Examination of sacral nerve impingement needs merely regard counter-nutation and nutation of each sacroiliac joint, the ventral sulcus of which lies just dorsal to the pre-sacral plexus which, when impinged, elicits IBS & IC.
The medical literature regards sacroiliac joint dysfunction (subluxation) to be etiology of chronic pain in 13-30% of people with chronic low back pain.
Best test for examination of SIJ dysfunction is Badgley Book Sign: As the patient sits upright on a firm seat, a 1” bolster (Gideon Bible works well) is alternately placed under each buttock in turn. Rotation of a few degrees of SIJ nutation & counted-nutation is observed by...
noting symmetry or asymmetry of the anterior tibial plateaus; surrogate marker for SIJ rotation about a sagittal trans-pelvic virtual axis of rotation that is through the approximate mid-SIJ. Of course nutation & counter-nutation of the SIJ are terms that describe...
a relative spacial relationship of ilium to sacrum at the SIJ. A few degrees of SIJ arching rotation is magnified by radius of the femur to 1-3” of asymmetry noted at the anterior tibial plateaus. Nutation manifests as functional lengthening of the ipsilateral femur...
Counter-nutation manifests as functional shortening of ipsilateral femur. Nutation is result of injury & loss of tethering integrity of Sacrotuberous ligament system. Counter-nutation is manifestation of injury & loss of tethering integrity of Iliolumbar ligament system.
The motive force that incites the Badgley Book Sign is gravity. The book bolster transfers ground force of chair seat into SIJ & tips upperbody mass toward one side or the other to impose upper body mass upon each SIJ in turn.
The Badgley Book Sign is measurable, reproducible, and teachable. Unlike most of the other 16 clinical Provocation Maneuvers of SIJ dysfunction, the Badgley Book Sign does not rely on the patient’s expression of subjective pain as an endpoint.
In 2013, at the 8th Interdisciplinary World Congess on Low Back & Pelvic Pain, at Dubai, Dr. Badgley presented the Badgley Book Sign & the first World announcement of a radiologic study demonstrating SIJ subluxation. The Study was published within the Proceedings.
Hopefully, someone can turn this Twitter tread into a thread-reader @jennywren_10.
Diagnosis of SIJ dysfunction is important because dysfunction of the SIJ causes a severe & disabling Sacroiliac Joint Subluxation Chronic Pain Disorder Syndrome. Treatments include fusion, prolotherapy, & dorsal medial sacral nerve ablation.
