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   The Dark Yearsand a disreputable diagnosis

The History of a Controversial

Before 1934 the sacroiliac joint (SIJ) was held responsible for a significant amount of low back and buttock pain -- over 50% in some reports. However, in that year, two surgeons, Dr. Mixter and Barr, speculated that it was the herniated disc that was causing a patient's back and leg pain, and when they removed the disc pressure on the nerve root, the patient was rapidly cured; and from that moment on, all other diagnosises for low back pain have suffered, fallen from grace, none more than the SIJ.

For the next sixty years, at the first hint of low back pain, buttock or leg pain, all attention was turned toward the disc, the hockey puck shaped cushion between the vertebral body bones that form the rigid structure of the spine. And in fact, herniated disks do account for 1% to 2% of low back and more importantly leg pain. That, of course, leaves over 90% of low back pain patients without a satisfactory diagnosis, one frequently misdiagnosed as herniated nucleus pulpous (herniated disc) and subsequently mistreated.

A Disreputable Diagnosis Made by Disreputable Doctors
on Disreputable Patients

During the dark years, while it was marginally acceptable to diagnosis the SIJ was a source of low back and buttock pain in rare incidences of anylosising spondylitis, tuberculosis or other infections, tumor or high velocity trauma, the vast majority of orthodox orthopedists held that since there was virtually no motion in the joint, it should not hurt.  And that notion became progressively more entrenched to the point that it was heretical to suggest to a patient -- at least in an orthopedist's office -- that he was hurting because of his SIJ.  To make matters worse, a variety of alternate parishioners flocked to the SIJ as a specialty, further alienating the academic and clinic orthopedic community.  While the alternate parishioners were frequently correct in their diagnosis, they were incorrect in that they thought they could manipulate the SIJ in and out of joint to affect symptoms -- they may have made the patient better with the manipulation, but it was not because they were setting or putting the joint back in place.




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