Anterior rotation of the innominate bone: Ipsilateral or contralateral cause?

[neuromuscular]

In much that is published, the anterior rotation of the innominate bone is viewed as caused by the quadriceps, sartorius, etc. or other cause on the same side or ipsilateral to the rotation.

Try this:

For every anterior rotation of the innominate bone try a lateral distorition of these muscles on the ipsilateral side. In the vast majority of cases, the quads and sartorius move laterally with little problem and no pain. Further, treating these muscles does not resolve the anterior rotation of the innominate bone.

Step 2:

Now try treating the contralateral adductor longus and/or pectineus. In the majority of cases, the contralateral anterior rotation of the innominate bone corrects to some extent and may in fact "overcorrect".

Once you have tried this, please give me your feedback.

Best regards,

Neuromuscular.

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[iliastolos]

Neuromuscular,
Do you mean anterior tilt of the pelvis with anterior rotation of the innominate? And what do you mean by lateral distortion?
ilias

[neuromuscular]

Dear Iliostolos:

Thank you for your reply.

What I am asking others to consider is that the contralateral adductor longus exerts a pull on the pubis ramus which in turn causes a opposing action by the psoas on the ipsilateral side as the innominate bone which has the PSIS superior to the ASIS.

In the position of the innominate bone, the PSIS is superior to the ASIS. If you wish to call this tilt, do so. What I am stating this that the innominate bone has rotated. There is so much difference in what people call the movements that the most important thing is to remember that the contralateral adductor longus is causing the PSIS superior to the ASIS on the innominate bone and not the quads or the sartorius. Is this what you find ?

What I am asking is that others treat the contralateral adductor longus and see if the "tilt" or forward rotation where the PSIS is Superior to the ASIS is corrected without doing any work to the quads or sartorius.

I hope that this explains the idea.

Best regards

Neuromuscular.

[iliastolos]

Neuromuscular,
Are you referring to a misaligned pelvis? That is a rotation or tilt of one innominate bone against the other? Please attach any reference you have.
Regards,
ilias

[neuromuscular]

Dear iliastolos:

If you wish to call it a misaligned pelvis that is up to you.

To see if the pelvic bones are differring from one side to the other do an ASIS to ASIS comparison with hip ABD.

This can be done by landmarking the ASIS to ASIS, maintain these landmarks as your patient does hip ABD from closed stance to foot positions of 25 cm, 50 cm, 75 cm, 100 cm, etc. to the ability of the patient to comply.

You can do an ASIS to PSIS on the side with the inferior ASIS and note if the innominate bone goes into further increase of pelvic angle or ASIS moves inferior to the PSIS significantly in anterior rotation movement.

The cause as I have found is not the quads or sartorius, but the contralateral adductor longus. See what your results are and tell me what you have found.

Best regards,

Neuromuscular.

[neuromuscular]

Dear Iliastolos:

The main objective of this is to see if the innominate bones move as hip ABD proceeds and if others get similar results to what I have seen. The cause appears rto be contralateral.

In the cases that I have used this test, the innominate bones move into anterior such that the ASIS is inferior to the PSIS on the right in the vast majority - over 90% of the cases with LBP.

The left is inconsistent: 60% move to posterior such that the ASIS is superior to the PSIS; 20% stay neutral that is near level for the PSIS to ASIS: the remaining ones have a slight anterior rotation , but usually less than the right side.

See what your expereinence is.

Best regards,

Neuromuscular.

[neuromuscular]

To all:

This is a mapping of bone position as hip ABD occurs. There are no references to quote as there is no one doing this to my knowledge.

Try the test and give any feedback you wish.

Best regards,

Neuromuscular

[alophysio]

Hi all,

For a critque on the test neuromuscular proposes, here is our "conversation" over the last year and a bit...please be sure to read from the start otherwise the end will be out of context!!

http://www.physiobob.com/forum/ortho...-si-joint.html

Try the test and see.

I personally had no change in my practice from the test. When i find an overactive Adductor muscle, i treat it.

I use a systematic and wholistic approach to assessment and diagnosis, not just one test or model...

