One of the things I most enjoy about being a chiropractor, other than seeing patient’s lives get better through care, is the problem-solving aspect of the job. Sometimes I feel like a bit of a detective as I try to analyze the mechanics of a patient’s spine to find the cause of their issues. Eventually, if you do this long enough, you start to see certain patterns that help guide you along.
One of those patterns concerns the relationship between the pubic bone and the alignment of the entire pelvis as it relates to low back pain. The pubic bone is the hard bone right at the base of the crotch where our legs come together. It is actually a joint call the pubic symphysis. While it is not an articular joint like our knees or fingers, the two sides of the pelvis do form a joint when they come together. As we walk and move, the entire pelvis shifts to accommodate these motions. While most of the motions occur at the sacroiliac joints at the back of the pelvis, movement does occur at the pubic symphysis. In fact, the pubic symphysis is the axis of rotation for the entire pelvis. This means that there are times when low back pain will not completely resolve unless the pubic symphysis is addressed.
The key then is to know when to look at that area. It is rare for a patient to have an actual complaint of pain in that area. Usually it does not misalign enough to cause pain. But any small amount of misalignment at the pubic symphysis will result in a greater amount of misalignment at the SI joints which will hurt. So I will look for pelvic misalignments that don’t resolve with a few adjustments. This is the patient that feels better after the adjustment then hours or days later the pain returns and when I examine them again the pelvis is once again misaligned.
The good news is that the pubic symphysis is a very stable joint. If it does manage to become misaligned, it is quite stable when it is put back into place. Sometimes one adjustment of that area is enough to dramatically stabilize the entire low back area.