How to diagnose SIJD?
Diagnosing
Most of the medical experts do following mistakes:
Measuring leg legth
How about heel lifts?
Don't follow the pain!
My words
Diagnosing
Well, if you have leg length discrepancy (LLD) you most likely have something wrong in your pelvis!!
Just ask your doctor how common it is to have LLD?
Patients lying (supine) and palpated. All example patients have left PSIS higher = left SIJD. That is more common.
Thumbs are not on PSIS but just above them, where the bone ends. That is easy to find.
Video how to diagnose and correct SIJD! (35MB)
Even if the correction looks easy on the video it is NOT! There are lot of preparations and other things left out
from that video! Do not try to copy that treatment yourself! There is precise technik: certain spot,
force and direction for that manipulation.
Problems resulting from pelvic misalignment
When a pelvis is out of alignment, the spine is out of alignment. When the spine is out of alignment, there are
adverse effects on the neurological system. For example - nerves entering and exiting the spine may be compressed
and thus unable to perform their function of ennervating the major organs to the full extent. The body will not be
served energetically as it should. Circulation and metabolism will be affected, and digestion and elimination can
suffer. Legs will be thrown out of alignment, potentially causing knee and ankle problems. More weight will be placed
on one hip than the other, causing more 'wear and tear' which can result in the need for hip replacement. And so the
list goes on.
This is what the medical world is teaching about measuring leg lengths:
"According to Magee's textbook pg. 590-591, "true leg length...is measured in a supine position...obtain the distance
from the ASIS to the medial or lateral malleolus. A difference of 1 to 1.3 cm is considered normal."
No wonder they make so many mistakes!!!
If you measure legs from ASIS you are not measuring leg length but leg+ilium bone length. Between those two there
can be two subluxations: One in hip joint (very common) and other in SIJ as iliac can be rotated forwar (SIJD - very common).
That is why other leg "seems" to be shorter! And because that rotated iliac (innominate) is very common so
true leg length inequality/discrepancy (LLI/LLD) is very rare...
Even if you take X-ray pictures to determine if there is true LLI you can make mistakes! Here is a picture
why it happens
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A) Normal postition for hip joint
B) New place when innominate is anteriorly rotated (forward rotation)
But camera sees them at the same place. And in case B the femur bone seems shorter even it is not! So case B leg
looks shorter even it is not!
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You have to check first if patient, on supine position, has his PSIS and ASIS aligned! And I mean left PSIS aligned
with right PSIS and left ASIS aligned with right ASIS. Very often they are not
because other innominate has rotated forward... So on short leg side PSIS is usually higher and hip joint more back
causing pelvis torsion. Easy to check!!!
It is not uncommon to meet people who have been told that they have 'one leg longer than the other' and as a
result advised to put a lift in one heel to ‘correct’ their problem. However, in the vast majority of cases there
is no true leg length differential and putting a heel lift in one shoe exacerbates the problem of a mis-aligned
pelvis by locking the pelvis out of alignment.
Even the small minority of people who have a true leg length differential frequently also suffer from a mis-aligned
pelvis, with the result that the size of heel lift prescribed is too large (again locking the pelvis out of
alignment). Several clients treated at the centre fell into this category: when their pelves were re-aligned
they exhibited a much smaller leg length differential and thus required a much smaller heel lift to maintain
correct alignment.
What is the other error experts do, including that most of them have never even heard about SIJD!
The second error is that they follow the pain! This is how they do palpation and provocation tests to
investigate SIJD:
Physical Therapy. Volume 82. Number 8. August 2002: Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester, Reliability study
According to Table 3
(Description of the Interpretation of the Possible Findings for Each Diagnostic Test):
1. Standing flexion test: "Left PSIS moves cranially more than right PSIS (left SIJ hypomobile)"
-My left SIJ lifted, so it was hypermobile! (hypermobile = dislocated = SIJD)
This test alone should have given enough evidence that it was left SIJ dysfunction/dislocation!
2. Prone knee flexion test: "Symptoms are on the right side, the right leg appears shorter than the left leg in
the prone knee extended position, and the right leg appears to be about equal
to or longer than the left leg in the prone knee flexed position"
-I had the pain on right side and right leg was longer, so this test gives the wrong
diagnosis to me: posteriorly rotated right innominate. Wrong diagnosis!
3. Supine long sitting test:< "Symptoms are on the right side, the right leg appears shorter than the left leg in
supine position, and the right leg appears to be about equal to or longer than
the left leg in long sitting position"
-Again I had the pain on right side and right leg was longer, so this test gives the
wrong diagnosis to me: posteriorly rotated right iliac. Wrong diagnosis!
4. Sitting PSIS test: "Right PSIS lower than left PSIS (left anteriorly rotated innominate if pain on left
side; right posteriorly rotated innominate if pain on right side)"
-This is the worst! I had pain on right side and left PSIS was higher. According to this test
I had posteriorly rotated right iliac. Totally wrong result!
And this is why I had wrong diagnosises and bad treatments for many years. It took 10 years to find a professional
who knew how to do it wright! Most of them didn't even check my pelvis at all! All the other (except one) PTs and
chiropractors did it wrong like in that paper. So that is a common mistake they do!
The pain is usually on the other side than the reason. That is where the mistake is made!
Left SIJ dysfunction -> pain and muscle stiffness on the right side!
This is why the manual treatment is not helping most of the patients... They do it to the wrong side. They try to
dislocate the healthy SIJ!
And one big reason is also that they try to do it by using chops under your pelvis and
push to twist your pelvis. That won't help at all. Or then they just twist your body and do "something"...
My opinion is that there might not be such a thing as posteriorly rotated innominate. It is (always) a misdiagnose because
the pain is very often on the other side than the cause. Innominate might only seem to be posteriorly rotated when compared
to the other one with no pain. Same thing with legs: One leg seems to be different length than the other leg with
almost all the people.
If SIJ is hypermobile it is so because it is dislocated. If PSIS is higher on the other side it is so because iliac
has rotated (dislocated) anteriorly on that side, no matter where the pain is! But it must be checked while patient
is lying, not standing!
That is why they say right SIJ is usually the problem. That is not true! The pain is usually on the right side! But
the reason for pain is on the other side. When left SIJ comes out - the left leg gets shorter - and all the body
weight is carried on right side of the pelvis. That’s why it hurts there!
I believe it is so. I have seen and interviewed about 100 back pain patients who have got help same way I did. First
some of them got diagnose to wrong side from chiropractors. So those chiropractors tried to dislocate their healthy SI!!
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