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

[neuromuscular]

For over one hundred years, after the standing SI joint test showed that the PSIS moved with the sacrum, it has been believed that the SI joint is "stuck" in the majority with low back pain. A simple test is disproving this. Try this: Landmark the PSIS to sacrum and have the patient do hip abduction directly lateral in the coronal plane from closed to the maximum that the patient can achieve At 15 cm increments. In virtually all of the patients with a positive for a stuck SI joint the PSIS will move superior and lateral to the sacrum. When the PSIS to ASIS is measured on the side of the supposed stuck SI joint, the innominate bone will move into anterior rotation.

The true condition of the patient is better described as APAS, asymmetric pelvic angle syndrome. The research paper on this is being prepared.

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[alophysio]

Hi Neuromuscular,

We can of course go on for hours about this.

I can use your arguments about your APAS against the OLST/Stork etc and vice versa.

Your "facts" about your APAS are not peer reviewed, nor published, nor statistically analysed so i would still call it "raw data" or "observations".

For researchers to acknowledge more research is required is not exactly a new concept...

To break down each subcategory in each main category would require thousands of patients...it aint going to happen - no one has the time or the money or the willpower to embark on a decades long project...case in point is your APAS - you are not even doing the research yourself but getting others to do it for you...!!!

This all started because of your statement "There is no such thing as a stuck SIJ" and i responded to the contrary and i believe your proposal has logical flaws which has been discussed.

The stork test is not superior to your APAS test nor is your APAS test superior to the stork test - they are both load transfer tests which measure movement at the pelvis in different planes.

As to your comments above, whilst you believe one muscle can be responsible for a problem in the pelvis, i think it is more realistic to acknowledge that muscles work in groups and there are synergies and it is impossible to put your finger on ONE muscle for the problem.

Also, you cannot ever be completely research-evidence-based in your practice otherwise you would have never come up with your APAS - it would be unethical to use your APAS to diagnose your patients because it has never (and still has not been) research tested, peer reviewed and published. So using that against the Stork test is plain stupid.

I have my own data, just like yours and my data is just as valid as yours. Therefore to say that the model i prefer has less data is simply stupid because it has as much research (actually much more research because at least some papers have been published and research done on different parts of the model) than your APAS.

I am getting upset sitting here simply because i can't believe you cannot see your own ignorance and arrogance in your statements!!!

You accuse others of tunnel vision and you cannot see yourself that you are stuck on your own model and your own tunnel vision and cannot acknowledge that the Stork test works on the Saggital Plane and your test works on the coronal plane!!

There is research on force closure, there is research on the emotional aspect of low back pain, there is research on form closure...

I AM NOT GOING TO DO YOUR RESEARCH FOR YOU - do your own work. If you don't know how to look up Pubmed.com, then learn how. I have given you hundreds of dollars worth of information for free.

The fact that you don't understand the model and thus dismiss it simply means you don't have an inquiring mind. Have you asked "how does this work"? Just because you have a limited evidence base to draw from doesn't mean that others out there don't have more to offer...

Buy the book or go borrow the book "The Pelvic Girdle" if you want more information. It is easily found in a university library if it an institution that educates physios. Otherwise Amazon is a good source...and before you cry poor, researchers often have to source their references for their research so if you seriously want your APAS model to be taken seriously, then put serious effort into understanding the competing theories etc.

Also, if you are going to cherry-pick your quotes, i will republish them fully for you...please note, there are tests that have withstood scientific scrutiny (unlike your proposed APAS test)...

So far, these are the only tests which have withstood scientific scrutiny for the
assessment of load transfer through the pelvic girdle; its primary function. Therefore it
is still not possible to be totally evidence‐based in clinical practice if evidence‐based
means only using those tests which have withstood scientific scrutiny. However, what
does evidence‐based practice truly mean? Sackett et al (1997) defines evidence‐based
practice as the process of integrating the best research evidence available with both
clinical expertise and patient values. Clinical expertise and the models which evolve
from it are still necessary to bridge the gap between what we know scientifically and
what we need to know practically to treat patients with pelvic girdle pain.

