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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. 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. Part 2. http://www.youtube.com/watch?v=tKYjwilI7Dk jerry hesch •
Tom, Great demo on the distinction! I also enjoy treating the first rib. The literature does not give a lot of direction, beyond elevated rib. I screen and treat for the following: 1. lateral elevation 2. posterior elevation with anterior depression 3. anterior elevation with posterior depression 4. anterior and medial rotation 5. posterior and medial rotation 6. inferior posterior portion elevated anterior 7. compressed medially at both ends. As the first rib is covered by the clavicle, the anterior portion can only be evaluated through the medial clavicle, and just beneath it. I agree with you re the relevance of treating the first rib, given the direct attachment of the top of the sympathetic chain. Keep up the good work, a client has found your posts. Best Regards, Jerry Hesch HESCH INSTITUTE 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 |
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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