Sacral Rotation About a Vertical Axis Dialogue with Jerry Hesch, MHS, PT
This is an email dialogue concerning the topic of Sacral Rotation about a vertical Axis.
I intentionally removed the name _____________ of the person initiating the e-mail. He/She is a PhD, PT from a University. I think this communication highlights a not uncommon misunderstanding regarding sacral mechanics, as described by the Osteopathic profession, as taught by some Osteopaths and Physical Therapists, etc. This dialogue references the basic and intermediate Hesch Method Seminar taught by Chris Gregor-Maxwell, MS, PT,* which covered:
Please note that there are a few other sacral motion dysfunctions in the Hesch Method advanced body of work. I am presently teaching it via distance learning and I have 4 students. Beta version! More on this later.
* (Email sent to Chris Gregor-Maxwell MS, PT, AT)
Friday September 28, 2007
Chris,
We will have to agree to disagree on several of the points we have exchanged. I will expand on several of them: The osteopathic model does not include the possibility of a right or left rotated sacrum. The most thorough reference is Greenman's Principles of Manual Medicine beginning on page 364. "I also think that as you start to evaluate the sacrum on individual patients with the Hesch spring tests..." This phrase is at the center of my misgivings about the method. There is no evidence base in current literature for the Hesch method.
I am hesitant to speak with Jerry himself, but I will think on it.
Have a good weekend,
(name intentionally removed), PT, PhD
Chris's reply sent Monday October 1, 2007
(I put her very quotable statment in italics, fabulous wording and it certainly echoes my sentiments.)
Hi __________,
I really do encourage you to speak with Jerry. I think you will have an excellent exchange, especially since you both know the Osteopathic literature so well. Yet I cannot help think that PT's are not inferior to Osteopaths in delving into this area- we are our own profession, and justly can develop our own techniques as long as they are based on solid anatomical principles.
Thanks- Chris
Jerry Hesch's reply sent Monday, October 1, 2007
Dear Chris and _________,
Very worthwhile debate. I appreciate Dr. Greenman's efforts at a "minimum diagnostic criterea". He has made significant contributions to the Osteopathic profession and I have read his works and attended some of his presentations. In fact back in the late 70's before getting into PT school I was reading his work, and works such as The Neurobiologic Mechanism of Spinal Manipulative therapy, etc. However, Dr. Greenman's work does not completely encompass Osteopathic manual Therapy, but rather his interpretation of what is relevant.
You can find the definition of sacral rotation about a vertical axis in the Osteopathic glossary, see figure 51 and the definition that refrences it. http://www.osteopathic.org/pdf/sir_collegegloss.pdf There are some peculiar contemporary writings in the Osteopathic profession, such as the belief that the occipito-atlantal joint moves through 90 degress of flexion/extension in a recent tome on Osteopathic theory, and I could name others. Biomechnical research indicates that cervical extension/flexion at the O-A joint is approximately 15 degrees, and no greater than 35 degrees. (see refernces 1, 2, 3 below). I think we need to interpret some of the Osteopathic writings in nlight of contemporary research. 1. Mercer S, Bogduk N. Joints of the cervical vertebral column. J Ortho Sports PT 2001;31:174-182. 2. Frobin W, Leivseth G, Biggemann M, Brinckmann P. Sagittal plane motion of the cervical spine: a new precision measurement protocol and normal data of healthy adults. Clin Biomech. 2002;17:21-31. 3. Panjabi, MM, crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load displacement curves. Spine. 2001;2692:2700. Back to the sacrum, in 25 years I have never seen a unilateral sacral flexion/extension and I have spoken with manual therapy educators who agree that it does not exist based on more data than the "mimimum diagnostic criterea." I use additional palpatory landmarks and many passive accessory motion spring tests to the sacrum (springing with awareness), this covered in the paper I presented at World congress on LBP 1992 and APTA national convention 1990 (I will post these references and the papers later). Sound biomechanical theory and respect for the viscoelastic nature of the SIJ required (1990) that I formally abandon the "minimum diagnostic criterea." While I can cite other examples, it is not my intent to be critical thereof. Yes, we need research. The McKenzie body of work was not researched until a considerable time after he started teaching and writing, I believe 10-15 years, and early publications were descriptive. I am doing my part in sharing this work and we need greater participation. I have had life-long considerable health challenge, economic challenge, etc. I make no apology for that, and no apology for the way it has impeded my ability to share this work.
Is there any significant research on the oblique axis or unilateral
flexion/extension Osteopathic Model? My understanding is that these are theoretical constructs, without any significant research, and my literature search was perfoemed yesterday (PubMed).
Dr William Brooks, DO in Kansa City Kansas is writing a major textbook that brings significant inquiry into Ostopathic musculoskeletal paradigm and offers significant enhancement, (I fear I am being too light with my language here). A recent e-mail is appended below. Please let me know if this is helpful and ________ I am happy to converse with you.
Best Regards
Jerry Hesch
Recent Email from William Brooks, DO
Friends -
Mike and I submitted and have received approval from the NSU IRB,
etc. for our next study - the intra-rater reliability study to be
completed next spring in Ft. Lauderdale. I will be spending a week
with Mike in FL in January, February, March, and April - to complete
the reliability study and present our initial seminar (Introduction
to Comprehensive Biomechanical DIagnostics - Level I) (in January).
In May Mike and I will be major presenters at the international
osteopathic conference in Germany and will immediately thereafter
present the Level I seminar to the German MD group "DGOM".
Attached is a minor revision of a chapter and a new chapter of the
book. This most recent chapter is a critique of the osteopathic
concept of somatic dysfunction and offers a new definition and criteria.
