[Critical Thinking] SIJ Dysfunction

**amacs** · 28-11-2009, 09:00 PM

Whilst poking about I came across this recen(tish) article. Probably someone else has posted it elsewhere here (I apologise for the repetition if so) but I though it was interesting reading and went much further than many of the other more recent structural treatments/theories although not far enough as it does no more than skim paost a neural element as "neuromuscular"

http://www.columbiapain.org/documents/SIJMechanics.pdf

ANdy

**Frédéric** · 29-11-2009, 05:35 AM

Interesting indeed. It is a meeting halfway between mesodermal and ectodermal perspectives.

**amacs** · 29-11-2009, 07:31 PM

hmm does seem to reflect a movement to a better or deeper understanding - all grist to the mill.

ANdy

expatient · 28-12-2009, 11:04 AM

All ostaopathics should know about malposition of sacroiliac and how to correct it. It is very common problem.
But unfortunately most of them don't know...

mrupe82 · 29-12-2009, 02:41 AM

expatient,

Could you please provide how you 'diagnose' a malaligned/malpositioned SIJ and how you correct it. From reading the article, it looks like they (osteopaths) are questioning their own conceptual model i.e. subluxation (even calling it invalid). Even with manipulation, there doesn't seem to be any change in 'alignment.'

jerry hesch · 08-04-2011, 04:46 AM

I have a rather long chapter on sacral torsion coming out this year, very close to completion. About 28 pages and 192 references, including Jordan's. It does go into theory and philosophy care and does point to the gaps in knowledge that we wrestle with daily. Will post again when it is released. Erik Dalton is the editor. I think the graphics are going to be remarkable.
Best wishes
jerry Hesch
Hesch Institute
hesch Method

Quote:

Originally Posted by mrupe82

expatient,

Could you please provide how you 'diagnose' a malaligned/malpositioned SIJ and how you correct it. From reading the article, it looks like they (osteopaths) are questioning their own conceptual model i.e. subluxation (even calling it invalid). Even with manipulation, there doesn't seem to be any change in 'alignment.'

Chris F · 20-10-2011, 08:27 AM

Quote:

Originally Posted by expatient

All ostaopathics should know about malposition of sacroiliac and how to correct it. It is very common problem.
But unfortunately most of them don't know...

Malposition? What is the function of joints? Position or motion? Marion E. Clark, D.O., wrote an article in 1907 called "Motion rather than position" trying to focus on function. This was to emphasise the idea that they didn't "get stuck"

Chris F · 20-10-2011, 08:39 AM

Malposition is definitely the "trademark" of osteopathic assessment, treatment and re-evaluation. Sure, some models do work on the basis of asymmetry, and their tradition continues to be taught, but as I say, each to his own

**Diane** · 20-10-2011, 08:52 AM

Chris, please consider starting a thread in the welcome forum, to introduce yourself.

Sheffphysio · 20-10-2011, 09:24 AM

The mal positioned SIJ........ I feel sorry for the SIJ. It gets such stick; it’s a small stiff joint that can withstand huge force without moving much. It does so little but gets blamed for so much.

It's just an opinion but I’d bet the leading cause for chronic SIJ pain is us, therapists. Up slip this, down slip that, twisted this way, nutated that way. Unstable here, "out of place there" is amazing any of us can still walk.

Peter O’Sullivan wrote two good master classes on the SIJ in Manual therapy. I will post them when on my home computer.

Steve Hill · 20-10-2011, 04:15 PM

Couldn't agree more with Dave. Of all the regions of the body that have had a thorough debunking, the SIJ has been the most debunked. So few of the tests to evaluate for supposed problems here have been found to be reliable, and the theories as to how or why it could be a source of problems are nearly entirely unsupported with quality literature. Asymmetry has been found to be the norm, not the exception, so basically any assessment towards supposed asymmetry having to do with pain here becomes moot. Spine. 2003 Jun 15;28(12):1335-9

Fletch · 21-10-2011, 06:02 AM

I was just reading over some old Vleeming papers recently, I don't understand how people have read his work and then jumped to the conclusions they have about torsions, slips etc as a 'cause' of pain.

Maybe I'm missing something... probably not.

**John W** · 21-10-2011, 02:47 PM

Quote:

I have a rather long chapter on sacral torsion coming out this year, very close to completion. About 28 pages and 192 references...

Why do I think this may be too long, Jerry?

