On hip height discrepancies

[MrsBossy]

In Orthomassage we were taught a basic assessment of the PSIS, with the high side correlated with a corresponding low shoulder on the same side. That, being the contracted side, would be the side treated.

Last week I had a client on the table with high left hip, low rightshoulder. I wasn't sure what to do, so I did the work for the left side first... and everything was even. Amazing.

I wondered what would happen if I did the work on the right side, because it did feel contracted to me as well... afterward, the imbalances were possibly even worse than before. Wrong move! I worked on the left side again, and corrected them, thankfully.

I am seeing that this work really does demand proper use so as to avoid making things worse for a client.

Anyway, any insight into hip/shoulder relationships and the above experience?

 

[yahoooo!]

Thanks for sharing this Ego. Having worked with a Chiropractor for almost 2 years now I have learned that situations can be as unique as the individual I work with, and whenever I start setting expectations of what I will find, I am greeted with a situation that goes beyond my original assessment. Based on your description you handled the situation brilliantly, reassessing after the initial work and making the corrections necessary.

Postural habits, daily activities, and previous injuries are all factors in the makeup of a client's current condition. A good therapist will take the time to put all the pieces of the puzzle together so they all fit, instead of taking a cookie cutter approach like "you have symptoms A, B, and C so you must be suffering from malady "Z". There are anomolies around every corner in bodywork, which is why I love the work so much. No session is ever the same. Without more background information on the client, I could only guess at what may have caused the secondary response after working the right side. You left the client balanced and that is the important part. Great job!

Your post has caused me to realize how much more I can learn in order to be more effective in my craft. Using structural imbalances to assess a clients condition and make a treatment plan was never covered in my formal education and I am just now getting into the habit of paying attention to them. I am sure there is much much more to learn.

In Peace and Light

 

[Linni]

Ah, spiral pattern. Love it!

 

[Terri E]

When you see a pattern like that, look closely at the neck and pec minor. You can get more information by having them lower the "high" shoulder slightly, and see if the neck comes with it. I'm guessing that the left shoulder was high, due to tension in the neck, and the right shoulder was actually where it needed to be. When you corrected the pelvic imbalance, the neck relaxed and the high left shoulder dropped.

Or it could be that pec minor was so tight it was pulling the right shoulder down from the front, in which case, working on the back would again make the issue worse.

 

[KellahPanda]

Interesting. Thanks Breathe!

Ah, spiral pattern. Love it!

BJB, care to expand on this? Is this from Myers' Anatomy Trains system?

 

[Chas B]

i]Ah, spiral pattern. Love it![/i]

BJB, care to expand on this? Is this from Myers' Anatomy Trains system?

No, shortening along his Spiral Line would look a lot like you described (high PSIS one side - low shoulder same side). I'm talking about something I've noticed and heard called "spiral pattern" by more experienced MTs. PSIS pulled up, opposite shoulder dragged down - I guess it's not so much a true spiral as a crossover pattern (one side of the back to the other crossing the spine). Pec minor is my usual suspect for the low shoulder opposite a high hip.

 

[Baby ANimal]

You ought to check out what Paul St. John has been developing within just the past few years on postural distortions. I just took his Posturology 101 course this weekend in Gainesville and it has been the best CEU course so far that I have ever taken... It was so exact and made so much sense when looking for reasons as to why clients hurt in the areas they do. Paul St. John holds to the saying from Wolff's law stating "form follows function and function follows form." I was so enlightened this weekend... this training will forever change how I treat clients. I would highly recommend you visiting his website http://www.neurosomaticeducators.com. From what you were saying in the information you shared it would really make sense to learn up on this approach. Also you might want check out a forum webpage I found tonight on the very same thing you wrote about. I was reading about the issue of muscle tonus- this discussion was posted on an Anatomy Trains webpage here: http://www.anatomytrains.com/forum/viewtopic.php?pid=470

 

[Guitar Guy]

Thanks Roxanne... Waslaski recommends him as well. Perhaps next year!

And thanks for that Anatomy Trains link... I didn't know they have a forum over there!

 

[smeaty3]

Actually James Waslaski and Paul St. John will be having a pain management seminar cruise together in mid January going to Ochos Rios and Grand Cayman Islands. Too bad I couldn't go b/c I would, I live only one hour from miami, oh well. I just bought the Anatomy Trains book... what do you think about it?

 

[starsky_1212]

Indeed... I've already committed to another CEU class during that time though.

I've seen the Anatomy Trains book, and some of the videos... great stuff.

 

[/<@te]

There is so much to assessing the pelvis. Much more than just PSIS or ASIS on the table.


I try and do as much assessment in standing. Visual posture assessment. Then palpate ASIS, PSIS and Iliac Crest. Then do forward flexion test and stork stand test. Then watch gait.

Then I have them on the table, and look at maleoli symmetry, compare the height of the base of the patella between legs, assess ASIS, and sacral mobility, Iliac crest (then PSIS when they roll into a prone position).

When assessing ASIS in the supine position, you want to look for height comparrison (make sure you are standing with your dominant eye overtop the person), sacral outflare or inflare, and hip height. The standing tests should give you an idea and then you confirm that in the supine position if there is an upslip, and anterior rotation, a posterior rotation or an outflare/inflare. then you can go to work using Muscle Energy Techniques and soft tissue work to correct those problems. Correct the outflare or inflare before correcting a rotation. After you do soft tissue work, make sure you perform stretching to lengthen the structures and then the approriate strengthening work to increase stability and integrity of the joint. DON'T do the exact same treatment to the other side! One side is asymetrical and it needs to be fixed. The other side may be alterted and need work (usually in the opposite direction of the affected side) OR, it may need to be left alone (just some general massage, but nothing clinical or treatment based).

Patrick