Pelvic Fractures: Understanding Your Injury and Why Getting Moving Matters

A pelvic fracture is a significant injury that can understandably leave people feeling anxious about moving. Many patients ask the same question:

"If my pelvis is broken, won't walking make it worse?"

It's a perfectly reasonable concern. The answer is often reassuring. Many pelvic fractures are stable injuries, and once your orthopaedic consultant has assessed the fracture, most people are encouraged to begin walking with an appropriate walking aid as soon as it is safe to do so.

Understanding how the pelvis works can help explain why.

What is the pelvis?

The pelvis is a large, strong, ring-shaped bony structure located at the base of your spine. It forms the vital connection between your upper body and your legs, allowing you to stand, walk, climb stairs and transfer weight during everyday activities.

It also provides a stable foundation for your spine and acts as a protective cage for many of the organs within your lower abdomen and pelvis.

The adult pelvis is made up of:

• Two hip bones (one on each side)

• The sacrum – the triangular bone at the base of your spine

• The coccyx (tailbone)

Each hip bone is itself formed from three bones—the ilium, ischium and pubis—which fuse together during adolescence. The two hip bones meet at the front through a strong joint called the pubic symphysis and join the sacrum at the back through the sacroiliac joints.

Together, these bones form the pelvic ring. This ring-like design gives the pelvis tremendous strength while allowing it to distribute forces evenly between your spine and your legs. It is this unique structure that enables us to walk, run, lift, climb stairs and maintain our balance throughout daily life.

What does the pelvis do?

The pelvis has several vital functions.

Supporting your body weight

Whenever you stand, your body weight passes from your spine into your pelvis before travelling through your hips into your legs. It acts as the bridge between your upper and lower body, allowing you to stand, walk and move efficiently.

Allowing movement

Every time you:

• Walk

• Climb stairs

• Sit down

• Stand up

• Roll over in bed

forces pass through the pelvis.

The pelvis also works closely with the muscles around your hips, abdomen, lower back and buttocks to keep you balanced during movement.

Protecting important organs

The pelvis provides a protective bony cage around several important organs including:

• The bladder

• Parts of the bowel

• Reproductive organs

• Major blood vessels

• Important nerves travelling into the legs

Providing muscle attachment

Many of the body's strongest muscles attach to the pelvis, including:

• The gluteal (buttock) muscles

• Hip flexors

• Hamstrings

• Abdominal muscles

• Lower back muscles

• Pelvic floor muscles

This is one reason pelvic fractures are often so painful—even gentle movement causes muscles to pull on the injured bone.

The pelvis is a ring

One of the most important concepts to understand is that the pelvis forms a ring. Imagine a metal hoop. If you damage one part of the hoop, the forces travel around the entire ring. The pelvis behaves in exactly the same way.

For this reason, doctors carefully assess the whole pelvis, even if only one fracture is visible on the initial X-ray. Sometimes there may be another injury elsewhere around the ring.

Understanding whether the ring remains stable or has become unstable is one of the most important factors in deciding how your injury should be treated.

Types of pelvic fracture

Pelvic fractures range from relatively minor stable injuries to severe injuries following major trauma.

Pubic ramus fractures

These are among the most common pelvic fractures, particularly in older adults following a simple fall. They occur at the front of the pelvis and are usually stable injuries that heal without surgery.

Iliac wing fractures

These involve the broad, wing-shaped part of the pelvis. Depending on the degree of displacement, many can also be treated without surgery.

Sacral fractures

The sacrum is the triangular bone at the base of the spine. Sacral fractures may occur following falls or higher-energy injuries and occasionally require further investigation if nearby nerves are affected.

Acetabular fractures

The acetabulum forms the socket of the hip joint. Unlike pubic ramus fractures, acetabular fractures involve the hip joint itself and sometimes require surgery to restore the smooth joint surface.

Pelvic ring fractures

Some injuries involve more than one part of the pelvic ring. Your consultant will determine whether the ring remains mechanically stable or whether surgical stabilisation is required.

What is an "Open Book" pelvic fracture?

One of the more serious pelvic injuries is known as an open book fracture. In this injury, the strong ligaments at the front of the pelvis tear apart, allowing the two halves of the pelvis to separate—rather like opening the covers of a book.

