DeCamp ON, Provencher S, Unger-Boyd M. A Pilot Study: Investigating a Sacroiliac Syndrome.  WFC’S 10th Biennial Congress. International Conference of Chiropractic Research.  Montreal, Canada. Apr 30 – May 2, 2009: 242-3.

Introduction: Some authors have showed 60% unreliability toward SIJ testing [1]. The purpose of this investigation is to propose a relationship between the present regional sacroiliac syndrome (SIS) [2] and additional somatic areas of neuromuscular compensatory postural stresses relating to sacroiliac joint dysfunction (SIJD) [3]. Comparative bilateral areas of pain/spasm as utilized in Sacro Occipital Technique (SOT) [4], termed indicators, were analyzed for clinical and neurophysiological correlation.

Method: 12 subjects were chosen at random, from the student population of Logan College of Chiropractic (IRB approved through Logan College of Chiropractic). Subjects selected were tested with an Algometer for pain response, and recorded, at specific somatic areas utilized diagnostically in SOT related diagnostic procedures (medial knee, lateral thigh, upper and lower aspects of the inguinal ligament, posterior 1st costovertebral junctions, temporalis muscle, occipitomastoid, and occipitoparietal sutures). Subjects were then analyzed for placement of orthopedic pelvic wedges (blocks) and treated according to SOT related protocols. The control group was lying supine for 5 minutes on a chiropractic Zenith table without any intervention.

Results: The Algometer measured the pain threshold differences experienced by the subject’s proposed SIJ related somatic indicators. The mean pain threshold value for the control, which the subject was not orthopedically blocked, was an increase or decrease in pain by -3 to 2 lbs/cm2 for all somatic indicators. Pain thresholds were found to be significantly increased (p < 0.05) when the subjects were treated with orthopedic blocks most noted to the left upper inguinal ligament (9.4 lbs/cm2; p < 0.05), left lower inguinal ligament (6 lbs/cm2; p < 0.05) and left occipitomastoid suture (3.6 lbs/cm2; p < 0.05). The major difference was seen in the left upper inguinal ligament with an increase of 9.4 lbs/cm2 in pain threshold.

Discussion: Based on the taxonomy for SIS provided by The International Association for the Study of Pain, McGrath indicates that diagnostic examination of the SIJ by palpation “is confounded by anatomical and sensory variables. Illustrative of systematic and possibly insurmountable anatomical and sensory confounding [5]” therefore, “the continued use of non-standardized, manual diagnostic palpation as a basis for manipulative intervention is questionable. There is a need to develop a sophisticated, technologically based alternative that offers a reliable multimodal input, standardization of findings and comparative indexing of such findings to a reference data-base [5].”
This study, involving analysis and treatment of SIJ torsion lesions, proposes a new definition of a sacroiliac syndrome based upon a novel interpretation of the neurophysiology and the current pilot clinical trial. Three of the 16 indicator’s pain thresholds increased significantly after orthopedic pelvic blocking as compared to the control group indicating a plausible relationship between the 3 indicators and sacroiliac dysfunction.

Conclusion: There is a clear need for diagnostic protocols that offer a reliable and valid method of evaluating sacroiliac joint dysfunction. It is possible that SOT related protocols may offer a viable alternative to what is used currently in orthopedic circles. The current pilot study while giving interesting information indicates that further studies are needed with a larger sample of subjects, with the full SOT protocols and delineating the possible SI osseous weightbearing versus nutation/counternutation (respiratory) dysfunctions.

References:

1. Laslett M, April CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual tests and composites of tests. Man Ther 2005, 10:207-18.

2. Cooperstein R. Sacro Occipital Technique. Chiropractic Technique. Aug 1996; 8(3): 125-31.

3. Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998 Mar; 79(3):288-92.

4. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005 Sep-Oct; 21(5):446-55.

5. McGrath MC. Clinical considerations of the anatomy of the sacroiliac joint (SIJ). A review of the characteristics of function, motion and pain. J Osteopath Med 2004; 7: 16-24.