Pelvic Flares PDF

Pelvic Flares Although innominates normally do not move lateral or medial in normal motion, it has been found that dysfunctions do occur where the innominate has appeared to swing in or out. Since this is not a normal function, we often describe it as a structural dysfunction, rather than a function...

Pelvic Flares Although innominates normally do not move lateral or medial in normal motion, it has been found that dysfunctions do occur where the innominate has appeared to swing in or out. Since this is not a normal function, we often describe it as a structural dysfunction, rather than a functional dysfunction. Therefore, we have no normal mechanics present, rather what has resulted are the muscles stabilizing the innominate adaptively shorten (to maintain a strength/tension relationship at the SI joint) once the innominate has become misaligned. INFLARE Testing Procedure/Findings G.A (This will be described for a left side dysfunction for ease of understanding) Stand behind client with your eyes at the level of their PSIS Palpate the P.S.I.S then move contact so thumbs are on inferior aspect of P.S.I.S Ask client to flex fully forward as far as comfortable. Monitors to see if one P.S.I.S travels a further distance anterior/superiorly overall. If one side travels a greater distance overall, it is the side of pelvic dysfunction. The standing flexion test gives us the side of dysfunction only. Results: There was a positive standing flexion test on left. S.A ASIS ASSESSMENT for FLARES Assessment position is described from finishing position for monitoring of innominate rotations. After monitoring for innominate rotations, flex distal phalanges to inside of crests. Monitor medial-lateral relationship of A.S.I.S in relation to midline for asymmetry. Refer finding to the side of dysfunction determined in the standing flexion test. Results: The left ASIS is medially positioned in relation to the right Results: Because the standing flexion test was positive on the left side, we relate our assessment findings to the left side. In this case the left ASIS was medial in relation to the right. Therefore, we can assume the condition is an inflare on the left. Cause: This condition is maintained by a hypertonicity of the internal/external obliques, transverse abdominus, although the main causative muscle of this condition is the illiacus . At this point we must isolate the dysfunctional muscle tissue through passive testing and/or palpation to determine the specific causative musculature. Because these muscles are difficult to isolate in order to test them passively, palpation bilaterally will be used in order to determine the causative musculature as well as verification of our findings. Extrinsic Treatment: Abdominal massage for therapeutic reasons varies a great deal from that of relaxation. We will perform our preparatory massage in the following manner: Effleurage The application of this technique is performed from an inferior to superior direction monitoring/altering the pressure as you approach the rib cage. Friction Friction is applied inside the innominate crest from PSIS to the ASIS. Monitor your pressure as you get closer to the ASIS as this is a sensitive area. Friction is also performed under the rib cage as well as on the anterior of the ribs. Stripping This technique is applied like stripping although its application is not necessarily in the direction of the muscle fibers in this situation. This technique is applied inside the innominate crest from PSIS to the ASIS. Monitor your pressure as you get closer to the ASIS as this is a sensitive area. Application is also performed from the zyphoid process, under the 10th rib, by curling the tissue under the rib cage as a stripping motion is applied with the thumb, as far posteriorly as comfortable. Extrinsic Treatment: Positioning/application Obliques/transverse abdominus hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Illiacus hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Upon completion of treatment of the dysfunctional musculature, reassess the bony landmarks to determine if the innominates have become realigned. Exercise Rehabilitation Stretches for the appropriate musculature causing this dysfunction can be found in the Exercise Rehabilitation Manual Unit#2 #3 #4 The following condition may be associated with this dysfunction: - 11th and 12th rib dysfunction OUTFLARE Testing Procedure/Findings G.A (This will be described for a left side dysfunction for ease of understanding) Stand behind client with your eyes at the level of their PSIS Palpate the P.S.I.S then move contact so thumbs are on inferior aspect of P.S.I.S Ask client to flex fully forward as far as comfortable. Monitors to see if one P.S.I.S travels a further distance anterior/superiorly overall. If one side travels a greater distance overall, it is the side of pelvic dysfunction. The standing flexion test gives us the side of