Dear Colleague:
The following paper represents positive advance for our
profession.
Balius R, Susín A, Morros C, Pujol M, Pérez-Cuenca D,
Sala-Blanch X. Gemelli-Obturator Complex In The Deep Gluteal Space: An Anatomic
And Dynamic Study. Skeletal Radiol. 2017 Dec 7. Doi: 10.1007/s00256-017-2831-2.
[epub ahead of print] pmid: 29218390
Perhaps you will remember the GOIC syndrome paper from 2005
written with Barclay Bakkum at National University of Health Sciences’ anatomy
laboratory? Skeletal Radiology just published a paper referencing our paper.
I will share this as the lead paper for the December 2017 Cox Research Pearls,
and I want to share it here.
Astounding when I look back historically and remember being
told by Skeletal Radiology when I submitted a paper to them for publication
that they only accepted high level research. Also Terry Yochum and I were both
told in the 1980’s by Saunders Medical Publishers that they only published
books written by doctors. Wonder how they feel about that statement today?
Anatomist Dr. Barclay Bakkum and I wrote a paper - Cox J, Bakkum B: Possible Generators Of Retrotrochanteric
Gluteal And Thigh Pain: The Gemelli Obturator Internus Complex. Journal Of
Manipulative And Physiological Therapeutics Volume 28 Number 7, September,
2005. Note the following paper uses our named condition – The GOIC Syndrome – and did an
ultrasound study of the anatomy. It Is Reference 25.
This paper by Balius et al studied the GOIC anatomy with
ultrasound of the retrotrochanteric bursa and revealed the presence of
connective tissue attaching the sciatic nerve to the structures of the
gemellus-obturator system at deep subgluteal space. The amplitude of the nerve
curvature during rotating position was significantly greater than during
resting position. During passive internal rotation, the sciatic nerve of both cadavers
and healthy volunteers transformed from a straight structure to a curved
structure tethered at two points as the tendon of the obturator internus
contracted downwards. Conversely, external hip rotation caused the nerve to
relax. The conclusion is that the sciatic nerve is closely related to the
gemelli-obturator internus complex. This relationship results in a reproducible
dynamic behavior of the sciatic nerve during passive hip rotation, which may
contribute to explain the pathological mechanisms of the obturator internal
gemellus syndrome.
I point out that at least a chiropractic paper led to
publication in a major medical journal, even though it is somewhat skewed in
its course. Nevertheless, our treatment of the GOIC syndrome as delivered in
didactic and hand on lecture is a great benefit in relieving sciatic pain.
Perhaps these studies will direct chiropractors to study the GOIC syndrome with
us.
Following is an anatomical illustration of the GOIC anatomy
from Cox J, Bakkum B: Possible Generators Of Retrotrochanteric
Gluteal And Thigh Pain: The Gemelli Obturator Internus Complex. Journal Of
Manipulative And Physiological Therapeutics Volume 28 Number 7, September,
2005.
Submitted by James M. Cox, DC, DACBR