Quick Links! | Modern Manual Therapy Blog

Quick Links!


Today's Quick Links come from Bill Hartman, Allan Besselink, and Harrison Vaughn.


Harrison Vaughn showed something we do not often see in PT school, or for that matter clinical practice, positive signs of an Upper Motor Neuron lesion. In 15 years of practice, I've never seen one! Here is the link to his post on Hoffman's Test and the Inverted Supinator Sign.

Bill Hartman posted a case complete with pics using the PRI Approach for unilateral lumbar and radiating posterior thigh Sx with mild lateral shift. This is an approach that I want to learn this year and take at least the two home study courses. Interesting stuff, but without knowing the corrective exercises, not sure exactly what happened here. Anyone able to elaborate?

Allan Besselink, a DipMDT is always on the lookout to educate patients and consumers on some of the misconceptions of the public and many clinicians. Does leg length discrepancy affect running, or for that matter most ADLs, or even cause pain? Not according to research showing many individuals have abnormal findings on scans, unilateral or not.

9 comments:

  1. Dr. E.

    Regarding Bill's approach. The positive L Obers, L SLR, and ER/IR asymmetries indicate a pelvis that is anteriorly tilted and right-facing per PRI approach. The L Obers suggests a bony block at the femoral-acetabular joint.

    The exercises utilized are akin to a self-MET to be able to mobilize out of this position. The goals (roughly and somewhat bastardizing) of the exercises are.

    90/90 hip lift w/ R UE reach: Basically a posterior pelvic tilt on the wall. The R reach helps to facilitate better length-tension of the L diaphragm (Zone of Apposition per PRI), which helps facilitate breathing in the R lung. So, correcting the Anterior pelvic tilt and pelvic asymmetry.

    Adductor pullback: Basically breathing in the exact opposite pelvic position from the right-face. The L LE rotates the pelvis right.

    R glute max: Not sure of this exact exercise, but again activating particular muscles to help facilitate pelvic asymmetry reduction.



    Hope this helps clarify things somewhat.

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  2. R glut max is most likely left side lying clam with a slight forward shift of right knee to start (creates IR/add of left 'hip'). A clean L AIC would focus on left glut med, adductors, and R glut max if memory serves me well.

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  3. Thanks Zac and Stephen, makes sense from a pathoanatomical perspective, which I mostly have moved on from, but can appreciate. What is the expected recovery for a patient using this approach, and how often do they have to perform these HEPs?

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  4. The HEP is usually 4-5x5 breaths per exercise, 2-3 times/day. To see if the correction took place the Ober's test is audited after the exercise.

    By expected recovery, do you mean how long do corrections usually take? Often times it is immediate, then there is a lot of education on tips to maintain the correction throughout the day, like cuing posture if someone responds to that. This is of course, combined with other interventions if utilized properly, to me PRI is the starting point.

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  5. Thanks for the shout out Dr. E! I was very surprised the first time I found it, but luckily it was a patient who has already had a fusion and def multiple comorbidities (I see a lot of this unfortunately in my neck of the woods), and it wasn't a need to refer out.

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  6. NP HV! Congrats on your win! I cheered for you as my wife said I was a nerd while I was watching the PT Awards last night. I even got asked by a researcher who was suprised that I'd honestly never seen these tests positive. It's probably b/c I haven't seen a fusion that was fresh in over 10 years.

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  7. I'd love to see some of these in a video, think you could shoot one for me?

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  8. Thanks man! I am very surprised you didn't get a win...but you had some tough competition going up against Mike on the top awards!

    Yeh I was even surprised clinically relevant technologies didn't have a positive sign on their vids. Quite rare

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  9. Dr. E,

    Here is the link to the adductor pullback exercise...
    http://youtu.be/EL5vVGwIBvw

    And the 90/90 hip lift...
    http://youtu.be/-zxaq9lANYg

    I noticed that you will be presenting in Naperville soon. I practice near there. Hopefully, I will try to make your course so I can learn more from you than I already have.

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