To be clear - there is NO evidence that painful pelvic joints are associated with the bones of the pelvis being misaligned...or out of place...and movement of the joint is barely detectable in people with pain. There IS evidence that people with disabling pelvic pain present with lower pain thresholds to pressure and mechanical stress, have poorer sleep, are more fearful and develop protective muscle guarding over these painful joints...which may manifest as 'stiffness' - or asymmetry - no different to clenching your fist stiffening your wrist. There is also evidence that feeling like 'something is out of place' in your pelvis is common. This is likely to reflect a combination of altered body perception and altered patterns of muscle tension - but NOT altered positioning of the pelvic bones. The likely effect of manual therapies is to provide pain relief and reduce protective muscle guarding....but NOT to put the bones back into position as is often believed. See research by: Palsson et al Pain 2012, 152 (11) 2233-40 Palsson et al Clin J Pain, 2015, 31 (7) 542-51 Kibgsard et al Clin Biomech, 2014, 29,4 Beales et al Man ther, 2016,21 69-75 Palsson et al, J Pain, 2014, 16 (3)
Fantastic news Peter O'Sullivan. It is long time for a huge over hall in the education of our Health care professionals on the subject of Chronic pain.
Thanks Peter for this video. Firstly David, in my opinion you should show this man a little more respect. He is at the top of his field and has researched this area to great length; to say that what he is saying is nonsense is unfair and inaccurate. I am interested to understand your background in relation to this conversation? Personally I am a big fan of evidence in the form of peer reviewed research, both qualitative and quantitative. Peter has outlined evidence of this nature. To address Dr mum, your evidence may have some validity, however its almost 20 years out of date. Times change and research develops. Thanks again Peter. Keep up the good work.
can I ask, what about women who have hypermobility syndrome and therefore are prone to joint issues. I was treated on the NHS by a women's specialist, who realigned my pelvis, and gave a brace to prevent dislocation. Having had physio since a teenager I know the importance of keeping joint movement "normal" even when in pain. I do have a high pain threshold, I am allergic to most painkillers, have broken bones and dislocated joints on numerous occasions. PGP meant that I was physically unable to move my leg (pain wasn't the issue, try as much as I wanted the joint would not move without help). It is unlikely there would be charities who deal with PGP and help organise best practice if it was just women being stupid. I didn't even know what PGP was until I was diagnosed, so fear of it was not the issue.
This is a terrible message for physios and patients. You have ignored data by Damen et al 2001 Acta Obstet Gynecol Scand 80(11): 1019-24 and Buyrek et al 1999 Eur J Obstet Gynecol Reprod Biol 83 (2) 159-63 that shows that asymmetry of movement in the SI joints associates with PGP (not laxity in general, we agree on that). I had bad PGP that was fixed in a couple of sessions by a physiotherapist who restored said symmetry of movement in my SI joints. My PGP was not in my mind, and I find it insulting that you would state otherwise! Of course mental attitude plays a role in recovery, but taking research that shows this and extrapolating out to the conclusion that it is the only factor for recovery is poor science. Thank goodness I didn't see this when I still had PGP, I might still be struggling with pain thinking it was all my fault for not being mentally robust enough, and would not have experienced the sweet relief that came with good hands on treatment by a skilled physiotherapist. You do a disservice to women with PGP.
This is nonsense. The SI joints, in particular, but any spinal or pelvic joint, can be misaligned or, in functional terms, have dysfunctional joint motion. All this can usually be corrected by mobilization or adjustment. Strengthening muscles around the joints helps preserve the adjustments. But to not tell people their joints are misaligned because they might be "afraid" (as you seem to suggest) is nuts! You are delaying people getting proper treatment. The "guarding" you are talking about is CNS mediated, involuntary, and NOT driven by conscious beliefs.
I have chronic pelvic pain and there are times when my SI joint gets painful and is stuck. However, I realize that it’s a chicken and egg dilemma because my pelvic PT would try and tell me that my SI stiffness is causing my pelvic pain but in reality I know it’s in the other direction. When my tissue sensitivity in my pelvis gets really high, I can feel the domino effect of my pelvic muscles starting to tighten. My pelvic PT can only Help me in a limited way. She mobilizes the tissue but because the nerve sensitivity is so strong, it just locks back up. Even if she could permanently loosen my joints and muscles it would only have a minor affect on the overall pain. I started incorporating fear reduction mechanisms into my life and the pain has changed for the better but I still have a long way to go.
To be clear - there is NO evidence that painful pelvic joints are associated with the bones of the pelvis being misaligned...or out of place...and movement of the joint is barely detectable in people with pain.
