Hi Grant, I appreciate your open mind and enthusiasm. Chad Cook in book Orthopedic Manual Therapy an evidence based approach advocates test-retest approach. I am teaching a lumbopelvic-hip course this week and advocate that it can be articular (rare) and can be a postural-movement whole body pattern. I have to understand things in order to apply and have significantly reinterpreted the traditional biomechanical model. The model taught in muscle energy based on Mitchell's 1970 book was fully articulated in 1958 by his father who culminated, synthesized the knowledge base which at that time covered the early and mid century. I have a book chapter in Movement Stability and Low Back Pain: the essential roldeof the pelvis. Old, and my perspective of course has changed but it is a good introduction. I prefer to test motion that is passively induced THROUGH the structure and admit we cannot isolate motion only IN the joint. For the simple fact that I teach courses that include the term sacroiliac I get a lot of flack but the problem is more complex than what is addressed in the published knowledge base part of evidence-based practice. Even that is over-interpreted, but that is another conversation. It is tricky to use hip pain provocation tests and ascribe pain to the SIJ, it is tricky to use injection with dye and fluroscopy into the SIJ, achieve pain relief and then state that the SIJ is the pain generator. There are several injection studies that explain why and are relatively ignored by those who promote the use of injection to bolster a cause such as evidence-based SIJ eval and tx and worse: SIJ fusion where enormous marketing dollars are being spent. Just go to spine journal and the other one, J of Spine (NASS) and look at the ads, same for online search, meaning in print and web. The complexity of the problem cannot be denied and it is more relevant for specific populations, women who have had children, golfers, foottball/soccer, etc, meaning in a greater context; not just SIJD. I appreciate that you try, that you do test and retest, readily admit what you do not know because THAT is the basis of learning; receptivity and humility. Were I a patient, you would be my clinican.
Dr. Jerry Hesch, DPT, MHS, PT
Married with 4 grown kids. Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico. I enjoy working with my hands and particularly making glass objet d'art.