Feb 6, 2013

Shift Correction in Standing


I often refer to assessing SGIS in standing as a first movement assessment for any unilateral lower quarter condition. I shot this video because it's an often requested one!

If a patient's DP is SGIS, sidegliding works better than sidebending. In sidegliding, you or the patient most likely reach end range without rib on iliac crest obstruction as you would in sidebending. The assessment itself is important because as the MDT Diplomats would tell you, "You miss a lot of shifts that are not visible." This is not saying the patients with a loss of SGIS toward the involved side are laterally shifted, but they do have a load bearing intolerance for whatever reason. Getting them repeatedly shifted toward end range TO the involved side often makes many hip, knee, and lower leg pains that happened insidiously to centralize and improve.


5 comments:

Steve Lockwood said...

Thanks for posting this! I have a friend who works in PT who performed a similar procedure to help me with some misaligned discs in my lower back. My sister has been having some back problems and has been in search ofmaternity products in Minnesota that will help her with her back pain. Any suggestions?

Edith said...

Hi . can you please write the abbreviations's full word once ? Sometimes I don't know . Sorry

Dr. Erson Religioso III said...

Hi, there is a permanent link to my abbreviations post at the top of my blog

JasonH said...

Thanks Erson for this post and several great clinical pearls mentioned in the one video. If a patient comes in antalgic to the left (so by MDT terms I guess that means right) Side bent and slightly flexed forward with pelvis slightly to the right. I have previously taken that patient to the wall doing the 'self therapy' hep that you described. I've typically attempted having them side push into this and its always highly highly painful to the point of the knee buckling. I've never attempted the grabbing onto their pelvis and attempting to load into it that way I've always tried going straight to arm on the wall.

Most of the time I wuss out and tell them to ice, cat camel and lets readdress in 24 hours. Are you suggesting in many patients push through that discomfort if it helps centralize their symptoms? I think I haven't attempted enough into it to really know and always just blamed it on inflammation.

Dr. Erson Religioso III, DPT said...

Very few of these conditions are truly inflammatory only, especially if they have a directional preference and/or affected by movement/positions. The self generated pressures are effective for HEP, but often the patient does not go far enough to reduce derangement.


What I'm suggesting for lateral shifts as you describe above is that under the MDT approach, you have about 6 weeks from onset before this becomes very tough to reduce. Whether or not it peripheralizes and even increases the complaints temporarily, your #1 goal is to reduce the shift, then restore sidegliding completely in the corrected direction, then add extension. We never want any of our treatments to make someone's Sx worsenen or peripheralize but temporarily we sometimes have to cause discomfort to reduce the shift because of the timeframe.

Post a Comment