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advice on correcting pelvic outflare
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advice on correcting pelvic outflare - December 4, 2000 4:07:00 PM
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AimeePT
Posts: 3
Joined: November 12, 2000
From: Stafford, TX, USA
Status: offline
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need some help on fixing a right pelvic outflare accompanied by an apparent scoliosis with left convexity, apex in the mid thoracic.
xrays of lumbar are negative; myofascial tightness variable left vs right.
just now attaining subacute phase of pain management. have begun mobilizations via isometrics.
patient experiencing LLE weaknes and pain similar to SI dysfxn.
getting nowhere....
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Re: advice on correcting pelvic outflare - December 5, 2000 6:47:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline
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Aimee,
Was that SI or S1 dysfunction with regard to your comment about LE weakness and pain?
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Re: advice on correcting pelvic outflare - December 6, 2000 3:09:00 PM
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AimeePT
Posts: 3
Joined: November 12, 2000
From: Stafford, TX, USA
Status: offline
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that would be a sacroiliac dysfxn. sorry for the possible confusion.
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Re: advice on correcting pelvic outflare - December 6, 2000 5:44:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Aimee:
As per our previous threads, you must be aware that palpation testing of SI joint has never been shown to be reliable. You may think you are feeling an outflare but how do we know?
A great lumbar program for SI or other disorders is the Richardson and Jull STabilization program. I suggest you get the book Therapuetic exercises for spinal segmental stabilization.
If you are looking for specific osteopathic technique advice, I cannot really help you.
good luck,
Marc
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Re: advice on correcting pelvic outflare - December 7, 2000 6:55:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline
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Please describe the weakness and pain pattern.
While symptoms may be similar to SI dysfunction, they also are similar to L3 dysfunction or illiolumbar lig. dysfunction.
Irritation to lumbar or lumbo-sacral areas will cause protective guarding producing a functional scoliosis and positional faults in the pelvis. Imagine sticking a knife into your right L5S1 region and feel what your body does to compensate--right side flex (scoliosis), lat rotate and flex hip and pelvis (outflare and post rotation of illium)
I would be very suspicious of the L spine structures, espcially since SI treatment has not achieved success.
[This message has been edited by edilling (edited December 07, 2000).]
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Re: advice on correcting pelvic outflare - December 8, 2000 6:26:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
Status: offline
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Aimee,
I don't actually think that pelvic outflares exist in the sense that this perceived malposition or assymetry of the bony prominence leads to any sort of predictable dysfunction. So I guess I'm saying that you've described a "problem" that can't be seen.
But if, and I'm saying if, it did exist. Why would it hurt?
------------------
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Re: advice on correcting pelvic outflare - December 8, 2000 12:24:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline
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Aimee,
I agree with Barrett. I once looked at a young female patient with a colleague...he was troubled by her presentation...and she was the only patient I've ever seen that truly looked like she had a flared out ilium. He rightly sent her back to MD with his concerns and turns out she had Ewing's sarcoma. Not to say that outflares never ever happen but it seems that if they did the symphasis would be spread and mighty sore. Over the last 15 years I haven't seen what I can confidently say was an outflare. And in a patient with scoliosis, what we interpret as an outflare may just be anatomic variance, or part of a rotational component to the scoliosis (be it functional or structural). As Mcap said, palpation has yet to be shown valid as an evaluative tool for SI dysfuntion. I'd go back again to the lumbar spine and do a detailed biomechanical assessment if necessary, mobilize what's stiff and stabilize what's loose. I like the Richardson, et.al, stuff too, if you need a resource. One last thought...what kind of LE weakness? Why would an SI dysfuntion cause LE weakness (other than reflex inhibition due to pain)?
I'd be interested to know what you do with this patient and how (s)he does.
Betty
[This message has been edited by Betty Smoot (edited December 08, 2000).]
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Re: advice on correcting pelvic outflare - December 10, 2000 1:59:00 PM
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AimeePT
Posts: 3
Joined: November 12, 2000
From: Stafford, TX, USA
Status: offline
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Thanks everyone for the advice. I am absorbing everything and have some probing to do into the references you all provided. after reviewing the patient again, it does appear to be coming more from the lumbar region with muscle guarding. i will let you all know what i find out.
thanks again.
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Re: advice on correcting pelvic outflare - December 10, 2000 3:40:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Aimee:
Just please remember when you proceed that you should not focus so much on the source of the problem. Why?? You probably won't be able to find it.
Dr. Nachemson, respected by many as the top researcher in low back pain recently spoke at a conference in NYC. He stated that most LBP, about 85% is NON-SPECIFIC low back pain. A precise diagnosis is only possible in about 15% of cases. This includes the use of diagnostic technology. Non-specific does not imply that there is no cause but it does mean that we are unable to find it, no matter what it is.
PTs can continue to proceed as if they can tell the difference between a facet, disc and SIJ problem, or a "muscle strain." But so far, there is absolutely no research that tells us we can. Anyone who thinks they can should step up with the research.
As PTs, our job is to find and address the mechanical deficits, not to find the exact problem in every case. By doing our jobs correctly we free ourselves from the burden that most spinal physicians have to wrestle with every day - telling the pateint where the pain is coming from. The truth is that we may not know!!!!!!!
If you are interested in low back pain - I suggest Waddell's Back Pain Revolution. I have recommended it several times in this forum but so far, I don't think I have had any takers [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Good luck,
mcap
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