In Summary
- there is published research to support the Stork test. There is NO published or properly run research to support the APAS.
- the stork test uses sagittal plane motion, the APAS uses coronal plane motion so becareful in direct comparisions
- don't write of a model because you can't be bothered to go find the articles yourself. I have given you plenty of references and they ALL have reference lists that you can go and investigate.
- Lastly, i don't know or understand why you fight so hard against something you can be collabortatively working to help?! There is no need to trash a model to make yours seem better. Your APAS test tests in the coronal plane - it did NOT add anything to my clinical practice and i have given it a fair go...have you given the stork test now that you have read the evidence (or have you) about how it works??

[neuromuscular]

Dear Alophysio:

I find it quite amusing at the strength of your passion to defend something. It is like Lady macbeth of which was said " Me think the lady doth protest too much!"

If you are so sure of your test methods and results, please calm down. I would surely not want to be responsible for you having a heart attack.

If you wish to continue to attack the APAS test by all means do so. I have no problem with you doing so.

It is of interest that I have had the most vicious attacks from AUstralia. I am not sure why? You say I am arrogant. Is that so - for questioning something that has not defined itself better? Really?

How much "form closure" have you found in reality? 10%? 20% 30% 40% 50%? or just how much in real time - in clinic? I can say that I have found no true form closure problems, even in patients over 70 years of age. Our brain has tremendous power that has been under rated. It can tune itself to many different structures. Our ears are as individual as our fingerprints, yet the brains still hears regardless of how the outer ear channels the sound into the inner ear. Do we think that the difference of form from one person to the next really matters that much? The Nazis had the idea that there was one ideal for everything. I do not share that view. Our brain can tune to a large or small SIJ; a may facetted one or a less facetted one; one with many ripples or few ripples. It will accomodate the SIJ as it finds it.

As for neurological, how often do you find it? 1%? 2% 3% 5%?
I would say from my experience that it is rare at best and marked by cerebral palsy, MS, polio or similar unless you include entrapped nerves or compressed nerves in this catagory.

I find mostly neuromusclar control problems. By this i mean guarding responses or protective spasm or adaptive shortening or whatever designation you wish to call it. Force closure in the sense of muscle "weakness" i rarely find as there is more inhibition than weakness.

As for emotional, most patients are distraught over their pain that no one has addressed than as a cause. It is more an effect of no relief than a cause of the problem.

Again sorry for your being distraught.

Don't take it so personal.

Best regards,

Neuromuscular

[alophysio]

Hi neuromuscular,

Interesting that you have a bias to neuromuscular diagnosis as evidenced by your login...

Anyway, i do not take this personally, just upset that you are so frustratingly stubborn - that is all...

As for protesting too much, i have to speak strongly to convey ideas to you... you do not take on ideas contrary to your own very well. Your statements demonstrate that you do not understand the model which you attack.

Ask yourself honestly..."how many people maintain contact with me on this topic?" - in fact, i think questioning people's work is one thing but disrespecting them is unprofessional.

So my anger and upset is based on what i believe your arrogance is - arrogance is defined as "an attitude of superiority manifested in an overbearing manner or in presumptuous claims or assumptions" - that is you neuromuscular!

You believe your way is superior. I have tried to reason with you. But in the end, you don't really listen too much.

Your way will lead to professional loneliness...

As for vicious attacks from Australia - perhaps the people you have encountered have a lot of education and research behind them to back themselves up with. Perhaps they see holes as big as freeway tunnels in your arguments. Perhaps they are fed up with your attitude?

But onto the subject at hand...

What difference does knowing how many % of all SIJ problems have one type of diagnosis help matters?

How does this help you in the clinic?

Perhaps you like to diagnose people based on the likelihood of things occurring?

It is great that you find most people have neuromuscular problems - so do i!!! They have the neural component which includes motor control and it blends into the way the myofascial component works. All clinicians who understand the Integrated Model of Function would agree. Which is why it is confusing that you attack the model...

And your statements on the emotional side of things is simply pure ignorance - go read Waddell and the Back Pain Revolution or Lorimer Mosely at the library.

Good luck to you neuromuscular - i am getting tired of trying to maintain contact...
Additional Comment I forgot:
By the way, my friend has terrible pain. It is so bad that he cannot lift enough groceries to feed himself and he has lost so much weight he is emaciated.

He feels real pain.

I cannot help him.

There is nothing physically wrong with him.

He has Conversion Disorder.

Don't tell me the brain/emotional reasons isn't the cause of some types of back pain...

[neuromuscular]

Dear ALophysio:

Thank you for your reply.