Thanks! Bill
(William Brooks, DO)
I intentionally removed the name _____________ of the person initiating the e-mail. He/She is a PhD, PT from a University. I think this communication highlights a not uncommon misunderstanding regarding sacral mechanics, as described by the Osteopathic profession, as taught by some Osteopaths and Physical Therapists, etc. This dialogue references the basic and intermediate Hesch Method Seminar taught by Chris Gregor-Maxwell, MS, PT,* which covered:
- sacral rotation about a vertical axis (left/right)
- sacral side-bending (right/left)
- sacral torsion about an oblique axis (4 types)
- superior and inferior sacral glide
- forward and backward bending of the sacrum
Please note that there are a few other sacral motion dysfunctions in the Hesch Method advanced body of work. I am presently teaching it via distance learning and I have 4 students. Beta version! More on this later.
* (Email sent to Chris Gregor-Maxwell MS, PT, AT)
Friday September 28, 2007
Chris,
We will have to agree to disagree on several of the points we have exchanged. I will expand on several of them: The osteopathic model does not include the possibility of a right or left rotated sacrum. The most thorough reference is Greenman's Principles of Manual Medicine beginning on page 364. "I also think that as you start to evaluate the sacrum on individual patients with the Hesch spring tests..." This phrase is at the center of my misgivings about the method. There is no evidence base in current literature for the Hesch method.
I am hesitant to speak with Jerry himself, but I will think on it.
Have a good weekend,
(name intentionally removed), PT, PhD
Chris's reply sent Monday October 1, 2007
(I put her very quotable statment in italics, fabulous wording and it certainly echoes my sentiments.)
Hi __________,
I really do encourage you to speak with Jerry. I think you will have an excellent exchange, especially since you both know the Osteopathic literature so well. Yet I cannot help think that PT's are not inferior to Osteopaths in delving into this area- we are our own profession, and justly can develop our own techniques as long as they are based on solid anatomical principles.
Thanks- Chris
Jerry Hesch's reply sent Monday, October 1, 2007
Dear Chris and _________,
Very worthwhile debate. I appreciate Dr. Greenman's efforts at a "minimum diagnostic criterea". He has made significant contributions to the Osteopathic profession and I have read his works and attended some of his presentations. In fact back in the late 70's before getting into PT school I was reading his work, and works such as The Neurobiologic Mechanism of Spinal Manipulative therapy, etc. However, Dr. Greenman's work does not completely encompass Osteopathic manual Therapy, but rather his interpretation of what is relevant.
You can find the definition of sacral rotation about a vertical axis in the Osteopathic glossary, see figure 51 and the definition that refrences it. http://www.osteopathic.org/pdf/sir_collegegloss.pdf There are some peculiar contemporary writings in the Osteopathic profession, such as the belief that the occipito-atlantal joint moves through 90 degress of flexion/extension in a recent tome on Osteopathic theory, and I could name others. Biomechnical research indicates that cervical extension/flexion at the O-A joint is approximately 15 degrees, and no greater than 35 degrees. (see refernces 1, 2, 3 below). I think we need to interpret some of the Osteopathic writings in nlight of contemporary research. 1. Mercer S, Bogduk N. Joints of the cervical vertebral column. J Ortho Sports PT 2001;31:174-182. 2. Frobin W, Leivseth G, Biggemann M, Brinckmann P. Sagittal plane motion of the cervical spine: a new precision measurement protocol and normal data of healthy adults. Clin Biomech. 2002;17:21-31. 3. Panjabi, MM, crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load displacement curves. Spine. 2001;2692:2700. Back to the sacrum, in 25 years I have never seen a unilateral sacral flexion/extension and I have spoken with manual therapy educators who agree that it does not exist based on more data than the "mimimum diagnostic criterea." I use additional palpatory landmarks and many passive accessory motion spring tests to the sacrum (springing with awareness), this covered in the paper I presented at World congress on LBP 1992 and APTA national convention 1990 (I will post these references and the papers later). Sound biomechanical theory and respect for the viscoelastic nature of the SIJ required (1990) that I formally abandon the "minimum diagnostic criterea." While I can cite other examples, it is not my intent to be critical thereof. Yes, we need research. The McKenzie body of work was not researched until a considerable time after he started teaching and writing, I believe 10-15 years, and early publications were descriptive. I am doing my part in sharing this work and we need greater participation. I have had life-long considerable health challenge, economic challenge, etc. I make no apology for that, and no apology for the way it has impeded my ability to share this work.
Is there any significant research on the oblique axis or unilateral
flexion/extension Osteopathic Model? My understanding is that these are theoretical constructs, without any significant research, and my literature search was perfoemed yesterday (PubMed).
Dr William Brooks, DO in Kansa City Kansas is writing a major textbook that brings significant inquiry into Ostopathic musculoskeletal paradigm and offers significant enhancement, (I fear I am being too light with my language here). A recent e-mail is appended below. Please let me know if this is helpful and ________ I am happy to converse with you.
Best Regards
Jerry Hesch
Recent Email from William Brooks, DO
Friends -
Mike and I submitted and have received approval from the NSU IRB,
etc. for our next study - the intra-rater reliability study to be
completed next spring in Ft. Lauderdale. I will be spending a week
with Mike in FL in January, February, March, and April - to complete
the reliability study and present our initial seminar (Introduction
to Comprehensive Biomechanical DIagnostics - Level I) (in January).
In May Mike and I will be major presenters at the international
osteopathic conference in Germany and will immediately thereafter
present the Level I seminar to the German MD group "DGOM".
Attached is a minor revision of a chapter and a new chapter of the
book. This most recent chapter is a critique of the osteopathic
concept of somatic dysfunction and offers a new definition and criteria.
Thanks! Bill
(William Brooks, DO)