I thought this horse was already beaten to death. However, after speaking with a group of future 2014 DPT graduates, it came to my attention that palpation and movement-based diagnostics for pain arising from the SIJ are still being taught. No, not at a weekend course on treatment of the SIJ to get CEUs, but yes, to the sponge-like minds in the next breed of physical therapists.
After this information was forwarded to me, I gave a long, confused, and somewhat evil eye their way. But it took me a few seconds to catch on…since they were taught this—they believed it. How can you blame them? Go back to your days in school. At that stage in learning, the job is to take everything in and agree with it. You haven’t built a skeptical mindset or second-guessed information.
Furthermore, it wasn’t as if individual tests (Gillet, Standing Forward Flexion, etc) were taught just to be taught. We all went through the individual tests. It is part of our history. I can understand teaching individual tests, as long as the bottom line is spread (aka poor diagnostic utility), but we have better research now. It is not like we do not know there is something bigger and better out there.
The argument from students towards my skepticism is that they were taught the combination of tests, not individual, that yield higher level evidence that SIJ is the source. The culprit: an article by Pamela Levangie in 1999 entitled, “Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain“.
Physiopedia cites this article with the following conclusion:
They reported that the cluster of these tests exhibited a sensitivity of 0.82, specificity of 0.88, + LR of 6.83, and – LR of 0.20.
I tell you, I don’t know how those numbers got pulled out of there. But needless to say, if it were pertinent, you would think the conclusions would rightly say so:
This article was published in 1999. We all know there has been better research since that date. You would think the old would be glossed over with the new. I thought it had, but we are just keep on hanging on to these tests for hope.
I first learned the best diagnostic criteria for SIJ through my training at the Spinal Manipulation Institute, and created my own blog posts several years ago: part1a, part1b, part2, part3a, and part3b.
I am not the only blogger screaming this. I recommend checking out the clinical utility of provocation tests elsewhere too. Recommendations include, Joe Brence’s blog Forward Thinking PT, Adam’s Sports Physio Blog, and Mike Reinold’s Blog. Even though spread by wildfire from level 5 (if blogger’s are even level 5) evidence, this information should be out there on every SIJ course, no matter if you agree or disagree with the findings. It is the best available to date comparing SIJ to the criterion standard.
The bottom line: Even though the students were fresh learners, it seemed to me that it was difficult for them to understand a different viewpoint. Makes me really think about what information is provided to clinicians first and how that shapes you.