Dear Jerry, I like your perseverance and 360° approach on treating SIJ dysfunctions,, but I feel we should really read the comment on Berthelot's 2006 article (one of the cornerstones of your work) by Laslett et al and then next read the systematic review by Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS. in
J Pain. 2009 Apr;10(4):354-68. "Diagnostic validity of criteria for sacroiliac joint pain: a systematic review". We can only establish that the SIJ is in part a potential source of nociception without any possibility of establishing what the actual cause is. I agree with Ina Diener; the actual possible movement in the SIJ is less than 6° which is not reliably palpable in any sort of way.
So any therapy based on these very low level evidence assumptions is based in reality only on clinical expertise and natural course combined with a possible placebo effect.
Let's say so to our patients: we do not know what the cause of your LBP is, but we have a potential treatment which might be effective....
Jerry Hesch • Erik,
I know that passive mobility tests do induce movement through the SIJ and that the springing with awareness (modification of traditional spring tests) can discern lack of movement going through the SIJ, and I know that there is a grey zone in which they are unable to replicate physiological forces. I have a few you tube videos showing the spring tests on the first H1N1 virus case in the nation who had a fused SIJ and in a client who was worked up for an SIJ fusion and I informed her with spring tests that she was already fused. A review of her CT scan revealed previously unreported encroachment of thoracolumbar fusion hardware into the lower SIJ on the right with no visible joint space. What absolutely astonished me about these two examples was the complete lack of left to right (1st one) and right to left (2nd) pelvic side-glide. No literature, kinesiology or joint structure and function textbook or published paper prepared me for that! I like the terminology lumbopelvic-hip which I use to convey that it is a system. In respecting the published studies I also respect the wide gap in topics where research is lacking. While movement is limited in the joints the spring tests are performed at a distance hence there is a multiplier effect between actual and perceived and I perform them using my whole body, hence an enormous number of receptors participate as opposed to just pushing with my arms. Sometimes specific treatment yields very dramatic results and quickly ends chronic severe pain and costly care as is shown in a video I posted that has Downslip and Upslip in the title. There is a link where the child's mother excoriates the medical profession and reiterates his journey. No research exists to support what I did for him, meaning no published. There are many topics still in need of research. I do spend a lot of time educating my clients and gently dismantling their cultural "SIJD" MYTHOLOGY. I think we all seek the same outcome for our clients. Thank you. best regards, Jerry Hesch
J Pain. 2009 Apr;10(4):354-68. "Diagnostic validity of criteria for sacroiliac joint pain: a systematic review". We can only establish that the SIJ is in part a potential source of nociception without any possibility of establishing what the actual cause is. I agree with Ina Diener; the actual possible movement in the SIJ is less than 6° which is not reliably palpable in any sort of way.
So any therapy based on these very low level evidence assumptions is based in reality only on clinical expertise and natural course combined with a possible placebo effect.
Let's say so to our patients: we do not know what the cause of your LBP is, but we have a potential treatment which might be effective....
Jerry Hesch • Erik,
I know that passive mobility tests do induce movement through the SIJ and that the springing with awareness (modification of traditional spring tests) can discern lack of movement going through the SIJ, and I know that there is a grey zone in which they are unable to replicate physiological forces. I have a few you tube videos showing the spring tests on the first H1N1 virus case in the nation who had a fused SIJ and in a client who was worked up for an SIJ fusion and I informed her with spring tests that she was already fused. A review of her CT scan revealed previously unreported encroachment of thoracolumbar fusion hardware into the lower SIJ on the right with no visible joint space. What absolutely astonished me about these two examples was the complete lack of left to right (1st one) and right to left (2nd) pelvic side-glide. No literature, kinesiology or joint structure and function textbook or published paper prepared me for that! I like the terminology lumbopelvic-hip which I use to convey that it is a system. In respecting the published studies I also respect the wide gap in topics where research is lacking. While movement is limited in the joints the spring tests are performed at a distance hence there is a multiplier effect between actual and perceived and I perform them using my whole body, hence an enormous number of receptors participate as opposed to just pushing with my arms. Sometimes specific treatment yields very dramatic results and quickly ends chronic severe pain and costly care as is shown in a video I posted that has Downslip and Upslip in the title. There is a link where the child's mother excoriates the medical profession and reiterates his journey. No research exists to support what I did for him, meaning no published. There are many topics still in need of research. I do spend a lot of time educating my clients and gently dismantling their cultural "SIJD" MYTHOLOGY. I think we all seek the same outcome for our clients. Thank you. best regards, Jerry Hesch
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