https://www.youtube.com/watch?v=agfRJi93D7c
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Knee Pain for 40 Years: Dramatic Response to 5-minute Hesch Treatment
https://www.youtube.com/edit?o=U&video_id=T6AFQWdk7W4
Just to remind you who I was.... although I had no symptomatic pain, my three lab partners and I recognized asymmetries in my pelvis.However, being new to the work, we had each misdiagnosed my issue.Once you went over upslip vs. downslip, you demonstrated on me.After you diagnosed my right downslip, you corrected it and I felt no different aside from that interesting tingling in the right side of my neck.For that, I already ordered Dr. Riter's device as you suggested. But when I went to my Pilates class this morning which involves many tandem standing exercises on the clinical reformer, I found that my need to self-correct my hips was ever so slight and in one pose, nonexistent.Consistently for the past 3 years, every time I was in a lunge type posture, my hips would always need correcting. Usually the left one would excessively rotate outward and only with feedback from a mirror or an instructor pointing it out would I be able to correct it. I understood that rotated was what my body felt was neutral.Not the case today. This morning in six different tandem standing poses, my need for self-correction was so minimal, it took my breath away.In one pose, I needed no correction at all.I even had the instructor come and double check what I thought was happening to make sure I was being objective! Thank you so much not only for correcting my downslip, but more importantly, for teaching us a new way to gently and simply help our patients. With more practice on my husband, I feel comfortable that I will be able to improve my awareness of recoil and improve my assessment skills. I am currently the primary investigator on a pilot study examining the effect of vibration during exercise on burn patients during both PT and OT. Although only on the 38th subject of 100 potential subjects and two years into the study, I am truly excited about the work's potential to help lessen burn patients' pain. Although in the burn center, we always assume our patients' pain is burn related, I am certain patients arrive with issues that may have preceded their burn injury. I am hoping once this study wraps up to design one which incorporates Pilates into their treatment and perhaps incorporate some of your work. I will certainly let you know when I get to that point. Thank you for a truly inspiring course and thank you for your continued work toward advancing our field in a helpful direction. Sondra Ulbrich, MSPTPhysical Therapist University of Miami Jackson Memorial Burn Center Jackson Memorial HospitalMiami, FL Journal of Orthopaedic Trauma:January 2014 - Volume 28 - Issue 1 - p 41–47doi: 10.1097/BOT.0b013e318299ce1bOriginal ArticleMagnetic Resonance Imaging for the Evaluation of Ligamentous Injury in the Pelvis: A Prospective Case-Controlled StudyGary, Joshua L. MD*; Mulligan, Michael MD†; Banagan, Kelley MD*; Sciadini, Marcus F. MD*; Nascone, Jason W. MD*; O'Toole, Robert V. MD*
Supplemental Author MaterialAbstractObjectives: Management of external rotation pelvic ring disruptions is based on which ligaments are disrupted within the pelvis. We hypothesized that magnetic resonance imaging (MRI) can evaluate the ligaments of the pelvic ring and differentiate injured from uninjured pelves. Design: Prospective cohort study. Setting: Level I trauma center. Patients: Twenty-one patients with 25 acute external rotation injuries of the hemipelvis; control group of 26 patients without pelvic ring injury. Intervention: All patients underwent the same MRI protocol reviewed by 1 musculoskeletal radiologist. Main Outcome Measures: Integrity of 5 structures: sacrospinous, sacrotuberous, anterior sacroiliac, and posterior sacroiliac ligaments and pelvic floor musculature. Results: Visualization of sacrospinous, sacrotuberous, anterior sacroiliac, and posterior sacroiliac ligaments, and pelvic floor musculature was possible for 91%, 100%, 98%, 91%, and 100%, respectively, of all studied structures. No injuries were identified in control group patients in contrast to ligament injury observed with all injured pelves (0% versus 100%; P < 0.0001). Observed relationship of ligament injury to pelvic injury type generally agreed with the Young–Burgess classification system, with the important exception that patients with anterior–posterior compression type II injuries had damage to the sacrospinous ligament in only 50% of the cases. Conclusions: Ligamentous anatomy and injury about the pelvic ring appears to be easily evaluated with MRI, arguing that there may be a role for this imaging modality in managing these cases. Tearing of the sacrospinous ligament is variable among anterior–posterior compression type II injuries, arguing that the injury pattern can be subdivided into those with and without sacrospinous ligament tears. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. From LinkedIn Sacroiliac dialogue May 11, 2014
