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The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
Are You a Bad Chiropractic Patient?
My father was a great DC. In fact, as you might expect, he was the doctor of chiropractic I measured all other doctors against. Sadly, he died at age 61 when I was in my early 30s.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Vaccines and Chiropractic: Evidence-Based Medicine or Medical Dogma?
Right or wrong, the chiropractic profession has historically been against vaccinations. However, a growing trend within the profession is seeking to reverse this position.
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
May, 2014, Vol. 14, Issue 05
The Accuracy of Sacroiliac Joint Evaluation Tests
By Whitney Lowe, LMT
The sacroiliac joint (SIJ) is a complex anatomical structure. It is the joint where the weight of the upper body, borne by the skeletal elements, is transferred to the lower extremities and eventually to the ground.The joint is held intact by an extensive webbing of anterior and posterior sacroiliac joints to prevent excessive movement (Figure 1). Yet, despite this tight webbing of ligaments, there is a slight amount of movement necessary at the SIJ. Biomechanics are complicated at the SIJ because there are two halves of the pelvis that must work in coordination with each other, but also somewhat independently. If movement is altered significantly at one joint and not the other, there is an imbalance of forces acting on the joint and this is frequently blamed for pain in the sacroiliac region.
Pathology at the SIJ may be responsible for pain sensations in the back, pelvis or lower extremity. It is often suggested that SIJ pathology be evaluated when an individual complains of pain in any of these regions, to see if it is playing a role. However, many of the high-tech diagnostic studies like MRI or X-ray may not tell us very much about pathology or dysfunction in mechanics of the SIJ. Therefore the clinical practitioner often must rely chiefly on physical examination procedures to gain information about whether the joint is functioning properly or if certain pain complaints are related to SIJ pathology.
One of the difficulties in evaluating SIJ pathology is that the movements at the joint are not easy to quantify or measure. The amount of movement is quite small and it is not easy to see exactly how the movements are occurring. There have been attempts to use palpation during movement to evaluate proper SIJ function, but it is unclear how accurate these attempts are. Many researchers and clinicians have suggested that improper movement (either excessive or decreased joint motion) is a likely source of pain for individuals with SIJ pain. This would certainly seem to make sense.
There are several procedures that have been used to evaluate SIJ movement and pathology through palpatory examination. These methods focus on finding bony landmarks and following them as an individual does certain movements of the pelvis. One of the more common methods is called the Gillet Test or Sacral Fixation Test. In this procedure, the client is in a standing position and the practitioner locates the client's posterior superior iliac spine (PSIS). Once the PSIS has been located, the client is instructed to lift one leg and bring it up toward the chest while the practitioner maintains contact with the PSIS. If the PSIS moves only minimally or in a superior direction, the joint is said to be hypomobile or "fixed." In normal movement, the PSIS should move in an inferior direction when the client lifts the knee up toward the chest. It is postulated that the lack of mobility in the SIJ is likely to be a primary cause of the client's symptoms.
In order to determine if an assessment procedure like this is accurate, we must decide if this motion is something that could be perceived by a number of individuals or if it is only likely to be picked up by one specially trained person. The way to judge the effectiveness of a procedure like this is to examine what is called its inter-examiner (or inter-rater) reliability. This reliability factor indicates the likelihood that several different practitioners, who all saw one client with a problem, would be able to come up with similar descriptions of the movement. For example, if Susan has low back and sacroiliac pain and she has her sacroiliac motion evaluated by Ellen who determines with the Gillet Test that there is a fixation on the right side SIJ, what would happen if she also went to Kevin, Mary and Steve for that same evaluation? Would they all find the same right side fixation when they performed the Gillet Test? If it were likely that they would all find the same thing, then we would consider the Gillet Test to have a high degree of interexaminer reliability. If it were unlikely that many of them would agree, we would say that this test has a low rate of interexaminer reliability.
Ideally any evaluation procedures should have a good level of inter-examiner reliability so we can rely on the information from the procedure. Unfortunately, many of the palpation tests that are used to evaluate SIJ don't have a high rate of interexaminer reliability. In addition to that, a number of these procedures seem to produce a high rate of false positives in an asymptomatic population.1 In the chapter from the Vleeming text just cited, M. Laslett also mentions that in addition to having a poor rate of interexaminer reliability, there is another significant concern that must be addressed. Even if there does appear to be a motion restriction, no clear causal connection has been identified between increased or decreased range of motion at the SIJ and pain complaints in the region. While there may appear to be some correlation, a direct cause-effect relationship has not yet been clinically validated.1
There is another type of test that is often used to evaluate SIJ dysfunction and this is called a pain Provocation Test. In these procedures, the practitioner is attempting to identify some movement or position of the joint that will reproduce the specific pain that the client has been experiencing. In essence, the practitioner is attempting to "provoke" the same pain that the client has been experiencing. This type of test is often considered more accurate because it is the very pain that the client has been experiencing that is used to determine the positive or negative result of the test.
A number of authors have investigated various pain provocation tests for the SIJ to determine the inter-examiner reliability. Several recently published reviews of the sacroiliac joint evaluation tests found a combination of tests to be more accurate than any one single evaluation procedure.2,3 The most accurate of the procedures that were evaluated appear to be two tests that focus attention on the role played by the anterior and posterior sacroiliac ligaments in SIJ dysfunction.3,4 Two procedures with the greatest level of interexaminer reliability were the Gapping Test and the Side-lying Compression Test.
The Gapping Test is a procedure done with the client in a supine position. The practitioner places their hands on the client's ASIS and presses them in a lateral direction (see Figure 2). The laterally directed pressure on the ASIS pulls the anterior aspects of the two pelvic bones apart and stretches the anterior sacroiliac ligaments. If these ligaments are damaged and causing SIJ pain, the pain is likely to be reproduced with this motion. This test may also apply pressure to the posterior joint surface on each side.
The Side-lying Compression Test is a procedure that puts additional compressive loads on the sacroiliac joint to see if the joint surfaces are irritated. The client is in a side-lying position on the treatment table. The practitioner places both hands on the lateral aspect of the ASIS and puts pressure down toward the treatment table (Figure 3). This motion compresses the sacroiliac joint surfaces and if they are not aligned properly it will reproduce the client's pain. Both of these procedures are useful to identify ligamentous damage and/or joint surface irritation, but are not accurate in discriminating between the two sources of pain.
If information about a clinical complaint is based on a certain assessment procedure, it is valuable to know if that procedure has a reasonable degree of accuracy. It appears that many of the different procedures for SIJ dysfunction, while often used by practitioners, may not have a high degree of reliability. Therefore, it is a good idea to use these procedures with caution and not rely on them as a clear determination of a client's problem. Based on the information in these studies, it appears that the Gapping and Compression Tests are most accurate, especially when used in combination with each other.
Click here for more information about Whitney Lowe, LMT.
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