Some therapists claim that "sacroiliac dysfunction" can be accurately
diagnosed by manual examination and treated successfully by manipulation.
However, there is considerable research which suggests otherwise. For
example, although manipulation of the sacroiliac joint has been shown to
normalise different types of clinical test results, it is not accompanied by
altered position of the sacroiliac joint, according to complex X-ray
analysis. Thus, because the supposed positive effects are not a result of a
reduction of subluxation, further studies of the effects of manipulation
should focus on the soft tissue response and neural factors.
Bengt Sturesson from Sweden shocked many practitioners at a congress in
Vienna some years ago with his precise measurements of SI motion. Using
radiostereometric x-ray imaging, he had shown that SI joint mobility in
healthy people is much less than had been assumed before (i.e., it is only
0.5 -1.6 mm translation or 2-4 degrees rotation in a standing or sitting
position), and that manual tests in which the practitioner assumes to palpate
SI motion in these positions, are therefore very questionable.
Would anyone like to comment on this topic?
Here are a few references on this topic to help you along the way:
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Spine 2000 Feb 1;25(3):364-8
A radiostereometric analysis of movements of the sacroiliac joints during the
standing hip flexion test.
Sturesson B, Uden A, Vleeming A.
STUDY DESIGN: The standing hip flexion test was evaluated by using a
radiostereometric analysis. OBJECTIVES: To evaluate whether the commonly used
standing hip flexion test reflects movement in the sacroiliac joints, or
whether the increased load of one sacroiliac joint also reduces the mobility
of the other sacroiliac joint according to the theory of form and form
closure in the sacroiliac joints. S
UMMARY OF BACKGROUND DATA: The standing hip flexion test, used frequently to
analyze sacroiliac joint mobility, is advocated as a test for study of normal
or impaired motion in the sacroiliac joint. METHODS: In this study, 22
patients considered to have sacroiliac pain were analyzed with
radiostereometric analysis when standing and when performing the standing hip
flexion test on the right and left sides.
RESULTS: Very small movements were registered in the sacroiliac joints. When
provoking one side, the rotations were small on both sides.
CONCLUSIONS: The small movements registered support the theory of form and
force closure in the sacroiliac joints. The self-locking mechanism that goes
into effect when the pelvis is loaded in a one-leg standing position probably
obstructs the movements in the sacroiliac joints. Therefore, the standing hip
flexion test cannot be recommended as a diagnostic tool for evaluating joint
motion in the sacroiliac joints.
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Spine 2000 Jan 15;25(2):214-7
A radiostereometric analysis of the movements of the sacroiliac joints in the
reciprocal straddle position.
Sturesson B, Uden A, Vleeming A.
STUDY DESIGN: A Radiostereometric analysis of the reciprocal straddle
position. OBJECTIVES: To evaluate the magnitude of rotation in the sacroiliac
joints in the reciprocal straddle position.
SUMMARY OF BACKGROUND DATA: The reciprocal straddle position has been
objectified in different studies, using different techniques, to show a
sacroiliac motion between 5 degrees and 36 degrees. Previous studies with
radiostereometric analysis during different provocations reported much
smaller movements. METHODS: Six women with posterior pelvic pain of long
duration after pregnancy (n = 5) and sacroiliitis (n = 1) underwent
radiostereometric analysis in the sustained reciprocal straddle position.
RESULTS: A reciprocal movement could be demonstrated in the sacroiliac joints
in the reciprocal straddle position. However, the movements were 10 times
smaller than reported in earlier studies of the reciprocal straddle position.
CONCLUSIONS: It was possible to demonstrate reciprocal movements of the
sacroiliac joints in the straddle position. However, the radiostereometric
analysis technique showed the movements to be small, as reported in other
mobility studies.
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Spine 1989 Feb;14(2):162-5
Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis.
Sturesson B, Selvik G, Uden A.