I am simply trying to "think outside of the box"

First, if every joint has form closure of what benefit is this in SIJ problems for treatment? Why is this almost exclusively used for the SIJ? It is just a simple statement of fact for every joint. If there are form closure problems, what are the definative problems?

In form closure problems of the knee I CAN find information on the form closure dysfunction in the knee. I know that in form closure dysfunctions of the knee, if we use that designation, that so many will have 1: torn meniscus 2: torn ACL, 3: articular cartilage problems, etc., etc., Further, I can get a definite diagnosis of these from various texts and radiographic examinations showing speciific tests and positive results to give a definitive cause. I do not find this for the SIJ. For example, how many are linked to a specific undulation of the SIJ surface? How many are liked to a specific size related problem or shape problem? Etc. etc. etc. I do not find such documentation. There are general statements, but not a specific research related base.

Yes I do find specific dysfunction of the pelvic area in the hip ABD tests. These are innominate bone position tests as I have stated and not specific ot the SIJ except the PSIS to sacrum with hip ABD. And yes I did state the hip ABD WITH PSIS to sacrum early on in the discussion, but you either missed it or did not see its' relevance at the time and ignored it. I had done this test early on to show that the Gillett test was a problem in assessment outcomes.

I am sorry if you feel intimidated by this open and frank discussion, but I am not.

We agree that the SIJ form closuire is the lessor cause of the problems in low back pain. Yet in every manual it is given extensive coverage as if other causes were of lessor importance. In the manual which I refered to Movement, Stability and Low Back Pain In the index over 3 pages are devoted to the SIJ and another section to the sacrum, yet not a mention is made of the adductors. This is a compilation of the greatest minds of our era on the subject - that is why I refer to it. My question is: are we preoccupioed with the SIJ and not looking outside the box for better answers?

I have always thanked you for your replies. I will continue to do so. However, I find these things perplexing.

Ola Grimsby has not always agreed with me, yet he has treated the core of the ideas with respect.

Thank you again. I do not find the definative results from the load transfer, SIJ with hip flexion or torso flexion or the Gillett test. If you do, more power to you.

Best regards,

Ed

[alophysio]

Hi neuromuscular,

Firstly, you seem unrepentant or ignorant of your attitude which has alienated so many people including me.

I am not going to try to educate you for free. I charge $280 per hour. I fyou would like some personal tuition, please make arrangements.

The stupid thing is that if you were nicer to other people, i am happy to give away the information for free...

If you do not feel you are being arrogant or offensive or patronising, then imagine if i tell you the following...

1. You are actually intimidated by our discussions but I am not
2. I do not find such documents - there are general statements, but not a specific research related base...the funny thing is that all you have to do is look up Vleemings articles and anyone who has done work based on his ideas. Keywords are able to be looked up and freely available. I WILL NOT DO YOUR WORK FOR YOU. The other funny thing is that whilst there is plenty of published and yet to be published material out there on the concepts proposed, THERE IS NOTHING ON THE APAS test you propose - so quit being so high and mighty about your test.
3. You probably think this is funny...

I find it quite amusing at the strength of your passion to defend something. It is like Lady macbeth of which was said " Me think the lady doth protest too much!"

If you are so sure of your test methods and results, please calm down. I would surely not want to be responsible for you having a heart attack.

4. I have pointed out why your words are offensive and you still do not know why??? The ideas are well-defined, your breadth of reading is simply lacking...

It is of interest that I have had the most vicious attacks from AUstralia. I am not sure why? You say I am arrogant. Is that so - for questioning something that has not defined itself better? Really?

5. THis is you simply being provocative and lazy...quote the searches and keywords used in your searches on various databases that you have done your searches on...if it is only Google, then undergrad students are smarter than you!

I am having trouble finding any corroberating evidence for the types of "form" closure in the form closure/force closure/neurological/emotional model.

Does any one know of a catagorization of the types of supposed "form" closure or is this just theory?

I cannot think of how form closure other that in deformed or tramatic injury problems or in the very aged. To me; we all have differring ear shapes and yet the neurological control hears equally well regardless of the shape of the outer ear. Does not the brain tune itself to what ever "form" there is in the individual SIJ and each form works well for the individual? Does "form" figure in prominently or very minimally in this theory? WHy is "form closure" listed first if it is of very inconsequntial proportions?

What evidence is there for a supposed "emotional" part? DO not people become emotionally distraught from not knowing what is wrong with them? Is it cause or effect????????

