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
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
1 Comment
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. 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 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. 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. “ |
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
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