I wrote this in response to a question on another blog, slightly edited to remove my wacky "humor". To isolate the Occiput-C1, C1-C2 find this persons neutral position of the head which sometimes is not how they lie on you table. Supine is best, better than sitting. Contact is in front of the ears, on the temples and zygomatic arch. Pull ever so gently until system is engaged say 5 lbs. You can test the pull force with a fish weighing scale for about $10.00. No, not on the patient! Observe the anatomy. The upper joint lies right below the and very slightly behind the pinna of the ear (lower lobe-like my big ones!). Whereas, the C2-3 on down lie at least a centimeter or a centipede below (adolescent centipede-the petulant variety) such that you will not be able to traction the upper in the same manner as the upper. OK, this arachnoid needs more coffee.
The Method works. It's changed my practice permanently and all it took was a two day seminar. You really filled in the blanks for me. It was exactly what i was looking for. As an LMT, we focus almost entirely on releasing muscles and I soon learned this wasn't enough to release some pain inducing patterns. Some commonly found patterns were just too stuck and some released and came right back dispite my "college try". After 12 years of practice, I consider myself to be a good therapist with good palpatory awareness and a problem solving mind that forces me to research and applies the findings clinically. Until I took your class, my basic and advanced understanding of joint and ligament dysfunction came primarily from Dalton's Myoskeletal Alignment Techniques. Although I gained confidence with putting my hands on dysfunction and addressing it throughout the pelvic area, there were still a few clients that I could only bring so far. Referring out wasn't an option because these people had already seen all sorts of medical specialists. Besides, I could feel something "off" and knew it was presenting something for me to find. Specifically when it came to hip abduction and extension, gluteus maximus,medius and minimus weakness were constantly returning. In the past two weeks, I have treated such cases and one where I had already seen a client for 18 sessions. Since The Hesch Method seminar, the constant (years) internal pulling the client felt stopped and the reflexive adductor and glute medius, minimus contractions that normally resume days after our intense sessions also abated. I knew that something I didn't know how to screen or treat was going on but I didn't know what. Neither did the doctors or others he saw for relief. I tested for ascending/ descending patterns and looked at the feet to the occiput over and over releasing the compensatory patterns all the while missing the "Key lesion". Your contribution to simplifying the Pelvic-SI dysfunction mystery by mapping a palpable pattern got rid of the guess work. Thanks for sharing across disciplines. Everyone who addresses musculoskeletal dysfunction should be using your spring assessments from DO's to PT's to LMT's and anyone who considers themselves Bodyworkers or Manual Therapists. Recalcitrant pelvic dysfunction begone. It works. Period.
Kiambu Dickerson LMT
A very nice compliment from a person I spent 45 minutes with. Sacroiliac dysfunction part of diagnosis
I just wanted to thank you again for taking time to check out my wonky pelvis, ha! I'm using the tool you gave me, my PT is keeping the leg/ankle in check and the difference in my gait is remarkable, my knee also thanks you and slowly but surely I'm feeling like my ole self again. This month marks year #3 since the MVA (although 2 years were wasted scrambling for an exit door & clinging on to hope)... I can't believe how far I've come in just a year, there is no feeling greater than this. I count my blessings 10 fold and give thanks to those who lifted me along the way!
At least by journaling thru my injury, people were able to see me slowly recapture my life non-surgically - that in itself was worth the time and effort!! Needless to say, I don't care for some of the social marketing groups that pressure you to get SI surgery without having the knowledge base to make such a recommendation. Conservative care rocks!
I hope today finds you well, may life treat you kindly and let the truth always speaks for itself!
With highest Regards,
D from the city with a Naval base! -)
TODAY’S EMAIL I RECEIVED
From: Facebook PRIVATE MESSAGE
Sent: Wednesday, January 18, 2012 8:49 AM
To: Jerry Hesch
Subject: New message from
8:34am Jan 18
I just wanted to say that I'm glad you're starting to speak up about your thoughts on SI surgery. I get stuck thinking in circles that I don't feel that it's appropriate for most people, even those who have exhausted their medical options, but where I get stuck is WHY it's not and HOW do we know when it's not? It's alarming to me the rate of surgeries that are happening, being patient-driven requests, and the variable outcomes. I wonder if the sample in the group is skewed, and not an accurate representation of true outcomes (how many more are doing great that we don't know about?). I have all this stuff floating around in my head -- concerns for those with upcoming surgeries and hope that they don't end up worse off, because I'm afraid they will, but I feel like me saying anything would be highly hypocritical, since I am a surgery success story.
Very insightful commentary. We should chat sometime if your busy schedule allows. I am deeply concerned about what I observe but the sad thing, mal informed patients make their choice and THEY live with the consequence. No, you are not being hypocritical. This would be a very appropriate post for you to put up, that is your perfect right and it carries much more power because 1. you are a knowledgeable clinician and 2. You are a successful Lumbar fusion with the cages and pedicle screws, though the topic is of course; sacroiliac fusions. Keep up the good work, I look forward to chatting if you have time.
I appreciate your private messages, apologize if I failed to reply to one-I cannot recall !