Sheffphysio · 21-10-2011, 03:05 PM

The more mystical they make the joint sound, the more expert the tutor appears. Sells more courses by playing on the fears of therapists that they know nothing, and if they just did this one more course all there SIJ patients would jump up off the bed, kiss them, and run down the street singing and dancing as there sacrum was not nutating inappropriately any longer.

**Barrett Dorko** · 21-10-2011, 06:05 PM

Dave says:

Quote:

The more mystical they make the joint sound, the more expert the tutor appears.

Interesting. Hesch will be within 40 miles of my home in a couple of weeks so I got a brochure. On the front it says:

Quote:

Finally, a course that demystifies the pelvis and SIJ

.

I've written in the past about the difference between puzzles and mysteries; the former being solvable and the latter remaining somewhat, well, mysterious.

Given the things we can only surmise and cannot see, pain's a mystery. The mesodermal parts (pelvis and SIJ) are puzzles, and, in fact, they were solved long ago.

Not that this makes any difference to those who will pile into that course. After all, the brochure is packed with words and 15 bullet points.

Jon Newman · 23-10-2011, 05:10 AM

Luke Rickards blogged about an important paper a couple of years ago--SIJ fusion and the implications for manual therapy

**marcel** · 23-10-2011, 03:20 PM

Quote:

Originally Posted by Jon Newman

Luke Rickards blogged about an important paper a couple of years ago--SIJ fusion and the implications for manual therapy

Makes one wonder how many manipulations are still given to fused SI Joints.
And the results of it.

I can only think of one group of people where SIJ dysfunction can occur: during
the final stages of pregnancy.

JoshV · 17-05-2012, 07:40 AM

I found Bret Contrara's article on the SIJ interesting.

http://bretcontreras.com/2012/05/the...kes-a-beating/

JoshV · 17-05-2012, 07:43 AM

Can anyone possibly share the article referenced by Bret above? I don't have access to it.

http://www.ncbi.nlm.nih.gov/pubmed/21311405

28-11-2009, 09:00 PM	#1
amacs A bear of little brain Join Date: Oct 2006 Location: UK Posts: 1,396 Thanks: 174 Thanked 255 Times in 128 Posts	SIJ Dysfunction Whilst poking about I came across this recen(tish) article. Probably someone else has posted it elsewhere here (I apologise for the repetition if so) but I though it was interesting reading and went much further than many of the other more recent structural treatments/theories although not far enough as it does no more than skim paost a neural element as "neuromuscular" http://www.columbiapain.org/documents/SIJMechanics.pdf ANdy __________________ "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

29-11-2009, 05:35 AM	#2
Frédéric Swaying against the breeze Join Date: Sep 2008 Location: Prévost Québec Age: 37 Posts: 1,880 Thanks: 92 Thanked 122 Times in 57 Posts	Interesting indeed. It is a meeting halfway between mesodermal and ectodermal perspectives. __________________ Frédéric Wellens, pht «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.» «Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate. » Friedrich Nietzsche www.physioaxis.ca chroniquesdedouleur blog

29-11-2009, 07:31 PM	#3
amacs A bear of little brain Join Date: Oct 2006 Location: UK Posts: 1,396 Thanks: 174 Thanked 255 Times in 128 Posts	hmm does seem to reflect a movement to a better or deeper understanding - all grist to the mill. ANdy __________________ "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

29-12-2009, 02:41 AM	#5
mrupe82 Senior Member Join Date: Feb 2009 Posts: 419 Thanks: 5 Thanked 168 Times in 54 Posts	SIJ... expatient, Could you please provide how you 'diagnose' a malaligned/malpositioned SIJ and how you correct it. From reading the article, it looks like they (osteopaths) are questioning their own conceptual model i.e. subluxation (even calling it invalid). Even with manipulation, there doesn't seem to be any change in 'alignment.'

