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Re: Sacral dysfunction
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Re: Sacral dysfunction - January 28, 2004 7:09:00 AM
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derekj
Posts: 1
Joined: January 27, 2004
From: pikeville, KY, USA
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Important to check pubic symphysis for pubic shears that could be producing a long axis restriction on normal SIJ motion. If assymetrical the standing forward bend test will show which side is dysfunctional, not necessarily the side with the pain. If anyone is interested will share some osteopathic approaches.
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Re: Sacral dysfunction - January 28, 2004 5:48:00 PM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Perhaps this is why so many fail with their MET techniques for this region..they fail to finish with the pubic symphysis, usually via the "shotgun" maneuver.
I was always taught there are three links to the pelvic ring..two SI joints and the pubic symphysis. I always finish with the shotgun and have great results.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Sacral dysfunction - January 29, 2004 3:22:00 AM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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The shotgun and other pubic maneuvers do not correct the pelvic torsion, but resolve an issue that most likely came about because of the torsion. Perhaps the SI dysfunction or just muscular imbalance, over time, altered the position of the pubic symphisis, putting more strain on the entire pelvic ring. One the other issues are resolved, you are just icing the cake by reseating that joint.
I am not aware of any test being done with regards to this maneuver, but perhaps would not be hard. Maybe over the next day or two I will try radiographs of a subjects pubic symphysis before and after shotgun, and see if there is any obvious change!
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Sacral dysfunction - January 29, 2004 5:57:00 AM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
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I have found that the shotgun is useful but not entirely adequate in all cases John...
Sometimes, lots of times, the pubes need individual attention, right and left, given that they are long ends of the two innominates, held together but not always symmetrically, by a fibrous joint with a disc in it, allowing multidirectional range of motion. Each innominate has multiple muscular attachment mostly of a reciprocal R/L kind..including all layers of abs. One must keep in mind various angles of pull of various abs.
I find assymmetric abs all the time in people; those with surgical scars, those who are posturally assymetric whether by scoliosis, by inactivity, by useage.. and those who have just given birth and their abs are still not especially functional. And they'll never get functional if their bony support is assymetric. Chicken/egg.
Abs hook onto the pubes and ASIS', and fold between these areas to form the inguinal ligaments. Many long cutaneous nerves must penetrate out through thickened attachment tissue in all these areas, and through the inguinal ligaments. Entrapment of them tends to not hurt, but creates tenderness one can find through palpation, and reflexive inhibition in some muscle around the pelvic ring combined with overcompensation of other muscle to keep the body up and moving around, somehow.
Knowing where the nerves exit points are and mopping those up with soft tissue work, shotgunning and otherwise symmetricalizing the pubic bones, facilitating the abs to be evenly functional on both sides (lying patient supine, providing very light resistance for knee drop while having the patient breathe out, and while pulling/pushing the skin of the ab wall diagonally over tender areas..), muscle energy using the LEs as levers to symmetricalize the two pubes, (much as one would for improving rotation at the SIs whether ant or post.. but with greater or lesser amounts of ab or add, IR or ER of the hip, and a lot more support of the leg) all these manouvers on the front of the body will encourage the central disk between the pubes to imbibe fluid, become mobile, properly and symmetrically and multidirectionally compressible again. Shears will vanish. (True shears where actual tissue is stripped off bone fortunately must be very rare, I've never seen one yet that hasn't been just a movement dysfunction.) Knowing where to look and how to assess them is the big trick.
For anyone squeamish about approaching the front of the pelvis, for goodness' sake educate yourself and your patients. Have a skeleton in your treatment room and point things out to people. Always treat all parts of the body as equally deserving of your time, condideration and attention. Always be appropriate and professional. There's a long distance between the top of the pubic symphysis and the bottom of it; most of the corrective work can be done from palpating/keying on the top edge. Your patients will be happy if you help their problems.
A small amount of distortion in this front mobile section of the pelvis can reflect backwards into a lot of dysfunction at the back. Think how the bones enlarge as you look posteriorly. In my point of view it is essential to get this front part to work right instead of continuing to beat up on the posterior side of the pelvis: Lots of times a problem isn't in the same place as the pain is. One must use one's brain combined with good working awareness of anatomical reality.
Diane
[This message has been edited by Diane (edited January 29, 2004).]
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Re: Sacral dysfunction - January 30, 2004 3:41:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: online
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EDC, there are indeed PT certification levels in Canada, predominantly joint and manipulation oriented. (Don't know what is available in the US.) My personal proclivity is toward soft tissue.. I study regularly with a DO who teaches near Seattle, close to Vancouver where I live.
Diane
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Re: Sacral dysfunction - February 1, 2004 10:54:00 AM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
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I really like the shotgun technique as well. Do you guys do the muscle energy version or the manipulation version? I just use the muscle energy version now. I think that the maniplation can be a little too aggressive. I know Diane Lee doesn't like it. You really don't want to add instability to the pubic symphysis.
Doug
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Re: Sacral dysfunction - February 2, 2004 6:19:00 PM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
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That has been my experience. Those people who regularly see chiropractors for "prophylactic" treatments are very loose and often crack with just a small amount of pa pressure.
I had one really interesting case right after I graduated. This guy had no history of neck pain but had been going to chiropractors for years. He woke up one day unable to actively turn his head to the right. He had to turn it to the right with his hand. With either the H or I pattern he couldn't get into the posterior left quadrant (being able to get into a quadrant one way but not the other is supposed to signify instability). I theorized at the time that during active movement the extra compression from the muscle activity locked him into the instability so he couldn't turn his head.
Doug
ps H pattern sideflexion before flexion/extension
I pattern Flexion/extension before sideflexion
pss Erl Pettman is obsessed with instabilities. He figures that it is these clinical cervical instabilities which are the main risk factor for vertebral artery dissection from manipulation.
[This message has been edited by Bournephysio (edited February 02, 2004).]
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Re: Sacral dysfunction - February 3, 2004 9:10:00 AM
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PTBuck
Posts: 3
Joined: January 20, 2004
From: Savannah, GA, USA
Status: offline
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[QUOTE]Originally posted by enlightenedDC:
Is anyone aware of any patients who have developed instability while undergoing frequent chiropractic manipulation? I don't know what the ligament deformation curves are for synovial ligs and am curious. This seems a possibility since most chiros don't think much of preexisting small instabilities.
[This message has been edited by enlightenedDC (edited February 01, 2004).][/QUOTE]
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