From LinkedIn Sacroiliac dialogue May 11, 2014
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
There are many motion patterns of the pelvic complex that can cause pelvic asymmetries. Having cleared lower extremity influences in a hypothetical client (this includes a seated leg length screen, and attempt to qualify symmetry of trochanters) one can focus on the pelvic structure. The majority of asymetries are not due to abnormal movement within the sacroiliac joint so the terminology I will use is faulty pelvic motion coupling. The other assumption being that lumbar influences are essentially ruled out. To be continued...
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
One does have to screen the pubic joint and test the SIJ, but in this example these are clear.
The Pelvis has 6 typical unilateral patterns and can have 2 typical bilateral patterns.
In advanced patterns there are several more which are unique to the Hesch model, but will defer elaboration.
These typical patterns are not based on traditional gross motion tests palpating pelvic landmarks but rather require ligament tone evaluation and passive spring tests to discern lack of mobility, typically treatable, sometimes pathological.
For additional info see the HeschInstitute web site.
Nearly every pattern (excepts those that do not recur) have a self-treatm,ent component. Some patterns including sacral, pubic joint, and advanced "ilium/hemipelvis patterns" are resolved with one treatment and therefore home program not needed. Uniquely described are predictable patterns of dysfunction such that a sequence of dysfunctions are treated in order to be thorough, rather than a single movement diagnosis and a single treatment. There are exceptions.
David Stern DC PT
Owner/Director at Rocky Point Physical Therapy
Jerry what do you think of Mark Laslett's PT research on the SI jt?
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
David,
I can speak to how it is interpreted and utilized and I will give an extreme example.
I have a you tube video and in my workshop I teach how one can relatively isolate the posterior ligamentous complex of the sacroiliac for intra-individual and inter-individual (left/right side) and suggest that a fair generalization is that there is a distinct gender difference on any given day in the clinic with few exceptions. So isolating the hip of which the mid acetabulum is <3" from the mid SIJ, and shares same innervation versus isolating the SIJ has some yet undefined (published research) margin of error.
The other tests need very cautious interpretation because they are also hip provocation tests.
The one test that gets closer to the SIJ the sacral thrust is problematic in that it stresses the elements of at least the lowest lumbar segment also, perhaps primarily.
Hip Int. 2013 Feb 12:0. doi: 10.5301/HIP.2013.10729. [Epub ahead of print]
Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement.
Morgan PM, Anderson AW, Swiontkowski MF
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
The intra-articular injections that were described as the "gold-standard" are not gold standards and new light has been shed on the problem with some injections. So we ahve some tests, up to three that correlate with a positive response to an intra-articular injection. How long does the benefit last, how about repeat injection, what about issues as described by the authors below such as a rent in anterior capsule such that the lidocaine bathes that lumbosacral plexus, etc.
Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S.Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31. http://www.ncbi.nlm.nih.gov/pubmed/17530380
Borowsky, Claude D. Fagen, Glenn1 (2008). Sources of Sacroiliac Region Pain: Insights Gained From a Study Comparing Standard Intra-Articular Injection With a Technique Combining Intra- and Peri-Articular Injection. Archives of Physical Medicine & Rehabilitation Vol. 89 Issue 11, p2048 9p.
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
I respect pain and I respect the fact that it is many times as Gregory Grieve stated "A good policeman but a poor counselor."
I find more biomechanical dysfunction in the lumbopelvic-hip complex than I do symptomatic and they can have wide reaching effects such as via the oculo-pelvic reflex. Complex topic that cannot get its due in a few posts. My workbook is at 277 pages right now. Many converging and especially many diverging opinions and very limited research. What do we do clinically...
The MET/Osteopathic model the latter fully articulated in 1958 culling works from prior decades does get a significant reinterpretation. Also my work on symphyseal diastasis has a de novo interpretation per MRI's from the trauma literature. It does predict a need for a novel treatment approach, was presented at CSM 2014, AAOMPT 2013, IPPS 2011. (Hesch).
What are your thoughts?
