Hesch Method of Manual Therapy Basic Information
While orthopedic Manual Therapy is a subset of PT, Hesch Method is a unique subset thereof.
“Spring Tests”, a very fundamental concept of Manual Therapy, have been improved upon by Dr. Jerry Hesch, MHS, PT, DPT. WITHIN Hesch Method, the method of spring testing applied is an enhancement referred to as “Springing With Awareness”. Specifically, this approach allows the clinician to experience and interpret the recoil of the viscoeleastic joint structure, as opposed to simply abruptly letting go of the spring. This refined testing is fundamental to empirically experiencing hypomobility and hypermobility with confidence. In this way, the Therapist will find that application of Hesch Method techniques will enhance clinical palpatory literacy. “Springing With Awareness” has application throughout the body in joints and dense connective tissue.
By enhancing traditional spring tests, Hesch Method allows the Therapist to evaluate true motion loss in each plane, as opposed to perceived loss. There is more precision in assessment, and ultimately greater success in restoration of normative joint function through precisely targeted treatment. Clinicians consistently report confidence in the clinical application of this evaluation and treatment paradigm.
Treatment is based on the viscoelastic creep model of connective tissue, and thoroughly addresses movement dysfunction in all planes of the body. Definitions are more accurate, an example being that Anterior Ilium dysfunction is truly not uniplanar or biplanar but rather involves all three planes of the body. Treatment is therefor much more effective when addressing the dysfunction in all three planes.
The traditional Manual Therapy education is a lengthy, expensive, and arduous process. While Mr. Hesch in no way negates the value of immersing oneself intensively in advanced Manual Therapy training, he believes there is also a basic skill set that should be accessible to all practitioners. Fundamentals of Manual Therapy, as applied to the joints, is not an esoteric and complicated educational pursuit. There are basic skills that can be readily learned and applied by any Therapist, with excellent clinical results. The successful application of these skills then encourages many clinicians to strive for attainment of more advanced manual skills.
Pelvic joint dysfunction, more than any other joint dysfunction, has been inadequately defined in the traditional method, on the basis of gross motion testing and limited bony landmark palpation. While modern research has provided insight into anatomy and dysfunction of this area, evolution of treatment methods have lagged behind. The Hesch Method addresses the need for a new approach to evaluation and treatment. This complex area of the body is finally addressed through advanced palpatory skills, accessory motion tests and a practical treatment approach. This approach recognizes that at times the specific joints of the pelvis may be involved, and at other times, the entire pelvic structure has movement dysfunction, which influences the kinetic chain both above and below. Also addressed are the concepts that muscle function can both affect, and be affected by, joint dysfunction. Treatment is based on neuromuscular factors as well as the viscoelastic nature of the joints.
There can be symmetry of the pelvis in standing, due to compensation in the lower extremities. Furthermore, the presence of a true symmetrical pelvis as noted in all functional positions, can still be involved in a symmetrical restriction of mobility. Therefore, the paradigm of symmetry as reflecting functional movement of the pelvic and sacroiliac, is invalid. Hesch Method tests intrinsic and extrinsic mobility of the pelvic structure. The traditional model cannot.
This approach recognizes several predictable sequences of dysfunction, aptly named “The 1st and 2nd Most Common Patterns of SI Joint Dysfunction”. This is in contrast with an a la carte approach which lists dysfunctions singularly. Many Therapists intuit problems with the traditional model. Old terminologies can be very confusing and make visualization difficult. Examples are, unilateral sacral flexion and extension, and sacral torsions about an oblique axis. With the Hesch Method, the naming of sacral torsions and other dysfunctions is much more lucid and biomechanically accurate. The traditional concept of unilateral sacral flexion and extension, a concept developed based only on a few clinical tests, has been invalidated with more thorough palpation and accessory motion testing (Hesch Double-Recoil (force-transmission) Joint Spring Tests). Another relevant concept is that different types of pelvic movement dysfunction appear to be very similar; and they cannot be differentiated or distinguished one from the other, by traditional approaches.
