Hi Mel,
> Some therapists claim that "sacroiliac dysfunction" can be accurately
> diagnosed by manual examination and treated successfully by manipulation.
I'd say I can do that fairly well.
> 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.
I agree that from a purely mechanical viewpoint facts are adding up
against the possibility of diagnosing a SIJD by manual examination and
treating it successfully with manipulation.
However I think you're spot on when you're looking in other directions
such as neural factors. I think that one may learn to recognize
different patterns of pain, hypomobility, etc, which can guide you to
succesful diagnosis and treatment. But that doesn't mean that it was a
mechanical problem we solved. As someone once said,"That a technique
works does not validate the rationale behind it".
> 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.
I'm well aware of this and I think this too clearly urges us to look in
other directions than the mechanical one.
David Felhendler, PT
Norrkoping, Sweden
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