Frank:
I'd have to agree with your last statement but there is a flaw in it.  Your
statement ":They're darn close
together, so judging that by sound or feel seems extremely unreliable."
Judging whether or not the manip to the sij was successfull also requires
knowing how the joint was manipulated.  There are some techniques that I can
gaurantee you don't come close to moving L5/S1 and others that are less
specific and could be moving L5/S1 so I think without knowing the mechanics
of the manip it is difficult to evaluate it's effectiveness.

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: "Frank Conijn" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 31, 2003 7:25 PM
Subject: Re: Sacroiliac Dysfunction and Treatment? (David]


> David,
>
> 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.
>
> You: "I agree that from a purely mechanical viewpoint facts are adding up
> against the possibility of diagnosing a SIJD by manual examination"
> Me: "Facts [...] adding up"? That looks to be the understatement of the
year
> when it comes position- and mobility-diagnosis, looking at the reviews
> done (1-4), which are based on large numbers of reproducibility studies.
>
> You: "and treating it successfully with manipulation"
> Me: Like you later already implied, here you are -- from a theoretical
> research-rules point of view -- being too harsh (on yourself). In itself,
a
> method can still be (cost-)effective even though the diagnostic
(sub)method
> has been proven to be unreliable. Nevertheless, manipulation applied to
LBP
> patients without prior McKenzie assessment
> has indeed been shown to be doubtful regarding effect, in not ineffective,
> in chronic LBP patients (5). 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)? They're darn close
> together, so judging that by sound or feel seems extremely unreliable.
>
>
> References:
> 1. Freburger JK, Riddle DL, Using published evidence to guide the
> examination of the sacroiliac joint region. Phys Ther 2001; 81:1135-43.
> 2. Van der Wurff P et al, Clinical tests of the sacroiliac joint. Manual
> Therapy 2000: 5(1):30-36.
> 3. Van der Wurff P et al, Clinical tests of the sacroiliac joint. Manual
> Therapy 2000: 5(2):89-96.
> 4. Conijn FJJ, Diagnosing abnormalities of the sacroiliac joint - a review
> of (systematic) literature reviews, and an update. Physical Therapist's
> Literature Update 2001: 1(5): editorial (www.ptlitup.com | Archive &
Search
> | Editorial May 2001).
> 5. Ferreira M et al, Does spinal manipulative therapy help people with
> chronic low back pain? Aust J Physiother 2002;48(4):277-84.
>
>
> R.,
> Frank
>
>
>
> ----- Oorspronkelijk bericht -----
> Van: David Felhendler
> Aan: [log in to unmask]
> Verzonden: dinsdag 28 januari 2003 19:45
> Onderwerp: Re: Sacroiliac Dysfunction and Treatment?
>
>
> 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
>