Hesch Method is not focused only on the intrinsic biomechanics of the SI joint, but also on extrinsic motion restrictors, including the biomechanics of the pelvis as an integrated structure. While true SI Joint Dysfunction is a reasonable paradigm in females, especially in the peripartum time frame, many times the true dysfunction is extrinsic to the joints and is a biomechanical dysfunction of the entire pelvic structure moving on and with the hips, and moving in relation to the trunk and lumbar spine. This significantly alters connective tissue tone, especially the dorsal SI ligaments, proximal muscles, and tendons. Re-balancing the pelvis and related soft tissue is very relevant in normalizing movement patterns in the low back, hips, and lower extremities. Distal compensations as high as the upper cervical spine are reflexively improved in direct response to balancing the pelvis. Sometimes the distal compensations are actually symptomatic, and are reflexively incapable of resolution until the primary cause, the lumbopelvic dysfunction, is addressed. The four mechanoreceptors that innervate ligament and capsule throughout the lumbopelvic girdle are effectively treated with this approach.
Global hypermobility of the pelvic joints is actually rare and is over diagnosed. The truth being that, quite often one direction is hypermobile and the opposite direction is hypomobile. When movement is restored, ablating the hypomobility, the hypermobility is also significantly improved as both directions approach the mean.
Hesch Method utilizes a few additional palpatory landmarks, ligamentous testing, and accessory motions evaluated in neutral and end range postures. This is a distinct contrast to the Osteopathic goal of “normalizing pelvic symmetry during the gait cycle”. As many lumbopelvic injuries occur at end range flexion, these can only be discovered in postures such as the Yoga Child’s Pose. Hesch Method goals include symmetry of position in all neutral and end range postures, and more importantly, symmetrical ligamentous tone and normative passive accessory mobility and stability.
In the early 1990’s. Hesch presented several papers on the problems associated with the traditional evaluative methods. Since then, several research studies have negated the traditional evaluation and validated the Hesch method. One supportive study uses fluoroscopy to demonstrate intra articular mobility with spring tests. Another validates that applying specific forces, as taught in the Hesch Method, has a high inter and intra rater reliability. A thesis further demonstrates the statistically significant value, reliability, and utility of Hesch Spring Tests. Research on the Hesch Method has been presented at both the 1998 World Congress on Low Back Pain and Sacroiliac Joint Dysfunction, and at the 2003 World Congress on Physical Therapy. It demonstrated that brief treatment was significant for pain relief, and that most positional tests and spring tests demonstrated clinical usefulness with better than 70% agreement. This shows that the Hesch Method is a profound improvement over the traditional approach, which, in multiple studies, had shown poor intratester agreement.
“Spring Tests”, a very fundamental concept of Manual Therapy, have been improved upon by Dr. Jerry Hesch, MHS, PT, DPT. WITHIN Hesch Method, the method of spring testing applied is an enhancement referred to as “Springing With Awareness”. Specifically, this approach allows the clinician to experience and interpret the recoil of the viscoeleastic joint structure, as opposed to simply abruptly letting go of the spring. This refined testing is fundamental to empirically experiencing hypomobility and hypermobility with confidence. In this way, the Therapist will find that application of Hesch Method techniques will enhance clinical palpatory literacy. “Springing With Awareness” has application throughout the body in joints and dense connective tissue.
By enhancing traditional spring tests, Hesch Method allows the Therapist to evaluate true motion loss in each plane, as opposed to perceived loss. There is more precision in assessment, and ultimately greater success in restoration of normative joint function through precisely targeted treatment. Clinicians consistently report confidence in the clinical application of this evaluation and treatment paradigm.
Treatment is based on the viscoelastic creep model of connective tissue, and thoroughly addresses movement dysfunction in all planes of the body. Definitions are more accurate, an example being that Anterior Ilium dysfunction is truly not uniplanar or biplanar but rather involves all three planes of the body. Treatment is therefor much more effective when addressing the dysfunction in all three planes.
The traditional Manual Therapy education is a lengthy, expensive, and arduous process. While Mr. Hesch in no way negates the value of immersing oneself intensively in advanced Manual Therapy training, he believes there is also a basic skill set that should be accessible to all practitioners. Fundamentals of Manual Therapy, as applied to the joints, is not an esoteric and complicated educational pursuit. There are basic skills that can be readily learned and applied by any Therapist, with excellent clinical results. The successful application of these skills then encourages many clinicians to strive for attainment of more advanced manual skills.