dysfunction only. Results: There was a positive standing flexion test on left. S.A ASIS ASSESSMENT for FLARES Assessment position is described from finishing position for monitoring of innominate rotations. After monitoring for innominate rotations, flex distal phalanges to inside of crests. Monitor medial-lateral relationship of A.S.I.S in relation to midline for asymmetry. Refer finding to the side of dysfunction determined in the standing flexion test. Results: The left ASIS is laterally positioned in relation to the right Results: Because the standing flexion test was positive on the left side, we relate our assessment findings to the left side. In this case the left ASIS was lateral in relation to the right. Therefore, we can assume the condition is an outflare on the left. Cause: This condition is maintained by a hypertonicity of the TFL and/or gluteus medius and minimus. At this point we must isolate the dysfunctional muscle tissue through passive testing and/or palpation to determine the specific causative musculature. Passive test for Gluteus medius and TFL Client is supine on the plinth, grasp the distal aspect of the tibia and adduct the leg as far as possible over the top of the opposite thigh (Gluteus medius). Client is supine on the plinth, grasp the distal aspect of the tibia (of the non testing leg) and flex it so it is out of the way. Adduct the testing leg as far as possible under the flexed thigh. (T.F.L) The pelvis will move at end point of adduction. Repeat procedure on opposite leg, and compare range of motion. Monitor for quality and quantity of movement. Compare bilaterally. Palpation is our greatest asset as massage therapists and is a very valuable tool when it comes to verification of our findings. Palpation of the gluteus medius/minimus and/or TFL is also performed to verify hypertonicity of the dysfunctional tissue. Extrinsic Treatment: Positioning/application Gluteus medius/minimus hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ TFL hypertonicity: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ MET (Isometric): Tightness Isometric treatment can be applied to be more specific to the gluteus medius/minimus or the TFL. Reference can be made to these separate isometrics by referring to an adduction restriction in the coxa. In this scenario, the intrinsic treatment will be demonstrated to achieve the effect to the dysfunctional musculature as a whole. Tightness of the Abductors Client is in a supine position. Stand on opposite side of dysfunction. Grasp lateral aspect of clients’ knee and distal tibia. Adduct to first barrier. Provide a non yielding resistance as the client attempts to abduct their coxa for 7-10 seconds. Take up any elongation which has resulted by further adducting the coxa to the next barrier. Repeat this protocol 3-5x. Comments _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Upon completion of treatment of the dysfunctional musculature, reassess the bony landmarks to determine if the innominate have become realigned. Exercise Rehabilitation Stretches for the appropriate musculature causing this dysfunction can be found in the Exercise Rehabilitation Manual Unit#2 #3 #4 The following condition may be associated with this dysfunction: - Valgus position of the Tibia - Coxa external rotation restriction - Coxa adduction restriction At the completion of each area of the body, we have placed a check list for students to use to help keep track of their findings during their assessment protocol. It may be photocopied to use when practicing on clients. The instructor will have some on hand related to the specific area of the body, for students to use in practical classes as students are attempting to put all the assessments of an area together. If you’d like, feel free to use these check lists as a guide to help you come up with a check list of your own that is tailored more to your needs Notes _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________ PELVIS Screening Tests: If you feel the need to perform any of these tests, they are performed first before any assessment protocol. A positive test is a recreation of your clients’ complaint. Only check if positive test. Valsalva Pos ___ Neg ___ Slump test Pos ___ Neg ___ Scour test Pos ___ Neg ___ Patrick test (Faber) Pos ___ Neg ___ General Assessment: Anatomical short leg L___ R___ Standing flexion test L___ R___ Seated flexion test L___ R___ Specific Assessment: Pubic tubercle assessment A.S.I.S (rotations) A.S.I.S (flair) Sup___ Inf___ Ant___Pos___ In ___ Out ___ Muscle Testing: Subluxation Rectus abdominus L___ R___ Palpation Adductors/Gracilis L___ R___ Adduction Obturators L___ R___ Palpation Rotations Hamstrings L___ R___ Knee extension Gluteus maximus Rectus femoris Illiocostalis L___ R___ Thomas test L___ R___ Knee flexion L___ R___ Palpation Quadratus Lumborum L___ R___ Ribs, Palpation Flares T.F.L L___ R___ Adduction Gluteus med/min L___ R___ Adduction