New research: No such thing as "stuck" SI joint

[alophysio]

Hi,

1. Speaking for myself, I am certainly open minded...in doing so though, i must be thorough and critically evaluating what you propose...

2. Can you see that by making such a definite statement such as "there is no such thing as a stuck SIJ" can be seen as closed-minded??

3. Motor control includes overactivity and neural patterning my friend - we might be disagreeing on terms here...

4. you mention the landmarks as ASIS to ASIS, PSIS to PSIS and ASIS to PSIS...If you are determining if the SIJ is stuck or not, then shouldn't you have a landmark on the sacrum itself??? One side of the joint will not be able to detect movement.

5. I am sorry for not understanding but can you explain what are the angles you are measuring - how are they formed? What planes are you measuring in?

6. You say measure hip ABD at 15cm foot positions - the leg moves in an arc. Also, different leg lengths will mean 15cm will be a different ABD angles for different people...do you mean 15degree increments? That would make more sense - angular kinematics vs linear kinematics.

7. If only ilial measurements were used, then i am unclear as to how you can ascertain what the problem/dysfunction is...

...back pain patients might have asymmetrical angles but htat could be from L5/S1, SIJ, Pubic Symph, and hip dysfunctions. From what i can deduce from the limited amount of information you have provided is that there is a dysfunction somewhere.

8. i will look up the references when i can.

9. i would like to compare my results of doing the test but i would like clearer methods and how to calculate the results...e.g. what do you mean by saying the majority have right ant rot, left post rotation - what is "anatomical neutral", etc etc.

10. From what i can concluded, the hip ABD test is testing whether or not you have pelvic-hip dissociation with contralateral hip stability. In other words, testing the client's motor control ability to maintain a stable pelvis whilst using an open chain movement.

11. From the post above this one, if there is no research done on pelvic angles, how would one use it and write it in an "eminent work".

12. if you use only the ASIS and PSIS in whatever combinations, the result is called "intra-pelvic torsion" (IPT) (as outlined by Diane and LJ Lee)...e.g. left ASIS and PSIS showing post rot and the right ASIS and PSIS showing ant rot = left IPT. It just tells you that the pelvis in not in neutral.

13. What is the therapy that is used to produce such wonderful results? Can you give a case study from over 1000 patients that you have seen?

14. Can you PM me the author of the research/PhD or his/her email or some other way of finding out what the method is please?

Thanks...your responses to the above would be very helpful.

[neuromuscular]

Thank you for your continued interest.

I have found that most people with the exlusion of Ola Grimsby and possible Dr. Robert ELlis have difficulty with this concept. I have talked to or had communication with Andry Vleeming & Diane Lee. Both of which had some trouble with the concept. One was very closed to any orthopeadic testing or landmark testing.

I agree that we must be critical and not accept something just because someone sayes it is so.

I did mention a test of the PSIS to sacrum with hip abduction. This shows that the PSIS moves away from the sacrum with hip abduction, but moves with the sacrum with torso flexion and hip flexion. This disproves the first as inaccurate. It was used to disprove other so called SIJ tests. The original standing SIJ test and others is an illusion that has caused many to pursue the illusive problematic SIJ.

I agree that the statement of no stuck SIJ does sound close minded, but it was said to get attention and it is said with the evidence in over 1,000 patients. Further, it does not preclude tramatic injury where the joint is crushed or damaged, but does say that there is no such thing as a stuck SIJ in most patients as we commonly hear in books like ORTHHOPEADIC PHYSICAL ASSESSMENT by David Magee U of A to name just one of many. This is more commonly believed that one would like to see.


Motor contrl to me is the signal controlling the muascle as differentiated from the other control factors which affect the signal. For example, we study about muscle spindle, but who has studied the "calibration" of the muscle spindle or golgi tendoon organ. Can these ge recalibrated to a different setting or set point from normal? I have not seen any information or research onthis. Neither has any one that i mentioned this to.

The angles are from the horizontal plane. If you do the test you will note that either the PSIS moves inferior to the ASIS or the ASIS moves inferior to the PSIS. It is obvious. You may measure the angles or the distance that the PSIS or ASIS moves inferior to the other. You will not have to guess as the movement with hip abduction in most is very pronounced as hip abdcuction proceeds. The movement is from the horizontal plane. I used the PSIS as the level of the horizontal plane, but you may choose to do as you see fit.

