust me, because he doesn't want to contribute to the hypermobility.

My PT is treating me with inner core strengthening: transversus abdominis, multifidus, and pelvic floor.  My problem is that whenever I work my transversus abdominis, either by itself, or co-contracting with the multifidus and pelvic floor, it seems to push my left hip out of joint.  I get pain at the trochanteric bursa and an achy, stretched feeling around my entire left hip joint.  When I stop the exercises, it gets better.  An si belt also pushed my left hip out, rather than keeping it in.

When I first started doing the transversus abdominis training, it pushed me so far out of alignment that I could feel my si joint flopping open on the left side and had symptoms of trochanteric bursitis at my left hip.  I discovered I could pull the si joint mostly back in my clenching my glutes.  But now, I've started co-contracting the transversus abdominis, multifidus, and pelvic floor, and even all three together push my hip out.

Any ideas?  Is my pelvic asymmetrical?  Does this mean my left pelvis is tilted to the front or back?

[Adam Tanase, D.C.]

X-rays would be needed to determine any osseous pelvic asymmetries. I would continue to let your PT work with you for a while, and if after 3 months there's no improvement, look into some other form of treatment.

You might consider receiving spinal/pelvic adjustments from a local chiropractor as well.

Adam Tanase, D.C.
www.drtanase.com