Sij testing

[neuromuscular]

I would like some input on why we do so much SIJ testing, when admittedly, the SIJ does not prove to be the problem in the majority.

True structural SIJ problems or "form closure" problems of a structural nature are admittedly rare. Therefore, is not SIJ testing just a repeat of the Patient information gathered in the patient history?

We already know that the patient has low back, hip or pelvic pain or a pain in the lower extremities. What does the SIJ test add if the SIJ is not the cause in the majority, but only the effect? Are we not taking up time that could be used on other tests? Is it not focusing too much of our attention on an area of no great importance? To me, this is like every MD in Canada doing a malaria test on every patient when admittedly malaria is very, very rare in Canada unless the patient has been to a tropical climate.

Every text starts with the standing SIJ test with hip or torso flexion using the landmarks of the PSIS to sacrum as in the "Gillett" test or in the 'swing phase" or "stance phase" of the stork test and adds other joint movement assessments. Why bother, it very little in relevant information is gained, but that we need to do more tests to determine what the cause is? Why not just go to the passive, active, ROM, resisted, etc., etc., types of tests without taking the precious time to do the SIJ test? As a note of interest, if you do a standing SIJ test using the PSIS to sacrum with hip ABD the PSIS moves superior and lateral to the sacrum in every positive for the Gillett test for a "fixation" or "stuck" SIJ. What is the significance of that?

I use the innominate bone position test as it gives me a starting point that moves through a successive steps of assessment that are relevant to the patient's condition. It is a starting point on which the other tests build successively. It gives me the information on which tests I need to do next.

What viewpoints are out there?

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[totout]

The function of the SI joints is to allow torsional or twisting movements when we move our legs. The legs act like long levers and without the sacroiliac joints and the pubic symphesis which allow these small movements, the pelvis would be at higher risk of a fracture.

[neuromuscular]

The function of the SI joints is to allow torsional or twisting movements when we move our legs. The legs act like long levers and without the sacroiliac joints and the pubic symphesis which allow these small movements, the pelvis would be at higher risk of a fracture.

Dear totout:


Thank you for the review of anatomy and physiology 101.

However, just because the item or piece of anatomy is there and the function is known does not mean that it is the cause of the problem. The question remains: is it the cause or the effect???

Tests for the SIJ are over 100 years old and this has not improved the statistics on low back pain.

To illustrate: You car has what are called ball joints in the steering mechanism. The mechanic who just tested the ball joints without looking at the tires and wheels for problems would be amiss and legally liable for the problems that you would encounter.

In physical disciplines of all vatieties, the testing in low back pain is focused to a large extent on the SIJ. True - it is there. True - it has a function,. However, is it the problem - the cause- or effect of another problem????

This is why I posted the item on the site. I have not seen good results from the numberous SIj tests and neither have others that I have demonstrated the newer test to. A most common complaint by physios is that the present tests leave them wondering if the information is reliable. That includes the Diane lee/Hungerford tests!

Some have looked at this throught tunnel vision - not wishing to "rock the boat" or wishing to examine their viewpoint. That is up to them.


Two Canadian professors and the OGI have shown interest in the newer test proposed using the innominate bone position test.

Best regards,

Neuromuscular.

[alophysio]

Hi totout,

Agreed.

For a full discussion on the topic, please see http://www.physiobob.com/forum/ortho...html#post35665

Thanks!

[alophysio]

Hi,

The test proposed should be studied...but it should go through serious scrutiny.

Just because you are not proficient at the use of the tests and other physios who complain about the tests are also not proficient does not mean that the tests are not reliable...it just means you need to practice more.

If i tested the ball joints of my car, it would not be as thorough a job as a mechanic who has done it for years. I would even get my first few 100 tests being unreliable i would reckon - simply because i would not know what to look for...

That is what an apprentice does - they go through 4 years of supervised training to learn how to fix cars.

Also, you would only hear from physios that aren't proficient at the tests - what about the ones who are good at it?? We are getting results that are excellent thank you very much.

I have examined you test and written much about it. I have asked lots of questions and not had them answered. Therefore, someone touting a test and avoiding questions seems like someone avoiding examination of their test...that is called tunnel vision!

Your APAS test does not add anything other than reminding people to do coronal plane testing - which all good physios should do anyway.

Where is the OGI research BTW?? Whom should we talk to there about the progress of the research done there?

I have shown interest but i am not doing research on your test...perhaps it is the same for them?? Who are the Canadian professors - will they accept an email from me?

Thanks - i hope you are well

[D-light]

I think we should not engage in a battle of words and rather look into the facts in each point of discussion. While I agree that more experience is needed to master particular tests and more research in needed to test the validity and reliability of new ones, I think we should consider the significance of testing to orthopeadic testings to us as physiotherapist. In the interest of efficiency of productivity, there is no need for a test if we can not generate useful information from it.
As physiotherapist our primary goal is to resolve our patients symptoms or ameliorate as much as possible. Our patients dont care what name the problem is either what they want is the pain resolved. Although SIJ testing may acurately inform us of a sij dysfunction, it does not tell us what and how to treat. This is the same for most orthopeadic tests. Our treatment would most likely be same for a +ve Varus and a +Ve valgus stress tests of the knee so why border?
My point is orthopeadic testings are more applicable to surgeons because they are structural based same as most of the diagnostic investigations. This model of clinical examination is purely biomedical and it is of little importance to us as physiotherapist. While the knowledge of biomedical testings are important, we as physiotherapist need to look into different models of assessment. The core of our treatment is to correct pathokinesiology. So our assessments need to be movement based as not structural based. A classical example is with a patient with +ve anterior drawers test from torn anterior cruciate confirmed with MRI and can still play competive football at high level. This is because Drawer's test assesses the passive stability in a relaxed position, while the active stabilizers kicks in when the patient is performing active function.
A few authors has been working functional differenciation and symptom modification procedures, although not fully researched yet, they are showing high clinical results. i think this is the next dirrection in the field of neuromusculoskeletal therapy.

