physiotherapy, J u n e 1982, voI 38, n o 2 43 TR EA TM EN T NOTE: A MOBILISING TECHNIQUE FOR THE SYMPHYSIS PUBIS R. M I T C H E L L , M .C .S .P .* This is a n i n tr o d u c t io n to a mo bilisin g tec hn iq u e o f the symphysis pu bi s which has been used for so m e years now. The c o n d it i o n o f sub lu x ed symp hy sis pubi s can easily be foun d, using kinesiology, pa rti cul ar ly by be h av io u ra l kinesiology, (B .K.) with m a n u a l ' localisation. If not a c q u a in t e d with B.K. testing th en this a re a can be tested by pressure o ve r the su p e ri o r a n d a r c u a te p ub ic ligaments. T endern ess indicates ligament s tr a in a n d th at so m e degree of su bl u x a ti o n is present. The side which is “ d o w n ” has an a sso ci ate d hy pe rto ni c a n d tende r gracilis muscle. T h e s u p e r i o r pubis r a m u s on the affected side is m or e difficult to pa lp a t e a n d is often tender. Resisted hip flexion on the affected side is weakened, c o m p a r e d with the “ g o o d ” side. H yp e r t o n ic it y o f p so a s/ i li a cu s plus a b d o m i n a l muscle i mb al an ce is a c o m m o n finding. Pain relieved so far includes reca lcitra nt sciatica (often on the o p p o si t e side); low bac k pain; kn ee pain; “ pe rio d p a i n s ” a n d o t h e r gyn aecological pains. It has a lso been not ed that cervical s u b l u x a ti o n s at C l & 2 often a p p e a r re duced after pelvic a d ju s tm e n t, parti cul ar ly in y o u n g wom en . ♦Private P ra c tit io ne r, D u r b a n . Received 30 April 1982. T E C H N IQ U E T his is simple bu t on e s h o u l d be war e o f p u t ti n g t o o m uch pressure o n the pa tie n t o r y o u r o w n co nt a ct h a n d . S t a n d on the affected side o f the sup in e pa tie nt , facing to w a r d s the p a ti e n t a t a b o u t waist level. T he c o n ta c t h a n d is on the sa m e side as the p a t i e n t ’s affec ted side. Slide this h a n d u p the inside o f the p a t i e n t ’s thigh, p alm o n thigh, t h u m b to w a r d s the head . M ak e c o n ta ct between the distal p a r t o f the 2nd m et a ca r p al a n d the inferior aspect o f the pu bi c ramu s. T h is point m ay be ten de r, so a p p ly pres sur e gently in the direc tion o f the p a t i e n t ’s chin. Th is pres sur e needs to be app lie d steadily for at least h alf a m inu te so reinforce the co n ta ct h a n d wi th the o t h e r h a n d a r o u n d the wrist o f the co n ta ct ha nd . Be careful to a v o id digging the t h u m b into the p a t i e n t ’s groin o r lower a b d o m e n . W he n the m o v e m e n t is felt, m ai n t ai n pressu re until the m o ve m e n t ceases. S om e p a ti e n ts feel m o v em e n t a n d a lt e ra t io n o f p ain level, whilst ot her s ask if a n y th i n g is ha pp en in g . Test a f te r w a r d s for in creased hip flexor stre ng th, re d u ct io n o f gracilis tension a n d tende rness, plus a m o r e easily p alp ab le p u b ic ramus. T he liga ment s are usually less tender. This is not a onc e only a d ju s tm e n t as gra vity a n d jer k y m o ve m e n t plus the u su al a b d o m i n a l muscle we akness a ss oc ia te d with this p ro bl em all mitig ate against total success in one session. T h u s follow up with a p p r o p r i a t e exercises for h o m e m an a g e m e n t but no sit-ups or straight-leg raising exercises! R a th e r use aw are ne ss training, f o r ex ample, F e ld en k r a is o r A l e x a n d e r techniques. RESEARCH PROCEEDINGS OF A MEETING OF THE NATAL COASTAL BRANCH OF THE SOUTH AFRICAN SOCIETY OF PHYSIOTHERAPY HELD ON 15 MARCH 1982 I n t e r e s t in r e s e a r c h a n d i n v e s t i g a t i o n a m o n g the m em b e rs h ip o f the N a t a l C o a st al B r a n ch increased its m o m e n t u m in early 1980 follow ing a Br a nc h lecture on research a n d its imp lica tions for the ph ysi ot her ap ist . As a result o f this lec ture an inf or ma l g r o u p of members particularly inte res ted in research was formed. C o n t a c t with the g r o u p has been m ai n t a i n e d o n a pe rsonal basis a n d d es p ite the m an y difficulties as soc iated with research in bu sy ho spital a n d p ri vat e practices, a n u m b e r o f projects hav e been u n d e r ta k e n ; these cover a wide range o f subjects. As p a r t o f the B r a n ch p r o g r a m m e for 1982 the co m m itt e e decided th at o n e B r a n ch mee ting sh o u l d be d e v o te d to those mem be rs w h o were involved in va r io u s fo rm s o f research a n d investigations. This mee ting was held in M a r c h wh en details p e rta in in g to ten different pr ojects were presented. These incl uded c om p l e te d studies, as well as tr end s ar ising ou t o f o n go in g studies. In a d d it i o n , the f o r m at for several projects a b o u t to be c o m m e n c e d were pr esented. R E F L E X O L O G Y (M rs O . Ison) M r s Iso n is on e o f a small g r o u p o f t her ap ist s w ho have been usin g reflexology (zone t h er a p y) in their pr actice for several years. A l t h o u g h she has tr ea te d a c o n sid era ble n u m b e r o f cases by this m et h o d , o nl y one pati en t has been referred by a d o c t o r specifically for reflexology. As a c o n s e q u e n c e M r s I s o n u s u a l ly uses r e fl e x o lo g y in c o n ju n c t io n with c o n v e n t i o n a l ph y si o th er a py . How eve r, she was able to re p o rt on so m e o f the results o f reflexology o b t a i n e d with p a ti e nt s who ha d sh ow n little o r no i m p r o v e m e n t when tr ea te d w it h the usua l p h ys io th er a p eu ti c modalities. Positive resp on ses were fo u n d in a g r o u p o f ne urologically im p a i r ed pa tie n ts w hich in clu de d ce re br al -v as cu la r accident (C .V.A .), cere bral palsy a n d P a r k i n s o n ’s sy nd ro m e. I m p r o v e m e n t was largely a t t r i b u t e d to a re d u ct io n in muscle tone, t h o u g h in o n e case o f C .V .A. there was som e re tu r n o f R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )