|image courtesy of sciencedirect.com|
I thought about writing this post when someone on google+ contacted me regarding correcting a shift and causing peripheralization. Do you give this approach up? Try the opposite direction? Read on to find out your options!
The question was that doing the recommended shift correction to the painful side, as in right sided leg pain with self or manual SGIS to the right (shoulders right, hips left) caused peripheralization. Prior to continuing, progression, or regression of techniques, you must ask yourself
- Does the peripheralization remain after the repeated movements are over
- If no - proceed with caution
- I usually have my patients walk for a minute or two if symptoms increase during the movements or position
- if the increased complaints go back to baseline, there is no irritation, and the MDT documentation would be SGIS to the right, increases pain, peripheralizes to the right LE, does not remain worse as a result
- the last part is key, if it does NOT remain worse, you can proceed with caution, i.e. a yellow light
- you may try the SGIS with slight lumbar flexion to unload a bit and make it more comfortable, thus attaining end range
- other manual techniques like ipsilateral QL and/or psoas release often help attain end range and make the SGIS movements more comfortable
- If yes - time to regress (or try manual techniques)
- try a standard lumbar roll position that is traditionally used for gapping, but have the involved side down for loading
- this can be further regressed by having the involved leg's hip and knee be slightly flexed
- after a sustained hold, or several sets of pressure on/off (grade 3 like oscillations) you may then extend the involved LE hip and knee to further load the involved lumbar spine
- this NWB but still loaded regression works great if someone cannot tolerate SGIS, but is not my preferred go to as patients cannot perform this one often throughout the day if they are working or out and about
- I have combined this technique with some of the PRI concepts I've been learning recently like blowing up a balloon in this position to encourage proper breathing and use of the diaphragm, plus reduce tone/threat
|for loading left side, hip/knee in slight flexion|
|somewhat progressed, hip/knee in more extension|
wife was tired when we took this! should be in neutral!
This is just one of the regressions from the shift correction manual SGIS or the wall technique pictured above. Don't give up the ipsilateral loading even if the symptoms peripheralize and/or remain worse as a result, try NWB techniques first!