Bill Hartman 30:32–32:04
Yes, you're a horrible, terrible person. So a couple of possibilities. With the limited straight leg raise, you have to consider your lower compressive strategy. Theoretically, you should not have anything that would approach a normal hip flexion measure because the limitation is at the hip. If you get what appears to be an exaggerated hip flexion measurement, you have a pelvis that is moving as a single unit in some way. Think about this: you have posterior lower compressive strategy, which means you have every other superficial strategy kind of tacked on there. So you have a pelvis that is orienting under almost all circumstances—turning towards you, turning away, or rolling straight back towards the table. In a one-at-a-time measurement, that would be a turn towards you. Chances are that's what you're seeing: you just turned them towards you as you were moving them up into hip flexion. This is very useful to distinguish between cases when you have curiosity and can't figure out what's going on because it becomes that outlier measure when you go, 'How could I possibly get that measure? It doesn't make sense that I have this really limited straight leg.' And I'm not going to say the shoulder too. When you get asymmetrical ones, where you get crazy deflection on one side and very limited on the other side, and you also see this with your ER measures—external rotation measures—it will help you distinguish that representation as well because the magnification of external rotation is definitely going to be the spinal rotation toward you. You get like a 25-30 degree ER on one side and 60-65 ER on the other. That's a spine that's turning. When you think about weight distribution of the measurements themselves, the straight leg raise displaces weight away from the center of gravity on the table. When you bend somebody's hip, you're shifting mass over top of the pelvis, which will allow it to turn, whereas in the straight leg raise it may not turn at all because the distribution of load is different. See the dip? See what I'm getting at? Again, the outlier—that's why I talk about coffee cups on the chessboard. Sometimes you get that one measure that's like, 'And but thankfully you get that one measure because that gives you the key to the whole thing.' You know, you see people that measure crazy symmetrical but limited, except for one thing. There are two reasons for that: you have a constraint that gave way, which would not be fun and you would know pretty much that it would be really uncomfortable when you do the measurement. Or you have somebody that, as I said, they're moving as units or they're orienting to create the magnification of the range of motion.
hip flexion measurementstraight leg raisepelvic orientationexternal rotationlower compressive strategy