In school, I took courses that referred to gross antalgic trunk positions relative to lumbar disc lesions. Too often, I was taught more about medical tests and accepted antalgic relationships than about the microcosm of single joint mechanical disorders and responses to single joint disorders or dysfunctions. For example, a left lateral disc protrusion can cause a lateral antalgic lean forward and to the right. Similarly, on a more focused (or micro) scale, one or both SI joints can adopt protective dysfunctional mechanical disorders in relation to an L-5 disc disorder or segmental dysfunction.
A specific example is a subluxation dysfunction (hypomobile) of L-5 upon S-1. Historically, I have referenced three main sacroiliac reactions to this disorder:
- A left ilium AS fixation, which releases automatically with the correction of the L-5 problem;
- Bilateral AS ilia fixations, which release automatically with the correction of the L-5 problem;
- A right ilium AS fixation, which does not release or convert to normal motion after an L-5 correction, but symptoms can clear. If you try to adjust the right AS ilium, it will often make no sound of release. Even then, it will not resume normal motion because it has a protective role.
I regard these as examples of segmental antalgia, mechanisms which are just as sophisticated as the gross disc antalgias which we must reference to insurance carriers as proof of problems. We have to cite such examples even to chiropractic reviewers to prove there is an injury. I regard the micro-type segmental antalgias such as the AS ilium compensations as being just as valid and important as a diagnostic screen. The microsegmental antalgias may be even more important, because they can signal problems before irreversible tissue damage occurs to discs and hip joints.
When a reviewer asks for objective signs of disorder, I let them know how SI joints and ilia function. It is wrong and improper to say that SI joint palpation is subjective, for it is a visual and tactile test. If you are familiar with SI joint testing, thumb movements can be estimated (and even measured) demonstrating ilia dysfunction visually.
Nobody will ever take over our work and do it as well as we do, but I wish we could make more headway in increasing awareness and acceptance of basic mechanical joint behaviors.
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.