Downslip Ilium With Paradoxical Upslip Ilium Appearance

Upslip and Downslip Ilium are patterns of sacroiliac joint (SIJ) dysfunction (SIJD) that are commonly described in the literature.[i] They are opposite dysfunctions in which the ilium moves up or down and remains fixated in a position that produces pain, strain and movement dysfunction, until passively corrected. A case is presented in which an adolescent presented with severe low back pain and occasional abdominal pain with a bizarre gait pattern. Extensive medical workup was non productive. A clinician diagnosed Ilium Upslip on the basis of appearance only, and treated him making him worse. The case illustrated the paradoxical presentation in which Ilium Upslip is misdiagnosed on the basis of appearance, when the actual mechanical dysfunction is its opposite; Ilium Downslip. The muscle guarding of the quadratus lumborum and external oblique muscles seem to occur as an ineffective strategy to stabilize the symptomatic side. Palpation of the sacrotuberous ligament revealed hypertonicity, and Hesch Springing with Awareness[ii], [iii] demonstrated that inferior spring to the posterior iliac shelf enhanced pain with discernable hypermobility, and superior spring to the ischial tuberosity indicated blocked mobility. Treatment utilized low-load long duration creep, the force being maintained for five minutes, in a position that approximated the combined planes of the joint. Resolution was realized in two visits and the client was asymptomatic for nine months. This case is posted on www.YouTube.com as Downslip Ilium That Looks Like Upslip: Parts I-III. The use of visual diagnosis is discouraged on the basis of a false positive conclusion, whereas tests that have a greater utility and reliability are encouraged, such as Hesch Springing with Awareness and ligament palpation.[iv] Posting videos on www.YouTube.com is a very economical way of sharing novel interventions with the medical community.

1Greenman PE. Principles of Manual Medicine. Baltimore, MD: Williams & Wilkins; 1989:225-270.

2 Hesch J. Course workbook: The Hesch Method of Treating Sacroiliac Joint Dysfunction: Integrating the SI, Symphysis Pubis, Pelvis, Hip, and Lumbar Spine. Hesch Institute,Henderson, NV USA 2010.

3 Hesch J. Evaluating sacroiliac joint play with spring tests. J ObGyn PT. 1996;20:3 4-7.

4 Olson L.  Effects from the Hesch Method Pelvic Mobilization on Lumbar flexion, Straight Leg Raise Performance, and Standing Pelvic Inclination Angles in Patients With Low Back Pain. Chicago, Il: Finch University of Health Sciences/The Chicago Medical School; 1998, Thesis.

5 Hesch J. The Hesch Method Advanced Course: Distance Learning. Hesch institute 2010 Henderson, Nevada, USA.

6 Hesch J.  Evaluation and treatment of the most common pattern of sacroiliac joint dysfunction: In: Movement, Stability & Low Back Pain: The Essential Role of the Pelvis.  Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R, eds. London:Churchill Livingstone 1997: chap. 42; 535-552.

7 http://erikdalton.com/media/published-articles/low-back-piriformis-si-joint-pain/

8 Swenson MR, Rothrock JF. Ilioinguinal neuropathy after iliac crest biopsy. Mayo Clin Proc. 1986 Jul;61(7):604.

9Parviz K.Amid, MD, FACS, FRCS. Personal communication, February 28, 2009.

Downslip Ilium With Paradoxical Upslip Ilium Appearance Videos

Response video posted by the mother of the patient in the above video series:  This illustrates what patients go through due to ignorance in the health care community, about assessment and treatment of joint dysfunction.