Sacroiliac Joint Pain Research Articles

Opioid Prescription Monitoring in Preoperative and Postoperative Sacroiliac Joint Fusion Patients.

An estimated 15%-25% of patients with chronic low back pain may in fact suffer from sacroiliac (SI) joint dysfunction. SI joint fusion has become a common treatment option for the management of SI joint dysfunction. However, little is known about opioid use prior to and after surgical treatment in this patient population. The medical records of 62 patients treated with SI joint fusion at our institution were reviewed in this retrospective study. The Colorado Prescription Drug Monitoring Program (CPDMP) was accessed to gather opioid prescription information for these patients. Only those patients who had received an opioid prescription within 3 months prior to their surgery were included in the study. Patients who had SI joint fusion but underwent another surgical procedure during the 12-month follow-up period were excluded from analysis. Preoperative (6 and 3 months) and postoperative (3, 6, 9, and 12 months) mean morphine milligram equivalents (MME) were collected from the CPDMP database for each patient. Patient demographic and medical comorbidity data were also documented to identify any correlations or potential risk factors for chronic opioid prescribing. Visual analog scale (VAS), Oswestry Disability Index (ODI), and Denver SI Joint Questionnaire (DSIJQ) scores were recorded for each patient to assess clinical outcomes. At 3 months prior to surgery, patients were prescribed an average of 47.2 mean MME/d. At no point postoperatively did the quantity of opioids, measured in MME/d, change significantly from the 3-month preoperative prescription quantities. There was no significant difference in the quantity of opioids received by men vs women, in patients with vs without anxiety and/or depression, or in younger vs older patients. Low body mass index was correlated with decreased opioid prescriptions at 6 months postoperative but became statistically insignificant again by 9 months postoperative.Significant improvements in VAS scores were recorded for all postoperative clinical evaluation timepoints (at 6 weeks and 3, 6, and 12 months) and compared to preoperative scores. By 12 months, VAS scores had decreased from 6.2 to 3.9 (P < 0.001). This change is not only statistically significant but also meets the criteria for minimum clinically important difference in scores. Both the ODI and DSIJQ patient-reported outcomes scores also showed significant improvements at 12 months after surgery (ODI: 48.9 preoperative vs 24.6 postoperative, P = 0.02; DSIJQ: 53.2 preoperative vs 17.4 postoperative, P = 0.014). The ODI improvement also met the minimum clinically important difference criteria. By 6 months postoperatively, there was no significant correlation in VAS or ODI and opioid use. There was no significant correlation between the DSIJQ scores and the daily dose of opioids at any point postoperatively. Quantity of opioid prescriptions received by patients with SI joint pain did not change significantly from 3 months preoperatively to any point postoperatively despite significant improvements in all patient-reported outcome measures. This discordance between long-term opioid requirements and positive clinical outcomes is concerning and warrants further investigation.

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature.

Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.

A Comprehensive Review of Cluneal Neuralgia as a Cause of Lower Back Pain.

Lower back pain (LBP) is one of the most common presenting complaints in clinical adult medical patients. While most often diagnosed as "nonspecific mechanical" in etiology, several lesser known, rarer causes of LBP exist, some of which can even cause neuropathic pain. One of these infrequent causes, cluneal neuralgia (CN), is associated most often with damage or entrapment of the cluneal nerves, particularly the superior cluneal nerve (SCN) and/or the middle cluneal nerve (MCN). These nerves supply sensation to the posterior lumbar and buttock area. However, the LBP caused by CN is often difficult to recognize because it can mimic radiculopathy or sacroiliac joint (SIJ) pain or lead to symptoms in the legs. This makes CN significantly important for clinicians and surgeons to include in their differential. A thorough history proves beneficial in the diagnostic workup, as many risk factors for CN have been reported in the literature. If a CN diagnosis is made, several effective conservative measures can alleviate patients' pain, such as nerve blocks, peripheral nerve stimulation, or high frequency thermal coagulation. Additionally, surgical treatments, such as CN release or endoscopic decompression, have resulted in fantastic patient outcomes. The purpose of the present investigation is to investigate the existing literature about CN as a cause for LBP, consider its epidemiology, discuss its pathophysiology and risk factors, elucidate its clinical presentation and diagnosis, and examine the various treatment modalities that have been reported across the world.

Sacroiliac joint pain in adolescents: Diagnostic and treatment challenges.