There IS evidence that people with disabling pelvic pain present with lower pain thresholds to pressure and mechanical stress, have poorer sleep, are more fearful and develop protective muscle guarding over these painful joints...which may manifest as 'stiffness' - or asymmetry - no different to clenching your fist stiffening your wrist. There is also evidence that feeling like 'something is out of place' in your pelvis is common. This is likely to reflect a combination of altered body perception and altered patterns of muscle tension - but NOT altered positioning of the pelvic bones.
The likely effect of manual therapies is to provide pain relief and reduce protective muscle guarding....but NOT to put the bones back into position as is often believed.
See research by:
Palsson et al Pain 2012, 152 (11) 2233-40
Palsson et al Clin J Pain, 2015, 31 (7) 542-51
Kibgsard et al Clin Biomech, 2014, 29,4
Beales et al Man ther, 2016,21 69-75
Palsson et al, J Pain, 2014, 16 (3)
Fantastic news Peter O'Sullivan. It is long time for a huge over hall in the education of our Health care professionals on the subject of Chronic pain.
Thanks Peter for this video. Firstly David, in my opinion you should show this man a little more respect. He is at the top of his field and has researched this area to great length; to say that what he is saying is nonsense is unfair and inaccurate. I am interested to understand your background in relation to this conversation? Personally I am a big fan of evidence in the form of peer reviewed research, both qualitative and quantitative. Peter has outlined evidence of this nature. To address Dr mum, your evidence may have some validity, however its almost 20 years out of date. Times change and research develops.
Thanks again Peter. Keep up the good work.
What a great message for physios and patients, Thank you Peter
can I ask, what about women who have hypermobility syndrome and therefore are prone to joint issues. I was treated on the NHS by a women's specialist, who realigned my pelvis, and gave a brace to prevent dislocation. Having had physio since a teenager I know the importance of keeping joint movement "normal" even when in pain. I do have a high pain threshold, I am allergic to most painkillers, have broken bones and dislocated joints on numerous occasions. PGP meant that I was physically unable to move my leg (pain wasn't the issue, try as much as I wanted the joint would not move without help). It is unlikely there would be charities who deal with PGP and help organise best practice if it was just women being stupid. I didn't even know what PGP was until I was diagnosed, so fear of it was not the issue.
This is a terrible message for physios and patients. You have ignored data by Damen et al 2001 Acta Obstet Gynecol Scand 80(11): 1019-24 and Buyrek et al 1999 Eur J Obstet Gynecol Reprod Biol 83 (2) 159-63 that shows that asymmetry of movement in the SI joints associates with PGP (not laxity in general, we agree on that). I had bad PGP that was fixed in a couple of sessions by a physiotherapist who restored said symmetry of movement in my SI joints. My PGP was not in my mind, and I find it insulting that you would state otherwise! Of course mental attitude plays a role in recovery, but taking research that shows this and extrapolating out to the conclusion that it is the only factor for recovery is poor science. Thank goodness I didn't see this when I still had PGP, I might still be struggling with pain thinking it was all my fault for not being mentally robust enough, and would not have experienced the sweet relief that came with good hands on treatment by a skilled physiotherapist. You do a disservice to women with PGP.
Pain-ed, can you reply on what you think of the data mentioned above?
@@ManjaWeijers yes please. I'd have my views on this also but would love to get feedback on this also
This is nonsense. The SI joints, in particular, but any spinal or pelvic joint, can be misaligned or, in functional terms, have dysfunctional joint motion. All this can usually be corrected by mobilization or adjustment. Strengthening muscles around the joints helps preserve the adjustments. But to not tell people their joints are misaligned because they might be "afraid" (as you seem to suggest) is nuts! You are delaying people getting proper treatment. The "guarding" you are talking about is CNS mediated, involuntary, and NOT driven by conscious beliefs.
evidently a chiropractor, perpetuate bollocks that lines your pockets. Nice one
I have chronic pelvic pain and there are times when my SI joint gets painful and is stuck. However, I realize that it’s a chicken and egg dilemma because my pelvic PT would try and tell me that my SI stiffness is causing my pelvic pain but in reality I know it’s in the other direction. When my tissue sensitivity in my pelvis gets really high, I can feel the domino effect of my pelvic muscles starting to tighten. My pelvic PT can only Help me in a limited way. She mobilizes the tissue but because the nerve sensitivity is so strong, it just locks back up. Even if she could permanently loosen my joints and muscles it would only have a minor affect on the overall pain. I started incorporating fear reduction mechanisms into my life and the pain has changed for the better but I still have a long way to go.