SIJD in osteopathy?

[sijtoni]

What is sacroiliac joint dysfunction in osteopathy?
Is it a strain in the joint? Is it damaged ligaments? Is it inflammation? Is it dysfunction on movement? Is it pain?

The answer depends who you ask it from.

Some say it is an inflammation due ligament damage. Some say it is just pain that can radiate. Some say it is possible only with women that have given birth. Some say it is very common disorder. Some say it is malposition/subluxation of a joint and pain is just a symptom. So which theory you support?

As my own experience as a patient I support the theory that says it is very common, it is malposition and pain is a result of that malposition. But pain is not always there where the malposition is! Usually pain is on the other side or in somewhere else as some osteopathians tell.

So how to diagnose it? There are a lot of methods that experts use when they make a diagnose. Many of them are for the symptoms like pain in low back. But low back pain is only one symptom of many and not all have it.

-There are studies that tell provocation tests are useless, yet many experts use them.
-There are studies that tell palpation tests are useless, yet many experts use them.
-Many experts use the combinations of both methods.

So who is right?

Many manual therapy experts claim they understand the problem well. Some experts say it is very rare disorder but some say it is very common. They all tell it is easy to diagnose, treat and they claim to treat it with great success. But do they? Studies tell it is not easy to diagnose nor to treat.

Alfonso Lepori, Alfonso Mandara, Caterina Di Mattia, Liria Papa (International College of Osteopathic Medicine, Milan, Italy) explane the situation in their report:
“The clinical assessing of the mobility dysfunction in the sacroiliac joint is a controversial issue, due to a plethora of manual tests performed through the disturbance of nearby structures.”

Not easy to diagnose?

Dr Gary Fryer, (Research Associate Professor, A.T. Still Research Institute, Kirksville) College of Osteopathic Medicine, USA.
“Many osteopaths believe that hypomobile sacroiliac joints are not necessarily a source of pain but may produce compensatory strain elsewhere; hence a diagnosis of sacroiliac dysfunction need not relate directly to low back pain. “

Many believe?
Why they all have not learned it the same way? Why some believe it is different?
Why there has to be low back pain for SIJ dysfunction to exist? No osteopathy teacher teaches that?

Dr Gary Fryer:
“It appeared that the majority of osteopaths use pain provocation tests, which are not advocated by any osteopathic text, but commonly referred to in the wider manual therapy literature.”

Why they are not using the techniques they have been taught to use?

Dr Gary Fryer:
“Ninety percent of respondents were of the opinion that the SIJ can be mechanically dysfunctional but not necessarily symptomatic. Fifty-seven percent indicated that the SIJ might be symptomatic but not necessarily mechanically dysfunctional.”

So it is about believe not facts? Or other just can't find a dysfunction? Perhaps they don't understand what it is?

American College of Osteopathic Sclerotherapeutic Pain Management, Inc.
Richard F. Leedy, D.O. & Herbert M. Fichman, D.O. & Andrew Kulik, D.O
“Record findings - usually one sacroiliac is found to be at fault.”

What is this fault they are telling? They continue:

“Traumatic force from below such as stepping down from a bus or stool is transmitted directly to the first movable joint - the sacroiliac. With counter force exerted from above by body weight, and the sacroiliac between, a sprain subluxation situation inevitably results.”

And how that subluxation can be “seen”? They continue:

“As a result then the pelvic rim would be drawn up and tilted anteriorly. Pain and spasm of this muscle then would account for (a) cough pain (b) lumbago pain, (c) why the pelvis subluxations are usually anterior in the acute low back problem. “

In the Foundations for Osteopathic Medicine book the experts tell about standing and seated flexion test. Then they tell “A true positive standing or seated test indicates a problem on that side. If positive, the tests should become negative after proper treatment.”. So why to look for pain with provocation tests? That only confuses the diagnose! If you follow the pain you end up to the wrong side of pelvis...

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[DeLaughterDO]

nice long post, but what is the point?

Almost nothing in OMM is concrete. If you are in medical school you will soon learn this.

 

[Taus]

There are actually decent studies out there on its prevalance as a pain generator in LBP (though not necessarily having anything to do w/ OMM). As far as diagnostics go...... you can do all the history taking and provocative maneuvers in the world, but w/o anesthesizing the joint w/ some local you can't prove the SIJ to be the culprit.