These injuries usually occur following major trauma such as:

• Road traffic collisions

• Motorcycle accidents

• Falls from height

• Crush injuries

Because large blood vessels pass through the pelvis, an open book injury can cause significant internal bleeding and is treated as a medical emergency. Treatment often involves urgent stabilisation, sometimes using external fixation or surgery. Fortunately, these injuries are much less common than stable pelvic fractures seen after simple falls.

How are pelvic fractures diagnosed?

Your healthcare team will begin by asking about how the injury happened before examining your pelvis and assessing your ability to move your legs.

Investigations commonly include:

• X-rays

• CT scans

A CT scan provides much greater detail than an X-ray and allows the consultant to determine whether the pelvis is stable or unstable.

Occasionally an MRI scan may be used if a fracture is suspected but not clearly visible.

Medical management

Treatment depends entirely on the type of fracture. Many pelvic fractures are treated without surgery using:

• Pain relief

• Walking aids

• Physiotherapy

• Gradual increase in activity

• Follow-up clinic appointments

More unstable injuries may require surgery using:

• Plates

• Screws

• External fixation

• Internal fixation

The aim is always to restore stability and allow the pelvis to heal safely.

Why are pelvic fractures so painful?

The pelvis is involved in almost every movement we make. Standing, walking, coughing, getting into bed, getting dressed or even rolling over can all place stress through the injured area.

In addition, the many muscles attached to the pelvis continue working whenever you move, causing further discomfort around the fracture.

The good news is that although pelvic fractures are often extremely painful initially, the pain usually improves steadily as healing progresses.

How can I walk if my pelvis is broken?

This is one of the questions physiotherapists hear most often. The answer depends on whether your fracture is stable. Your orthopaedic consultant carefully reviews your scans to determine how much weight your pelvis can safely tolerate.

Many pelvic fractures are surprisingly stable because the remaining parts of the pelvic ring and surrounding ligaments continue to provide support.

If your consultant has advised you to weight bear, walking will not usually damage the fracture.

Instead, it plays an important role in your recovery.

Why is walking encouraged?

Once your consultant confirms it is safe, walking provides many benefits.

Walking helps to:

• Maintain muscle strength.

• Reduce stiffness.

• Improve circulation.

• Reduce the risk of blood clots.

• Reduce the risk of chest infections.

• Improve confidence.

• Maintain independence.

• Prevent muscle weakness (deconditioning).

Even a few days of prolonged bed rest can lead to significant muscle loss, reduced balance and reduced fitness. For this reason, physiotherapists aim to get people moving safely as early as possible.

Why do I need a walking aid?

Walking aids are not simply there for balance. They play an important role in reducing the amount of force travelling through the pelvis while providing additional support and confidence during walking.Depending on your injury, you may be provided with:

• Elbow crutches

• A walking frame

• A wheeled frame (rollator)

Using a walking aid allows many people to walk more comfortably while their fracture heals. As your pain improves and the bone becomes stronger, your physiotherapist will gradually reduce the amount of support you need until you can walk independently again.

For most people after a pelvis fracture they will usually require crutches, a walking frame or a gutter frame, these allow more weight bearing to be taken through the arms, reducing the load through the legs and thus pelvis, which often makes walking more comfortable.

How can Occupational Therapy help?

Recovering from a pelvic fracture isn't just about healing the bone—it's also about finding safe ways to manage everyday activities while your pain gradually improves.

An Occupational Therapist (OT) specialises in helping people remain as independent as possible during recovery. They can assess how you move around your home and recommend equipment or simple adaptations that make daily life safer and more comfortable.

Depending on your needs, an OT may recommend equipment such as:

• A raised toilet seat or toilet frame to reduce the effort of sitting down and standing up.

• A shower chair or bath board if standing to shower is difficult.

• Grab rails beside the toilet, shower or steps for extra support.

• A perching stool for the kitchen if standing for prolonged periods is uncomfortable.

• A long-handled shoe horn to avoid excessive bending when putting on shoes.

• A sock aid (sock-on) to help put on socks without bending forwards.

• A reacher or grabber for picking up items from the floor or reaching into cupboards.

• A long-handled sponge to make washing your feet and lower legs easier.

Simple equipment like this can make a significant difference during the first few weeks of recovery. Importantly, most of these aids are only needed temporarily while your mobility and confidence improve.