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
There are many motion patterns of the pelvic complex that can cause pelvic asymmetries. Having cleared lower extremity influences in a hypothetical client (this includes a seated leg length screen, and attempt to qualify symmetry of trochanters) one can focus on the pelvic structure. The majority of asymetries are not due to abnormal movement within the sacroiliac joint so the terminology I will use is faulty pelvic motion coupling. The other assumption being that lumbar influences are essentially ruled out. To be continued...
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
One does have to screen the pubic joint and test the SIJ, but in this example these are clear.
The Pelvis has 6 typical unilateral patterns and can have 2 typical bilateral patterns.
In advanced patterns there are several more which are unique to the Hesch model, but will defer elaboration.
These typical patterns are not based on traditional gross motion tests palpating pelvic landmarks but rather require ligament tone evaluation and passive spring tests to discern lack of mobility, typically treatable, sometimes pathological.
For additional info see the HeschInstitute web site.
Nearly every pattern (excepts those that do not recur) have a self-treatm,ent component. Some patterns including sacral, pubic joint, and advanced "ilium/hemipelvis patterns" are resolved with one treatment and therefore home program not needed. Uniquely described are predictable patterns of dysfunction such that a sequence of dysfunctions are treated in order to be thorough, rather than a single movement diagnosis and a single treatment. There are exceptions.
David Stern DC PT
Owner/Director at Rocky Point Physical Therapy
Jerry what do you think of Mark Laslett's PT research on the SI jt?
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
David,
I can speak to how it is interpreted and utilized and I will give an extreme example.
I have a you tube video and in my workshop I teach how one can relatively isolate the posterior ligamentous complex of the sacroiliac for intra-individual and inter-individual (left/right side) and suggest that a fair generalization is that there is a distinct gender difference on any given day in the clinic with few exceptions. So isolating the hip of which the mid acetabulum is <3" from the mid SIJ, and shares same innervation versus isolating the SIJ has some yet undefined (published research) margin of error.
The other tests need very cautious interpretation because they are also hip provocation tests.
The one test that gets closer to the SIJ the sacral thrust is problematic in that it stresses the elements of at least the lowest lumbar segment also, perhaps primarily.
Hip Int. 2013 Feb 12:0. doi: 10.5301/HIP.2013.10729. [Epub ahead of print]
Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement.
Morgan PM, Anderson AW, Swiontkowski MF
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
The intra-articular injections that were described as the "gold-standard" are not gold standards and new light has been shed on the problem with some injections. So we ahve some tests, up to three that correlate with a positive response to an intra-articular injection. How long does the benefit last, how about repeat injection, what about issues as described by the authors below such as a rent in anterior capsule such that the lidocaine bathes that lumbosacral plexus, etc.
Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S.Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31. http://www.ncbi.nlm.nih.gov/pubmed/17530380
Borowsky, Claude D. Fagen, Glenn1 (2008). Sources of Sacroiliac Region Pain: Insights Gained From a Study Comparing Standard Intra-Articular Injection With a Technique Combining Intra- and Peri-Articular Injection. Archives of Physical Medicine & Rehabilitation Vol. 89 Issue 11, p2048 9p.
Jerry Hesch
President Hesch Institute - Las Vegas Manual Therapy
I respect pain and I respect the fact that it is many times as Gregory Grieve stated "A good policeman but a poor counselor."
I find more biomechanical dysfunction in the lumbopelvic-hip complex than I do symptomatic and they can have wide reaching effects such as via the oculo-pelvic reflex. Complex topic that cannot get its due in a few posts. My workbook is at 277 pages right now. Many converging and especially many diverging opinions and very limited research. What do we do clinically...
The MET/Osteopathic model the latter fully articulated in 1958 culling works from prior decades does get a significant reinterpretation. Also my work on symphyseal diastasis has a de novo interpretation per MRI's from the trauma literature. It does predict a need for a novel treatment approach, was presented at CSM 2014, AAOMPT 2013, IPPS 2011. (Hesch).
What are your thoughts?
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