Your SI Joint: An Owner’s Manual (WebPT)

First of all, WebPT seems to be a really interesting endeavor overall.  As the author of this article, Ann Wendell, writes,

“Anyone who is active in social media in the field of physical therapy knows that these are exciting times. PT’s are interacting in the public forum about practice issues affecting the current and future state of the profession. As more PT’s begin blogging, Tweeting, and connecting on LinkedIn groups, increasing opportunities exist to explore the role of communication.”

(Ms. Wendell is, by the way, a PT who runs her own private practice, PranaPT).


Now, the part on the SI joint.  First, allow me to copy and paste what I found to be the most useful snippets:

“Your (physical) therapist should perform multiple tests during the physical exam which can help to assess your spine. Therapists gain useful information by placing their hands on you to look for tenderness, and to palpate structures to determine what provokes your symptoms. Therapists also perform mechanical testing in order to utilize an impairment-based clinical reasoning approach. Current research points to the effectiveness of utilizing a patient-response, impairment-based approach versus an overly biomechanical approach to the assessment, treatment, management, and understanding of pain.

You should look for a physical therapist who can explain the many factors that contribute to your pain versus one who is quick to tell you that your pain is being caused by a misalignment of your spine or pelvis. If the therapist is quick to announce that your pain is coming from an SI joint that is out of alignment based only on the results of their palpation, in the absence of multiple symptom provoking tests, you should ask more questions. Current research does not support treatment based solely on palpation of the symmetry of the bony structures of the spine and pelvis. Evidence from diagnostic and therapeutic studies of the SI joint doesn’t suggest a clinically useful role for diagnosis via palpatory movement. Symptom provocation testing, rather than positional palpation, appears to have greater support in the current literature.

As enticing as it is to believe that a simple, quick “adjustment” or “manipulation” of a joint could take away your pain, you should know that a therapist should not make the decision to manipulate your spine based solely on their palpation skills. The results from the entire evaluation should be taken as a whole, to utilize a clinical reasoning approach to decide which patients may benefit from manipulation. If your therapist has utilized a manipulation, they should also provide patient education to explain your condition, and to teach you about how the body perceives and modulates pain. Ideally, your therapist will provide you with a multidimensional treatment that includes hands on work as well as exercises to strengthen and re-educate motor control of the segments of the spine that need to be better stabilized.

Beware of practitioners that offer you a “quick fix” and feel free to ask questions until you are satisfied that you are placing yourself in the right hands. You should feel that your questions and concerns are addressed prior to beginning treatment for any spine injury. A physical therapist that is up to date on the most current research will assist you in reaching your functional goals. Keep in mind that the most recent research shows that even the use of manual provocation and double blind injection studies has not eliminated the serious doubts and clinical challenges associated with the “SI joint-related pain” clinical entity and that the publication of SI joint palpatory movement schemes in light of the considerable evidence against them may perpetuate a bio-mechanical model of pain and dysfunction that is culturally popular but poorly supported in the scientific literature.



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