Anyway, try neuromuscular's test and see what happens

[neuromuscular]

Dear ALOphysio:

Thank you for your reply.

I propose this test since the SIJ test is a bit of useless information about nothing related to the cause in the majority.

You have agreed a number of times that the SIJ itself is not the cause in the majority.
I agree that the SIJ is not the cause in the majority.

Therefore, why start with the SIJ test,when it will not contribute to the overall information on the patients's true cause of the problem?
The innominate bone position test WILL lead directly to testing for the muscular componant. It provides continuous information flow that builds on the one prior. The SIJ testing only tells that the joint does not move optimally, but does not give the cause. Structure or function. That the practitioner must do many other tests regardless of the SIJ results - "fixation" or "failed load transfer". It only tells you that you need to do many more tests. The standing innominate bone position test leads to the musculature involved right off the bat and builds on the muscles indicated by the muscular imbalance moving the innominate bones off the standard position. Is that not what we all want???????? Something that provides immediate information on the patient's true condition and is not just a bit of frivolity????
Best regards,

Neuromuscular

[roycar]

i've been following the "conversation" here for the last while. i decided i would try the proposed test and the adductor longus theory before i posted.

i did and to be honest, i havent found that focusing treatment on the contralateral adductor longus has been particularly succesful.

i dont think that il continue with it.

all the best neuromuscular, il keep an eye on future developments

[neuromuscular]

Dear roycar:

Thank you for trying the test.

I can honestly say that in test after test, the add longus does create anterior rotation on the contralateral innominate bone such that the right ASIS is inf to the left ASIS in the majority.

Please give it a second try.

The treatment protocol is direct pressure into the add longus. You will see a difference in the level of the ASIS such that the ASIS on the right is inferior to the ASIS on the left as hip ABD increases the difference will increase.

I am not sure if you are from a country where the driver is seated on the right side of the vehicle. That could make a difference.

Best regards,

Neuromuscular.

[neuromuscular]

Dear roycar

I can think of a couple of reasons for the difference as I have looked up your location.

I believe that you are from Ireland. It is possible that like Alophysio, the driver position on the right of the vehicle may have a bearing on your not getting the same results. Further, the shorter driving distances and lessor times of travel may account for some of the other variables.

The test has had similar results in Canada and USA. However, in our countries, people do more of what we call "windshield time" as distances are greater and driving is a necessary evil.

Second, the driver position is different even though the pedal position is the same. When I was in New Zealand for three weeks, I noticed a great difference in changed driving comfort for the left side driver position. This could have a bearing on the results obtained by yourself and Alophysio.

I cannot say if it is the amount of driving and/or the driver position which contributes to the common outcome of the test here, but I would think from the patient profiles that it is. Ergonomic factors also seem to be a factor.

Therefore, just do the test and see what results you obtain. Yours may be different, but they are important. I am most interested in what you did exactly find.

I thank you for giving it a try and hope that it will add some information base to your therapy.

Thanks again for your reply.

Best regards,

Neuromuscular.

[neuromuscular]

Dear roy car:

Please try the test without any ideas of outcome.

I use a standing innominate bone position test followed by a supine ASIS to ASIS.

In the standing test, please note any variances of the ASIS to ASIS, PSIS to ASIS (R&L) and the PSIS to PSIS which increase as the width of the foot stance increases due to hip ABD.

ALso, would you be so kind as to do a PSIS to sacrum with hip ABD for every positive that you get with the "Gillett" test? I find that for every positive of the Gillett test, the PSIS moves superior and lateral to the sacrum in the results of the PSIS to sacrum with hip ABD which would be opposite to the Gillett positive. If you get the same, of what relevance do you think that this is?

My findings using the innominate bone position test with hip ABD are as follows:

When the right ASIS is inferior to the left ASIS, the add longus on the left is tender to palpation and the right psoas,iliacus or iliopsoas is tender to palpation. Do you find the same? THEORY: The left add longus and the right iliopsoas are in an imbalance or guarding response to each other.

When the right ASIS is inferior to the right PSIS the iliopsoas, psoas, or iliacus is most probably involved. THEORY: The right iliopsoas with possible interaction to a left add longus in a guarding response are in a muscular imbalance.

