My pelvis is hypermobile and goes out of place – really?

The research (e.g. here and here) and clinical practice of Dr. Britt Stuge (Physiotherapist) has helped her develop a reputation as one of the leading international clinical researchers in the management of pelvic girdle pain. Here she discusses a recent paper by her research group on the degree of motion occuring in the pelvis among people with pelvic girdle pain. This is very relevant as thousands of people are told – by many different professions – that their pain is related to alterations in the structure, alignment or mobility of their pelvis. Does the evidence support these proposals?

What we did?

The sacroiliac joint is a possible cause of pain in patients with low back- and pelvic girdle pain. In a recent study we examined the movement in the sacroiliac joint with precise x-ray (radiostereometric) analysis. Under general anesthesia, tantalum markers were inserted into the pelvis of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, x-ray analysis was conducted while the subjects stood on one leg.

What we found?

Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac joint, a total of only 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint. A complex movement pattern was seen during the test, with a combination of movements in the two joints.  Our findings do not support a belief that hypermobility in the painful sacroiliac joint is responsible for movement in the pubic symphysis. It is unlikely that the minimal sacroiliac joint movement found, can cause a clear and large movement in the pubic symphysis. The movement in the sacroiliac joint while standing on one leg is small and almost undetectable by the precise x-ray analysis.


Based on these findings, sacroiliac joint pain is probably not caused by hypermobility of the sacroiliac joints and the sacroiliac joint movement is probably too small to be assessed with palpation, especially in weight bearing. Instead, the evidence suggests that a range of physical, psychological, social, lifestyle and hormonal factors may interact in the development and persistence of pelvic girdle pain, and that management should address these factors for each individual.

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