Flawed Recommendations

Dear Editor:

Dr. Todd Cielo's expertise in "risk management, medical errors, medical necessity and record keeping/documentation" ["The Truth About Malpractice Claims Against DCs (Pt. 1)," December 2018 digital exclusive; part 2 in the January 2019 digital issue] should be questioned, as he apparently is unaware of common clinical practice guidelines for uncomplicated neck / low back pain with radiculopathy.

The fact that the doctor in his scenario "does not request taking a single lateral view of the spinal region involved," and that this scenario could be improved by "taking standard view(s)" is evidence of Dr. Cielo's ignorance regarding basic treatment guidelines. This scenario as described does not, in fact, warrant any imaging based on guidelines for the appropriate use of this modality.

Dr. Cielo would benefit from reading a recently published review on the current evidence for spinal X-ray use in the chiropractic profession by Jenkins, et al. (Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & Manual Therapies, 2018;26:48) before documenting any further "expert" opinions.

Brian Anderson DC, MPH, MS, PhD (c)
Associate Prof., National University of Health Sciences (NUHS)
Lombard, Ill.

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Lacking Up-to-Date Information

Dear Editor:

While the article by Dr. Douglas Briggs ["Quick SI Assessment: 8 Tests," January 2019 issue] offers a quick overview of eight SI assessments, it fails to give the reader any clinical utility. There is no mention of how the exams support a diagnosis showing a pathoanatomical SI joint. Yet there are authors who have not only investigated the validity and reliability of these tests, but also reviewed the available literature and provided clinical diagnostic rules for their use.

One of the earlier studies from 2003 integrated McKenzie evaluation to look at the validity of diagnosing painful SI joints. This study gave manual therapists the "Laslett rule." Since then, Laslett has reinforced findings, which have also been supported by other authors (Kokmeyer and van der Wurff, for example).

More recently, a 2017 review by Peterson, et al., supported a clinical diagnostic rule for the sacroiliac joint. They recommend "the Laslett rule comprising at least 3 positive out of 5 of the following findings from physical examination: distraction, compression, thigh thrust, Gaenslen's test, or sacral thrust."

The eight tests offered, while suitable from a review standpoint, fail to uphold the most up-to-date information regarding SI joint involvement in pelvic and low back pain. Doctors performing assessments supported by the best available evidence should be conducting the Laslett protocol, and save their valuable office time by performing five instead of eight tests.

Mathew DiMond, DC, DACRB
Assistant Professor, University of Bridgeport
Bridgeport, Conn.

Resources

• Laslett M, Young S, Aprill C, McDonald B. Diagnosing painful sacroiliac joints. A validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother, 2003;49:89-97.
• Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. JMPT, 2008;16(3):142-52.
• van der Wurff PV, Buijs EJ, Groen GJ. A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehab, 2006;87(1):10-14.
• Kokmeyer DJ, Wurff PV, Aufdemkampe G, et al. The reliability of multitest regimens with sacroiliac pain provocation tests. JMPT, 2002;25(1):42-48.
• Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskel Disord, 2017;18(1):188.

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