On Acetabular Soft Tissue Kinematic Influences on Seated FA ER/IR…
I still have some confusion about a concept learned in the Myokinematic Course. It is regarding the assessment of internal and external rotation. I am refering to the chart on page 35, letter D (acetabular soft tissue kinematic influences on seated femoral acetabular rotation). Please explain what it is meant by a patho-compensatory pattern of a Left AIC, a non-pathocompensatory pattern of a left AIC (and is that different from non pathocompensatory pattern in the box above), and a patho-compensatory and non pathocompensatory pattern of a right AIC.
Secondly, you make a reference to the chart on page 36 for FA and AF treatment rationale for the L AIC pathocompensatory pattern. My question is…do I refer to that chart only when I find passive values of decreased L IR less than R, increased L ER more than R, increased R IR more than L and decreased ER less than L (second line of boxes in the chart)?
When the pelvis moves into a L AIC pattern, hip ranges will change because of the orientation of the hip sockets that have moved with the shift and rotation of the pelvis. This is primarily an osseous consideration and it is explained at the bottom of page 33. Initial measurements do not always look like this, because sometimes the ligaments get excessively stretched out or really tight in response to the pattern (what we are referring to as the pathology).
You won’t know for sure if you have a ‘soft tissue’ pathology until after the pelvis is repositioned (factoring out the osseous ‘impingement’ issues) and you recheck the measurements and cross reference them with page 36. In other words, the pathocompensatory L AIC is the one we are the most interested in after repositioning because it is the only one needing clinical attention (hip stretch, inhibition or the application of ligamentous muscle) to ensure the ability to properly shift back into both hips with control to reverse the L AIC pelvic pattern. The non-patho L AIC issue will naturally work itself out with normal reciprocal shifting after getting repositioned so we don’t worry too much about it.
For the sake of teaching, we have reversed the scenario to show you what a non-patho and patho R AIC would present like if we were ever to encounter one.
James Anderson, MPT, PRC
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