Please provide any details if you can find them.

6. It says in the Bible in Matthew 7:6 "Do not give dogs what is sacred; do not throw your pearls to pigs. If you do, they may trample them under their feet, and then turn and tear you to pieces."...i have provided you with quantification and qualification of the Stance Phase of the Stork Test. Based on those papers and obviously more work, a PhD was awarded to Dr Barbara Hungerford. To patently ignore material which costs me money and freely given to you is insulting...

Have you done a quantification and qualification process on the test???

Anyway, have a merry christmas. I too will provide you with a generic "Thanks" for your posts...thanks

Antony
Additional Comment I forgot:
BTW, people who "Think outside the box" understand the current ideas fully before doing so.

Otherwise you would reinvent the wheel.

Get educated.

Get more reading done.

Discuss ideas without inflammatory remarks.

Ask questions and then don't ask them again when they have been answered.

Confirm your understanding of the current positions.

THEN think outside the box.

Try that...

[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

[alophysio]

Dear Neuromuscular,

If you look at the tone of my messages (all including emails) - they have been at first friendly and supportive and careful.

But my friend, you have not seen any other point of view but you own.

You have not even replied to the comments i posted last.

Therefore, in response to your post to me...

1. I quoted scripture because if i had just said it, i would not have been referencing the source of my comments...which is what i do - but you don't

2. Your attack on my beliefs is personal...but i suppose your blind adherence to your APAS test and my attacks on it might be considered personal.

3. I have given you research papers which cost money to obtain. They are the pearls i am throwing before you but to blatantly ignore them as i showed above and in your comments above is to treat the pearls like a pig would...

4. At least i quote people - i can do so because i have looked up their work and read it.

The CHALLENGE is for you to list the keywords you used in your searches as you claim you have done

[alophysio]

To All,

I can summarise what i believe neuromuscular's intentions are.

1. He wants to engage in conversation but he will not consider your ideas - simply read the posts above to see what i mean

2. He proposes his APAS test and rubbishes the Gillet Stork test, etc. Proposing your own idea is fine - i am all for it but uneducated trashing of someone else's work is unprofessional.

3. Whilst i disagree with his APAS test, i have tried it personally for 2 weeks on all my patients and found that it did NOT add one scrap of difference to my results. In fact, i missed diagnoses with it.

4. The trouble is that there is a little truth mixed in with lies.
a. The Stork test on the whole has been shown to have unreliable results HOWEVER, there is biomechanical and intertester reliability studies that have shown that the STANCE phase of the test is reliable - this is the one i use.
b. forward flexion test is NOT a test i use.
c. These are not EXCLUSIVELY SIJ tests but neuromuscular would have you believe that they are... and have probably been taught that way to people.

5. Try it and post the results for all to see. his APAS test is unresearched and untested and has NOT been through any proper peer review publication at all. The Stork test has.

6. If you would like a more sophisticated and evidence-based approach, then feel free to email/PM me.

Cheers!

[neuromuscular]

To All:

Please read the original post.

The agreement has been reached that the original post was correct. All of the SIJ testing reveals little or not SIJ problems. That was the post. Further, the original post was that the PSIS to sacrum with hip ABD disproves the idea of a stuck SIJ in the same test where a stuck was shown with hip flexion or torso flexion.

The one test shows movement: The other is said to show a "stuck" joint or "fixation" of the joint. Which it has been admitted the older test is in error in.

No one has tried the hip ABD test according to Andry Vleeming, Ola Grimsby, Jim Rivard, etc., etc., etc., etc., etc., etc., If no one has tried it then maybe they should.

If results differ, then what are the possible reasons for the differences instead of just dismissing the newer test, because we are comfortable with the older one and quote others to prove why we like the older test?

That is the point.

This was to be an "open" discussion and not a qoute everyone from here to Timbuctoo. There is no peer review of this, because everyoneelse is chasing the SIJ and no one has tried this testing method.

As for my intentions, they were to bring something new to the forum. In that, it has been successful, because no one has been doing a pelvic assesment with hip ABD. That is a totaly new thought.

Try it with an open mind.

Best regards,

Neuromuscular.

[alophysio]

Hi,

There is such a thing as a stuck SIJ, neuromuscular just hasn't seen one.

The point is that on certain tests which claim to be a stuck SIJ, it isn't - neuromuscular and i agree on this.

