From a LinkedIn blog on pelvic asymmetry August 2013
Taso Lambridis • Hi Jerry,
Thanks for the very clear comments surrounding the pubic symphysis, I do take a very similar approach to this as you do & yes radiographic findings certainly are more helpful than when considering the SIJ. Apologies for any misunderstanding around the comment regarding Andre Vleeming, it was directed to an earlier comment by Roel Lameris. Not sure if you are attending the upcoming world congress in Dubai end of Oct/begining Nov but certainly lookinf forward to any new material that comes out of the conference and any new perspectives that Andre & others involved in the area may have for us. Regards, Taso
Hi Taso,
I find the A-P films of the pelvis to be challenging because they typically are taken either in standing or supine and not from a perpendicular angle to the sagittal orientation of the pubic bones. Nonetheless, they can give some information and at times one can measure the interpubic width at the middle of the joint which as you probably know, is an accepted protocol.
I have a modified machinists tooll that is best described as a plunger with a ruler which I use on very rare occasions when a client presents with a significant palpable depression of the symphyseal fibrocartilage. I also use a Carpenters contour gauge to measure pre-and-post shape of the pubic bones and fibrocartilage. In an ideal world of course, we would have access to imaging tools and a litany of good research to guide us. In the absence thereof, given that there are knowledge gaps, as I know you agree, we have to do the best with what we have to help our patients. There is a paucity of published research to guide treatment of the symphysis pubis. The orthopedic trauma literature as I posted earlier, does bring a novel perspective to the traditional physical therapy and women’s health physical therapy approach to both pubic joint dysfunction and pubic joint AKA symphysis pubis diastasis, AKA symphyseal diastasis.
Sadly, in parts of the world there are women who are still in wheelchairs from having had intentional, meaning surgical cutting of the symphysis pubis to facilitate easy birth. In some regions such as Zimbabwe this is a life saving procedure and the statement is made that they do not suffer any long-term sequelae. However, there is no objective measurement to demonstrate that they do heal. Separately, there is a very small amount of literature which hints at a difference in ability to recover and a difference in experienced pain related to childbirth and to trauma as related to childbirth such as intentional or non-intentional symphyseal diastasis. So, the topic of pelvic asymmetry as relates to the symphysis pubis is a very relevant topic and it has to do with an underserved population. I would hate to even imply that medicine and rehabilitation ignores such and has a paternalistic and chauvinistic undergirding. Who knows?
I did intend to attend the world Congress in Dubai and I had two abstracts accepted. One on the very topic of symphyseal diastasis, presenting MRI images for a novel biomechanical interpretation. However, I have decided to focus my resources of economy and time and need, and will schedule surgery around that time. I do have 2 presentations at AAOMPT in October, much more economically feasible. Will you attend the congress?
No need to apologize I just wanted to clarify that it was not I who made the comment regarding Andry Vleeming.
I look forward to hearing more of your work. Thank you for your thoughtful, engaging, and polite interactions.
With best regards,
Jerry Hesch
Taso Lambridis • Hi Jerry,
Thanks for the very clear comments surrounding the pubic symphysis, I do take a very similar approach to this as you do & yes radiographic findings certainly are more helpful than when considering the SIJ. Apologies for any misunderstanding around the comment regarding Andre Vleeming, it was directed to an earlier comment by Roel Lameris. Not sure if you are attending the upcoming world congress in Dubai end of Oct/begining Nov but certainly lookinf forward to any new material that comes out of the conference and any new perspectives that Andre & others involved in the area may have for us. Regards, Taso
Hi Taso,
I find the A-P films of the pelvis to be challenging because they typically are taken either in standing or supine and not from a perpendicular angle to the sagittal orientation of the pubic bones. Nonetheless, they can give some information and at times one can measure the interpubic width at the middle of the joint which as you probably know, is an accepted protocol.
I have a modified machinists tooll that is best described as a plunger with a ruler which I use on very rare occasions when a client presents with a significant palpable depression of the symphyseal fibrocartilage. I also use a Carpenters contour gauge to measure pre-and-post shape of the pubic bones and fibrocartilage. In an ideal world of course, we would have access to imaging tools and a litany of good research to guide us. In the absence thereof, given that there are knowledge gaps, as I know you agree, we have to do the best with what we have to help our patients. There is a paucity of published research to guide treatment of the symphysis pubis. The orthopedic trauma literature as I posted earlier, does bring a novel perspective to the traditional physical therapy and women’s health physical therapy approach to both pubic joint dysfunction and pubic joint AKA symphysis pubis diastasis, AKA symphyseal diastasis.
Sadly, in parts of the world there are women who are still in wheelchairs from having had intentional, meaning surgical cutting of the symphysis pubis to facilitate easy birth. In some regions such as Zimbabwe this is a life saving procedure and the statement is made that they do not suffer any long-term sequelae. However, there is no objective measurement to demonstrate that they do heal. Separately, there is a very small amount of literature which hints at a difference in ability to recover and a difference in experienced pain related to childbirth and to trauma as related to childbirth such as intentional or non-intentional symphyseal diastasis. So, the topic of pelvic asymmetry as relates to the symphysis pubis is a very relevant topic and it has to do with an underserved population. I would hate to even imply that medicine and rehabilitation ignores such and has a paternalistic and chauvinistic undergirding. Who knows?
I did intend to attend the world Congress in Dubai and I had two abstracts accepted. One on the very topic of symphyseal diastasis, presenting MRI images for a novel biomechanical interpretation. However, I have decided to focus my resources of economy and time and need, and will schedule surgery around that time. I do have 2 presentations at AAOMPT in October, much more economically feasible. Will you attend the congress?
No need to apologize I just wanted to clarify that it was not I who made the comment regarding Andry Vleeming.
I look forward to hearing more of your work. Thank you for your thoughtful, engaging, and polite interactions.
With best regards,
Jerry Hesch
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