The "Shift"

Pain & Rehab Forum [Moderated]
1

Hello, good doctors.

I’m digesting a fair amount of the awesome BBM material concerning pain science, and I have a question about the “bio” aspect of the biopsychosocial model as it relates to something I’ve experienced a handful of times (not currently, thankfully). So, I guess that makes this is a hypothetical question, if you don’t mind.

Like most humans, I’ve had occasional episodes of non-specific low back pain of varying intensities ever since I was a teenager (I’m 54 now). These episodes almost always involve discomfort, stiffness and weakness on one side of my spine or the other, just above the buttocks. It usually also entails sciatic pain. This always simply goes away on its own over a course of days, or sometimes weeks for more intense episodes.

But a handful of times in my life I’ve experienced really quite intense pain, stiffness and weakness in this area that is accompanied by a change in my body that is actually visually quite apparent – and that change is that, when viewed from the sagittal plane, my hips/lower body have “shifted”, if you will, so that they are no longer lined up directly underneath my upper body…like I was in a fun-house mirror. In short, I looked crooked face-on, so much so that other people even noticed and pointed it out to me (as though I wasn’t already acutely aware of it!).

Here again, though, the pain associated with these thankfully rare episodes, as well as the visual appearance of “the shift”, usually both completely abate on their own within a few weeks.

I’ve never experienced the shift without also experiencing very intense pain, though there have been many more times in my life when episodes of back pain have NOT been coincident with a shift.

It seems that in these shifting episodes, my otherwise non-specific back pain might actually be something more specific, and, in fact, perhaps largely biological?? – after all, I and others could SEE that something changed with my body (though temporarily).

My question is, what exactly causes such a temporary shift? Muscle spasms? A jostling of the SI joint from its usual configuration?

2

Hey Threjack, I am an ortho/sports PT, hard to say without knowing all the details but most likely the “shift” you are describing is related to your low back pain occurring at the lumbar spine and it’s a short term compensation into the position that is most comfortable until the back pain resolves with its natural course, I think Derek and Mike wrote a clinical athlete paper awhile ago debunking the SI joint movement narrative. I can tell you from my experience that movement in the SI joint is measured in millimeters, is imperceptible to the eye and any special tests to “detect” SI joint mal-alignment are trash. The SI joint and the ligaments that surround it are among the most stable in the body. I have actually seen 2 SI joint shifts in my career. One was a rodeo cowboy who got bucked and the saddle horn drove into his pelvis and disarticulated his joint and he went to the ER for massive internal bleeding and the other was a teenage girl who was in head on car crash at around 70 mph and was pushing her legs into the floorboard at the time of impact. That’s an idea of how much force it takes for the SI to shift. Same with the muscle spasms, they are not going to contract violently enough to cause a noticeable shift in the spine.

Most likely the shift is a lateral shift of the lumbar spine to temporary off load discomfort especially if you are having a flare up that involves some sciatica, hope this helps

3

Sorry it was a logic of rehab post, not clinical athlete

https://thelogicofrehab.com/2018/07/31/stop-telling-people-their-rotated-hips-are-causing-their-pain-seriously-stop-it/

4

I agree with Keith Kahil. The shift you are referring to seems to be what we consider a lateral lumbar shift. And as Keith said this is a compensatory position your body adopts to decrease pain. I’m guessing this typically occurs with some of your more painful episodes with pain that goes further down the leg and that your shoulders are typically shifted away from the painful side or leg. There are some therapist that can help correct the shift but in the end it will resolve on its own in most cases as the pain subsides, as you have already described.

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Thanks! Yes, the shift is evident in the lumbar region, immediately above the hips.

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Hey @Threjack , thanks for starting this thread. There has been some good input already. I just wanted to add that in any pain experience it isn’t a question of primarily biology or primarily psychology or primarily sociology but rather the level of involvement is variable based on the contextual factors surrounding the experience and the person experiencing pain. Even in acute trauma situations, psychology and sociology of the person will influence the experience. What you are describing certainly sounds like an adaptive response, whether it is entirely necessary is a different discussion. It is also VERY unlikely anything needs correcting by a clinician in these scenarios and as you’ve described will self-resolve, likely by continuing to move and not avoiding positions/movements/postures. Finally, more pertinent to the discussion, the level (Intensity/severity) of pain symptoms experienced by someone is not well correlated to any tissue issue. We simply can’t state because someone feels pain more severely in “X” situation then “Y” is going on and directly correlates to a problem. Hopefully that makes sense. Happy to discuss more.

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Thanks, doc Rey.

I’ll say that I’d never suspected “tissue damage” with the shift so much as some sort of “pinched nerve” (not sure if that is really a thing) as a result of something in my lower back area having moved from its standard position. But it sounds like this is confusing the cause and effect, ie the shift is probably a compensatory move as a result of the pain I experienced, not the other way around.

In the last analysis, the pain is an intense and sharp sensation of muscle cramping and lactic acid burn. When this happens, the only relief I have gotten is by lying on my stomach on a hard floor (a position that is not at all fun to settle into at first), maybe even with some “cobra” upper body lifts using my arms.

Through the years I’ve slowly learned not to get to keyed up over it when it happens, as I know it will eventually go away.

Thanks again.