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• W2021937306 abstract "Pain perceived in the sacroiliac region is common in patients presenting to osteopaths. A range of hypotheses have been proposed to explain the origin of this pain and a variety of physical examination tests devised to identify relevant clinical dysfunction or injury. Physical examination of the SIJ can be broadly considered in two categories: (1) examination procedures that are intended to reproduce a patient’s familiar symptoms (‘provocation tests’); and (2) procedures intended to detect joint dysfunction. Textbooks in osteopathy have tended to focus on evaluating the SIJ from the perspective of somatic dysfunction (rather than symptom reproduction) and describe the use of palpation and motion testing to evaluate joint range of motion, perceived quality of movement, tissue texture change, end feel and other characteristics.1Greenman P.E. Principles of manual medicine.3rd ed. Lippincott William & Wilkins, Philadelphia2003Google Scholar, 2Ehrenfeuchter W.C. Sandhouse M. Muscle energy techniques.in: Ward R.C. Foundations for osteopathic medicine. 2nd ed. Lippincott William & Wilkins, Philadelphia2003: 881-907Google Scholar, 3DiGiovanna E.L. Schiowitz S. Dowling D.J. An osteopathic approach to diagnosis & treatment.3rd ed. Lippincott William & Wilkins, Philadelphia2005Google Scholar The findings of research into physical examination methods for SIJ dysfunction are not encouraging and raise doubts about the clinical utility of these procedures.4Fryer G. McPherson H.C. O’Keefe P. The effect of training on the inter-examiner and intra-examiner reliability of the seated flexion test and assessment of pelvic anatomical landmarks with palpation.Int J Osteopath Med. 2008; 8: 131-138Abstract Full Text Full Text PDF Scopus (34) Google Scholar, 5Holmgren U. Waling K. Inter-examiner reliability of four static palpation tests used for assessing pelvic dysfunction.Man Ther. 2008; 13: 50-56Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 6Kmita A. Lucas N.P. Reliability of physical examination to assess asymmetry of anatomical landmarks indicative of pelvic somatic dysfunction in subjects with and without low back pain.Int J Osteopath Med. 2008; 11: 16-25Abstract Full Text Full Text PDF Scopus (24) Google Scholar Other approaches to SIJ assessment have been developed that rely less on palpation and more on the extent to which symptoms can be reproduced using combinations of procedures that ostensibly stress various structures.7Laslett M. Aprill C.N. McDonald B. Young S.B. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.Man Ther. 2005; 10: 207-218Abstract Full Text Full Text PDF PubMed Scopus (352) Google Scholar In reality practitioners tend to develop their own variations and idiosyncrasies and research into the practice of UK osteopaths suggests that practitioners combine components of both dysfunction and symptom reproduction in assessing the sacroiliac region.8Fryer G. Johnson J.C. Fossum C. The use of spinal and sacroiliac joint procedures within the British osteopathic profession.Int J Osteopath Med. 2010; 13: 143-151Abstract Full Text Full Text PDF Scopus (6) Google Scholar, 9Fryer G. Johnson J.C. Fossum C. The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 2: treatment.Int J Osteopath Med. 2010; 13: 152-159Abstract Full Text Full Text PDF Scopus (18) Google Scholar Careful consideration of the anatomy of the sacroiliac region reveals that both intra and extra-articular structures may be involved in symptom generation and it has been suggested that more localized pain may involve more superficial extra-articular structures.10McGrath M.C. Composite sacroiliac joint pain provocation tests: a question of clinical significance.Int J Osteopath Med. 2010; 13: 24-30Abstract Full Text Full Text PDF Scopus (10) Google Scholar A particularly interesting development has emerged from the findings of anatomical studies that reveal a close relationship between branches of the dorsal sacral rami and myofascial structures of the sacroiliac region.11McGrath M.C. Nicholson H.D. Hurst P.R. The long posterior sacroiliac ligament: a histological study of morphological relations in the posterior sacroiliac region.Jt Bone Spine. 2009; 76: 57-62Crossref PubMed Scopus (33) Google Scholar, 12McGrath M.C. Zhang M. Lateral branches of the dorsal sacral nerve plexus and the long posterior sacroiliac ligament.Surg Radiol Anat. 2005; 27: 327-330Crossref PubMed Scopus (56) Google Scholar In this issue of the journal Chris McGrath and colleagues present the findings of a ‘proof of concept’ study using Doppler ultrasound to provide images of the vascular signature of the dorsal sacral rami.13McGrath M.C. Jeffery R. Stringer M.D. The dorsal sacral rami and branches: sonographic visualization of their vascular signature.Int J Osteopath Med. 2011; 15: 3-12Abstract Full Text Full Text PDF Scopus (5) Google Scholar They reason that if ultrasound is able to provide imaging of these delicate