However that doesn't mean that there is no such thing as a stuck SIJ - that would be a logical error to conclude this from comparing one erroneous test to another.

However as discussed, it may be taught that the SIJ is stuck if a positive Stork Test is found. I disagree but i have made that clear.

An open discussion amongst anonymous people can still result in quoting the sources of your ideas.

Doing Hip ABD is NOT NEW. I have been doing it for years. you see, you take the principle of a test and you apply it to movements. Sagittal, Coronal and Transverse planes - and a combination of all 3 - that is after all the world we live in.

Perhaps you mean that you haven't found research done on coronal movement - this may be true. However the concept is not new.

Neuromuscular - in all seriousness and kindness, the APAS test has flaws which would not survive rigorous testing and come to the same conclusions as you have. You cannot claim the muscles are holding positions from this test alone. That is the problem i have with it.

I invite all people to try your test and see for themselves Neuromuscular - i haven't said it is a waste of time to try. I have said that it has done nothing for my clinical practice...and Roycar has said the same. I wonder who else has as well...

Have you tried the Stork test the way i have asked you to?
Additional Comment I forgot:
Also, if you don't like to know where other people get their information or reference where ideas and concepts have already been published, you mustn't be interested in what is actually out there...

...therefore you have an agenda...

If you want an informed discussion, read the material, do research and discuss the ideas.

A discussion is a two way street. Read the posts above - does it sound like you understand what i have asked you to do?

You ask us to try your APAS test and i have.

I have asked you to list the Google search terms or Pubmed search terms you have used and you haven't listed them yet - why? I can only presume that you haven't looked.

Therefore your agenda is to

1. Put forward an idea without background
2. Put forward an idea and hope people give you the background (which i have done a lot of)
3. Don't care about the past or what is out there and push on ahead with your ideas...

Therefore, i have a problem with your assertions which are uneducated, unresearched and incorrect.

Thanks

[neuromuscular]

Dear Alophysio:

You have been on the offensive from the start by inferring negative in your first post.

I have tolerated this by giving you the benefit of the doubt.

However, you have shown that you have not listened to things which I have said.

I put forth the comparison of the SIJ test (Gillett or swing phase) to the SIJ with hip ABD from the start. You either suffer from dementia or chose to ignore what has been said. You stated that this was a new test later in the discussion. That I had changed my logic to your credit. I had put it forth from the start. Read the first post on the thread.

You started by inferring things and continue to do so.

I have read Diane Lee and communicated with her. I have talked to Andry Vleeming on the phone. I have talked to Ola Grimsby and Jim Revard on the phone also. I have talked to several professors at several universities.

One professor reminds me of you. I had a patient come down to show the assessment and techniques. The professor delayed until the patient had to leave. A group of students were in the room and followed as I did the assessment and therapy. One student approached me after to ask if I would consider doing her as in the three years of training, she had not gotten any relief. I did the assessment and therapy. She had considerable relief. During this the professor arrived. I showed the assessment on the student and the therapy. There was more improvement. The only comment by the professor was: "How long will it last?" So I had the student do several activites such as squats, bends, sit down and get up, etc., etc. The therapy held through all of the activities. The professor simply said: "Yes, but how long will it last?" The standard therapy had done nothing for the condition, but all the professor could think of as an excuse was: "how long will it last?"

You stated that you gave it an honest try. How come then you did not even try it until I insisted several times and only after many, many, many weeks? Is this evidence of a great open mind? Further, you dismissed it without any thinking of the differences of results may be in the ergonomics of driving on the left vs driving on the right. It was an open and shut case to you. That is great openess of mind! There could be other ergonomic factors. Truly "considering something" is different.

You qoute everyone of note - why? Do you not think others can read. I have read many things. When I bring up the fact that there are many gapping holes in the theory that further research is admittedly needed you dismiss it as cherry picking? Who is cherry picking? The one who qoutes others as verbatim truth or the one who sees the flaws in the theory?

Why do you not start your own thread on " The joy of SIJ testing" Or "All you ever wanted to know about SIJ testing but were afraid to ask" Or "The SIJ testing expert is in"

I would appreciate you leaving this discussion. Not because I feel intimidated by your inferences and inuendos, but because I am simply tired of you not truly considering what has been stated and put forth. You can put forth all of the "peer review" you wish as if you are the most informed person on the planet earth. You can quote Biblical passages as if you have God's backing. You have said that "you can attract more bees with honey than gaul". Yet, you dispense gaul freely along with inferences and inuendos. I suggest "Practice what you preach."

