Low Back & Pelvis

What It Is

Your pelvis is the ring of bones at the base of your spine, around your hips. Pelvic fractures are uncommon, making up only about 3 percent of all fractures in adults (Soles, n.d.), but they can happen if one part of this ring takes enough force.

Most pelvic fractures are caused by high-energy trauma, such as a car or motorcycle collision, a crush accident or a fall from a significant height (Soles, n.d.). Depending on the size and direction of the force, these injuries can be life-threatening and may need surgery. Because the pelvic bones lie close to major blood vessels and organs, high-energy pelvic fractures can cause heavy bleeding and other injuries that need urgent treatment (Soles, n.d.).

Older people with osteoporosis (weakened bones) are also at risk. In people with osteoporosis, even a fall from standing, such as when walking down stairs or getting out of the bath, can fracture the pelvis. These injuries are usually stable fractures of a single pelvic bone that do not damage the overall structure of the pelvic ring (Soles, n.d.).

Less commonly, a small piece of the ischium (the "sitting bone") is pulled away by the hamstring muscles where they attach. This is called an avulsion fracture. It is most common in young athletes who are still growing, and it usually happens when the hamstring muscles suddenly contract forcefully (Soles, n.d.; Schoensee and Nilsson, 2014). It is often mistaken for a pulled hamstring and can go undiagnosed (Schoensee and Nilsson, 2014). This type of fracture does not usually make the pelvis unstable or injure internal organs (Soles, n.d.).

Pelvis Fracture Anatomy

The pelvis is a ring of bones at the lower end of the trunk, between the spine and the legs. Each side of the pelvis is made up of three bones (the ilium, ischium and pubis), which are separate in childhood and fuse together as we grow older (Soles, n.d.).

Strong ligaments join the pelvis to the sacrum (the large triangular bone at the base of the spine), forming a bowl-like cavity just below the rib cage. On each side, a hollow cup (the acetabulum) forms the socket of the hip joint (Soles, n.d.).

Major nerves, blood vessels, and parts of the bowel, bladder and reproductive organs pass through the pelvic ring. The pelvis is also an attachment point for the muscles of the hip, thigh and abdomen (Soles, n.d.). This is why pelvic fractures can cause significant bleeding, nerve injury and damage to internal organs.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How a Pelvis Fracture is Treated

As your medical team allows, rehab usually involves improving the movement in your hips, with exercises for flexibility, strength and endurance to help you get back to your daily activities (Soles, n.d.). I can support your team's plan with hands-on work and exercise, within the limits they set. See the My Approach tab for how I work.

1. Non-Surgical Treatment

Stable fractures, such as most avulsion fractures in athletes and many low-energy fractures in older people, often heal without surgery (Soles, n.d.). Your medical team will tell you how much weight you can put through your legs, and whether you need a walking aid such as crutches or a walker. This varies with the type of fracture: some people need to avoid putting weight on the leg for a period, while others, such as many older people with a fractured pubic ramus (a common low-energy pelvic fracture), are encouraged to walk as pain allows (Soles, n.d.; Worcestershire Acute Hospitals NHS Trust, n.d.). Always follow your own team's instructions.

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Options outside my scope

Prescription medicines: your doctor may prescribe pain relief, and a blood-thinning medicine to lower the risk of blood clots in the leg veins while you are less mobile (Soles, n.d.).
Surgery: unstable fractures may need an operation, for example to hold the bones in place with an external frame, or with plates and screws (Soles, n.d.).

How I can help (see the My Approach tab)

Easing the areas that work overtime while you heal
Setting up walking aids and practising walking
Exercises for hip movement, strength and endurance, as your team allows

Tips

Individuals with stable fractures often heal well.
Because of damage to the muscles around the pelvis, it isn't uncommon to walk with a limp for several months. These muscles may take up to a year to become strong again (Soles, n.d.).
If you have ongoing pain, reduced mobility, bladder or bowel problems, or sexual difficulties after a pelvic fracture, these need further investigation, as they can result from nerve or organ damage (Soles, n.d.).
When playing sports, do everything you can to avoid forceful hits to the pelvic region.

Treatment

My Approach

After a pelvic fracture, your medical team decides how much weight you can put through your legs and what you can do as the bone heals. I work inside those limits. If your fracture was treated with surgery, or it stops you doing your normal daily tasks, I need your team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

Early On

Easing the low back, shoulders, arms and other leg, which work overtime on crutches or a walker
Gentle lymphatic drainage and positioning for swelling, away from the fracture
Setting up your crutches, cane or walker and practising walking safely within your weight-bearing limits

As It Heals

Hands-on work for the hip, thigh and buttock muscles, and scar work once any surgical wound has healed
Gentle hip movement, then strength, flexibility and endurance work, building to balance and gym-based exercises
For a hamstring avulsion in a young athlete, a graded return to sport once your team agrees

Work around the buttocks, hips and groin is only with your informed consent and a written consent form. If you get calf pain or swelling, call your medical team urgently; chest pain or shortness of breath means calling 911.

What to Expect

Typical Course

Typical course: Most people come once or twice a week early on, then weekly, with a reassessment at about 4 to 6 weeks, all fitted around your medical team's plan. It isn't unusual to walk with a limp for several months, and the muscles around the pelvis can take up to a year to get strong again.

What I Focus On

Working Within Your Team's Limits

Compensation Relief

Walking Aids & Gait

Hip Strength & Endurance

Gradual Return to Activity

Please read

When to See a Doctor First

When to get urgent help

If you have been in a high-energy accident (such as a road traffic collision or a fall from a height) and have pain around your pelvis, hip or groin, or difficulty walking, call 911 or go to the emergency room at your nearest hospital. Also call 911 if bone is sticking out through the skin, as open fractures are serious and need immediate treatment (Soles, n.d.). If you are older or have osteoporosis and have pelvic or groin pain after a fall, get medical help promptly, as even a minor fall can cause a fracture (Soles, n.d.).

Sources

References

Soles, G.L.S. (n.d.) Pelvic fractures. American Academy of Orthopaedic Surgeons OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/pelvic-fractures/ (Accessed: 7 October 2026).
Schoensee, S.K. and Nilsson, K.J. (2014) 'A novel approach to treatment for chronic avulsion fracture of the ischial tuberosity in three adolescent athletes: a case series', International Journal of Sports Physical Therapy, 9(7), pp. 974–990.
Worcestershire Acute Hospitals NHS Trust (n.d.) Fractured pubic rami. Available at: https://www.worcsacute.nhs.uk/leaflets/fractured-pubic-rami-waht-pi-2231/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooPelvis Fracture

What It Is

Pelvis Fracture Anatomy

Self-Care & Treatment

How a Pelvis Fracture is Treated

1. Non-Surgical Treatment

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Tips

My Approach

Early On

As It Heals

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPelvis Fracture

What It Is

Pelvis Fracture Anatomy

Self-Care & Treatment

How a Pelvis Fracture is Treated

1. Non-Surgical Treatment

Treatments you may want to discuss with your family doctor, nurse practitioner or medical team

Tips

My Approach

Early On

As It Heals

Typical Course

When to See a Doctor First

When to get urgent help

References

Related Conditions

Ankylosing Spondylitis (AS)

Cervical Spondylotic Myelopathy

Coccydynia

Coccyx Fracture

Book a session