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

[neuromuscular]

Dear ALophysio:

I am a little perplexed at your strength of reply in support of SIJ testing.

Why bother?

You agree that IN THE MAJORITY there is no SIJ problem.

You have agreed to this many times.

Then why do SIJ testing? It is a bit of useless information, since in the majority is makes no difference if there appears to be a supposed SIJ dysfunction or not. It is an unnessary step in the assesssment proceedure since you will not be treating for SIJ dysfunction IN THE MAJORITY.

The standing innominate bone postion test gives me real information that leads directly to testing the muscular component which you have agreed is the cause IN THE MAJORITY. If the ASIS on the right is inferior to the ASIS on the left, then the add longus and pectineus on the left is the one to be treated.(the Iliopsoas will probably be treated later also.) If the ASIS on the left is superior to the PSIS on the left then the add magnus will have to be treated. This with one test only tells you what must be done. One step only needed, if so deisred. Of course, other test may be done to confirm this. However, it is not useless information. IT points in the same direction as the other tests.

The SIJ tests do not provide useful information in the assessment proceedure that leads one step to the next in a continous order. That is my thought exactly. Why do something that proves nothing other than there is a problem??????????????????

Why be preoccupied with the SIJ when it is not the cause in the majority? That is a lot of mental activity to the part that is not the problem. It diverts attention from the job at hand.

Best regards,

Nueromuscular.

[neuromuscular]

Dear Alophysio:

Again I must say that since you have agreed that the SIJ itself is not the cause in the majority and that a truly structural problem in the SIJ is rare, my question is:why do SIJ testing? This is a useless repetition of what information was gathered in the patient history - that the patient has a problem: if all the SIJ test proves is that the patient has a problem. It may be relevant later on in the assessment process if another cause cannot be found.

This was to be a thinking process and not a heavy handed process of bias to the authority of the time period.

I have found that the SIJ tests differ from the same landmarks with hip ABD - Gillett to PSIS to sacrum with hip ABD. The results differ. The load transfer test only tells a person that the load transfer failed, but not why. Other tests are needed to find out why. Patient history can do the same. The patient has pain and defines what that pain is specifically.

If other tests are needed, what benefit is the SIJ test?

I have found that the standing innominate bone position test with hip ABD test points me in the direction of the cause and limits the number of tests that I need to make a specific treatment protocol. You disagree. I believe in the freedom of speech - do you?

You have made Biblical statments. I am not a person who quotes chapter and verse, but I have read it. An account of a certain scenario seems to fit this situation. I believe that It is in the first chapters of a book called the book of Acts of the Apostles. In the account the authority of the time wishes to surpress freedom of thought and speech. The authority of the time was similar to the Supreme Court of a country, it was called the Sanhedrin. The pharasees , sadducees and the scribes of note were a part of the "peer group" which made up the court. They chose to act against the apostles of a great teacher by the name of Jesus. They used threats and abuse to try to supress the followers of this man. The followers were undetered, because they had heard, seen and expeienced something of importance. The Sandhedrin said basically something like " Put up and Shut up!" The apostles said something like: "Do as you like, but what we saw and heard is bigger than us" " we will not stop."

You appear to be a bored again Christian who likes to use the scripture as a club. There are other scriptures which state to: "Do unto others as you would have them do to you." " Love your neighbour as yourself." Maybe it is time to apply these!.

If you prefer to use a heavy hand, then maybe you should retire from this discfussion.

Thank you Alophysio and good bye.

Neuromuscular

[neuromuscular]

To all:

This was to be an open and free discussion on the problems with SIJ testing.

For some, it has turned out to be a forum to use the status quo by quoting all of the peer "authorities" of the time.

What has been agreed on?

First, that IN THE MAJORITY, there is no structural problem with the SIJ. That the SIJ itself is not the problem.

Therefore, my comments stand that there is no such thing as a "stuck" SIJ IN THE MAJORITY as indicated by the most used tests of our time.

These tests are then useless or redundant at the best.

If we have already found out from the patient history that the patient has LBP or pain in the hip, pelvis or thigh, of what benefit is it to do the standing SIJ test of every type straighaway when it will only tell us that there is another problem outside of the SIJ itself IN THE MAJORITY? Should we not be doing a test that flows in an orderly way to a conclusion of the patient's true condition?

Why the SIJ test when there is no true SIJ "form closure" problem in the majority?

I have proposed a standing innominate bone position test for all to give feedback on. I find that it gives me information on which to build and gives a flow of information that leads to a better assessment quicker.

The test is of the ASIS to ASIS with hip ABD. ASIS to PSIS (R) with hip ABD. ASIS to PSIS (L) with hip ABD. PSIS to PSIS with hip ABD.

The exact wdth of foot stance positions is not as important as having the patient do the hip ABD directly lateral in the coronal plane. For those in the metric world the width can increase from closed to the maxmum width for the patient by 25 cm or less increments. For those in the Imperial or US realm, the widths can increase by 6 inch or one foot increments.

Some disagree that the new test tells them anything new. However, is it because all of the authority has focused on the SIJ testing and that anything other is not considered or is there a logical demographic factor that is not considered? If true structural problems are rare, should the model of form closure/ force closure/neurological/emotional be changed to have the neuromuscular or force closure part first so that less emphasis would be placed on the SIJ itself??? Do we wanrt to keep putting so much emphasis on the ASIJ or move the emphasis to where the most common problems are?

That is what would be of interest to find out.

However, if so far the agreement is that the SIJ structure is not the problem, of what use is all of the SIJ testing, if all we know after the test is that we need to do other tests????????????

Best regards,

Neuromuscular.

[neuromuscular]

To All:

I would like to define the purpose of this thread.

After one hundred years of focus onthe SIJ what has been accomplished?

From this thread we see an agreement that the SIJ is not a factor in the vast majority of cases of LBP, hip pain, pelvic pain, "sciatica" or referred pain into the lower extremity. This has been agreed upon.

I would therefore like to have your opinion on the problems with SIJ testing and should it remain to be the first step after the patient history in the asssessment for LBP, hip pain and related?
If it tells us nothing of a real nature to the patient's true condition other than we need to do more testing, of what use is it?

FAILURE IN THE SIJ TESTS

The Gillett test is supposed to show a "stuck" SIJ or a "fixation" of the SIJ. Does it?????????????????
If the two bones move together, the joint is supposed to have a problem.
Does it have the problem indicated?????????????

Try a comparison test of the same landmarks of PSIS to sacrum with hip ABD. What happens? In my experience, limited as it is, I have found that in every case (well into the hundreds) the PSIS moves superior and lateral to the sacrum in the PSIS to sacrum with hip ABD when compared to a positive in the GIllett test
What do you find???????


The load transfer test is a newer variation of this older test. What does it tell you? Only that the load transfer failed. Big deal. You have to do several other tests to show what caused it to fail. It is a redundant step of information gathering that the patinet history already inferred.

If one does the innominate bone position test with hip ABD, you get percise informatiuon that leads to the next step. So why bother with the load transfer test?

The theory on the form closure/force closure/neurological/emotional base is biased toward the SIJ, which the agreement was reached that the SIJ structure is not the problem IN THE MAJORITY. So why is the form closre or structural problems listed first as if it were the primary problem????????

Why infact do we bother to do the SIJ test when it is more of an external problem than an internal joint problem. SIJ tests tell us almost nothing of the external part of the problem. Why bother?

How do you feel about this? Have you found that there are more "structural" or form closure problems in you patient load?

Please give me your feedback.

Best regards,

Neuromuscular