Wedge Revival

Recognize these? Various professions use pelvic wedges to “balance the pelvis” or other more nefarious (manipulative) usages. In my early training, I was presented with a decidedly biomechanical model of causation and intervention. If the body is misaligned, this was seen as the cause of problems, along with restricted fascia and emotional stuck-ness in that fascia (that’s a whole different bag of donuts), and in need of our skilled correction.

I spent years working from that framework and saw good outcomes. We view those outcomes through our lenses of perception, along with the subjective perceptions of our patients, which would be perceptions2. However, results are complex and not always due to what we think was wrong or what we thought was done. My insertion of those wedges under a wonky pelvis seemed to reduce pain and a more equally aligned pelvis. But how much did that pelvis change, in a lasting manner? Did it need to “correct” for changes in pain to be noted by the patient? Using those wedges was a part of a complex 2-person interaction, one filled with contextual factors and assuaging of many parts of the body and mind, and there was a time in the 1990s, and early 2000s that I used these wedges many times a day. Most patients with low back problems were put on them as a part of my recipe (yes, MFR has a recipe like any other narrative or modality). In the mid-2000’s I began to brank out into more neurocentric ways of thinking and viewing problems. I read studies that spoke to the normalcy of skeletal and postural asymmetry, which challenged my views that posture and skeleton my b aligned for proper functioning. And I began to understand the limitations of single-source models of pathology, which included the fascial paradigm. As a result, I used these wedges less and less. Those leg length discrepancies were left alone, and I was still able to help people feel better. How could these changes happen from an intervention that did not include balancing the pelvis???

I got my wedges out today to introduce some novel sensations and awareness to a patient. They’d had a hip replacement nine months ago, and they were feeling a bit awkward as they returned to running. I did a length in length check that I pulled out of some musty old drawer in my brain and saw a ½” length difference. Now I knew nothing about this person’s leg length before their surgery vs. after, so trying to state a claim implying it was implicated in the problem would have been wrong, so I didn’t even try. There was also a pelvic torsion, and I decided to wedge the pelvis, just for old-time sake. I spent some time fiddling in my old MFR manner, but with entirely different thoughts about what might be going on between my patient and myself. I began to ask what was being felt and allowed them to take over. Described was a lengthening and relaxation on the surgical side of the body, which they reported as the awkward side. We did our thing with the wedges and conversation for a while, and I finally pulled them out and asked them to stand up and move around a bit. The report was much greater ease of movement and balance. I put my patient back on the table and rechecked the pelvic alignment and leg length; nothing changed. Nothing changed from what I used to look for and at. But their sense of change occurred and transferred into a felt sense of greater ease and balance in walking (and running).

My take-home message? I don’t need to abandon the tools and models that gave me benefits in the past, but updating what is occurring during those interactions was necessary. Interventions are multifactorial and are seldom m(never?) the result of simply stretching a muscle, releasing fascia, or mobilizing a joint. My patient’s perceptions are critical. Placing those wedges allowed a centeredness of their attention to an area of their concern, possibly influencing change. I’m sure there are dozens of other factors at play, as there are in any intervention. Be open to uncertainty.

Walt Fritz, PT

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