[neuromuscular]

I think we should not engage in a battle of words and rather look into the facts in each point of discussion. While I agree that more experience is needed to master particular tests and more research in needed to test the validity and reliability of new ones, I think we should consider the significance of testing to orthopeadic testings to us as physiotherapist. In the interest of efficiency of productivity, there is no need for a test if we can not generate useful information from it.
As physiotherapist our primary goal is to resolve our patients symptoms or ameliorate as much as possible. Our patients dont care what name the problem is either what they want is the pain resolved. Although SIJ testing may acurately inform us of a sij dysfunction, it does not tell us what and how to treat. This is the same for most orthopeadic tests. Our treatment would most likely be same for a +ve Varus and a +Ve valgus stress tests of the knee so why border?
My point is orthopeadic testings are more applicable to surgeons because they are structural based same as most of the diagnostic investigations. This model of clinical examination is purely biomedical and it is of little importance to us as physiotherapist. While the knowledge of biomedical testings are important, we as physiotherapist need to look into different models of assessment. The core of our treatment is to correct pathokinesiology. So our assessments need to be movement based as not structural based. A classical example is with a patient with +ve anterior drawers test from torn anterior cruciate confirmed with MRI and can still play competive football at high level. This is because Drawer's test assesses the passive stability in a relaxed position, while the active stabilizers kicks in when the patient is performing active function.
A few authors has been working functional differenciation and symptom modification procedures, although not fully researched yet, they are showing high clinical results. i think this is the next dirrection in the field of neuromusculoskeletal therapy.

Dear D-light:

Your reply came to my computer as I am not joining in the discussion anymore.

First, SIJ testing tells us little to nothing about the joint conditions. Only in very rare cases does it show ANY TRUE CONDITION of the joint. The IAOM of Europe does not teach SIJ testing according to several of its teachers. Why? Because it is not linked to reality.

The IBP, innominate bone position test, does give verifiable and accurate information on the patient's TRUE problem, because it maps the forces generated as hip ABD progresses and notes the imbalances produced. It is of interest to note that if you do the IBP test before and after therapy that most of the common approaches make little or no difference in the test results. However, if you change your treatment protocol to conform to the test results that ROM, joint positioning change, pain reduction, etc. result.

It is of interest that numerous studies are confirnming that present therapy results from using traditional testing and treatment protocols are proving disappointing in the numerous trials such as the September 2007 report in Archive of Internal Medicine.

The trouble is that many would like the SIJ test to be accurate and do not want to try anything new until pressured to do so. Too bad. The old saying is : If wishes were horses, beggars would ride. How true! Bias will always be a problem.

If you choose to use a hundred year old test or decades old tests of the SIJ as your information gathering method, you may do so. But then, why don't we return to penicillin only and not use the newer drugs?????

Thank you

Neuromuscular

[alophysio]

Thanks D-Light,

I think balance is required in all things Your comments are much appreciated.

Thanks!

[alophysio]

Hi Neuromuscular,

Welcome back! I trust you are well

Just by way of an update, how is the research into your "IBP" - you used to call it your APAS Test - going?

Are there researchers i can speak / email to about it?

As you know, I am happy to try new things.

The new edition of The pelvic Girdle by Diane Lee is out now...interesting read...i recommend it to all.

THanks and good to see you back

[neuromuscular]

To all:

There has been a name change as evidenced some time ago in another thread.
The term IBP is for the test. IBP is an acronym for innominate bone position test and better describes the reason for the test.
The term APAS is for the condition. APAS is an acronym for asymmetric pelvic angle syndrome. It describes the symptoms exhibited by most with differring innominate bone positions from left to right or those who evidence it as hip ABD progresses. There are Type 1, type 2, type 3, type 4, and type 5 APAS.

To A LO:

You first challenged the test without trying it for over two months. That is not even considering the syndrome or the test without bias. Sorry, but your bias showed from the start.

You should talk to a fellow Australian, Kit Laughlin, who did the same when I introduced it to him. He fought it without considering the the idea. I used to think of the Aussies as free thinkers and free spirits, but I have not found that to be true in discussions with them. I have found the Americans, who have looked at the research, to be far more open to newer ideas without bias or name dropping of experts.

Presently, I have been working with chiroprators on the idea and have had quite a turn around for at least one in the group. The common problem is the ingrained ideals from their discipline. This makes it difficult for them to wrap their minds around the concept, althought there is valid anatomical and physiological basis for the ideal. That is not uncommon in any discipline as I have found out.

THe research in the USA proceeds, but there is so much to deal with in the bias of the main stream, that the paper chase is greater than one would like to imagine.

AS for Diane Lee, most of her work is a rewrite of Andry Vleeming et al. Their work has not survived the various trials. The success rate is not as good as one would like to think.

As stated earlier, the IAOM of Europe does not consider the SIJ testing as relevant or consistent or accurate - regardless of type used. If others choose to use this method, so be it. I do not. The stork test is not much better for verifiable results.

Good bye.
Neuromuscular.

[alophysio]

Dear neuromuscular,

I am sorry you feel that way about things.

To be fair, I did try your test.

As for what happened initially, sometimes - and this may be hard for you to accept - one can see the result of a test before you do the test simply because I am used to coronal plane motion assessment.

But, as i have asserted before, i encourage all to try the test.

As for research, it isn't hard to do an observational study - not much in the of ethics to deal with there. Do you have names of researchers we can contact?

Hope you are enjoying yourself despite some frustration you may be feeling. I do wish you all the best