Paris FRANCE

To Monsieur Kanye West:

Congratulations on the birth of your daughter, Nord! This is a truly auspicious time for you -- and so it is with great sadness that we must lodge a formal complaint against the song "I am a God" from your new album Yeezus.

Our organization represents bakers across France, many of whom have taken great offense at this particular rhyming couplet:

“In a French-ass restaurant
Hurry up with my damn croissants”

Assuming you, as a man of means, dine exclusively at high-end restaurants and boulangeries during your voyages to Paris, it could not be possible that the delay of your "damn" croissants originated from slow service. And certainly, you are not a man to be satisfied with pre-made croissants from the baked goods case reheated and tossed out on a small platter. No -- you had demanded your croissants freshly baked, to be delivered to your table straight out of the oven piping hot.

And it was with great joy you ordered croissants  -- not crêpes or brioches -- because only croissants can proudly claim that exquisite combination of flaky crust and a succulent center. The croissant is dignified -- not vulgar like a piece of toast, simply popped into a mechanical device to be browned. No -- the croissant is born of tender care and craftsmanship. Bakers must carefully layer the dough, paint on perfect proportions of butter, and then roll and fold this trembling croissant embryo with the precision of a Japanese origami master.

This process, as you can understand, takes much time. And we implore the patience of all those who order croissants. You may be familiar with the famous French expression, "A great croissant is worth waiting a lifetime for."

We could easily let this water pass under the bridge, as they say, but we take your lyrics very seriously. From the other lines in the song, we have come to understand that you may in fact be a "God." Yet if this were the case -- and we, of course, take you at your word -- we wonder why you do not more frequently employ your omnipotence to change time and space to better suit your own personal whims. For us mere mortals, we must wait the time required for the croissant to come to perfect fruition, but as a deity, you can surely alter the bread's molecular structure faster than the speed of light, no? And with your omniscience, perhaps you have something to teach us about the perfect croissant. We await your guidance and insights.

We appreciate your continued patronage of French culture. (Your frequent references to menage perhaps speak an interest in the structure of the French household?) We hope from the deepest recesses of our hearts, however, that in the future you give croissants the time they need to fully mature before you partake. With that, we say, adieu. And our member Louis Malpass from Le Havre wants you to know that he loves "Black Skinhead."

Salutations cordiales

Bernard Aydelotte
Association of French Bakers

Dear Jerry, I like your perseverance and 360° approach on treating SIJ dysfunctions,, but I feel we should really read the comment on Berthelot's 2006 article (one of the cornerstones of your work) by Laslett et al and then next read the systematic review by Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS. in
J Pain. 2009 Apr;10(4):354-68. "Diagnostic validity of criteria for sacroiliac joint pain: a systematic review". We can only establish that the SIJ is in part a potential source of nociception without any possibility of establishing what the actual cause is. I agree with Ina Diener; the actual possible movement in the SIJ is less than 6° which is not reliably palpable in any sort of way.
So any therapy based on these very low level evidence assumptions is based in reality only on clinical expertise and natural course combined with a possible placebo effect.
Let's say so to our patients: we do not know what the cause of your LBP is, but we have a potential treatment which might be effective....

Jerry Hesch • Erik,
I know that passive mobility tests do induce movement through the SIJ and that the springing with awareness (modification of traditional spring tests) can discern lack of movement going through the SIJ, and I know that there is a grey zone in which they are unable to replicate physiological forces. I have a few you tube videos showing the spring tests on the first H1N1 virus case in the nation who had a fused SIJ and in a client who was worked up for an SIJ fusion and I informed her with spring tests that she was already fused. A review of her CT scan revealed previously unreported encroachment of thoracolumbar fusion hardware into the lower SIJ on the right with no visible joint space. What absolutely astonished me about these two examples was the complete lack of left to right (1st one) and right to left (2nd) pelvic side-glide. No literature, kinesiology or joint structure and function textbook or published paper prepared me for that! I like the terminology lumbopelvic-hip which I use to convey that it is a system. In respecting the published studies I also respect the wide gap in topics where research is lacking. While movement is limited in the joints the spring tests are performed at a distance hence there is a multiplier effect between actual and perceived and I perform them using my whole body, hence an enormous number of receptors participate as opposed to just pushing with my arms. Sometimes specific treatment yields very dramatic results and quickly ends chronic severe pain and costly care as is shown in a video I posted that has Downslip and Upslip in the title. There is a link where the child's mother excoriates the medical profession and reiterates his journey. No research exists to support what I did for him, meaning no published. There are many topics still in need of research. I do spend a lot of time educating my clients and gently dismantling their cultural "SIJD" MYTHOLOGY. I think we all seek the same outcome for our clients. Thank you. best regards, Jerry Hesch

From a LinkedIn blog on pelvic asymmetry August 2013

Taso Lambridis • Hi Jerry,

Thanks for the very clear comments surrounding the pubic symphysis, I do take a very similar approach to this as you do & yes radiographic findings certainly are more helpful than when considering the SIJ. Apologies for any misunderstanding around the comment regarding Andre Vleeming, it was directed to an earlier comment by Roel Lameris. Not sure if you are attending the upcoming world congress in Dubai end of Oct/begining Nov but certainly lookinf forward to any new material that comes out of the conference and any new perspectives that Andre & others involved in the area may have for us. Regards, Taso

Hi Taso,

I find the A-P  films of the pelvis to be challenging because they typically are taken either in standing or supine and not from a perpendicular angle to the sagittal orientation of the pubic bones. Nonetheless, they can give some information and at times one can measure the interpubic width at the middle of the joint which as you probably know, is an accepted protocol.

I have a modified machinists tooll that is best described as a plunger with a ruler which I use on very rare occasions when a client presents with a significant palpable depression of the symphyseal fibrocartilage. I also use a Carpenters contour gauge to measure pre-and-post shape of the pubic bones and fibrocartilage. In an ideal world of course, we would have access to imaging tools and a litany of good research to guide us. In the absence thereof, given that there are knowledge gaps, as I know you agree, we have to do the best with what we have to help our patients. There is a paucity of published research to guide treatment of the symphysis pubis. The orthopedic trauma literature as I posted earlier, does bring a novel perspective to the traditional physical therapy and women’s health physical therapy approach to both pubic joint dysfunction and pubic joint AKA symphysis pubis diastasis, AKA symphyseal diastasis.

Sadly, in parts of the world there are women who are still in wheelchairs from having had intentional, meaning surgical cutting of the symphysis pubis to facilitate easy birth. In some regions such as Zimbabwe this is a life saving procedure and the statement is made that they do not suffer any long-term sequelae. However, there is no objective measurement to demonstrate that they do heal. Separately, there is a very small amount of literature which hints at a difference in ability to recover and a difference in experienced pain related to childbirth and to trauma as related to childbirth such as intentional or non-intentional symphyseal diastasis. So, the topic of pelvic asymmetry as relates to the symphysis pubis is a very relevant topic and it has to do with an underserved population. I would hate to even imply that medicine and rehabilitation ignores such and has a paternalistic and chauvinistic undergirding. Who knows?

I did intend to attend the world Congress in Dubai and I had two abstracts accepted. One on the very topic of symphyseal diastasis, presenting MRI images for a novel biomechanical interpretation. However, I have decided to focus my resources of economy and time and need, and will schedule surgery around that time. I do have 2 presentations at AAOMPT in October, much more economically feasible. Will you attend the congress?

No need to apologize I just wanted to clarify that it was not I who made the comment regarding Andry Vleeming.

I look forward to hearing more of your work. Thank you for your thoughtful, engaging, and polite interactions.

With best regards,

Jerry  Hesch