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.