The aim of this review was to assess diagnostic and treatment challenges of adolescents with SI joint pain. We diagnosed 13 of the patients who were referred to our chronic pain clinic because of low back pain (30%) with SI joint pain based on provocative tests response. We performed SI joint steroid infiltration. Six patients (46%) felt better immediately after the procedure and 1 (8%) patient had a one‐side only pain relief after a bilateral block. Four of these patients (31%) did not experience any further episode of pain during the follow‐up and three patients reported recurring pain on average 2 months after the initial procedure. The 2nd procedure was successful in two patients and the third one experienced pain again 12 months later, requiring a third successful infiltration. Six patients (46%) experienced pain again within a few hours or days after the infiltration and their pain score were unchanged compared with what they had reported prior to the procedure. We were unable to place the needle within the joint under fluoroscopy in 1 patient; however, we were successful repeating the procedure under CT guidance. One patient experienced a motor and sensory block in the distribution of the sciatic nerve immediately after the procedure, which resolved within 24 and 48 hours, respectively. SI joint pain is a distinctive pathology that can be present in children and adolescents and is often overlooked by practitioners. Its diagnosis and management are challenging in this population as it is in adults. SI joint steroids injections may play a role in the management of these patients.

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature.

Sacroiliac joint (SIJ) pain is responsible for approximately a third of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.

Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study.

Sacroiliac joint injection aims to provide pain relief, improve work status, and early return to work. We aimed to investigate the role of corticosteroid and anesthetic mixture to provide short- and long-term pain relief in patients with sacroiliac joint pain. This prospective observational study included 27 patients with sacroiliac joint dysfunction who received a combination of triamcinolone and ropivacaine for sacroiliac joint injection followed by three scheduled visits at four weeks, eight weeks, and six months. The pain was assessed using visual analogue scale (VAS), physician's assessment on the number of positive provocative tests, and patients' self-reported assessment to evaluate their functional outcome. At the four weeks and eight weeks follow up evaluations, the mean VAS reduced from 5.85 (±1.03) at baseline to 3.30 (±1.77) at four weeks, 3.30 (±1.86) at eight weeks, and 3.00 (±1.86) at six months. At each interval, improvement in terms of clinical assessment using a series of provocative tests was seen with a mean of 1.37 (±1.33), 1.63 (±1.31), and 1.48 (±1.05) at four weeks, eight weeks, and six months, respectively. For the functional effectiveness parameters (Roland-Morris questionnaires), the sacroiliac joint (SIJ) injected with these drugs combination showed a more significant improvement in symptoms and function, baseline (13.56±3.36), at four weeks (9.04±3.33), at eight weeks (9.07±4.13), and six months (8.26±4.92). Using the one-way repeated measures ANOVA, the SIJ pain, provocative test, and functional outcome significantly improved over time after injection with triamcinolone and ropivacaine (p<0.001). No complications of the administration of these medications were noted. Our findings support the intermediate-term (six months) effectiveness and safety of a combination of corticosteroid and anesthetic injection for patients with SIJ dysfunction who failed conservative treatment.

Patient with Lumbar Spondylosis and Diskogenic Pain

Diskogenic low back pain (LBP), defined as pain that originates from a damaged vertebral disk, is a common cause of LBP. It is characterized by a three-phase cascade of degeneration marked by dysfunction, instability, and stabilization. A distinct pathologic characteristic of the disks from patients with diskogenic LBP has been found to be the formation of the zones of vascularized granulation tissue, with extensive innervation extending from the outer layer of the annulus fibrosus into the nucleus pulposus along a torn fissure. In addition, there appears to be an association between microbial infection and symptomatic disk degeneration. Low-virulence microorganisms, in particular Propionibacterium acnes, might be causing a chronic low-grade infection in the lower intervertebral disks in some patients. The diagnosis of diskogenic pain is primarily based on clinical manifestations, physical examinations, imaging studies, and provocative diskography. Diskogenic pain should be differentiated from other axial back pain conditions, such as facet arthropathy, sacroiliac joint pain, myofascial strain and pain, vertebral compression fracture, and other, less common conditions. Treatment options should be tailored to individual needs. Early and gradual physical and behavioral therapies are encouraged. Pharmacologic therapy, composed primarily of analgesics, nonsteroidal antiinflammatory drugs, muscle relaxants, and antidepressants, may have modest positive effects. A subset of patients with Modic type I changes in magnetic resonance imaging may benefit antibiotic therapy directed at the infected disks by P. acnes and other low-virulence microorganisms. There is evidence that supports the use of epidural steroid injections and intradiskal injections (methylene blue, ozone, steroids) for diskogenic pain. Additional options include intradiskal biacuplasty, gray ramus communicans nerve blocks/radiofrequency ablation, and intradiskal stem cell injections for disk repair/regeneration, all of which have gained support in clinical trials. These treatment modalities have shown promise to provide equal or even better outcomes compared with surgical spinal fusion or total disk replacement with an artificial disk. This review contains 2 figures and 149 references. Keywords: collagen, diskogenic low back pain (LBP), herniation, intervertebral disk, spondylosis

Best Practices for Postoperative Management of Posterior Sacroiliac Joint Fusion.

