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Pelvic inominate Upslip

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Nov 27, 2010.

  1. David Smith

    David Smith Well-Known Member


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    Do you have any comments on this condition described here.

    http://www.maximumtrainingsolutions.com/Upslip.html

    I haven't come across this before

    I have a young patient 16yrs old. I won't go into great detail but he has a high left innominate (comparing iliac crests) with cavus adducted inverted foot with low 1st ray and equinus forefoot. His left GM / buttock sits higher than the right. Mobilising the foot and ankle and releasing the hamstrings made the left innominate even higher than the right by 50mm and when sitting the left illiac crest is higher by 30mm. His leg length from lat mall to Gr Troc is 2 cm longer on the left.

    It seems reasonable that he could have a pelvic 'upslip' as its called here but is this a valid Dx. It could just be a larger ilium on the left side but then the buttock alignment would probably be the same.

    Regards Dave
     
  2. Stanley

    Stanley Well-Known Member

    Hi Dave,

    If you have an upslip, then there would be an upslipping of the entire pelvis. The confirmatory of this is to check the symphysis pubis to see if one pubic bone is higher than the other.
    I have found this is related to an imbalance of the adductors to abductors of the hip.

    Regards,
    Stanley
     
  3. musmed

    musmed Well-Known Member

    Dear Dave and Stanley
    Hi
    I agree with Stanley but also Dave in travell and Simons book Vol2 they stress a hemipelvis and this could be what you are seeing.
    A hemipelvis is wher one innominate is smaller than the other.
    When you read their book this large section (relative to other topics) one would think it is everywhere, but in fact is quite rare in my 30 odd years of doing pelvic work

    Regards
    Paul Conneely
     
  4. David Smith

    David Smith Well-Known Member

    Dr Beekman

    I had hoped you would reply: How do you mean the entire pelvis? Do you mean on side or one half? Examining the symphysis pubis might just be to risqué for me but perhaps the patient might palpate this himself.

    Paul

    Thanks for your reply:

    .

    Yes this was my thoughts but before I mobilised the ankle and released the hamstrings and TFL tricep group the iliac crests were level when sitting and uneven in stance. After mobs etc, the iliac crests were even more uneven i.e. the left higher one even higher and the left one was also higher when sitting.

    I thought how could this come about? Then I came across this upslip proposal and if valid then it might be possible that before mobs the uneven muscle tension might have been pulling the upslip down and when mobilised and released the half pelvis, hemi pelvis or innominate (aren't they the same thing? see below) regained its pathological or unnatural relative position. Does this seem reasonable?

    The presentation is unusual in that it is something I have not come across before. I think the treatment of his original problem would be greatly influenced by the correct evaluation of the underlying problem here.

    [​IMG]

    Regards Dave
     
  5. musmed

    musmed Well-Known Member

    Dave
    Thanks for the diagram
    The name innominate is derived from the religious trinity. Three bones make the innominate.
    It is not 1/2 the pelvis, only the innominate, The sacrum is normal and fits the other innominate very well.

    The upslip is a term made by either Mitchell or Fryette. Fryette is the god of osteopathy while Fred Mitchell did a great deal to revive the osteopathic (USA) profession in the 50's onwards.

    What is an upslip.

    Basically an upslip is where one innominate is stuck relative to the sacrum at the sacro-iliac joint.
    There is a huge difference between sacro-iliac motion and ilio-sacral motion.

    How to Test:
    You stand behind the patient.
    Place your thumbs on their PSIS while gently grasping their hips.
    Line your eyes up with your thumbs throughout the whole process.
    Now get them to slowly bend over.
    If all is normal the sacrum extends first and once the ligaments are taut the pelvis as a WHOLE starts to rotate forward ie. flex or positive nutate (depending on which school you went to)

    When a Ilio-sacral joint is fixed and they start to bend over one side (thumb) will begin to move instantly or before the other side, while the other side is still taking up ligament laxity.

    The diagnosis is the side to move first ONLY
    NOT how far it moves.
    That is an upslip
    It is an exttremely common cause of deep seated back ache not pain ACHE. Immobile joints ache not pain, hypermobile joints pain.

    If you want the correction technique, let me know and I will sends it to you. It is very easy.
    The intersting thing is
    1. the psoas on that side will be alwasy short
    2. 90% of sacral lesions ie flexions, torsion and upslip are on the left side. I have no idea why. Iam open to anyone throwing in their 5 cents plus VAT

    Another problem could be:
    Vladamir Yanda used to talk about facial asymmetry.
    If one puts a:
    1. dot between their eyes
    2. tip of nose
    3. mid point of their chin

    In most of us they line up.
    If you look at newsreaders who sit to an angle to read the news, these people look square but when you do this little test they are not square.

    They had a bigger breast, hand and foot on the concave side.
    Yanda used to say you can never square them up no matter what you do, They just go further into dysfunction.

    As a collective look at the souls you just got nowhere with, I bet you will find they fit this mold.

    Let me know of your thoughts
    Keep well
    Regards
    Paul Conneely
    Musmed.com.au
     
  6. Stanley

    Stanley Well-Known Member

    Hi Dave,

    Sorry I didn't reply sooner and sorry for the confusion. Upslipping is when one half that moves upwards.
    For this to be, you will see on one side the iliac crest, the PSIS and the ASIS all elevated on the one side. This would mimic a long leg. The difference is the elevation of the pubic bone. If the pelvis is tilted due to an elevation of one leg, there will be congruence of the symphysis pubis. An up-slipping will cause an incongruence.

    Blockage does occur, but I never put too much faith in that test, as this can be caused by a posterior innominate whether due to a subluxation or due to position. By this I mean if the posterior innominate is due to pronation of the opposite foot, then supinating the foot in stance will change the blockage.
    Another thing to keep in mind about blockage is that this is a reason never to do leg length measurements in the seated position.
    Personally, I do not even work on the pelvis to correct it. For instance a lateral talus will show a posterior innominate with no equinus. Fix the lateral talus and the pelvis corrects.
    Paul, when we live half way around the world, the terminology can be different. What happens in the patient is the same regardless of the terminology.

    Regards,

    Stanley
     
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