Jerry’s Blog – A Manual Therapy Client & Practitioner Discussion Forum

WHAT THE HECK IS A POSTERIOR SACRUM?

3/11/2013

http://robshapiropt.com/2013/03/06/what-the-heck-is-a-posterior-sacrum/
ROB SHAPIRO'S BLOG, jERRY ADDENDUM BELOW

What the heck is a posterior sacrum ?

Great case study this weekend at the Hesch Method seminar in Las Vegas
where I had the opportunity to assist Jerry teach. I’m just hoping what gets
taught in Vegas does not stay in Vegas.
. One of the students presented with what Jerry Hesch calls a
“posterior sacrum”. A posterior sacrum is defined as a dysfunction in which the
entire sacrum is stuck in a posterior glide between the ilia and bilateral
sacral sulci are shallow. When trying to spring the sacrum and ilium all motions
are blocked and both sacrospinous and sacrotuberous ligaments are taut to
palpation. This dysfunction can cause havoc up the kinetic chain up to the
occiput. The mostly likely cause of this non-physiological dysfunction is some
sort of trauma such as landing on the buttocks. A common complaint by the
patient is increased fatigue, headaches and increased urinary frequency. This
weekend one of the students had this seemingly rare dysfunction with these same
complaints. She was used as a case study using the Hesch Method which consisted
of gentle mobilizations which were performed both manually and with the use of
props to enhance soft tissue mobility based on the the principle of viscoelastic
creep. The treatment took a total of about 15 minutes and consisted of 5
different mobilizations to correct the dysfunction and associated mobility
restrictions and the student got off the table and stated how loose and mobile
she felt. She was given a home exercise program to follow and will report back
to us on her progress.

The main purpose of this short article is to
share with you another tool that can help you with those hard to figure out and
often frustrating cases. For more information go http://www.heschinstitute.com
or check out Jerry’s many videos on YouTube (search
JerryHesch)

jERRY WRITES:
I look forward to following up with her soon, the case of posterior
glide sacrum. AQlso, found the first one in a tall slender male, never have
encouontered it in a male before. Gotta stay awake and pay attention and be
cautious of belief; never say never. The spontaneous exclamation when the gal
stood up and walked was "Wow" x3! Putting drama and enthusiasm aside, it is a
very relevant very under-appreciated and under-treated dysfunction. How can we
spread the word, get researcers engaged, case studies...any volunteers to work
together?

MORE ON SACROILIAC PATTERNS

7/26/2012

1. Downslips occur frequently but self-correct during the gait cycle. False,
this is just a belief articulated a very long time ago. The orientation of the
SIJ is such that forces going superiorly through the hip joint do n

More SIJD

7/26/2012

Physican compliment re Hesch treatment for SIJD. I am an MD. I was attending a conference on pelvic pain where Jerry Hesch PT was speaking. I have a lot of issues of my own so I went to see him. I have lax ligaments and in particular lower back pain as

7/24/2012

JERRY'S INTERVIEW ON The Pelvic Messenger broadcast! Here is the link to the archived broadcast: http://www.blogtalkradio.com/pelvicmessenger/2012/06/28/jerry-hesch-of-the-hesch-institute-and-his-work-with-cpp

6/29/2012

Inquiry re videos on fused sij and micromotion

3/30/2012

Amy:
I feel a little "101" here, but what is the bullet point implications here - I kinda assumed fused = no movement anywhere. The SIJ might not move much but lose that micromotion and some macromotions get effected. What is that lateral marco motion used for, is probably a better way to ask my question.

Jerry Hesch
Amy, just after I posted it I scrolled through my You tube videos and made the discovery some time ago, just did not recall! So there is another video on same topic with CT scan evidence. Yes fused left sij means no movement in the left SIJ. I do believe that every biomechanical expert would be very surprised to see that a one-sided SIJ fusion significantly restricts pelvic side-glide mobility. Pelvic side glide is not thought to be a pure motion in the sij, but rather very minuimal sij motion and more motion of the lumbar spine and of the hip joints. Place your hand on the sacrum and try to glide it left and right, tell me what you find. lie the person on their left side and compress the right ilium and spring test it. What do you feel? I will explain.

Jerry Hesch
The lateral micromotion is a functional motion during gait, lateral weight shift, etc. It of course becomes a macromotion during such movements. The test for this motion is very relevant as some clients have it restricted, yet it is treatable with Hesch Method and it is a preventive model. Side-glided pelvis' even if subtle alter weight bearing throughout the kinetic chain, especially the lower extremities, and of course as you know; will create a distal compensation such as at the occipitoatlantal joint, which in time becomes symptomatic and non responsive to "adjusting the upper cervical spine". Does that answer your question. Micromotion is such a fundamental property of joints like the SIJ, so very relevant to test if one is using terminology such as "joint". Otherwise one is talking about the bony pelvis as it moves on the hips, which is NOT sij motion, despite the popularity thereof. I believed such for many years, but could not ignore the burgeoning research.

