At 09:03 PM 12/18/00 +1000, you wrote:
>She has left lateral hip pain aggravated by sitting and end ROM lumbar
>flexion.
Scott,
I'd suggest you forget the articular structures for now and concentrate on
the resting posture of the left hip. Simply have the patient lie supine and
look at the relation of the feet to the midline and their angulation from
the surface. The closer they are held to the midline and the more the toes
point toward the ceiling, the more persistent internal rotation and
adduction she has in the ipsolateral hip. It is a biomechanical fact that
this will increase neural tension on that side (Breig, Alf "Biomechanical
Considerations in the Straight Leg Raising Test," Spine, Vol 4, No.3. 1979,
pg. 242-250. See also "A Simple Test of Autonomic Balance" by Barrett L.
Dorko Copies available from the author.)
It's been my experience that the symptomatic side will be easily identified
as habitually internally rotated. It might also be held here because the
path from the acquired posture is uncomfortable or simply unusual. This
persistent posturing reduces the slackness of the nervous system on that
side and, I think, will lead to symptoms at end range. To me, this is a
biologically plausible explanation for a lot of painful problems. It has
the advantage of being quite simple as well.
Getting to a normal resting posture in supine (full external rotation of
both hips) may be a challenge unless you know how to elicit spontaneous
correction, but I would not suggest you stretch anything. I provide my
patients with a couple of exercises modified from Feldenkrais specifically
for this.
Barrett L. Dorko, P.T.
"The Clinician's Manual" <http://barrettdorko.com>
Also at <http://rehabedge.com>
And <http://prorehabonline.com>
And <http://physicaltherapist.com>
And <http://rehabmax.com>
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