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How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
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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