Jerry Hesch President Hesch Institute - Las Vegas Manual Therapy There are many motion patterns of the pelvic complex that can cause pelvic asymmetries. Having cleared lower extremity influences in a hypothetical client (this includes a seated leg length screen, and attempt to qualify symmetry of trochanters) one can focus on the pelvic structure. The majority of asymetries are not due to abnormal movement within the sacroiliac joint so the terminology I will use is faulty pelvic motion coupling. The other assumption being that lumbar influences are essentially ruled out. To be continued... Jerry Hesch President Hesch Institute - Las Vegas Manual Therapy One does have to screen the pubic joint and test the SIJ, but in this example these are clear. The Pelvis has 6 typical unilateral patterns and can have 2 typical bilateral patterns. In advanced patterns there are several more which are unique to the Hesch model, but will defer elaboration. These typical patterns are not based on traditional gross motion tests palpating pelvic landmarks but rather require ligament tone evaluation and passive spring tests to discern lack of mobility, typically treatable, sometimes pathological. For additional info see the HeschInstitute web site. Nearly every pattern (excepts those that do not recur) have a self-treatm,ent component. Some patterns including sacral, pubic joint, and advanced "ilium/hemipelvis patterns" are resolved with one treatment and therefore home program not needed. Uniquely described are predictable patterns of dysfunction such that a sequence of dysfunctions are treated in order to be thorough, rather than a single movement diagnosis and a single treatment. There are exceptions. David Stern DC PT Owner/Director at Rocky Point Physical Therapy Jerry what do you think of Mark Laslett's PT research on the SI jt? Jerry Hesch President Hesch Institute - Las Vegas Manual Therapy David, I can speak to how it is interpreted and utilized and I will give an extreme example. I have a you tube video and in my workshop I teach how one can relatively isolate the posterior ligamentous complex of the sacroiliac for intra-individual and inter-individual (left/right side) and suggest that a fair generalization is that there is a distinct gender difference on any given day in the clinic with few exceptions. So isolating the hip of which the mid acetabulum is <3" from the mid SIJ, and shares same innervation versus isolating the SIJ has some yet undefined (published research) margin of error. The other tests need very cautious interpretation because they are also hip provocation tests. The one test that gets closer to the SIJ the sacral thrust is problematic in that it stresses the elements of at least the lowest lumbar segment also, perhaps primarily. Hip Int. 2013 Feb 12:0. doi: 10.5301/HIP.2013.10729. [Epub ahead of print] Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement. Morgan PM, Anderson AW, Swiontkowski MF Jerry Hesch President Hesch Institute - Las Vegas Manual Therapy The intra-articular injections that were described as the "gold-standard" are not gold standards and new light has been shed on the problem with some injections. So we ahve some tests, up to three that correlate with a positive response to an intra-articular injection. How long does the benefit last, how about repeat injection, what about issues as described by the authors below such as a rent in anterior capsule such that the lidocaine bathes that lumbosacral plexus, etc. Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S.Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31. http://www.ncbi.nlm.nih.gov/pubmed/17530380 Borowsky, Claude D. Fagen, Glenn1 (2008). Sources of Sacroiliac Region Pain: Insights Gained From a Study Comparing Standard Intra-Articular Injection With a Technique Combining Intra- and Peri-Articular Injection. Archives of Physical Medicine & Rehabilitation Vol. 89 Issue 11, p2048 9p. Jerry Hesch President Hesch Institute - Las Vegas Manual Therapy I respect pain and I respect the fact that it is many times as Gregory Grieve stated "A good policeman but a poor counselor." I find more biomechanical dysfunction in the lumbopelvic-hip complex than I do symptomatic and they can have wide reaching effects such as via the oculo-pelvic reflex. Complex topic that cannot get its due in a few posts. My workbook is at 277 pages right now. Many converging and especially many diverging opinions and very limited research. What do we do clinically... The MET/Osteopathic model the latter fully articulated in 1958 culling works from prior decades does get a significant reinterpretation. Also my work on symphyseal diastasis has a de novo interpretation per MRI's from the trauma literature. It does predict a need for a novel treatment approach, was presented at CSM 2014, AAOMPT 2013, IPPS 2011. (Hesch). What are your thoughts? |
Dr. Jerry Hesch, DPT, MHS, PTMarried with 4 grown kids. Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico. I enjoy working with my hands and particularly making glass objet d'art. Powered by Calendar Labs Archives
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