pelvic torsion - fisiokinesiterapia
TRANSCRIPT
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Pelvic torsion:Frontal plane
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Pelvic torsion:Sagittal plane
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Pelvic Torsion:Principal Contacts
short lever
medium leverlong lever
lumbar apex
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A Basic Distortion(not same as Logan’s)
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PSIS palpation for torsion
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Pelvic Contacts
PSIS
Sacral Notch
Sacral Apex
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Side-Posture: Extension
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Side-Posture: Flexion
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Side-Posture Body Drop:PSIS Contact
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Modified Pettibon:PSIS Contact
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The Big Ugly
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How much force to cavitate?
Cavitation No Cavitation pMean Spine Force (SD) 38.0 (42.4) 94.31 (117.2) 0.13Mean Pelvis Force (SD) 459.8 (217.7) 284.9 (180.2) 0.02Mean Thigh Force (SD) 356.1 (198.2) 134.3 (106.2) 0.0002Mean Total Force (SD) 853.9 (187.3) 517.8 (201.2) 5.39 E-05
Mean Spine/Total Force (SD) .048 (.0554) .176 (.184) 0.03
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
0 1 2Cavitation No Cavitation
Spine/TotalForce
When the majority of total force is applied directly to the lumber spine, as opposed to more peripheral sites, the probability of notachieving cavitation is greatly increased.
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Side-Posture Pelvic moves (I)
• In extension, eg. classic Gonstead–indications: disc herniation, extension restriction, loss of lumbopelvic lordosis–contraindicated: pain on extension, hyperlordosis, facet syndrome
• In flexion, modified Pettibon–indications: doctor arm problem, flexion restriction, hyperlordosis, facet syndrome–contraindications: IVD syndrome, hypolordosis
•Body neutral, body drop–most typical move used
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Side-posture moves and rotation
• Seem safe, data scant• If PI side up
– especially well-tolerated, reduces helical distortion
• If AS side up– less tolerated; cf “Farfan torsion
test”• Forearm stabilization can hurt
sensitive rib cages, esp. with much rotation
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Sacral apex move: Special clinical
applications
• Retrolisthesis, anterolisthesis– range: L4-5– mechanism: tension on PLL
• Anterior coccyx– side-specificity depends on AP
deviation of coccyx, if any– global distortion not a factor– done in inspiration
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Coccygeal subluxation
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LOD for correcting anterior coccyx
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Anterior coccyx: internal method
Maigne’s technique of coccygeal mobilization. The coccyx is kept in hyperextension, which stresses the sacrococcygeal and intercoccygealjoints and stretches the levator anus.
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Diversified coccygealadjustment
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Sacral apex move:Swiss army knife of moves
• Lumbar hyperextension• Spondylolisthesis• Retrolisthesis• Anterior coccyx
– side-specificity depends on AP deviation of coccyx, if any
– global distortion not a factor– done on inspiration
“modified Pettibon move”
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Anterior coccyx: internal method
Maigne’s technique of coccygeal mobilization. The coccyx is kept in hyperextension, which stresses the sacrococcygeal and intercoccygealjoints and stretches the levator anus.
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Pelvic floor muscles and coccygeal movement
Active flexion (movement in a forward direction) is performed by the levator ani and the sphincter ani externus muscles. Extension (movement in a backward direction) is due to relaxation of these muscles and to the increased intra-abdominal pressure which occurs during defecation and parturition
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Spondy correction with inversion therapy
upright neutral 1981
60 sec inversion 1981
10 min inversion 1981
1983 film
1991 film
81 neutral + 81 10 min
Case 1 Case 2
upright neutral
60 sec inversion
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Sacral base
• sacral base palpation– which SI joint deeper? (innom ref
pt)– which side relatively posterior?
• posterior side pain/fixation• PA sacral base thrust
– anterior side pain/fixation• PI “pull” move
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Traditional sideposture move
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Side-Posture Body Drop: Segmental Lumbar Contact
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Side posture pull move
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Lumbopelvic decision making
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Lumbar spine
• lumbar spine analysis– global ROM, observing “kinks”– lateral curvature
• hand placement– fingers across spine– segmental contact: side of spine
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Which side up for side-posture manipulation?
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Which side up for side-posture manipulation?
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Assisted/resisted example
Resisted: contact on sacral base gaps L5-S1, segment superior to contact hand
Assisted: contact on L5 introduces motion to L5-S1, below contact hand
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Which lumbar motion unit is primarily affected?
• Resisted adjustment– Above contacted bone– eg, using P-A thrust on crossed
elbows or shoulder• Assisted adjustment
– Below contact hand– eg, using significant body drop
and lateral-medial LOD
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Integrating curvature and restriction into adjusting protocol
Inconsistent criteria: thrust indeterminate. Decide which more important
Consistent criteria: thrust left to right
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Which curvature is structural?
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Thoracolumbar JunctionPre-Stressed Anterior