Pelvic joint dysfunction, more than any other joint dysfunction, has been inadequately defined in the traditional method, on the basis of gross motion testing and limited bony landmark palpation. While modern research has provided insight into anatomy and dysfunction of this area, evolution of treatment methods have lagged behind. The Hesch Method addresses the need for a new approach to evaluation and treatment. This complex area of the body is finally addressed through advanced palpatory skills, accessory motion tests and a practical treatment approach. This approach recognizes that at times the specific joints of the pelvis may be involved, and at other times, the entire pelvic structure has movement dysfunction, which influences the kinetic chain both above and below. Also addressed are the concepts that muscle function can both affect, and be affected by, joint dysfunction. Treatment is based on neuromuscular factors as well as the viscoelastic nature of the joints.
There can be symmetry of the pelvis in standing, due to compensation in the lower extremities. Furthermore, the presence of a true symmetrical pelvis as noted in all functional positions, can still be involved in a symmetrical restriction of mobility. Therefore, the paradigm of symmetry as reflecting functional movement of the pelvic and sacroiliac, is invalid. Hesch Method tests intrinsic and extrinsic mobility of the pelvic structure. The traditional model cannot.
This approach recognizes several predictable sequences of dysfunction, aptly named “The 1st and 2nd Most Common Patterns of SI Joint Dysfunction”. This is in contrast with an a la carte approach which lists dysfunctions singularly. Many Therapists intuit problems with the traditional model. Old terminologies can be very confusing and make visualization difficult. Examples are, unilateral sacral flexion and extension, and sacral torsions about an oblique axis. With the Hesch Method, the naming of sacral torsions and other dysfunctions is much more lucid and biomechanically accurate. The traditional concept of unilateral sacral flexion and extension, a concept developed based only on a few clinical tests, has been invalidated with more thorough palpation and accessory motion testing (Hesch Double-Recoil (force-transmission) Joint Spring Tests). Another relevant concept is that different types of pelvic movement dysfunction appear to be very similar; and they cannot be differentiated or distinguished one from the other, by traditional approaches.
Hesch Method is not focused only on the intrinsic biomechanics of the SI joint, but also on extrinsic motion restrictors, including the biomechanics of the pelvis as an integrated structure. While true SI Joint Dysfunction is a reasonable paradigm in females, especially in the peripartum time frame, many times the true dysfunction is extrinsic to the joints and is a biomechanical dysfunction of the entire pelvic structure moving on and with the hips, and moving in relation to the trunk and lumbar spine. This significantly alters connective tissue tone, especially the dorsal SI ligaments, proximal muscles, and tendons. Re-balancing the pelvis and related soft tissue is very relevant in normalizing movement patterns in the low back, hips, and lower extremities. Distal compensations as high as the upper cervical spine are reflexively improved in direct response to balancing the pelvis. Sometimes the distal compensations are actually symptomatic, and are reflexively incapable of resolution until the primary cause, the lumbopelvic dysfunction, is addressed. The four mechanoreceptors that innervate ligament and capsule throughout the lumbopelvic girdle are effectively treated with this approach.
Global hypermobility of the pelvic joints is actually rare and is over diagnosed. The truth being that, quite often one direction is hypermobile and the opposite direction is hypomobile. When movement is restored, ablating the hypomobility, the hypermobility is also significantly improved as both directions approach the mean.
Hesch Method utilizes a few additional palpatory landmarks, ligamentous testing, and accessory motions evaluated in neutral and end range postures. This is a distinct contrast to the Osteopathic goal of “normalizing pelvic symmetry during the gait cycle”. As many lumbopelvic injuries occur at end range flexion, these can only be discovered in postures such as the Yoga Child’s Pose. Hesch Method goals include symmetry of position in all neutral and end range postures, and more importantly, symmetrical ligamentous tone and normative passive accessory mobility and stability.
In the early 1990’s. Hesch presented several papers on the problems associated with the traditional evaluative methods. Since then, several research studies have negated the traditional evaluation and validated the Hesch method. One supportive study uses fluoroscopy to demonstrate intra articular mobility with spring tests. Another validates that applying specific forces, as taught in the Hesch Method, has a high inter and intra rater reliability. A thesis further demonstrates the statistically significant value, reliability, and utility of Hesch Spring Tests. Research on the Hesch Method has been presented at both the 1998 World Congress on Low Back Pain and Sacroiliac Joint Dysfunction, and at the 2003 World Congress on Physical Therapy. It demonstrated that brief treatment was significant for pain relief, and that most positional tests and spring tests demonstrated clinical usefulness with better than 70% agreement. This shows that the Hesch Method is a profound improvement over the traditional approach, which, in multiple studies, had shown poor intratester agreement.