Next problem, is the Superior Pubic Shear.
When you check the pubic bones and there's an
assymetry - one side that's high on the other,
you're gonna need to fix that in
order for the patient to be able to
function normally and have
equal leg lengths.
So the patient is going to
have to use their own muscles
and the piriformis and the rectus
abdominis and the internal hip flexors
are good muscles to pull the
pubic symphysis equal and level
I use isometric counterforce
and have that patient push
in order to have the internal
muscles restore functioning.
I repeat several times until you have
more comfort and ease of motion.
That's the pubic shear.
Moving on to the Innominate
Shear, back to the pelvis
at the junction of the sacrum and the ilium,
innominate shears are very common,
that's why it says "high-yield",
and it's something you
need to pay attention to.
You look at the motion of the
pelvic bones, and the sacrum.
Is one locked or both moving?
And a shear suggests the entire ilium
on the one side is not moving well
relative to the sacrum so you want to look at
a shear versus a motion of the full pelvis.
Most shears are gonna be superior and
you'll see it in the top portion
where the sacrum and the ilium meet.
So superior innominate shear is
going to have a lateralization
when you do "hip drop test", you'll notice one
side of the hip moves better than the other.
If you do it, see the flexion
that takes the hip out..
and I'm sorry - takes the pelvis
out by stabilizing the pelvis
And you do a pelvic compression test or
a pelvic rock test looking for motion.
The treatment of a superior innominate
shear is by putting the patient supine and
grasping the medial malleolus, pulling
the leg and helping internally rotate
and yanking the leg in order to
bring the muscles into alignment,
ease the muscles and their functioning and
movement of the musculoskeletal system.
We call this a loose-pack
positioning of the sacroiliac joint
and is moving the joint through the hip.
So you are going to ABduct and flex the
leg in order to help facilitate motion
and you do this until you engage
motion, you find the barrier,
and play some traction and
then employ the force.
You can also do a msucle energy here by having
the patient pull for 3-5 seconds and then relax
And as long as you get increased motion on each
pole, you're doing good - maintain the traction,
bring the joint to the barrier so that you're going to
have the ability to change the musculoskeletal functioning
Another way of doing this is to have
the patient use a respiratory force,
or cough or somehow have the respiratory force
change the functioning and change the motion
So when the patient is
breathing in or coughing,
that's when you're going to engage
the barrier and have the tug.
Recheck the leg length levels, to
make sure you have evened them out
and repeat the procedure again if necessary.