Frank,
> Mel: "Some therapists claim that "sacroiliac dysfunction" can be accurately
> diagnosed by manual examination and treated successfully by manipulation.
> You: "I'd say I can do that fairly well."
> Me: So probably all other clinicians used in the reproducibility studies
> said. Still, two systematic reviews found that diagnosing SIJ abnormalities
> by means of palpation is unreliable. One could just as well toss a coin.
I realize that I should have been more specific about how I do the
examination. One of the procedures I use is pain provocation tests,
which have been shown to have a decent reliability (1,2).
Also I almost always start treating all my patients from the top of the
spine and down to avoid false positives created by problems higher up in
the spine.
Dysfunctions high up in the spine have been shown to affect the low back
(3,4) and hips (5).
> Frank: And there's another question: how do you know for sure that the
> 'cracks' produced with an SIJ manipulation are produced by the SIJ
> (chambers), and not by the L5-S1 facet(s)?
I agree that one can never be sure by judging from a sound alone (I
mainly use a longitudinal traction manipulation technique which rarely
causes a 'crack'). I always reassess and to me one important indicator
is that the patient feels an improvement in pain and mobility. If no
improvement occured I would consider either giving the technique another
try or looking for another strategy.
Regarding the L5-S1 facets they tend to be involved in a large part of
all SIJD. I think that many treatment techniques aimed improving the
function of the SIJs also affect these facets to a high degree.
As I indicated in my previous mail I'm not at all convinced that a SIJD
is mechanical ('crack' a joint) problem and that as Mel put it: "further
studies of the effects of manipulation should focus on the soft tissue
response and neural factors".
1. Broadhurst, N.A., Bond, M.J.,Pain provocation tests for the
assessment of sacroiliac joint dysfunction, J. Spinal Disord., 11 (1998)
341-5
2. Kokmeyer, D.J., Van der Wurff, P., Aufdemkampe, G., Fickenscher,
T.C., The reliability of multitest regimens with sacroiliac pain
provocation tests,
J. Manipulative Physiol. Ther., 25 (2002) 42-8
3. Nansel, D.D., Waldorf, T., Cooperstein, R., Effect of cervical spine
adjustments on lumbar paraspinal muscle tone: Evidence for facilitation
of intersegmental tonic neck reflexes, J. Manip. Physiol. Ther., 16
(1993) 91-95
4. Pollard, H., Ward, G., A study of two stretching techniques for
improving hip flexion range of motion, J. Manipulative. Physiol. Ther.,
20 (1997) 443-447
5. Pollard, H., Ward, G., The effect of upper cervical or sacroiliac
manipulation on hip flexion range of motion, J. Manipulative. Physiol.
Ther., 21 (1998) 611-616
Kind regards,
David
