Did you know that less than 10% of all lower back pain can be attributed to the Sacro Iliac Joint?
This is according to a double blinded study with provocation to various structures in the lumbo pelvic area. The SI ligaments provoked lower back pain complaints less than 10%. Yes, pain is an output from the brain, but it is based on the CNS continuous and ongoing interpretation of inputs that are normally deemed threatening or safe. In some cases, the periphery matters, or at least what structures you direct treatments and exercises at to modulate pain.
I recently had a reader thank me for the blog, and saying he was "all in" with a neurophysiologic approach in most explanations, except the SIJ. After all, it sure is easy to find a "rotated" pelvis, move it with x technique, find that the patient's legs, or landmarks or whatever it is you have chosen to "measure" are now more symmetrical, plus they feel and move better. GREAT!
Except, that is NOT what is happening. If you are all in with not being able to
- break up scar tissue
- cross friction massage and re-align fibers
- deform fascia or joint capsule
The next step would be to believe that
- manipulation/mobilization does not change bony position
- the SIJ barely even moves after the age of late teens
Remember, you find what you're looking for.
If you are looking for a right posteriorly rotated ilium, you'll find it. If you are looking for an apparent asymmetry in the pelvis and ribcage that exists in everyone but is responsible for every condition known to man, you'll find it.
Just like how I look for a unilateral loss of sidegliding in standing accompanied with a deviation with standing extension. The patient can replicate a repeated motion exam test and treatment. Not only can another clinician not replicate your SIJ testing results (some of the worst reliability in the history of the world - I'm looking at you Stork test!), but a patient most certainly cannot either. They also cannot replicate the treatment, thus enforcing the "need" for passive care.
Sticking to tight fascia or rotated pelvis and stretching it out, or putting it back into place may as well be using pixie dust and magic spells, since none of those things are really happening.
Remember, I did not develop plausible sounding neurophysiologic explanations for every facet of my care overnight. I first took Explain Pain in 2002, and did not go all in until about 4 years ago. Even that was about a year long transition. My explanations for why various treatments work are continuously evolving.
I would suggest going cold turkey for the SIJ palpation and movement testing and do lumbar repeated motion testing instead. It's reliable, and more important, simple! Why do we insist of making things more complex than they need to be?
Keeping it Eclectic...
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