- trauma or microtrauma, directed to the ilium;
- thoracolumbar and/or thoracic segmental fixations;
- cervical fixations.
There are other less common or less frequently seen causes, such as:
- lower extremity disorders;
I want to draw attention to the most commonly encountered situations: right-sided AS (anterior superior) ilium fixations resulting from trauma to the right ilium such as falling on one's buttocks; and thoracolumbar/thoracic fixations (with extension loss as the major contributor). In previous references (articles for Dynamic Chiropractic and the manual The Connection), I've presented the hypothesis of counternutation with AS ilium fixation as the main result. The greatest question fo a practitioner is when a right-sided AS ilium manifests, with or without pain, how does one approach the correction with the greatest safety? How does one restore ilium motion with safety? If you review the restoration of PI (posterior inferior) ilium motion, it will involve nutation of the sacral base, resulting in increased loading of the posterior disc and facet joints. If one concludes that this represents a safe process for the L/S region, then you may proceed with a safety protocol. The following procedures have fulfilled the protocol most effectively in safely releasing a right AS ilium fixation:
1. Adjust thoracolumbar and thoracic extension and rotation fixation restrictions.
- This is a main source of release of right-sided AS ilium fixations. Stated another way, right-sided AS ilium fixations are a common result of T/L and thoracic extension fixation restrictions.
2. Adjust the right ilium as an AS ilium fixation if the TL/thoracic adjusting has failed to restore normal ilium motion, or if there is only a partial release of the AS ilium fixation. In other words, both the TL/thoracic fixations and the right-sided AS ilium fixation can contribute to the total AS ilium fixation dysfunction on the right side; or either one separately can contribute as the sole causative agent. In evaluating the contributions of any causative agent or process, one must perform before and after testing of the SI joint, using seated forward flexion and the standing bent knee leg raise.
3. Adjust L-5 (or the most significant lower lumbar fixation) as an LP listing, followed by a right AS ilium adjustment.
In The Connection, reference is made to severe, deep, or significant L/S pain on the right side. This type of symptom often is related to an L-5 LP rotation, with right L-5 facet anterior fixation on a right AS rotated ilium side. If L-5 is adjusted, the AS fixation does not release. However, L-5 rotation contributes to the pain and stress, and the AS ilium fix may be a compensatory maneuver of some sort, yet contributing to the side effect of right L-5/S-1 jamming. Anyway, the ilium may palpate normally after the L-5 and right AS ilium are corrected by adjustment.
4. Adjust a significant upper cervical fixation (if present) if the right ilium still does not palpate normally.
It is common to see the following developments following the AS ilium fixation:
- Hypertonic gluteal muscles, especially at the upper half of iliac crest.
a. Sore nodular areas can develop in the upper iliac crest region, especially the medial aspect.
b. These muscles shorten or resist elongation.
- Strain and hypertonus of the hip flexors.
a. Proximal groin pain due to tendon strain can develop.
b. Distal tendon strain due to rectus femoris tightening, causing anterior knee compartment disorders and Osgood-Slaughter types of disorders.
- Hip joint hypermobility, strain, pain and crepitus.
a. It is common sense to assume that doubling hip joint activity will lead to increased wear and tear in the hip joint proper, leading to increased loss of cartilage due to wear. I see this process, from this perspective, as a significant potential contributor of hip cartilage premature destruction.
- Hamstring strain and hypertonicity, leading to:
a. Ischial tendonitis/bursitis
b. Posterior knee strain/tendonitis
These disorders numbered 1-4, as I have identified them are called associated disorders because they occur as a consequence of spinal and pelvic joint complex disorders (subluxations, dysfunctions, fixations, etc.).
It is, therefore, more important for doctors of chiropractic to be proficient in identification of joint disorders, before and after correction of such, and their correction, than the treatment of associated disorders. It is also very important to be proficient in the correction/treatment of such associated extremity disorders. These secondary disorders can be treated with a variety of methods, including a myriad of modalities available to us.
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.