Canadian RMT Magazine Spring 2016 Volume 1 - Page 19

Contrary to what many docs tell their “patients, most low back and pelvic pain Fig. 1 Fig. 2 Fig. 3 Fig. 3 Fig. 4A Fig. 4A does not result from a single traumatic lifting, bending or sports injury. ” interacts with the spinal cord and brain to provide joint stability and coordinated movement…or lack of it as is the case in chronic upslips. In the presence of chronic upslips, prolonged cyclical loading can deform SI joint ligaments to a point where an act as innocent as slamming on the brake, tumbling on one hip, or clumsily stepping off a curb, can jostle the joint enough to cause the ilium to ‘jump-a-notch’ on sacrum. Here’s an interesting ‘upslip’ case study of a client named Marion who called complaining of stabbing buttock and low back pain. Marion the Hairdresser I’d treated Marion off-and-on for a chronic whiplash injury, but today it was her hip and she was in a world of hurt. This was her first visit since becoming a momma a year earlier and her history in-take revealed two related factors contributing to her injury: 1) Cumulative viscoelastic creep (hypermobility) left over from the relaxin birth hormone, and 2) Prolonged one-legged cyclical loading at her hairdressing job. A classic upslip case, Marion presented with acute right-sided lumbopelvic pain, funky gait, and anatomical landmarks showing a 1 1/2” short right leg, lax sacrotuberous ligament right, OL and psoas spasm right, and superior/posterior right ilium. Spring testing of the right ilium (supine and prone) revealed no inferior glide. Marion’s right QL fired before gluteus medius on the hip abduction test and she lifted the swing leg with the spasmed QL as she tried to walk. Over the years, I’ve noticed that in the early stages of ligamentous creep, the brain down-regulates nociceptive pain signals. But when the joint finally jams, the brain immediately reacts with pain and protective guarding to prevent further insult to the damaged area. Fixing the Fixation Here are a couple of techniques that helped fix Marion’s upslipped hip. In Figure 4A, she’s pulling the knee to her chest to inferiorly drag the ilium while I slowly elbow my way through the lumbodorsal fascia, QL, and iliocostalis myospasm. Once these hypertrophied (hip-hiking) soft tissues regain flexibility and mobility, a maneuver is used to get the sacroiliac “grooves-a-groovin.” In Figure 4B, Marion lies supine and I apply an inferior tractioning force to drag the ilium to the first restrictive barrier feeling for neutral leg and hip alignment. By taking the limb into a bit of internal rotation, I’m able to bony-lock the hip allowing the tractioning force to travel through the SI joint. Using my body weight with her thigh securely arm-locked, a distraction force is applied as Marion forcefully contracts the QL and hip-hikes against my resistance. After a few seconds, she is asked cough vigorously to help jostle the joint and reposition the soft tissues. Traction combined with the forced exhalation allows Marion’s ilium to drop down into the groove “from whence it came.” Rest, ergonomic retraining, and regular follow-ups are mandatory until pelvic stability is established. Remember, the first couple weeks are critical; even the slightest jar can turn the ligaments back into silly putty. References: 1.Bogduk N, Twomey LT. Clinical Anatomy of the Lumbar Spine. 2nd ed. Melbourne: Churchill Livingstone, 1991 2. Gracovetsky S, The Spinal Engine, Springer-Verlag, NY, 1988 Reprinted with permission from the July 2011 issue of Massage Today, Spring 2016 19