20-10-2011, 08:52 AM	#9
Diane Human Primate Social Groomer and Neuroelastician Join Date: Mar 2004 Location: Weyburn Sask. Posts: 19,663 Thanks: 1,482 Thanked 3,177 Times in 1,560 Posts	Chris, please consider starting a thread in the welcome forum, to introduce yourself. __________________ Diane www.dermoneuromodulation.com SensibleSolutionsPhysiotherapy HumanAntiGravitySuit blog Neurotonics PT Teamblog Diane Jacobs.com (personal website) Canadian Physiotherapy Pain Science Division (Archived newsletters) Canadian Physiotherapy Association Pain Science Division Facebook page @PainPhysiosCan WCPT PhysiotherapyPainNetwork on Facebook @WCPTPTPN Neuroscience and Pain Science for Manual PTs Facebook page @dfjpt SomaSimple on Facebook @somasimple "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

28-12-2009, 11:04 AM	#4
expatient Junior Member Join Date: Aug 2007 Posts: 2 Thanks: 0 Thanked 0 Times in 0 Posts	All ostaopathics should know about malposition of sacroiliac and how to correct it. It is very common problem. But unfortunately most of them don't know...

20-10-2011, 08:39 AM	#8
Chris F Junior Member Join Date: Oct 2011 Posts: 10 Thanks: 0 Thanked 0 Times in 0 Posts	Malposition is definitely the "trademark" of osteopathic assessment, treatment and re-evaluation. Sure, some models do work on the basis of asymmetry, and their tradition continues to be taught, but as I say, each to his own

20-10-2011, 09:24 AM	#10
Sheffphysio Senior Member Join Date: Jan 2011 Location: Sheffield, UK Age: 34 Posts: 615 Thanks: 93 Thanked 240 Times in 97 Posts	The mal positioned SIJ........ I feel sorry for the SIJ. It gets such stick; it’s a small stiff joint that can withstand huge force without moving much. It does so little but gets blamed for so much. It's just an opinion but I’d bet the leading cause for chronic SIJ pain is us, therapists. Up slip this, down slip that, twisted this way, nutated that way. Unstable here, "out of place there" is amazing any of us can still walk. Peter O’Sullivan wrote two good master classes on the SIJ in Manual therapy. I will post them when on my home computer. __________________ Dave Nolan

20-10-2011, 04:15 PM	#11
Steve Hill Member Join Date: Jan 2006 Location: Madison WI USA Posts: 73 Thanks: 16 Thanked 9 Times in 6 Posts	Poor innocent SIJ Couldn't agree more with Dave. Of all the regions of the body that have had a thorough debunking, the SIJ has been the most debunked. So few of the tests to evaluate for supposed problems here have been found to be reliable, and the theories as to how or why it could be a source of problems are nearly entirely unsupported with quality literature. Asymmetry has been found to be the norm, not the exception, so basically any assessment towards supposed asymmetry having to do with pain here becomes moot. Spine. 2003 Jun 15;28(12):1335-9

21-10-2011, 06:02 AM	#12
Fletch Senior Member Join Date: Jan 2011 Posts: 112 Thanks: 7 Thanked 8 Times in 3 Posts	I was just reading over some old Vleeming papers recently, I don't understand how people have read his work and then jumped to the conclusions they have about torsions, slips etc as a 'cause' of pain. Maybe I'm missing something... probably not.

21-10-2011, 03:05 PM	#14
Sheffphysio Senior Member Join Date: Jan 2011 Location: Sheffield, UK Age: 34 Posts: 615 Thanks: 93 Thanked 240 Times in 97 Posts	The more mystical they make the joint sound, the more expert the tutor appears. Sells more courses by playing on the fears of therapists that they know nothing, and if they just did this one more course all there SIJ patients would jump up off the bed, kiss them, and run down the street singing and dancing as there sacrum was not nutating inappropriately any longer. __________________ Dave Nolan

23-10-2011, 05:10 AM	#16
Jon Newman Enjoy a moment of whimsy Join Date: Dec 2005 Posts: 9,024 Thanks: 5 Thanked 54 Times in 40 Posts	Luke Rickards blogged about an important paper a couple of years ago--SIJ fusion and the implications for manual therapy

17-05-2012, 07:40 AM	#18
JoshV Junior Member Join Date: Feb 2012 Location: New Mexico Posts: 10 Thanks: 7 Thanked 0 Times in 0 Posts	RE I found Bret Contrara's article on the SIJ interesting. http://bretcontreras.com/2012/05/the...kes-a-beating/

17-05-2012, 07:43 AM	#19
JoshV Junior Member Join Date: Feb 2012 Location: New Mexico Posts: 10 Thanks: 7 Thanked 0 Times in 0 Posts	Article Can anyone possibly share the article referenced by Bret above? I don't have access to it. http://www.ncbi.nlm.nih.gov/pubmed/21311405

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