The test must be full weight bearing as the postural control muscles cause the distortion. Therefore, a floor measure was used. Since I am still familiar with the foot and inches I used the equivalent of 6 inches or 15 cm for the initial test. I now use the one foot increment as I have become familiar with the test and know what I am looking for. Distortion increases most after 75 cm. It does not matter which kinetics you use as the distortion is with distance and the measure is only for a coomon reference.

The problem or dyfunction is evident from the distortion of the innominate bones. Once you use the test you will see the data that has been missed. The anterior pelvic angle on the right is from a contralateral cause. This causes a correction by the proprioceptive sense to keep the eyes in line with the feet and the distortion progresses.

Anatomical neutral as published and as I have seen, is when the ASIS and PSIS are level in the horizontal plane. The PSIS should not be inferior to the ASIS or to the other PSIS. The same is true of the ASIS.

I find that any test of motor ability has a very substantial subjective factor. I use the postural assessment first. It is most objective and provides the most objective data. It is much like the resisted tests of the Muscle Testing manual by Kendall. They are of some use, but there are too many subjective factors - even when an instrument replaces the human factor.

The reason that pelvic angles were not in the eminant work, which was research papers, is that none of the participating papers or the editor considered pelvic angles of any concern. There were extensive research papers on the SIJ but not one o the authors considered the pelvic angles or innominate bone position.

The therapy is direct pressure into the muscle at 90 degrees to the muscle body. the distortion is the indicator of the muscular problem.

Thank you again. Best regards.

[estherderu]

dear everybody,

the discussion about the SI joint being able to move/not move get stuck/ or not, has been around as long as I have been a physio. I did train as a OMT with Cyriax and Kalternborn.... at the time, so you could say I have some extra education in this field.
I am, however, not going to react in detail to this Y/N discussion but with a little practical idea of mine.

Because I have always found spinal + SI mobilisation/manipulation physically strenuous and an extremely passive way of treating patients I optrd for a more active approach.
Whatever the real reason, stuck or not stuck, we will find asymmetric movement patterns and strenght differences in these patients.
One of the most efficient ways of dealing with this is, in my opinion, using the PNF trunk patterns. I can really recommend them to everybody.
If you never learnt them, ( most college´s + UNI´s only teach you the arm and leg patterns) you can go to the PNF website for the names of people who have followed the "official course(s). IPNFA

Why tell you?, because even without always knowing (Y/N stuck SI), using these techniques has helped me help many people get rid of their symptoms and pain.


Esther
Good luck with your discussion. I do find it very interesting but will leave that up to you.

[neuromuscular]

[QUOTE=estherderu;23438]dear everybody,

the discussion about the SI joint being able to move/not move get stuck/ or not, has been around as long as I have been a physio. I did train as a OMT with Cyriax and Kalternborn.... at the time, so you could say I have some extra education in this field.
I am, however, not going to react in detail to this Y/N discussion but with a little practical idea of mine.

Because I have always found spinal + SI mobilisation/manipulation physically strenuous and an extremely passive way of treating patients I optrd for a more active approach.
Whatever the real reason, stuck or not stuck, we will find asymmetric movement patterns and strenght differences in these patients.
One of the most efficient ways of dealing with this is, in my opinion, using the PNF trunk patterns. I can really recommend them to everybody.




Thank you.

I agree that one hundred years of believing the the SIJ is the problem is too long. Try the test for APAS. You will find the data obtained of interest.

The problem with doing what we feel will make the patient better or makes the nociceptors " recalibrate " to allow for an abnormal condition is that we may not have made the patient's condtiion actually better.

We need an objective, reliable, accurate guage of how the patient is progressing.

I feel that in the low back or pelvic treatment the four sided assessment using the ASIS and PSIS landmarks gives us a benchmark for deciding if what we did actually improved the patient's condition by returning them to a more anatomical neutral.
I have been to several seminars where after the "therapy" the patient felt "better" and the ego of the therapist was pacified, but there was no difference in the pelvic position. So did they like the manipulative therapy that opens and closes joints but does more to reset the nociceptors to an atrificial normal than normalize the postural position of the patient to anatomical neutral.

The PSIS to sacrum with hip abduction will disprove the SIJ dysfunction "posivite" and is a guage of the joint better than the present "standards".

The SIJ is not stuck, but present direction is stuck in testing it. Try the APAS test on your patients to see if there is a change after your theraputic intervention. Please give me feedback.

Best regards,

Neuromuscular.