structures, that it might be developed as a useful tool to investigate entrapment neuropathy or other neurogenic causes of localised posterior pelvic pain. Ultrasound imaging has been gaining considerable attention amongst clinicians and clinical researchers in the manual medicine arena over the last decade because it offers an accessible and reasonably priced option that in the hands of a skilled sonographer can provide high quality images and measurement of a wide range of anatomical structures. Moreover, ultrasound can provide real-time insight into function (such as vascular flow) and it is this technical functionality that McGrath and colleagues are exploiting to gain further insight into the structure and function of this region. We look forward to watching further developments in this area as this group continues their ongoing investigations in this area. Staying in the region of the pelvis, we also present in this issue an article on anterior hip pain that is of direct clinical interest. It is well recognised that pain perceived in the anterior aspect of the hip can originate from tissues local to the hip, or from remote structures such as the spine and viscera. One of the difficulties in diagnosis of hip pain comes from the multitude of possible diagnoses to consider. Notwithstanding more sinister causes, anterior hip pain might be attributed to osteoarthrosis of the hip, iliopsoas dysfunction or even dysfunction of the thoracolumbar junction. It may also be blamed on iliopsoas bursitis, SIJ dysfunction, or spinal referred pain amongst others. Uncertainty in arriving at an appropriate working diagnosis is lessened when we can draw on data regarding the utility of diagnostic tests and historical features. In order to even consider the possibility of a diagnosis, we first have to be aware of the possibility of the condition. Chakraverty and Snelling, in their brief review of anterior hip pain in this issue,14Chakraverty J.K. Snelling N.J. Anterior hip pain – have you considered femoroacetabular impingement?.Int J Osteopath Med. 2011; 15: 22-27Abstract Full Text Full Text PDF Scopus (11) Google Scholar remind us of ‘femoroacetabular impingement’ as a potential cause of anterior hip pain. They provide data regarding the potential anatomical predisposing factors for impingement syndrome and their radiological features. Also covered is clinical presentation and management options including discussion of osteopathic management and a brief overview of surgical options. We hope that readers will find the article of direct use in clinical practice. The Editors are always interested in receiving short review papers on clinical topics. Finally, in this issue we wish to highlight an interesting review by Lisa Hodge on the topic of osteopathic lymphatic pump techniques to enhance immunity in the treatment of pneumonia.15Hodge L. Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia.Int J Osteopath Med. 2011; 15: 13-21Abstract Full Text Full Text PDF Scopus (25) Google Scholar While lymphatic pump techniques were initially developed with clear objectives in mind, what is not clear from the literature is if they operate in the way intended. Lymphatic pump techniques have been of interest to osteopaths as far back as Still’s era (see Chikly16Chikly B.J. Manual techniques addressing the lymphatic system: origins and development.J Am Osteopath Assoc. 2005; 105: 457-464PubMed Google Scholar for a historical perspective) and appear to be attracting greater research interest from basic and clinical researchers in the United States such as Hodge’s group17http://www.hsc.unt.edu/Sites/TheHodgeLab/ [Retrieved 1 February 2011].Google Scholar and others.18Noll D.R. Johnson J.C. Revisiting Castlio and Ferris-Swift’s experiments testing the effects of splenic pump in normal individuals.Int J Osteopath Med. 2005; 8: 124-130Abstract Full Text Full Text PDF Scopus (9) Google Scholar, 19Ehrlenbach H. A preliminary investigation of the effect of the osteopathic lymphatic pump technique on salivary immunoglobulin A levels in asymptomatic subjects: A single systems design pilot study. Masters thesis – Master of Osteopathy, Unitec Institute of Technology. Retrieved 1 February 2011 from: http://hdl.handle.net/10652/1748; 2011.Google Scholar Do lymphatic pump techniques actually mobilise the lymphatic system and cause clinically relevant movement of lymphatic fluid? Do they induce any change in immune function and is this likely to bring about positive changes? Do patients who receive lymphatic pump techniques improve in clinically meaningful ways, such as shorter hospital stays, faster return to work, or less need for antibiotic therapy. Dr Hodge’s short review addresses these questions and draws attention to this fascinating field." @default.
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• W2021937306 title "Reporting new developments in sacroiliac imaging and lymphatic pump techniques" @default.
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