Twenty-five patients (21 females and 4 males) with sacroiliac joint disorders
were studied with roentgen stereophotogrammetry in physiologic positions as
well as in the extreme of physiologic positions. There was a constant pattern
of motion with different load, especially around the transverse axis. The
rotations were small and in mean between position 2.5 degrees (0.8 degree-3.9
degrees). The translation was, mean, 0.7 mm (0.1-1.6 mm). There was no
difference between symptomatic and asymptomatic joints.
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Spine 1998 May 15;23(10):1124-8
Manipulation does not alter the position of the sacroiliac joint. A roentgen
stereophotogrammetric analysis.
Tullberg T, Blomberg S, Branth B, Johnsson R.
STUDY DESIGN: A roentgen stereophotogrammetric analysis study of patients
with sacroiliac joint dysfunction. OBJECTIVES: To investigate whether
manipulation can influence the position between the ilium and the sacrum, and
whether positional tests for the sacroiliac joint are valid.
SUMMARY OF BACKGROUND DATA: Sacroiliac joint dysfunction is a subject of
controversy. The validity of different sacroiliac joint tests is unknown.
Long-standing therapeutic tradition is to manipulate supposed dysfunctions of
the sacroiliac joint. Many manual therapists claim that their good clinical
results are a consequence of a reduction of subluxation.
METHODS: Ten patients with symptoms and sacroiliac joint tests results
indicating unilateral sacroiliac joint dysfunction were recruited. Twelve
sacroiliac joint tests were chosen. The results of most of these tests were
required to be positive before manipulation and normalized after
manipulation. Roentgen stereophotogrammetric analysis was performed with the
patient in the standing position, before and after treatment.
RESULTS: In none of the 10 patients did manipulation alter the position of
the sacrum in relation to the ilium, defined by roentgen
stereophotogrammetric analysis. Positional test results changed from positive
before manipulation to normal after.
CONCLUSIONS: Manipulation of the sacroiliac joint normalized different types
of clinical test results but was not accompanied by altered position of the
sacroiliac joint, according to roentgen stereophotogrammetric analysis.
Therefore, the positional test results were not valid. However, the current
results neither disprove nor prove possible beneficial clinical effects
achieved by manipulation of the sacroiliac joint. Because the supposed
positive effects are not a result of a reduction of subluxation, further
studies of the effects of manipulation should focus on the soft tissue
response.
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Spine 1994 May 15;19(10):1138-43 Related Articles, Links
Positive sacroiliac screening tests in asymptomatic adults.
Dreyfuss P, Dryer S, Griffin J, Hoffman J, Walsh N.
STUDY DESIGN. In a prospective, single-blinded study, the incidence of
false-positive screening tests for sacroiliac joint dysfunction was
investigated using the standing flexion, seated flexion, and Gillet tests in
101 asymptomatic subjects. OBJECTIVES. This study determined if these
commonly used sacroiliac screening tests can be abnormal in an asymptomatic
population.
SUMMARY OF BACKGROUND DATA. The sacroiliac joint is a potential source of
back and leg pain. One condition affecting this joint is termed sacroiliac
joint dysfunction. Diagnosis of this is made primarily by physical
examination using screening tests as preliminary diagnostic tools. These
screening tests evaluate for asymmetry in sacroiliac motion due to a
relative, unilateral hypomobility in one the sacroiliac joints. The
specificity of these tests, however, has not been thoroughly evaluated in a
well-selected asymptomatic population. METHODS. A single-blinded examiner
performed the standing flexion, seated flexion, and Gillet tests on all
subjects. An asymptomatic and a symptomatic group were studied.
RESULTS. Overall, 20% of asymptomatic individuals had positive findings in
one or more of these tests. The specific percentage of false positives are
reported by test, age, sex, and side.
CONCLUSION. This study suggests that asymmetry in sacroiliac motion due to
relative hypomobility as determined by these tests can occur in asymptomatic
joints. Obviously, one should not rely solely on these tests to diagnose
symptomatic sacroiliac dysfunction.
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Dr Mel C Siff
Denver, USA
http://groups.yahoo.com/group/Supertraining/
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