By Marty Sems Lori Garris
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3. Side gliding Having considered over the past twenty-five years the relevance of the information obtained by assessing the movements of rotation and side bending separately, I have come to the conclusion that it is better to combine the two movements in the one movement of side gliding. In order to examine side gliding the standing patient is asked to move his shoulders and pelvis simultaneously in opposite directions while keeping the shoulders parallel to the ground. As some patients have difficulty in performing this movement, it may be necessary to assist the patient by guiding the movement with a hand placed on one of his shoulders and the other hand on his oppositic iliac crest (Fig.
Perhaps, when the viscosity of nucleus and annulus reaches an equilibrium, internal derangement is less likely to occur. This could account for the decreased incidence of low back pain from age fifty onwards. Of all the intervertebral discs the lumbar discs are by far the thickest and bear the greatest loading and stresses. Even when slightly degenerated they behave hydrostatically7 - that is, the pressure within the disc is equally distributed in all directions of the intervertebral compartment.
This change should become apparent within a few days at the most. There are various methods of measuring the leg length, but the only truly reliable way to detect minor differences in leg lengths is by taking an x-ray of the pelvis and both full legs with the patient in standing. However, it is doubtful that minor leg length discrepancies cause significant low back pain. At this stage, with the patient still standing, it may be advisable to quickly test the integrity of the conduction of the lower lumbar and upper sacral nerve roots.