resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
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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