b'CODING Update ComplianceLEGAL NUTRITION UpdateANJC News ANJC Leadership ANJC News! LEGAL EASE NUTRITION Member Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE Update A New Approach MedicareQ&AMedicare Update for SI Evaluation OUR HEALTHBy Dr. Gregory H. Doerr and TreatmentChiropractors have been treating SI (sacroiliac) joint(considering the minimal number of degrees at the SI joint), it dysfunction for as long as we have been manipulating.Iscant move much further posteriorly.The compensation for a manipulation the only way to address these concerns?Areleft posterior ilium, is a right anterior ilium.With the right side there times when manipulation is not the answer to a SI jointanterior, it has the ability to rotate further posteriorly giving problem?Manipulation is obviously effective for SI disorders,the appearance of the left leg lengthening as the acetabulum but I discovered something 25 years ago that changed theraises on the right side.way I treated some SI joint disorders. This test in itself is simply a screen.The true test to ensure I was working in a DC, PT, MD office when I was a studentSI involvement are force closures at the SI joint.Professor and during my first nine years in practice.During Year One,Vleeming described these force closures during supine active the PT in our office came to me one day asking, What wasstraight leg raise.I prefer to perform these tests standing I doing differently than the other chiropractors?I honestlyduring LS ROM tests since the SI is really a weight bearing could not figure out what I did differently.The PT furtherjoint.The key to performing these tests is to not compress stated that when I manipulated the patients, they had lessthe SI joint in a force closure parallel to the floor.Instead, the pain than when the other doctors did.I still had no answer. force closure should create vectors as if pushing to the top of It took a few hours before I realized I did Pisiform pushesa pyramid.One hand is placed on the PSIS pushing anterior while the partners did more pull moves with the forearmand superiorly, the other hand is placed on the ASIS pushing laying across the SI joint.Eric, the PT, and I spent some timeposterior and superiorly.The force closures are performed discussing this issue and what we could do to further improveduring painful LS ROM.I frequently find extension and side and isolate patients that had negative reactions.The next fewflexion to be the most commonly involved with SI, but it can paragraphs will summarize the conclusions and treatments Ibe any of the ranges.I ask the patient to rate their pain as have now used for over two decades. a 10 initially, then perform the painful ranges again while The newest evaluation procedures I discovered have beenperforming the force closures.If the pain reduces by at least well described and researched by people like Diane Lee50% (rate a 5 or below), or the ROM increase drastically and Andry Vleeming.I was first exposed to some of thesebefore pain starts, the SI joint is a primary cause of the pain.evaluations by Eric Brummer.The supine to sit test wasIt is important to remember that SI joint involvement on completely new to me.At NYCC, I was taught Derifieldhistory frequently is associated with pain on changes of testing.It never made much sense to me as it was too easy toposition (sit to stand, in and out of a car, twisting in bedand influence, and only accessed from knee flexion while prone. at times hill or stair walking).It is also important to remember The supine to sit test to me was a wonderful assessment ofthat SI pain can be local, L/S, or have radiation but not usually pelvic mechanicsnot that it did not have its faults.Withbelow the knee unless it is muscle referral patterns associated the patient lying supine, the patient is asked to sit up.Thewith the SI disfunction.Treatment for this disorder that we clinician is to look at the ankles of the patient.I tend to resthave found so effective for 25 years include a combination of my thumbs on the top of the medial malleolus.Then themuscular and joint treatments.clinician looks for leg length changes from supine to sit.ForMFR/IASTM to the pelvic stabilizers (glutes, piriformis), the academic purpose of this article, we can state that whileiliopsoas, TFL (especially with LE radiation), adductors, supine the patient has a left short leg.Then when the patientand the LS erectors and QL are the primary muscles I treat.goes seated, the left leg appears to lengthen (or the rightInterestingly enough, following just this treatment you will leg shortens, if you prefer).Mechanically this makes sensefind the LS ROM weight bearing has improved drastically regarding pelvic mechanics and positioning. without any joint treatment.Following the soft tissue Considering the situation above, if the left leg was shorttreatment, I determine manipulation vs. muscle energy lying supine and it is not anatomical and without fractures ortechniques for the joint issues.I tend to use manipulation surgery, we have to consider the pelvis.It can be assumedmore with men and muscle energy techniques with females that the left pelvis is in posterior rotation.The simple reasonthat have had children in the past or currently pregnant.The for this is if the ilium is posterior the acetabulum raisespelvic angles as well as ligament stretching from hormones superiorly creating a shorter limp while supine.However,or past pregnancy creates more of an imbalance in the pelvis when the patient goes to the seated position, the iliumwith these patients.I find muscle energy techniques to work rotates posteriorly.If the left ilium is already posteriorextremely well in these situations without risk of irritating the 18 I Fall 2021 www.anjc.info'