Does the Ilium of the Pelvis Internally Rotate? Asking for a Friend
Short answer-no, not like that. Let's review pelvic ring anatomy and discuss how to navigate the intersection of emerging research, clinical innovation, and social media hype.
Content Without Context
Social media is full of content without context. It’s difficult to navigate. We strive to keep up with the latest-emerging evidence, clinical insights, and new ideas. Algorithms also dictate what we see, and provides it on repeat. So the same ideas seem to float our way from different accounts. At some point the pure volume of folks that are lauding a new technique, course, or thought process gives it weight in our minds. Doubt creeps in…am I behind, am I not providing best practices? Something that sounded fringe, now sounds sorta reasonable.
How do we innovate clinically in a way that optimizes the patient experience and avoids stagnation, but steers clear of what are at best ineffective treatment strategies or at their worst dangerous to patients? Social media is the third wheel in the relationship between research and clinical innovation that can hype a good idea, or propel a bad one (see video).
How do we pursue evidence informed care and sift through social media sourced ideas?
How do we innovate clinically to bring change and avoid harm to thought or body?
Folks often say “research always catches up with clinical” so how can we actually be evidenced-based clinicians? On the contrary, if research leads the way, how do we create research questions that have clinical relevance and utility?
Since the answer is likely somewhere in-between…. what does the ideal inter-relationship between emerging research, clinical insights, and social media hype look like? (PLEASE check out a companion recorded Q and A that discussed exactly this complexity in a respectful, collegial context- a clip and more details below!)
How we can hold the middle ground?
Here are some ideas on how to navigate the Wild West of low quality evidence and high volume social media advice at the edges of clinical care.
Clinical Reasoning is Queen- Dichotomous extremes (always/never, either/or), formulas, factoids, and social media sound bites run out of utility fast in real life client situations. But solid clinical reasoning applies to every patient.
Filter new ideas through what is known- Is it logical? Does it make sense? Is it presented with context to allow you to connect dots between known and new? What questions does it bring up for you to help you test the waters?
Extrapolate research from other areas of practice- Sports medicine can inform pelvic health; pelvic health can inform sports medicine (How can we apply what we understand over there, here?)
Reflect and re-assess regularly- Reflect, reflect and reflect some more. Take a step forward, monitor, modify, consider different responses…adapt. Rinse, repeat.
Patient context-Consider what worked, what didn’t through the lens of the context of the patient in front of us - their history, their story, their needs, their environment, their goals. Tailor what we do know in the evidence within their context.
Learn from different responses to care-Why did Patient A respond and Patient B didn’t? What was unique or were there other variables to consider for each patient?
Ask a lot of questions- Ask questions, then refine your questions, and ask more questions. Develop a clinical question then hit up Pub Med, and answer it yourself with existing evidence (social media is not the only place to stimulate your thinking!).
Look Before You Leap
Before you jump on a social media trend or band wagon - please ask questions, consider the context, seek out the evidence to support it. There may not be a randomized control trial, but what’s the thought process behind the idea? How’d they get there- can you retrace their logic and reasoning? And certainly work with the concept clinically with an appropriate patient, troubleshoot the idea, learn, modify, consider…..before you share it back out into the socials.
IMPORTANT EPILOGUE
I knew this post could cause a stir. My hope is to call out concepts, not people. But I didn’t realize how rampant this had become. When I typed into google- does the ilium internally rotate….the AI slop said ‘yes’, and used video and blogs of folks with these springy pelvises as support for the answer. Red alert. Mixed in were skeletal anatomy textbook chapters and research that acknowledged only small amounts of movement occur at pelvic joints (both the SI and PS-millimeters and a few degrees of motion in different planes) which was good to see.
So I cut the video above into something social media length and waiting for the right time to post when I could weather the storm.
Q and A Convo
to the Rescue (Here’s a Clip)
But then we actually had an incredible conversation on my April Quarterly Q and A discussing how to evolve practice with well reasoned interventions in the absence of evidence . How do we innovate in a grounded way in the era of social media? That led us to a respectful, in-depth, collegial conversation thinking through the birth position/hip internal rotation mechanism. With permission from the two PT pros that were there (Micaela Zettel and Haley Mitchell) that conversation is now a public post, not a paywalled post. It honestly highlights and models how we should be navigating complexity in this era of social media hot takes. Interacting in a safe space around the real issues we have on the ground trying to be evidence informed clinicians. This conversation is exactly why I created this Substack- in-person, respectful, nuanced conversation.
If this brings up questions, challenges your thinking, or raises concerns-please watch the Q and A before responding. Hoping to continue having thoughtful discussions that support being evidence informed and well reasoned in the gaps.
Don’t wanna miss a post?
Wanna share with a friend?
Lewis CL, Laudicina NM, Khuu A, Loverro KL. The Human Pelvis: Variation in Structure and Function During Gait. Anat Rec (Hoboken). 2017;300(4):633-642. doi:10.1002/ar.23552
Sako N, Kaku N, Kitahara Y, Kubota Y, Tagomori H, Tsumura H. Three-Dimensional Evaluation of Innominate Bone Rotation in Female Patients with Developmental Dysplasia of the Hip. Clin Orthop Surg. 2022;14(2):196-204. doi:10.4055/cios21032