Case study. Fused right sacroiliac from pathology, spring tests

3/29/2012

After the seminar we filmed a PT who has a pathological fusion of one sacroiliac joints. I was amazed to see how significantly this restricted pelvic side-glide tested passively. The SIJ might not move much but lose that micromotion and some macromotions get effected. There are 2 videos, part 1, 2.
Please copy and paste in browser.
Part 1.
http://www.youtube.com/watch?v=xc1NU7XnmwE
Part 2.
http://www.youtube.com/watch?v=tKYjwilI7Dk

Compliment from a respected colleague

3/21/2012

Received March 2012. I am pleased to receive this from Scott Burch, PT. Especially so because I respect his manual skills and clinical skills in general. He teaches and has taught a lumbopelvic course for many years, and I am pleased that this approach is meaningful to him, additive. I gave him my Power Point program and permission to use whatever he wants to from workbook etc. He helped me understand the value of very specific hip capsule testing beyond the usual hip scour test. I kind of envy his clinical situation as he is part of a team, multiple specialties in the same building. I am limited in my clinical hours, so best option is the specialty consults via home office and writing, teaching. Two surgeries are in the wings, one a hard mass under forarm impinges ulnar nerve. Please forward a triplicate complaint form! OK back on topic.

Jerry,
Thank you for your letter. I am sorry for the delay, in replying to you. I wanted to wait and see how your methods work, and how i could add it to what i already do. I have found that your
techniques are very beneficial. The more chronic the condition, the more benefit has seem to benefit the pt, and is a good adjunct to what i do. I have been able to make some progress with a few folks that i had been stuck with.

I have not gotten together with my teaching partner, so we have not decided upon anything. I will let you know.
Thanks,
Scott

sacroiliac alignment

3/18/2012

In response to an inquiry re pelvic/sij alignment.
Derek,
I have seen x-rays of "aligned" clients who had surgery and they were not aligned at the symphysis pubis joint and not aligned in the transverse plane. Tops of iliac crests appear to be symmetrical. a huge problem is the fact that the body can cause asymmetry of the pelvis from joints in the spine, hip, knee, the 26 bones in foot and ankle, all the musculature, even asymmetry of shoulders can pulll on a muscle that connects the shoulder to the ilium; latissimus dorsi.

Research on x-rays covered in my torsion chapter briefly, positional artifact can affect some of the alignment. Some clients have a developmental asymmetry of the hemipelvis and this can be readily discerned. I am much more concerned about maximizing joint function than "alignment". Asymmetry, visual malalignment guides me to do passive joint testing to confirm or negate possibilities.

Several pelvic asymmetries look very similar, so the passive mobility testing and ligament testing is crucial to discern. Further there are advanced patterns that are not taught to Physical Therapists, that PT's cannot find with the traditional testing. It is what it is. It is far more comnplex than what is being propounded, but fortunately for the majority, the presentation is fairly typical such as the Most Common Pattern. If interested in more you can find more at the Hesch Institute web site. Snake oil or purple kool aide $$$ dunno but we can be much more thorough in testing and treating and much more honest in the information we give to desperate clients. It is a choice we (as clinicians) can make.

Nice follow up: severe sciatica 2 years duration

2/22/2012

This is a spontaneous Email from a PT from out of state. I saw her once and gave a strong letter suggesting a work up for discitis (infection in the disc) and this or a lower thoracic herniateion after testing with provocation, first in neutral, then extension, then child pose, tapping T1-S5. She had 2 fairly normal MRI’s yet severe sciatica for 2 years, obviously in significant duress, runs a large practice, has a 3 year old and a one year old and this really affects her ability to be a mom.

“…I have felt improvment no doubt due to seeing you. I have more range of motion without
such a stiff end range in every position I tried. I would have unrelievable pressure that seems you have really helped. I do think the underlying cause you are probably right on track with the discitis. After researching it, it makes more since. This is the best I have felt in over a year, and the cheapiest thing yet.

…Shirley Sarhmann has a great outlook on the effects on mal alignment and recoil etc.…If
someone would put her methods and yours together, it would be amazing. In fact that was the approach I took. I had two 270 pound men who were thinking of surgery become pain free by using your and her techniques. And they lost no weight….THank you, Thank you, Thank you. And I will now return any help i can to you. “