Why not have research that states pain ratings and functional ratings.
Isn't that more significant?
Patrick Zerr
www.apluspt.com
The easiest way to prepare for the National PT Exam!
www.summitpt.com
Summit Physical Therapy; Tempe, Arizona
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, January 25, 2003 6:31 PM
Subject: Sacroiliac Dysfunction and Treatment?
> 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:
>
> -----------
>
> 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.
>
> ------------
>
> 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.
>
> --------------
>
> 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.
>
> ---------------
>
> 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.
>
> ---------------
>
> 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.
>
> ----------
>
> Dr Mel C Siff
> Denver, USA
> http://groups.yahoo.com/group/Supertraining/
>
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