The Mystery of Low Back and Pelvic Pain

For countless people, persistent low back, hip, or pelvic pain is a frustrating and confusing journey. Diagnoses can be vague, treatments often provide only temporary relief, and the underlying cause remains a mystery. This cycle of pain and uncertainty has led many to believe that their condition is simply something they must learn to live with.

However, the extensive clinical work of Dr. Jerry Hesch, DPT, MHS, PT, offers a paradigm-shifting approach that challenges many conventional ideas about this complex region of the body. His work suggests that what we think we know about "sacroiliac joint dysfunction" is often incomplete or misleading. This article distills five of his most impactful takeaways—revelations that reframe the pelvis not as a simple hinge but as a dynamic force transducer, and shift treatment away from forceful cracks toward the power of sustained, gentle change.

1. Your "Sacroiliac Joint Dysfunction" Is Probably a Misnomer

One of the most foundational concepts in Dr. Hesch's work is that an isolated problem in a single sacroiliac joint (SIJ) is uncommon. The term "Sacroiliac Joint Dysfunction" (SIJD) is often used as a catch-all diagnosis, but this can narrow the focus of treatment incorrectly. Dr. Hesch argues for the more accurate and comprehensive term "lumbopelvic-hip dysfunction." This acknowledges the deep, functional interconnectedness of the lumbar spine, the pelvis, and the hip joints.

This isn't just a matter of semantics; it fundamentally changes the approach to both evaluation and treatment.

This distinction is crucial because it shifts the focus from a single "problem joint" to a more holistic view of faulty movement and posture involving the entire complex. Effective, lasting treatment must address the system as a whole, not just one of its parts.

2. Pressing for Pain Can Be Misleading

A common diagnostic procedure for SIJ pain involves a series of "pain provocation tests," where a clinician presses or stresses the joint to see if it reproduces the patient's familiar pain. While these tests can be useful, Dr. Hesch cautions against their over-interpretation. He points out that due to the close proximity of structures and overlapping nerve pathways, these tests can easily provoke pain in the nearby hip or lumbar spine, leading to a misdiagnosis.

Even more surprisingly, the absence of provoked pain does not mean that a biomechanical problem is absent. A significant, treatable dysfunction can exist without being painful when pressed. This challenges a common diagnostic benchmark and suggests that many underlying issues may be missed if pain provocation is the only guide.

3. The Pelvis is a Force Transducer, Not Just a Hinge

Discussions about the SIJ often center on the small amount of motion that occurs within the joint itself—a few millimeters of glide and a few degrees of rotation. While this movement is a factor, Dr. Hesch emphasizes a far more critical function: the transmission of forces through the joint. The pelvic girdle acts as the body's architectural center, a crucial shock absorber and force transducer between the spine and the legs.

This function is a key property evaluated with the Hesch Method's "Recoil Spring Tests," which assess how well the structure dissipates and communicates force.

This reframes the purpose of the pelvic joints. They aren't just simple hinges; they are sophisticated force communicators that play a dynamic role in every step you take. A restriction in this force-dampening ability can create stress in other areas, like the lumbar discs or hip joints. Critically, this restriction can be external to the SIJ itself—in tight muscles or ligaments—yet still prevent the healthy transmission of motion through the joint, making treatment of these surrounding tissues essential.

4. The Myth of Being Stuck "Out of Place"

Many patients are told their pelvis is "out of place," conjuring an image of a joint that has slipped to the very end of its range of motion and become stuck. Dr. Hesch's clinical model reveals a more nuanced reality: a hypomobile (stuck) joint can become restricted anywhere along its available range—at the beginning, in the middle, or at the end.

Critically, he observes that the pelvis is seldom stuck at its absolute end range. This explains a seemingly paradoxical finding: a restricted joint can often be gently pushed further into the direction of its dysfunction, but it cannot move out of it. This detail is essential for understanding the gentle, specific mobilizations used in the Hesch Method, which are designed to restore motion without forcing a joint that isn't actually at its physical limit.

5. Lasting Change Comes from Creep, Not Cracks

In the world of manual therapy, a forceful, high-velocity "crack" or manipulation is often seen as the gold standard for correcting joint dysfunction. The Hesch Method's philosophy is fundamentally different. It avoids forceful techniques and instead emphasizes gentle, low-load, long-duration stretches and mobilizations.

This approach is based on the "viscoelastic/creep model" of connective tissue. The goal is not a sudden release but a lasting change in the ligaments and fascia through sustained, gentle pressure held for two minutes or more. This allows the tissues to slowly deform and adapt, leading to a more stable correction. Critically, this philosophy empowers the patient with simple, effective self-treatment techniques that are safe to perform, fostering independence rather than reliance on a practitioner for repeated manipulations.

A New Lens for an Old Problem

The insights from Dr. Hesch's work offer a profound shift in perspective. They move the conversation from a painful, isolated joint to an integrated lumbopelvic-hip system; from a diagnosis based on pain provocation to one centered on functional biomechanics; from viewing the pelvis as a simple hinge to understanding it as a dynamic force transducer; from the myth of being "out of place" to the reality of being restricted within a range of motion; and from forceful manipulations to gentle, sustained corrections. By understanding these principles, those suffering from chronic pain can begin to see their bodies not as broken, but as complex systems capable of change.

Given these insights, how might you reconsider the story you've been told about your own body's aches and pains?

Jerry Hesch, Sr., DPT, MHS, PT is coming to NYC in November 2025 to teach the Hesch approach to treating the Pelvis. Don't Miss Out!