trochanteric burisitis

[alophysio]

Thanks SigMik and DrDamien,

about what i wrote DrDamien, i don't believe i have ever said that this is new or not done before. In fact i reference the fact that i have spent lots of money learning these things...which implies it is not new...

As for your 83y.o. man, you simply agreed with me It has become structural - that is joint pathlogies have caused structural changes which physically limit this man's ROM...however what is functional for this man? Does his joints work properly in the positions that he is in. It may well be true that we cannot help him and i agree that "myofascial release, realignment and postural correction" would not make any difference but that is the point of the assessment procedure i outlined above.

I guess my point is that there are physios who would try to do those things which wouldn't likely help...

...but i have a better example for you...

90+y.o. woman who came in unable to look parallel to the ground. Severe kyphoscoliosis and had pain for about 2 weeks. I asked her when her pain started the first time...she said 2 weeks ago. Thinking i was unclear, i asked, "no, i meant when was the first time ever you had back pain?" and she said again"2 weeks ago"!! I would have sworn that she had pain before but she didn't.

I assessed her, found FLT in her ribs, released the myofascial structures causing a problem and in 2 sessions she was painfree and back to normal ADLs. She didn't look 1 degree straighter but she was back to her "normal"...

The author you refer to is Shirley Sahrmann - she has an interesting point of view - one that i think is coloured by the fact that US physios often only get a handful of funded sessions from private insurance companies so she does very well with chornic pain in limited time but there could be so much more elegant things done with her work...

Lastly, again, the concepts i talk about are not new, just not common. That is why i talk about them. Hopefully people get interested and try to broaden their experience...

SigMik, The Pelvic Girdle 4th edition by Diane Lee and LJ Lee (no relation to each other) will be out very soon. Stuff will be in that but it is the overall concepts proposed by Panjabi, Vleeming, Lee etc thru various models which ask therapists to think of different systems throughout the body.

To be good at detecting FLT, you have to know what "normal" is so Shirley Sahrmann's book, kendalls Muscles Testing and function book etc outline normal muscle and joint motion so you will then see poor movement patterns and FLT.

Examples of FLT you are already aware of (no doubt):
- loss of ER control of hip during squats, STS, lunges, step up/down etc.
- overpronation at the feet during WB
- anterior shoulder translation during GH movement
- Scapula winging during loaded shoulder girdle movement

Examples of FLT you may not be aware of... but play with them and see!
- uncontrolled lateral glide of C/S during arm movement - cervical column should not move if your head is stationary.
- Hip anterior translation during increased WB or in NWB
- SIJ FLT and what that looks like
- excessive L/S rot during sagittal plane motion

Have fun. Happy to help out more but have to run.

Drdamien, i hope it clears a few things up. I am sorry if you got the wrong idea. Cheers!