A dislocation the SIJ is imaged on a ct scan and x-rays (more than one view) whereas the same ct scans and x-rays for "malalignment" does NOT show malalignment in the SIJ. An elevated iliac crest is NOT indicative of a malalignment in the sacroiliac. Falsely overinterpreted in texts such as Professor Dihlman in Diagnostic Radiology of the Sacroiliac Joint, pp91-99. (Of
note, Dick DonTigny gave me that book in 1990, the book published in 1980.) He clarifies that functional films such as standing on one leg and then the other cannot be read with a line across the top of the sacrum (ala) and contrasted with one across the top of iliac crests, unless there is a concommitant vertical change in the height of the symphysis pubis. If the vertical symmetry of the pubic changes when you stand on the other foot, AND the iliac and scarl lines
change; then yes a valid case of hypermobility is objectively noted. Simply observing an iliac crest being higher than the other can be a purely muscular phenomen and there are problems of patient positioning when the x-ray or ct is taken which I have detailed in my chapter on sacral torsion. Dihlman goes on to insightfully state on p95, "Functional films only provide information as to whether the displacement (pubic and crest) is mobile or interlocked, or wheteher the pelvic rigidity which developed with the displacement of the sacroiliac joints and the pubic symphysis is complete or incomplete. Such information is important for determining the therapy". I assure you that any x-ray of iliac crests and SIJ's must include the entirity of the symphysis pubis and standing on one leg and then the other with fluroscopy imaging or x-ray
imaging or standing CT scan are mandatory. For me, I would never ever let
someone talk me into getting surgery on the basis of uneven iliac crests, unless
that grape kool aide is very, very spiked, rendering me vulnerable. knowledge is
power and carries an ethical responsibility. I invite clinicians to participate
in this public forum.
Jerry Hesch, Hesch Institute
True tennis elbow is a tendinitis of the extensor muscles and that tendon group originates on the humerus above the elbow. When there is pain that is below the elbow, and is in the lateral forearm, it might actually be an annular ligament sprain with a minimally subluxed radial head. The neck, just below the radial head (radius bone) is 2 to 3 fingers below the lateral elbow joint. It can be exquisetely tender when isolated. there will be a reduction of proximal supination, though oftentimes missed as the distal supination increases and compensates. However, careful over pressure comparing both forearms will be indicative. Traction to the radius will be lacking on the painful side as the mechanism of injury may be repetive trauma or a heavy lift that tractions the radius bone inferiorly. You will note less space between the end of the radius and the wrist. The radial head is round with a flat edge where the annulkar (ring) ligament wraps around it. So a traction injury is a bit like pulling a funnel down, because part of the ligament is significantly stretched, being pulled beyond the neck into the radial head..
Treatment? Gently grasp the radius, stabilize the upper arm, oscillate with moderate force after taking up the slack, 30 reps. Very effective and long lasting. Of course other rehab things can be pursued, this part addressed the primary restriction and positional ligament strain. If you unyielding tennis elbow, do have the above joint evaluated. Best Wishes, Jerry
Wishing all the blessings of the season to all, regardless of religion or not. Merry Christmas, Happy Hannukah and a very blessed New Year! Everyday is Christmas being a grandparent. I want to wish everyone good health in the new year.
I just uploaded some new videos to my YouTube account. They are on various topics and may be worthwhile to familiarize yourself with the video library.
Here's a link to my channel http://www.youtube.com/user/JERRYHESCH?feature=mhee
I welcome any comments.
When I evaluate feet and ankles and note very different function side to side, and see 2 identical orthotics, I am puzzled. When I see the same but 2 very different orthotics; I am pleased. Before getting for for orthotics it is ideal to have all of the joints of the foot and ankle evaluated and treated. There are several movement restrictions that are treatable and can distinctly improve the function of these joints. Long ago I learned that the orthotics do not make much change in the transverse plane, (where rotation occurs) they do affect frontal (front and back view of foot) and sagittal planes (lateral view). These joints are very strong, so they can take some abuse, and in fact do. They may or may not have local pain, but the body reflexively compensates elsewhere and this distal area over time may become symptomatic. It is not unusual to find muscle imbalances in the presence of joint restrictions, and these reflexively restore when the joint, ligament, tendons and muscle are balanced. Treat all. Per above, rotation in the transverse plane must be treated, especially at the subtalar joint. It can be very rewarding, one treatment, and the clinet should then know self management. Terms like pronation can be misued, most clients I see have been told they pronate (too much) and I find they do so only at the forefoot. Why? Because the rear foot and mid foot supinates excessively, in fact remain in supination. So the joint mobilization addressthe supination and restores functional pronation of the rear foot and mid foot, and then the forefoot pronates, less, now normally. If foot and ankle joint dysfunbction persists it can alter forces and movements at the knee, the hip, the pelvis and reflexively; as far as the neck. If "whole-body" is important, incorporating foot care in the paradigm provides a good foundation, literally and figuratively. Happy Friday! Jerry
This was a very remarkable presentation. A poker player cam to see me for headache and neck pain and low back pain. I was astonished at how very tight and unyielding his upper cervical spine was (occipito-atlantal) where the head and neck connect. Nothing I did there was effective so I knew to find the cause elsewhere. His hip were extremely tight bilaterally and I previously thought that this was simply the way they developed; concluded on a false positive for a hard bone-on-bone end-feel. Nothing else seemed to explain his presentation. This was the tightest upper cervical I had seen for some time, and sitting at the poker table and at his business computer would only compound the problem as the posture induces flexion throughout the spine but hyper-extension in the upper neck.
I treated both hips for 10 minutes, using a fulcrum to induce a very gentle force.
His neck released and in 2 visits, neck was normal with more hip range of motion, much less pain and muscle tightness. He was taught self-treatment, so he will be able to keep these gains, does not need to "keep coming back...".
Releasing the hips released the neck.
This is an example of the Hesch Method; treating the cause, not "the pain". Or perhaps worded better; treating the pain very effectively and efficiently by treating far away, treating the source.
Rule: When you cannot achieve gains in one part of the body, go elsewhere, typically below. If unilateral, go to the opposite side, below.
Thanks for visiting my blog.
Dr. Jerry Hesch, DPT, MHS, PT
Married 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.