Today’s twitorial In the old man screaming at clouds series.
Poulter’s paradox, the hips pelvis SI joint and lumbar spine. Some clinical types, suggestions and clinical gems, by ME.
Pictures and illustrations will appear at the end of the thread.
The lumbar spine transitions..
Poulter’s paradox, the hips pelvis SI joint and lumbar spine. Some clinical types, suggestions and clinical gems, by ME.
Pictures and illustrations will appear at the end of the thread.
The lumbar spine transitions..
To the semi rigid pelvis via it’s L5/S1 disc in most cases and its muscular and ligamentous attachements. The semi rigid pelvis transitions to the lower limb via the hip joint, which shares muscles with both the spine pelvis and femur. This area can be a complex and confusing
But if one understudy’s some simple principles, it may not be as complex as first thought. I often use the quote “ our spine is a series of phones and joint running up our back, our head sits on one end and we sit on the other” this is the simple proposal that I will use..
The lumbar spine depends on the semirigid pelvis and the hips for its functional mobility, the pelvis can be viewed as the last large lumbar vertebrae for understanding the relationship between lumbar motion and hip motion.
Lets get the elephant in the room out of th way first. The semi rigid pelvis. i have chosen to describe th pelvis as “semi rigid” for a reason. I am going to propose that the SI joints and the symphesis pubis joint allow the pelvis to be pliable and adapt to enormous force....
Transmitted through the hip joints and into the lumbar spine and vice versa. Much has beeen written and debated about the SI joint, it’s clinical relevance in Back pain and stability, debate about ability to palpate motion and detect upslip s, down slips & nutations of the illia
the evidence current vast evidence base suggests most if not all palpation examination techniques or of the SI joint motion and position as unreliable and non valid. Only pain provatcaion test clusters have reliability and validity, i refer you to the work fo my friend & mentor
@marklaslett_NZ who has published extensively on this area.
I have been known to say “detecting spinal and SI joint motion with palpation is like trying to read Braille through a rump steak, I stand by this statement based on current evidence.
I have been known to say “detecting spinal and SI joint motion with palpation is like trying to read Braille through a rump steak, I stand by this statement based on current evidence.
The SI joint is like the expansion joints in a wooden house roof joist or a key stone in an arch. The shape of the sarcomere and articular surfaces of the Illia form a stable “creaking joint” that allows the pelvis to be semi rigid and pliable. The Symphysis is a rubber like bung
Situated between the pubic bones. The three joints allow distortion not motion per se, there are no muscles which run over the joint to allow voluntary motion. The strong ligament complexes allow stability and pliability. Evidenc for this is seen in traumatic injuries.
People with Don Juan or Casanova bilateral calcaneal fracture from jumping out of windows (lovers) or ladder falls onto the heels rarely fracture the pelvis due to its pliability and ability to transfer force to the lumbar spine, heel fractures go hand in hand with high lumbar
And thoracic spine vertebralbody crus fractures. Even in severe Road traffic accident it is more likely to fracture your pelvis than dislocate and SI joint. The SI joint is a robust stable entity, it is not out of plac end in need of adjusting. I propose the pelvis is not
A “pubic cube” in need of regular adjustment and manipulation.
The lumbar spine and hip have a relation ship like the head joint and cervcial spine, the hips can move with, without and in opposition to lumbar motion. Remember if we sit on the pelvis we can move the hip joint with little or no motion in the lumbar spine.
I have described what I call “Poulter’s paradox” I know it is quite egotistical to have an eponymous paradox, but no one else seems to have described it. I propose that when we perform lumbar Flexion in standing sliding our hands down our legs to touch our toes (standard Mckenzie
Standing flexion exam position) that the lumbar spine flexes and so do the hips. If one places ones hands in the small of the back and bends backwards over the hands into lumbar extension (again a standard McKenzie extension in standing exam) the lumbar spine and hips extend.
This will probably be obvious and well accepted. Poulter’s paradox come into play when you sit and slouch, then roll your pelvis forward and sit up erect and into lordosis. There is no doubt this is lumbar flexion slouching & lumbar extension lordosis. The paradox is the hip...
Motion. when you slouch the hips extend and when you sit erect and lordose the hips flex. This is now an excellent clinicl differentiation tool if we monitor pain and mechanical responses to the two test positions. Standing the hips and spine move in the same direction, sitting
They move in opposing directions. (Picture illustrating this at the end of the thread.) I have found this a useful clinical assessment tool, and hope you do too. Sitting slouched and erect as in the slouch over correct procedure is also a good way of loading the spine with short
Leverage and gravit without large garavitational forces at play. It was McKenzie’s number one go to repeated movement test despite what others may believe or understand (I worked closely with him on a daily bais for three long, long years).
The slouch over correct procedure is also one of my number one go to exercise for self mobilizing the hip joint. It fixes the femor and moves the acetabular portion of the hip on the femoral head. It also allows assessment of the hip motion with out load.
So that’s it a few clinical tests and a new test or two to ponder on and try out. thanks for reading this far. Stay safe.
@threadreaderapp unroll please