You have stated that you would charge me $280.00 dollars per hour. I would charge $2500.00 per hour plus penalties for every close minded remark.

Further, if I was in a class of yours, I would transfer to another university.

Think about it.

Neuromuscular

[alophysio]

Dear neuromuscular,

i am sorry that you feel that way.

Let the public decide about your test.

Let your peers decide.

Have you tried the test as described for two weeks as I have suggested?

Have you read the references?

Have you considered my opinion?

I am not the most informed person in the world but it seems i have read more on SIJ research that you have.

Why is it that Andry Vleeming actually asked you to stop communicating with him?

Why is it that you claim research is being done and yet no one from the OGI seems to back you up in our email communications (whom you include as a cc)?

Why is it that Diane Lee doesn't want to talk to you?

Why is it that others don't want to talk to you.

I understand your frustration. I just believe you are going about it the wrong way.

I think there is something to be said about testing for coronal plane dysfunction. Your test is one in the coronal plane.

I happen to disagree with your claims about the test. I have research to back up my claims. I have sent you such research.

If i were in your class, i would leave in frustration...think about that.

I have stated in emails and elsewhere that i have tried the nice way but you don't seem to listen. That is why i had to be more heavy handed.

However, all the questions i have asked you have ignored...

1. What search terms did you use in your researching of the current papers?
2. Have you tried the test as i have described to you?
3. Where are your supporters?
4. You claim the APAS test can stand alone - how can it tell between an OA hip problem and a myofascial problem or a jammed facet in the back??

As i have stated elsewhere, i have no doubt you are a fine clinician. However what you believe in with regards to your APAS test has flaws as far as i am concerned.

And that professor you refer to is not like me. In fact, if i did the exact same thing with my tests, you would say that the SIJ is not the problem in the majority of people and why am i wasting time on testing it and not treating the myofascial problem...right?

Anyway, good luck with trying to convince others.

The bottom line facts are (backed by reserach in a lot of cases)

1. The SIJ moves and can get stuck therefore there is such a thing - just perhaps not as often as others might think (which is what i think you are ranting about).

2. The joint itself can be the source of pain, can be the source of dysfunction and can have many different reasons why it fails load transfer

3. The stork test is reliable on the stance phase assessment as shown by Hungerford and there are clear differences between failed load transfer and normal function

4. The Intergrated Model Of Function is just one model which has been adapted from Panjabi's model of Active, Passive and Neural. Diane Lee and LJ Lee now use what is called the Clinical Puzzle. Aspects of these models (which are all very similar) have research done on the different causes of dysfunction.

5. Your APAS test does not have research behind it nor do your claimed researchers leap to your defence in email communications

6. It is a coronal plane test that demonstrates whether an intrapelvic torsion occurs with increasing hip ABD. More testing is required to determine if it is a hip, SIJ, L/S, T/S or knee problem that is causing the intrapelvic torsion. Still more testing is required to determine if the dysfunction is articular, myofascial, neural, etc in nature. Therefore it CANNOT be a stand alone test on which you can make a diagnosis on. (Neither is the Stork Test BTW...but i have never claimed that - i have said that it does give me more information than the APAS test though).

7. You are avoiding the questions i am asking which leads to the obvious question of "why?"

8. you want me to leave this discussion - but a discussion involves answering questions that are asked. Answer my questions (which are not unreasonable) and i will be happy.

Insult me all you like - i do think it is all you have left - you have not answered my points on the logical flaws of your claims...

I hope you aren't this angry in your retirement...i really do worry about your health. Just take it easy.

I am sorry for your distraught.

Don't take it so personal...

Thanks

[alophysio]

BTW,

The title of the thread is "New Research: No such thing as a 'stuck' SI Joint"...

But the papers by the OGI (Ola Grimsby Institute) as claimed are not forthcoming...

There is no new research...

Studies have not commenced...

But to be fair, Neuromuscular does present some general statistics from his own cases (over 1000 apparently). But i don't think the methodology would stand up as a case for refuting the existence of a stuck SIJ...

[physiobob]

Dear neuromuscular & alophysio

Firstly happy new year to you both. Secondly, thanks for your continuing contributions to the forum as I am many others enjoy a heated debate. And your's is one of the best.

