Abstract
Background: Low back pain (LBP) is common, costly, and disabling. This study assesses a novel and simple LBP evaluation method and its merit in guiding the direction of a self-treatment exercise.Methods: Randomized open-label intention is used to treat the study. Consecutive patients with LBP ≥ three months and pain ≥ 5/10 were evaluated in a Vancouver clinic with the sacroiliac forward flexion test (SIFFT) by comparing the height of posterior superior iliac spines using a level. Those with asymmetry ≥ 5 mm were offered participation. The assistant, who generated and encrypted the randomization, assigned participants: group 1 learned a two-minute, SIFFT-derived, sacroiliac-leveling exercise (SIFFT-E) as needed for LBP relief; group 2 used a pelvic stabilization belt as needed to prevent LBP, and group 3 continued the usual care. After one month, all participants used SIFFT-E and belt as needed for one month. The identifier number of this article in Clinicaltrials.gov is #NCT03888235. The trial is closed.Our primary outcome measure was the Oswestry disability index (ODI) (decrease) from baseline to one and two months. We also followed SIFFT improvement (decrease).Findings: Of 72 LBP patients, 62 (86%) had ≥ 5 mm asymmetry. From zero to one month, the 21 (one dropout) SIFFT-E participants outperformed the 20 usual care participants for ODI improvement (12.5 ± 14.8 vs. -3.4 ± 14.9 points; mean difference 15.9 [CI 6.7-25.0]; P = 0.002 with number needed to treat (NNT) of 3.0 for ODI improvement ≥ 11). Belt use results were intermediate. At two months, after all the 62 participants used the exercise and belt as needed, combined ODI improvements were clinically significant (12.0 ± 18.4 points), and SIFFT asymmetry was reduced by 8.6 ± 8.6 mm. Five (8%) exercise and 12 (19%) belt wearers experienced mild side effects.Interpretation: Sacroiliac asymmetry appears to be frequent. SIFFT may be clinically useful as an evaluation tool for prescribing a simple self-directed corrective exercise as seen by clinically significant improvements in function and asymmetry.
Highlights
Low back pain (LBP) is a strong driver of medical visits, expensive treatments, and absenteeism [13]
In patients suffering from sacroiliac joint pain, decreased strain on pelvic stabilizer muscles and pain relief have been obtained with a pelvic compression belt [15,16,17]
There were 75 callers to the office with LBP > three months, but three said they could not return for followup, so 72 were given an assessment appointment (Figure 8)
Summary
Low back pain (LBP) is a strong driver of medical visits, expensive treatments, and absenteeism [13]. The sacroiliac joint (SIJ) is a common source of LBP, and yet, LBP is commonly treated generically whether or not the SIJ is a pain generator. A new examination that Dr Bertrand developed in 2014, the sacroiliac forward flexion test (SIFFT) (see Section "Sacroiliac Forward Flexion Test" and the video "How to diagnose and treat low back pain from sacroiliac joint displacement" given in the section "Group 2: Pelvic Stabilizer Belt"), uses a small level to measure the height difference between left and right posterior superior iliac spines (PSISs) and determine. Low back pain (LBP) is common, costly, and disabling. This study assesses a novel and simple LBP evaluation method and its merit in guiding the direction of a self-treatment exercise
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