  Miniscule Movement in the SI Joint Substantiated
Again in Recent Issues of Spine
By Drs. Deed and Don Harrison
In the fall of 1997, we published a review of the
literature on SI joint motion, which was extremely small in rotation
(2.5 degrees or less) and translation (2 mm or less). Dr. Deed Harrison
was lead author on this review paper that was published in JMPT.1
In this article, he had critiqued an article by Smidt et al 2
which had appeared in Spine in 1995. Smidt et al 3 had
written another article on SI joint motion that appeared in Spine in
1997. This article3 was in review at the same time as our
article in JMPT and thus impossible for us to have read for our JMPT
review.
Chiropractic students tell us that DCs, who practice
the “segmental persuasion” and “motion” variety of chiropractic,
are teaching that we have misrepresented the literature and performed
selective reviews on the SI joint. In other chiropractic technique
society newsletters, this same idea has been expressed by using the
Smidt et al 2,3 studies. However, as my son pointed out about
the first Smidt et al 2 study, the second Smidt et al 3
study also had faulty methods for determining SI joint motion. Smidt et
al 2 used “skin markers” instead of x-ray methods to
measure SI joint motion. In their in vivo study, they claimed SI joint
motion of 9°.2
In their 1997 study, Smidt et al 3 reported SI joint motion
means of 7°
to 9° using an erroneous equation from CT scans of
cadavers.
In two recent articles in the journal Spine, Sturesson, Uden, and
Vleeming4,5 investigated Smidt et al’s claims, but they
used 3-D stereographic x-ray instead of skin markers or erroneous
equations with CT scans of cadavers.
From their Standing Hip Flexion Test abstract5,
“Very small movements were registered in the sacroiliac joints. When
provoking one side, the rotations were small on both sides.” “The
self-locking mechanism that goes into effect when the pelvis is loaded
in a one-leg standing position probably obstructs the movements in the
sacroiliac joints.” From their Results section, “The innominates
rotated a mean of 0.2°
posteriorly.” “The mean rotation of the helical axis was 0.6°.”
“In all cases, the translations were very small (mean, 0.3 mm).”
In the Reciprocal Straddle Position study, Sturesson,
Uden, and Vleeming4 reported that rotations on the x-axis
averaged less than 1.8°,
on the y-axis these averaged less than 1°,
on the z-axis these averaged less than 0.5°,
and on the helical axis these averaged less than 1.9°.
They state, “However, the RSA technique shows the movements to be
small, as reported in other movement studies; these data are in contrast
to the reports of Smidt et al.”
In Gillets’ test, Sturesson, Uden, and Vleeming
reported that patients previously diagnosed as having SI joint syndrome
by DCs, MDs, and PTs, SI joint movement was much less than 0.5°.
One wonders why chiropractors wish to hang onto
outdated, mechanically incorrect ideas, when the literature clearly
demonstrates that SI joints have an extremely limited motion. This
motion cannot be palpated, cannot be found without 3-D x-ray methods,
and cannot be claimed to exist on projection distorted 2-D radiographs.6
If the SI joint was truly subluxated, then necessarily it would
have torn ligaments or fractures. This kind of displacement would
require stabilization such as SI joint belts or surgery.
1.
Harrison DE, Harrison DD, Troyanovich SJ.
The Sacroiliac Joint: A
Review of Anatomy and
Mechanics. J Manipulative
Physiol Ther 1997; 20(9): 607-17.
2.
Smidt GL, McQuade K, Wei S-H, Barakatt E. Sacroiliac kinematics for
reciprocal straddle positions. Spine 1995; 20: 1047-54.
3.
Smidt GL, Wei S-H, McQuade K, Barakatt E, Tiansheng S, Stanford W.
Sacroiliac motion for extreme hip positions. Spine 1997; 22: 2073-82.
4.
Sturesson B, Uden A, and Vleeming A. A radiostereometric anlaysis of the
movements of the sacroiliac joints in the reciprocal straddle position.
Spine 2000; 25(2):214-217.
5.
Sturesson B, Uden A, and Vleeming A. A radiostereometric anlaysis of the
movements of the sacroiliac joints during the standing hip flexion test.
Spine 2000; 25(3):364-368.
6.
Harrison DD, Harrison DE, Troyanovich SJ, Hansen D. The Anterior-posterior Full-spine
View: The Worst
Radiographic View for Determination of Mechanics of the Spine.
Chiropr
Tech
1996;8(4):163-170.
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