I utilize passive accessory motion testing for the SI joints and symphysis pubis. The pelvis as a structure moves in relationship and in concert with the hips and lower extremities and the same is true with respect to the trunk. Gross motion tests do not tell us about passive accessory motion tests. Passive accessory motion tests (spring tests) can only be perfor,med with the body in stable positions, such as prone, supine, side lying and I prefer "muslim-prayer position" over sitting. Gentle force is applied in specific direction to the first resistance point and then the spring test is performed with an additional force. A paper was presented on these tests and on the additional palpatory tests and there is good data, in fact the best with respect to intra-rater reliability which is poor to fair at best with the traditional evaluation methods. It was presented at World Congress Physiotherapy in Barcelona 2003. An outcomes study will be presented in February at APTA combined Sections. The SI has been quite mis-understood and the Muscle Energy model uses a description of joint mechanics that was fully articulated in 1958 by Fred Mitchell, DO, based on a theory of how the SI moves in response to gait. My body of work evaluates an emergent property of the pelvic structure (be it joint - or pelvis as a whole) which is passive accessory motion and treats on the basis of what is found. My philosophy is in line with Gregory Grieve's who stated that ' dOGMA DULLS THE WITS,....we should allow the joint to speak for itself......"etc. This structure does move in ways that have not been described in the popular literature. As my health improves i will contribute more to the literature and make this approach available. For those of you who suspect that is more to the SI joint than the Muscle Energy model describes - you are correct! tREATMENT NEEDS TO TAKE INTO CONSIDERATION THAT THIS IS A VISCOELASTIC STRUCTURE AND mUSCLE ENERGY DOES NOT ADDRESS, cannot address the viscoelastic properties. I utilized low load-long duration accessory motions to treat the structure. I could go on but it is late.
Best Regards
jerry Hesch
The Hesch Method www.heschmethod.com