First, in regards to the Myokin manual, I’m having a little trouble making sense of the table on page 35 which is the soft tissue passive values for FA motion. The patho pattern values make sense to me, but the non-patho ones don’t. Since the patient must be re-positioned in order to use these values (as James states in the course), how does the non-patho Left AIC patient have increased FA IR on the Left and decreased FAIR on the Right, with corresponding ER values?
The non-repositioned patient appears to have a decrease in Left FAIR and a decrease in Right FAER when measured passively in the seated position, but these values are really just a result of faulty joint position when the pelvis is positioned in the Left AIC pattern. The explanation of osseus (boney) impingement on both the Left and Right sides is explained on the previous page at the bottom of the chart titled “Non patho-compensatory test results for the Left AIC Pattern”. The apparent lack of seated Left FAIR and Right FAER is the result of boney joint position restrictions, and is not a true problem with the joint itself or with the soft tissue associated with the joint.
The true available motion of the joint and the soft tissue structures supporting the joint (the joint capsule and the associated ligaments) cannot be realized until the joint is repositioned to neutral and the osseus impingements are removed. When positioned to neutral, it becomes clear that the joint itself and the soft tissue structures associated with the joint have always had plenty of available motion, but that the joint was not able to realize the motion because of the boney joint position restrictions. If the true available motion into Left FAIR is now increased, it indicates that the left hip joint did not become pathologically restricted across the posterior capsule and ischiofemoral ligament. If the true available motion into Right FAER is now increased, it indicates that the right hip joint did not become pathologically restricted across the anterior capsule and the pubefemoral/iliofemoral ligaments. This presentation after repositioning indicates that true soft tissue pathologies did not develop on either side and that the patient is a non patho-compensatory pattern of a Left AIC. – James Anderson
With FA motion in mind, the table on page 36 (AF and FA Treatment Rationale) is also a little confusing. How does each box differ? For example, what is the difference between “Left IR decrease vs. Right” and “Right IR increase vs. Left”? Aren’t they the same things?
Thank you for observing that the decreased Left IR vs Right box is similar to the increased Right IR vs Left box. Yes, they are potentially the same thing, but they won’t always necessarily be the same thing, depending on how the patient compensates. A patient could become pathologically loose across the front of the Left hip and pathologically restricted across the back of the Left hip (a common presentation). But they could also become loose in the front and not tighten up in the back, they could tighten up in the back and not become loose in the front, they could also loosen up in both the front and the back and they could tighten up in both the front and the back.
As you compare the Left side to the Right side, it is also important that you do not expect an inverted pathology of laxity or tightness to be present on the other side, in spite of what you may commonly expect to occur. For example, you mentioned decreased Left IR vs Right and increased Right IR vs Left in your question. They could end up being the same thing, yes, but they could also end up being quite different in their result and the degree of their comparative result. The first comparison is a side specific analysis of Left posterior hip capsule restriction and the second comparison is a side specific analysis of Right posterior hip capsule hypermobility. They may both be occurring at the same time, but as explained above, one may be occurring in the absence of the other and vise versa. Building in a side specific analysis of both the front and back of both hip joints (the reason we have 4 boxes) allows us to understand the specific pathological presentation of each patient on each side and to understand the specific treatment approach that may be needed for the unique way each person compensates. – James Anderson
