Inquiry from a sacroiliac FB group:
For those of you who had surgery from Shamie, Rudolf or Kube-how are you doing? How did they handle the alignment situation prior to surgery? Did they monitor for nerve issues during surgery? Thanks much. Any other surgeons one would recommend outside the GA team. Thanks

Jerry Hesch One who turns away clients because she/he discerns that there are other issues present. Any surgeon who does not believe that magically everyone who walks in the door needs their kool aide surgery. One who educates, refers out, orders more tests when appropriate, one who stays in touch with medical literature, one who has the patient's best interest at heart, one whose Physician:Patient (I call them clients) is one of committment such
that if you have any problem, any concern after the intervention; you can get a return call in 48 hours, sooner for emergency, one who communicates with your at-home physician team, one who does not pay anyone to Facebook market him, one who does not do surreptitious private messaging marketing, one who does not say "You want to get you life back don't you?" who has the balls to stand up to any physical therapist who tries to dictate what kind of hardware to install, one who does not have a financial relationship with the Physical Therapist, nurse, PA, or kool aide stand. Who understands that joint alignment and alignment of the external landmarks: ASIS, PSIS, pubic tubercles, pubic crest, sacrum and PSIS, ischial tuberosity et al; ARE NOT ONE AND THE SAME. One who values constant continuing education as opposed to dogma, on who belongs to several professional organizations, and who refers to Physical Therapists who are members of APTA, Orthopedic Section APTA, AAOMPT, active in clincal AND research, writing and presenting, (or at least 2 of these) PT who reads Spine journals, JOSPT, PTJ, J MAnual & maniupulative Therapy, etc., etc. One whose success rates are objectively measured. Whether this surgeon and PT are  in GA as you ask or in Norfolk, or Tuscon; well worth the research. and more...

SACROILIAC FUSION ALIGNMENT???? 
I see fusion x-rays in which the vertical measurements are fairly "aligned" but the medial to lateral are NOT, and I see symphysis pubis that are NOT aligned. Please explain. Is there some
hidden research or even sound theory that states "you only have to align the vertical aspect of the ilia" prior to some form of SI fusion, but not the medial to lateral?  Not the symphysis pubis??? Separately, I have good research that indicates that you cannot use these x-rays to determine "alignment" because of something called boundary conditions, AKA frame of reference. If the person is x-rayed lying on the table a slight muscle spasm of any major lumbopelvic muscle can cause asymmetry, such that an x-ray will look like the pelvis is "mis-aligned". The SI joint might very well be perfectly aligned. I could go on and on, but the alignment mythology does not hold up to scrutiny. There is a deeper problem and yes we should optimize structure and function, but there is a vast grey zone between alignement of the pelvic bones and what happens inside the SI joints and inside the symphysis pubis. This I know, you cannot have an aligned SI fused joint and have a misaligned symphysis pubis joint (with very few exceptions). Cherry picking literature to pass out purple kool aide = $. There are more than a dozen dysfunctions that are missed with the traditional SI alignment theory. For example, lower pubic alignment; not even evaluated. Medial to lateral ischial alignment: not even evaluated in this vintage paradigm.  Anterior – to - posterior ischial alignment; not even evaluated. Oblique PSIS (mobility and) alignment, Anterior/posterior glide PSIS movement and "alignment" yadayadaya!  Apparent superior/inferior pubic alignment is not being addressed in these case series. I can help as can many others. Perhaps this new not for profit (or non-profit; 2 distinct legal entities) should work on better prevention, better screening, not proving that the grape kool aide is best. Sign me up if science is what we want.
It is what we need; not mythology. However if marketing is what is needed...Sacroiliac belief systems are quite a bit like faith based beliefs.  They are not factual in whole, much is by definition; faith based. I suggest that anyone considering SI fusion follow the protocol to the nth degree.  COMPLETELY rule out lumbar as primary, COMPLETELY RULE OUT hip as primary, etc.
The carnage is immoral. SI-Bone gets mentioned frequently, but they are the manufacturer. The responsibility of how it is applied falls in the hands of those clinicians that are allowing and encouraging these surgeries, and it is their responsibility to follow the protocol COMPLETELY.  The manufacturer cannot legislate how the individual practitioner practices. There is and has been very good care for SIJD happening all over the country as has been for decades. This new kool aide in which SIJD is POORLY DEFINED becomes a trash-can diagnosis for any, and all kinds of failed back syndrome, is dumber than goats smoking weed. 

Sign me JERRY HESCH, MHS, PT HESCH INSTITUTE accountable to the Ethiics and standards of the American Physical Therapy Association, the Nevada Association APTA, the
State of Nevada Physical Therapy licensing board, AAOMPT, etc. Call me on the carpet if I violate any of the above.

Dear Jerry,
I just wanted to thank you again for taking time to check out my wonky pelvis, ha!  I'm using the tool you gave me, my PT is keeping the leg/ankle in check and the difference in my gait is remarkable, my knee also thanks you and slowly but surely I'm feeling like my ole self again. This month marks year #3 since the MVA (although 2 years were wasted scrambling for an exit door & clinging on to hope)... I can't believe how far I've come in just a year, there is no feeling greater than this. I count my blessings 10 fold and give thanks to those who lifted me along the way!

At  least by journaling thru my injury, people were able to see me slowly recapture my life non-surgically - that in itself was worth the time and effort!! Needless to say, I don't care for some of the social marketing groups that pressure you to get SI surgery without having the knowledge base to make such a recommendation. Conservative care rocks! 

I hope today finds  you well, may life treat you kindly and let the truth always speaks for itself! 
With highest Regards,
D from the city with a Naval base! -)

SACROILIAC FUSIONS
 TODAY’S  EMAIL I RECEIVED

From: Facebook PRIVATE MESSAGE
Sent: Wednesday, January 18, 2012 8:49 AM
To: Jerry Hesch 
Subject: New message from
_________
 8:34am Jan 18
Dear Jerry
I just wanted to say that I'm glad you're starting to speak up about your thoughts on SI surgery. I get stuck thinking in circles that I don't feel that it's appropriate for most people, even those who have exhausted their medical options, but where I get stuck is WHY it's not and HOW do we know when it's not? It's alarming to me the rate of surgeries that are happening, being patient-driven requests, and the variable outcomes. I wonder if the sample in the group is skewed, and not an accurate representation of true outcomes (how many more are doing great that we don't know about?). I have all this stuff floating around in my head -- concerns for those with upcoming surgeries and hope that they don't end up worse off, because I'm afraid they will, but I feel like me saying anything would be highly hypocritical, since I am a surgery success story.
 
Dear ___________,

 Very insightful commentary. We should chat sometime if your busy schedule allows. I am deeply concerned about what I observe but the sad thing, mal informed patients make their choice and THEY live with the consequence.   No, you are  not being hypocritical. This would be a very appropriate post for you to put up,  that is your perfect right and it carries much more power because 1. you are a  knowledgeable clinician and 2. You are a successful Lumbar fusion with the cages and pedicle screws, though the topic is of course; sacroiliac fusions. Keep up  the good work, I look forward to chatting if you have  time.

I appreciate your private messages, apologize if I failed to reply to one-I cannot recall !
 J