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Principles of Manual Medicine

Right Inferior Pubic Shear

Overview A direct action, muscle energy procedure for treating a right inferior pubic shear.

Diagnosis

  • Position: Supine
  • Positive standing flexion test on the right side, confirmed by a right one-legged stork test standing, finding the pube on the right side to be inferior in relation to the left, and the right inguinal ligament to be more tense, and usually more tender.

Step 1 We are going to want to develop a technique which will move the pube on the right side in a cephalic direction.

Step 2 The operator's fingers are placed on the patient's right posterior superior iliac spine. The heel of the hand is in contact with the ischial tuberosity. The operator moves the left leg into hip flexion while the patient performs a muscle effort of hip extension.

Step 3 The operator resists three to five efforts of a 3- 5-second muscle contraction by the patient. After each effort the operator engages the new barrier by more hip flexion and compression against th erigth ischial tuberosity.

Step 4 Three to four to five efforts are usually sufficient to restore the pube back to level against the horizontal plane. Remember, always re-examine to make sure you have accomplished what you set out to do.