Interpubic Ligament Damage and Symphysis Pubis Shearing

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Interpubic Ligament Damageand Symphysis Pubis
Shearing
An intact pubic ligament prevents pubic shearing
by amount d when one stands on the right leg,
as shown.
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Symphysis Pubis Instability in Inflammatory
Arthritis
Osteitis condensans illi (Applied Radiology, 2/92)
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Symphysis Pseudo-Subluxation
Fig. 2.1 Pubic symphysis showing subluxation
(Bourdillon)
... or does it?
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Inter-innominate subluxation and pelvic joints /
contour
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Greenmans Dirty Half-Dozen for chronic LBP

• pubic shear
• sacral shear
• innominate shear
• ilio-psoas syndrome
• anatomic LLI
• non-neutral lumbopelvic syndrome

(DC readers should note that Greenmans study was
unblinded, and very suspect in not having
addressed validity issues. I can find no other
references supporting Greenmans often-mentioned
dirty dozen.)
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Pelvic torsion, hip axis of rotation
A Gonstead model? Not really.
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Gonstead pelvic torsion
PI ilium
AS ilium
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Torsion hip vs. SIFrom bad to worse
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SI Pivot Worse Than Hip Pivot
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Logans Basic Distortion
Logan had the innominate crest superior on side
of low sacrum, His students complained.
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LOGANS THEORY OF THE PI
Logan thought line A-B was the longest
measurement of the innominate bone, and that
pelvic torsion occurred around some interior
innominate axis.
This mistaken belief led him to mistakenly think
that the iliac crest would be elevated on the PI
side when there was pelvic torsion.
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Bad ad for postural chiropractic
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Kendalls Better Basic Distortion
Kendall has the sacrum and the innominate crest
inferior on the same side, accounting for a much
more graceful and plausible postural distortion.
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Inter-Innominate Rotation and Symphysis Pubis
Shear
If the hip were the pivot point for pelvic
torsion, there would be an insupportable shear
stress at the symphysis pubis.
symphysis shear
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Weird ad for a book . . .
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PI Ilium and the Short Leg The Traditional
Explanation

• Innominate rotates around SI joint.
• Hip is pulled up.
• Foot is pulled up by similar amount.

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Typical Statement of theHip-Pulled-Up Genre

Posterior Rotation of the Right Ilium on Sacrum

• Right PSIS lower than left. Right ASIS higher
  than left.
• Pull of iliolumbar ligament rotates L5 to the
  right .
• ACETABULUM FORCED ANTERIOR AND SUPERIOR
  ??functionally shorter leg in standing or supine
  ...
• from CLINICAL T.E.N.S. ,
  Mannheimer, RPT

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Theoretical basis of the functional short
legThe geometric model
A posterior rotation of the ilium supposedly
pulls up the hip creating a short leg on the
so-called PI side
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Pubic luxation, unwitting
Haldeman, 2nd, p. 220
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Whats wrong with this picture?
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Symphysis Luxation and PSIS Unleveling as
Function of Short Leg
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