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Forward Thinking PT
Incorporating Evidence into Physical Therapy Practice
Featured: The Experinece Wall Part 2
In my last blog post “The Experience Wall” I spoke about the dangers of clinical experience and I broke up clinical experience into 3 parts. 1) The perception of clinical events (seeing, hearing, feeling etc) 2) The memories of those events 3) The interpretation of those perceptions (cause and effect,etc) My next three posts will […]
PROBLEMS WITH ISOLATION WITH THIGH THRUST TEST The thigh thrust test can be very non-specific. Prior to performing it one should clear the hip joint, especially for possible FAI, labral tear, etc meaning screen for these ase to discern if they are present and are the primary pain generators. If ruled out, then the clinician can palpate the dorsal ligaments of the SIJ, just medial to the PSIS to discern when forces are localized there, which is very proximal to the mid-joint. Further isolation can be achieved with adduction. The clinician can also palpate the lumbosacral junction. There is great intra, and sometimes inter-individual differences in isolation of forces in the proximity of the SIJ such that the 90 degree angle can yield false positives and false negatives. The anteriro SIJ capsule and ligament has an upper lumber nerve supply, whereas the posterior SIJ ligaments and capsule has a lower lumbar and S1, S2 =/- S3 contribution. The old macromotion “SIJ mobility tests” do not, cannot isolate the SIJ are actually pelvic mobility tests (Hesch 1990, 1992), Sturesson et al did several nice studies affirming the SIJ does not move with these typical tests, except for a very small amount of motion such as end-range straddle position. Passive forces imparted tot he pelvic structure do induce compression and release in the SIJ, demonstrating that normative motion goes through the SIJ, a much more functional perspective than “motion IN the SIJ”. This was demonstrated with fluroscopy. True SIJ hypermobility and symphysis p[ubis hypermobility and pain such as post-partum is valid, although it effects a minority, fortunately. However, itt is easily over-interpreted as a case study demonstrated in which a cleint in late pregnancy presented with all classical signs and symptoms of “instability”. Her symptoms were most likely mediated by her pelvic organs, because her SIJ and pubic joints were surprisingly void of descernible motion. One treatment yielded significant pain relief, resolved antalgia, resolved urinary frequency and perhaps facilitated a very easy delivery. It also greatly lessened a 15-year diagnosis of “interstitial cystitits”. Another proximal concept is that of sacroiliac supports. Applied at the ASIS’ they actually enhance lower pubic and lower sacroiliac hypermobility in the post-partum state. Much more appropriate is aplication at the trochanters which imparts up to 40% greater compression of pubic joint and SIJ. There is ample research to undergird this. Jerry Hesch, Hesch Institute