When the left PSIS is inferior to the left ASIS , the left add magnus and the hamstrings are most probably involved. (Mostly the left add magnus) THEORY: The left add magnus is overlooked, but has a "hamstring" type of action for part of the muscle.

THe PSIS to PSIS is less useful as differences are less noticable than the other landmarks.

If you do not get the same results. Then, please, tell me your results. I am most interested.

I build on this test by doing the tests of the muscles indicated such as active. resisted, etc. as well as passive, ROM , etc.

I have found that this leads me to less assessment time and more therapy time as I do not have to do a lot of the SIJ teting that seems to dominate much thinking.

If the supine assessment of the ASIS to ASIS reveals an inferior ASIS on the right, then what happens when you use digital pressure into the left add longus? In most cases, I find that the right ASIS moves superior to come to a position closer to the left ASIS after therapy. However, the ASIS can also do one of three things:

After treatment of the left add longus, The right ASIS will
1: Move superior and Stay at the same distance from the therapy bench or plinth as the left
THEORY: The left add longus was in a muscular imbalance with the right iliopsioas where the add longus factor was greater than the iliopsaoas factor.
2: move superior and move closer to the therapy bench or plinth than the left
THOERY: The left add longus was in a muscular imbalance with the right iliopsoas where the iliopsoas was the greater factor.
3: move superior and move away (or elevate) from the therapy bench when compared to the left
THEORY: This is the most complicated imbalance that I have found in this part of the test and therapy. There are many factors which require more assessment and palpation of the musculature involved. This is the least common result.

Again, your results may differ, and please, do not take these into the assessment settings, but use them after you have come to your own conclusions. See what you get. I am most interested in your results.

I use digital pressure into the muscle at 90 degrees to the muscle fiber. You can use whatever therapy you want to try, but please give me your results. I know what mine are and others in North America, but your situation with the driver's position on the right may impact on the outcomes found.

Thank you again for your interest in this topic.

My very best to you,

Neuromuscular

[alophysio]

Dear Neuromuscular,

1. Just because the SIJ joint does not have an articular problem doesn't mean it does not have a load transfer problem from myofascial or neural or visceral factors.

2. Schwartzer found that SIJ joint as the cause of low back pain in the Fortin area of pain was not in the majority of patients but 15-20% is still significant - So stop misquoting me!!!

3. Here is a recent study for you i will show you for free!

Wiley InterScience :: Session Cookies

The cartilage in the joint of the SIJ may be a pain producer - which comes under the articular dysfunction heading and so by presuming the problem is myofascial, you are potentially missing other possible reasons for the pain.

4. I am pretty sure that the accelerator is on the right and the brake is in the middle and the clutch is on the left everywhere around the world so that is not a reason for the difference.

5. If you want to be less than thorough to save time and bet on the majority, then please do so. I personally want to be more sophisticated than that and will use my test which takes all of 20secs to do which gives me info on articular, myofascial and motor control problems.

6. Your APAS test is flawed. The reasons for it are outlined elsewhere as you know!

Cheers

To Roycar,

Thanks for trying the test and treatment. I support new ideas too and will give most things a go. Good luck on the emails from neuromuscular!

Thanks

[neuromuscular]

To All:

I do not wish to continue with this forum as I feel that the ideas presented are fought without trying them. That would be a very closed mind.

If you wish to try the model and agree or disagree that is up to you... You have the freedom to do or not do.

Please do not accept "peer pressure" as "peer review".

Be open to something which may or may not change your viewpoint.

Goodbye to all.

[alophysio]

Dear neuromuscualr,

Please note that i have tried your test as has Roycar. It is unfair to suggest people don't try your test. Just because we don't think it works well shouldn't be taken personally.

In fact, i have been thinking about your test and your treatment and perhaps you are doing something different (other than the test) which leads to a better result and you haven't quantified (or qualified) it yet...

In the same way you ask all to be open minded to new ideas, i ask that you be open to the possibility that the flaws pointed out to you might actually be correct...

All the best. Please feel free to contribute about any subject matter - i am sure you have more to offer than just your APAS test and theories...