If you're finding everyday tasks difficult, ask your consultant, physiotherapist or GP whether an Occupational Therapy assessment would be helpful.

Sleeping and positioning

Finding a comfortable position during the first few weeks can be challenging.

Many people find it helpful to:

• Sleep on their back with a pillow beneath the knees.

• If lying on your side is comfortable, place a pillow between your knees.

• Roll onto your side before sitting up, rather than trying to sit straight forwards.

• Avoid sudden twisting movements when turning in bed.

Small changes in technique often make getting in and out of bed much easier.

Sitting

Sitting for long periods can increase stiffness. Try to:

• Change position regularly.

• Stand and walk little and often.

• Choose a firm chair that is easy to get out of.

• Avoid very low or soft sofas if they make standing difficult.

Things to do

✔ Take your pain medication as prescribed.

✔ Follow your consultant's weight-bearing instructions.

✔ Use your walking aid correctly.

✔ Walk regularly throughout the day.

✔ Stay hydrated.

✔ Eat a balanced diet rich in protein, calcium and vitamin D.

✔ Continue your prescribed physiotherapy exercises.

✔ Be patient—healing takes time.

Things to avoid

✖ Don't ignore your weight-bearing restrictions.

✖ Avoid heavy lifting until advised.

✖ Avoid twisting while carrying weight.

✖ Avoid standing for prolonged periods if it significantly increases pain.

✖ Don't stay in bed all day unless specifically advised.

✖ Don't compare your recovery with someone else's—every fracture is different.

How long does healing take?

Most stable pelvic fractures heal over 8–12 weeks, although more complex injuries may take considerably longer. Pain is usually:

• Most severe during the first two to three weeks.

• Noticeably improved by six weeks.

• Continuing to improve over the following months.

Some mild aching after prolonged walking or standing is common while the bone continues to remodel.

Will I need physiotherapy?

Physiotherapy plays an important role in helping you return to normal activities. Treatment may include:

• Walking practice.

• Progressing your walking aid.

• Strengthening your hips and legs.

• Balance exercises.

• Improving confidence.

• Increasing endurance.

• Returning to everyday activities such as stairs, getting outdoors and shopping.

Recovery isn't simply about waiting for the bone to heal. It's also about helping your muscles, joints and confidence recover alongside it.

Final thoughts

A pelvic fracture can feel frightening, particularly because every movement seems to involve your pelvis. However, many pelvic fractures are stable injuries that heal very well with time, appropriate pain relief and gradual rehabilitation.

Once your consultant has confirmed it is safe, walking—often with the support of a walking aid—is one of the most important parts of recovery. Staying mobile helps maintain your strength, prevents complications and supports your return to independence.

Recovery requires patience, but with guidance from your orthopaedic team, physiotherapist and occupational therapist, most people steadily regain their mobility and return to the activities that matter most.

About Physio at Home

Physio at Home specialises in expert home visit physiotherapy across Mid Cornwall, providing high-quality assessment and rehabilitation in the comfort of your own home. Our service is particularly suited to people who are housebound, have reduced mobility, are recovering from surgery or illness, have neurological conditions, or simply find travelling to a clinic difficult.

Our HCPC-registered physiotherapists provide comprehensive home assessments, personalised treatment plans and tailored exercise programmes designed around your individual goals and your home environment. We can also assess how you move around your home and offer practical advice to help improve confidence, mobility and independence.

We cover Falmouth, Penryn, Truro, Helston, Redruth, Perranporth, Feock, St Agnes and many surrounding areas across Mid Cornwall.

Whether your goal is to reduce pain, improve mobility, regain confidence after illness or surgery, or remain independent at home, we're here to help.

If you'd like to find out more about our home visit physiotherapy service, we'd be delighted to hear from you. More information here https://www.physioathome.uk/

Disclaimer

This article is intended for general information only and should not replace individual medical advice. Every pelvic fracture is different, and your rehabilitation should always follow the advice of your orthopaedic consultant, physiotherapist or healthcare team. Always follow your prescribed weight-bearing instructions and seek urgent medical attention if you experience worsening pain, increasing swelling, numbness, weakness, loss of bladder or bowel control, or any other concerning new symptoms.