 

[sijtoni]

There are actually decent studies out there on its prevalance as a pain generator in LBP (though not necessarily having anything to do w/ OMM).

Yes because they don't know what is causing that pain.

As far as diagnostics go...... you can do all the history taking and provocative maneuvers in the world, but w/o anesthesizing the joint w/ some local you can't prove the SIJ to be the culprit.

The question was why to look for pain when the original osteopathian method is to look asymmetry? Pain is just one symptom and it can be anywhere, usually on the other side than the cause of pain. So if you find pain it doesn't mean you have found the problem but only one symptom.

 

[MaximusD]

Yes because they don't know what is causing that pain.


The question was why to look for pain when the original osteopathian method is to look asymmetry? Pain is just one symptom and it can be anywhere, usually on the other side than the cause of pain. So if you find pain it doesn't mean you have found the problem but only one symptom.

The ****ing adjective is osteopathic. NOT OSTEOPATHIAN. Learn proper english, and I'll be able to take your post seriously.

Damn it.

 

[sijtoni]

The ****ing adjective is osteopathic. NOT OSTEOPATHIAN. Learn proper english, and I'll be able to take your post seriously.

Damn it.

Sorry. English is not my language.
The question was why to look for pain when the original osteopathic method is to look for asymmetry? Pain is not always there where the cause of pain is. Many experts tell in case on pelvis the pain is usually on the others side than the cause.

Dr Gary Fryer:
"It appeared that the majority of osteopaths use pain provocation tests, which are not advocated by any osteopathic text, but commonly referred to in the wider manual therapy literature."

So, why they use them?

 

[DeLaughterDO]

Probably because that is what patients complain of - pain - and it is usually as easy to move from point of pain to origin as trying to guess possible origins from the description of pain.

That said, Taus is correct, pain can be referred to many different places in the body - classic ones are lower back problems causing pain in the hip, hip fracture/arthritis causing knee pain, MI appearing as arm/neck/jaw/shoulder/abdominal/back pain, etcetera. The SI is no different in this aspect. SI dysfunction is probably about as common as breathing. The difficult prospect, as pointed out by Taus, is determining if the SI dysfunction is actually the CAUSE of the pain, not just an associated finding (as it would be if you motion tested every person you could).

As far as why do some schools and experts think one thing and why do others disagree? Because everyone is entitled to their own opinion - until something is proven as natural law, it is debatable. Almost nothing in Osteopathic manipulative medicine is proven as natural law.

 

[sijtoni]

The SI is no different in this aspect. SI dysfunction is probably about as common as breathing.

Not all osteopathics believe that.
And what is this sij dysfunction?

The difficult prospect, as pointed out by Taus, is determining if the SI dysfunction is actually the CAUSE of the pain, not just an associated finding (as it would be if you motion tested every person you could).

What is this motion testing?

Original osteopathic litterature tells almost every patient has it as a cause of many problems. Why some osteopatics don't believe it is very common?

As far as why do some schools and experts think one thing and why do others disagree? Because everyone is entitled to their own opinion - until something is proven as natural law, it is debatable. Almost nothing in Osteopathic manipulative medicine is proven as natural law.

So many believe things wrong if they interpreter the evidence wrong? Or they don't even understand what evidence to look for?

 

[facetguy]

Not all osteopathics believe that.
And what is this sij dysfunction?


What is this motion testing?

Original osteopathic litterature tells almost every patient has it as a cause of many problems. Why some osteopatics don't believe it is very common?


So many believe things wrong if they interpreter the evidence wrong? Or they don't even understand what evidence to look for?

A good portion of manual medicine falls under the "art" component of "the art, science and philosophy of medicine". So, you should expect different notions, techniques, assessment methods, etc when it comes to applying manual medicine procedures to the sacroiliac joint. As to the science related to the sacroiliac joint, there are multiple journal articles, textbooks, conferences, courses...you name it...describing the many aspects of this important joint. From a clinical perspective, I can tell you first hand that addressing problems associated with the sacroiliac joints can make a HUGE difference in the lives of patients. Those who would say otherwise have obviously never been there.

 

[osli]

Not all people have an SI joint. I think for them the pain is referred from someone else.