I just posted a YouTube video demonstrating the limits of a traditional AP pelvic film in discerning vertical asymmetry. Repeat films with stork stance can show alteration, whereas a single static film may simply show long standing asymmetry. I believe itwas Walheim in 1984 who suggested the above.
http://www.youtube.com/watch?v=ojxCI0bIqLA
I just posted a YouTube video demonstrating the limits of a traditional AP pelvic film in discerning vertical asymmetry. Repeat films with stork stance can show alteration, whereas a single static film may simply show long standing asymmetry. I believe itwas Walheim in 1984 who suggested the above.
0 Comments
Posture assessment and treatment is only a part of patient care and yes many explanations exist. Because I can only be responsible for my own clinical behaviour I choose to make a quick discernment of the relevance to the patients overall presentation (not always possible in the short-term). A recent cases was a woman who could not sleep because she knew the scheduled sacroiliac joint fusion was not the right thing. This based on a large degree on a physical therapist explaining that because her faulty pelvic posture did not "correct" that becvause she was still symptomatic; she had SIJD AKA SIJ instability. INsanity. Bizarre. Yes I found faulty posture but clarified that it was present in standing and not in prone or supine. Yes, i know of the studies that discourage my belief that I can palpate SUBTLE asymmetries, such as 5mm or less and the studies that show 11mm or more of leg length difference is relevant (search Lynton F Giles if interested). The cause of her faulty posture was a lack of hip extension which responded very readily-one treatment of two minutes and taught self-treatment. Another case a PT with perfect pelvic posterior yet a lack of passive accessory motion which we restored, one treatment and taught self care and she can now sleep two visits total, grateful. The research encourages cautious interpretation, the research encourages us to up our game, not to discontinue. When we discern that the posture does not appear to be maleable nor contributory to prevailing symptoms or patients goals (one of the pillars of EBP) we move on. In the realm of probability honoring the research that does exist and honoring the research that does not yet makes for humble, committed care. When the posture model applies, apply therapeutic effort, when it does not then go to then next relevant screen.
From message 09-03-2013: Erik Dalton Yes Jerry~ You're chapter in Dynamic Body continues to receive rave reviews. Love to do something with you in the future.
Hi Grant, I appreciate your open mind and enthusiasm. Chad Cook in book Orthopedic Manual Therapy an evidence based approach advocates test-retest approach. I am teaching a lumbopelvic-hip course this week and advocate that it can be articular (rare) and can be a postural-movement whole body pattern. I have to understand things in order to apply and have significantly reinterpreted the traditional biomechanical model. The model taught in muscle energy based on Mitchell's 1970 book was fully articulated in 1958 by his father who culminated, synthesized the knowledge base which at that time covered the early and mid century. I have a book chapter in Movement Stability and Low Back Pain: the essential roldeof the pelvis. Old, and my perspective of course has changed but it is a good introduction. I prefer to test motion that is passively induced THROUGH the structure and admit we cannot isolate motion only IN the joint. For the simple fact that I teach courses that include the term sacroiliac I get a lot of flack but the problem is more complex than what is addressed in the published knowledge base part of evidence-based practice. Even that is over-interpreted, but that is another conversation. It is tricky to use hip pain provocation tests and ascribe pain to the SIJ, it is tricky to use injection with dye and fluroscopy into the SIJ, achieve pain relief and then state that the SIJ is the pain generator. There are several injection studies that explain why and are relatively ignored by those who promote the use of injection to bolster a cause such as evidence-based SIJ eval and tx and worse: SIJ fusion where enormous marketing dollars are being spent. Just go to spine journal and the other one, J of Spine (NASS) and look at the ads, same for online search, meaning in print and web. The complexity of the problem cannot be denied and it is more relevant for specific populations, women who have had children, golfers, foottball/soccer, etc, meaning in a greater context; not just SIJD. I appreciate that you try, that you do test and retest, readily admit what you do not know because THAT is the basis of learning; receptivity and humility. Were I a patient, you would be my clinican.
|
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
August 2016
Categories
All
|