Canadian RMT Magazine Spring 2016 Apr. 2016 | Page 19

Fig. 1

Fig. 2

Fig. 3

Fig. 3

Fig. 4A

Fig. 4A

Contrary to what many docs tell their
“patients,
most low back and pelvic pain
does not result from a single traumatic
lifting, bending or sports injury.

”

interacts with the spinal cord and brain
to provide joint stability and coordinated
movement…or lack of it as is the case in
chronic upslips.
In the presence of chronic upslips,
prolonged cyclical loading can deform SI
joint ligaments to a point where an act
as innocent as slamming on the brake,
tumbling on one hip, or clumsily stepping off a curb, can jostle the joint enough
to cause the ilium to ‘jump-a-notch’ on
sacrum. Here’s an interesting ‘upslip’
case study of a client named Marion who
called complaining of stabbing buttock
and low back pain.
Marion the Hairdresser
I’d treated Marion off-and-on for a
chronic whiplash injury, but today it was
her hip and she was in a world of hurt.
This was her first visit since becoming
a momma a year earlier and her history
in-take revealed two related factors
contributing to her injury: 1) Cumulative
viscoelastic creep (hypermobility) left
over from the relaxin birth hormone, and
2) Prolonged one-legged cyclical loading
at her hairdressing job.
A classic upslip case, Marion presented
with acute right-sided lumbopelvic pain,
funky gait, and anatomical landmarks
showing a 1 1/2” short right leg, lax sacrotuberous ligament right, OL and psoas
spasm right, and superior/posterior right
ilium. Spring testing of the right ilium
(supine and prone) revealed no inferior
glide. Marion’s right QL fired before
gluteus medius on the hip abduction
test and she lifted the swing leg with the
spasmed QL as she tried to walk. Over
the years, I’ve noticed that in the early
stages of ligamentous creep, the brain
down-regulates nociceptive pain signals.
But when the joint finally jams, the brain

immediately reacts with pain and protective guarding to prevent further insult to
the damaged area.
Fixing the Fixation
Here are a couple of techniques that
helped fix Marion’s upslipped hip. In Figure 4A, she’s pulling the knee to her chest
to inferiorly drag the ilium while I slowly
elbow my way through the lumbodorsal
fascia, QL, and iliocostalis myospasm.
Once these hypertrophied (hip-hiking)
soft tissues regain flexibility and mobility, a maneuver is used to get the sacroiliac “grooves-a-groovin.” In Figure 4B,
Marion lies supine and I apply an inferior
tractioning force to drag the ilium to the
first restrictive barrier feeling for neutral
leg and hip alignment. By taking the limb
into a bit of internal rotation, I’m able to
bony-lock the hip allowing the tractioning
force to travel through the SI joint. Using
my body weight with her thigh securely
arm-locked, a distraction force is applied
as Marion forcefully contracts the QL and
hip-hikes against my resistance. After a
few seconds, she is asked cough vigorously
to help jostle the joint and reposition the
soft tissues. Traction combined with the
forced exhalation allows Marion’s ilium to
drop down into the groove “from whence
it came.” Rest, ergonomic retraining, and
regular follow-ups are mandatory until
pelvic stability is established. Remember,
the first couple weeks are critical; even
the slightest jar can turn the ligaments
back into silly putty.
References:
1.Bogduk N, Twomey LT. Clinical Anatomy of the
Lumbar Spine. 2nd ed. Melbourne: Churchill Livingstone, 1991
2. Gracovetsky S, The Spinal Engine, Springer-Verlag,
NY, 1988

ErikDalton_Feature6.indd 19

Spring 2016 19

2016-03-02 9:16 PM