But I think generally you guys are getting a little personal, perhaps through frustration as you both believe strongly in the views you are suggesting.

Alophysio is perhaps on the hard line or peer reviewed trials and evidence based stuff. Neuromuscular is perhaps on that side where people are trying to come up with something practical that others can later investigate to their satisfaction.

I would not want any comments that "get personal" to interfere with your great contributions.

For what it is worth I think it is great that someone is clinically trying to develop our assessment. As a pure maths and physics student prior to physio I am also very, very critical on the collection of data, the operationalisation of the initial questions asked as to what that data was collected and importantly the subsequent conclusions or statements that are made about the results. I do take alophysio's comments on that and think this is worth stating.

For what it is worth this topic refers to a "Stuck SIJ". This is where I believe most people researching this topic miss the point. You cannot look for mobility in something that is stuck. You cannot show it in realtime MRI etc. The point is that it move from a position at time A and through some force moved to a position B. Clinically we cannot see the move from A to B as they are at B when they come t visit us.

Perhaps a 3D scan such as PET or SPEC scan when the patient is asymptomatic (perhaps a position A) with some type of rotational marker system and later a follow-up comparison3D scan when they are symptomatic (perhaps a position B) might lend itself to assisting us whether or not to acknowledge that a shift is the SIJ is possible and then whether that might lead to pain. So far I have not seen evidence of this but it seems pretty logical to me.

Clinically though it doesn't really matter what us going on as long as there is an assessment technique that leads to a treatment technique/process, that leads to a reduction in symptoms. For the later is what we are after as clinicians.

We do not like to remove any commentary from this forum suffice to say that I am happy to remove any personal things that may have been said in frustration. SO please let me know via a direct message if there are things you'd like removed.

Try to keep things on track, perhaps (as I have seen from email correspondence) you two should be working on the same development as coming up with something together after all this debate would be a benefit to us all and a great forum on which to facilitate that for the wider community.

Big smile to all.

[alophysio]

THanks Physiobob.

A few things.

1. The thread is supposedly new research that proves that there is no such thing as a stuck SIJ...
- a. the test proposed has the same inherent flaws that the tests rubbished have - bony landmarks...
- b. The proposed test does not explain how other joints are excluded - in my opinion the hip is most important here - and therefore these other joints can confound the results and thus cannot be used as a proof.
- c. There is no new research from the OGI on this

2. As a coronal plane assessment, it might have some merit but it cannot be a stand-alone test as stated.

3. Neuromuscular is not interested in considering changing his test, merely convincing others how good it is and to do the research for him (because he is semi-retired and too busy are his reasons for not doing the research himself). Therefore, as evidenced above, my input doesn't seem to be helping.

4. As much as i admire neuromuscular's passion, i feel his disrespect towards others and the fact that i don't seem to be heard would preclude me from working collaboratively with him...however, i am happy to work with others and will do so and continue to do so.

Just a few thoughts but i appreciate your input.

A big smile to all as well

[neuromuscular]

To all:

I do not wish to continue with this forum.

I do not appreciate people fighting tooth and claw an idea without trying it. If you wish to try the test do so. If you do do so without prejudice. Your results may differ. There may be several factors.

I do not have any hidden agendas other than you try the test.

I am not interested in using your research for my ends. Sorry for those who think so. It is just an interest in an idea - an observation that I have seen.

I thank those who have tried the test wihtout prejudice.

Best regards,

Neuromuscular

[alophysio]

Thanks Neuromuscular,

i am sorry you feel that way.

In defense of at least myself, i have tried your test and treatment (as stated many times) and found it to be without any clinical benefit compared to what i do now.

Your observation of myofascial involvement and the appearance of SIJ motion when other tests apparently show a "fixation" is great and to be encouraged (as mentioned elsewhere - "kudos to you" i believe were the words i used) but i believe your reasoning is flawed...that is not unprofessional, just honest.

I seem to be the main person "fighting tooth and claw" with you on this forum so i apologise for you feeling this way but i have to correct you and tell you and others that i have tried the test.

I also tried the test without prejudice...and have asked you to do the same for the stork test as described which you have failed to do.

But good luck with whomever is interested in your idea...it would be interesting to see if they have similar questions and challenges for you...

Cheers - i honestly and sincerely hope this year is good to you.