Sacroiliac joint (SIJ) pain is a common cause of low back pain. Traditionally, treatment for SIJ joint pain and dysfunction has consisted of physical therapy, medication management, SIJ injections, and SIJ ablations. Improved recognition of the SIJ as an etiology for back pain has led to advances in treatment options. Radiofrequency of the lateral sacral branches has been shown to be effective, though evidence is fraught with inconsistent patient selection, study design and procedural technique. It also does not directly address the mechanical dysfunction of the SIJ. In order to create a more enduring approach SIJ fusion has become an attractive option to reduce pain and to improve function. This method of SI joint treatment requires guidance in the perioperative phase of care from both the physicians and advanced practice providers (APP). In order to improve care and outcomes of those undergoing posterior SI joint fusion the American Society of Pain and Neuroscience appointed an expert panel of physicians and advanced practice providers to create a best practice for the post operative care of this approach. As with any best practice, the panel considered current peer reviewed literature and clinical expertise to create guidance today. This is intended to be a living document with modifications as additional evidence comes to light in data publication. The goals of this paper are to focus on (1) wound care, (2) medication use, (3) physical activity and (4) therapeutic exercises.

Spine Roundtable: Sacroiliac Joint Pain

The purpose of the JOPA Roundtable discussion is to give orthopaedic physician assistants insight into how each participating provider treats certain clinical scenarios in their current practice. For this Spine Roundtable, providers with expertise in spine will discuss sacroiliac joint pain. Participants will share their knowledge and experience on the topic.

Osteopathic approach to sacroiliac joint pain in pregnant patients.

This paper aims to provide a comprehensive review of the management of sacroiliac (SI) joint pain in pregnant patients. Although SI joint pain is highly prevalent among pregnant patients, the unique anatomy of the joint is rarely discussed in a clinical setting. This paper provides comprehensive review of the epidemiology, anatomy, alarm findings, standard treatment, osteopathic assessment, and osteopathic manipulative treatment (OMT) of the SI joint, and it provides a general and in-depth understanding of the SI joint pain in pregnant patients and its management.

An ultrasound study of the long posterior sacroiliac ligament in healthy volunteers and in patients with noninflammatory sacroiliac joint pain.

To describe the sonoanatomy of the long posterior sacroiliac ligament (LPSL) in healthy volunteers and to assessby ultrasound the LPSL in patients with noninflammatory sacroiliac joint pain (SIP). We assessed 64LPSLs of 32 healthy controls and 40 LPSLs of 40 patients with unilateral noninflammatory SIP and a positive Fortin fingertest. LPSLs in both groups were assessed for the presence of alterations in their structure, continuity and echogenicity andtheir thickness was measured in three predefined points. All patients were examined in prone position following a strict scanningprotocol. Detailed sonoanatomy description and measurement of the LPSL in healthy volunteers are provided(length: 31.32±4.79 mm, width: 8.14±1.28 mm, thickness: 2.05±0.55 mm; 1.64±0.41 mm and 1.51±0.42 mm at the iliac andsacral entheses and in its middle part, respectively). The LPSLs were found to be significantly thicker in the SIP group, withan optimum criterion value of >2.0 mm in its middle part to identify pathologically thickened ligaments. In addition, LPSLs inthe SIP group presented significantly more often hypoechogenicity/altered fibrillar structure (57.5% vs.16%) and/or periligamentousedema (72.8% vs 28%). The combination of either altered structure or periligamentous edema, with thickening of theligament's body showed the best diagnostic accuracy (sensitivity and specificity 83.9% and 94.7% for the first combinationand 100% and 84.6% for the second combination) to identify LPSL pathology in noninflammatory SIP. LPSLcould be assessed by ultrasound and sonopathological lesions could be identified in patients with SIP.

Using Radiology images to characterize an angle of insertion for S1/S2 and SI joint injections: A retrospective observational study

ObjectiveSacroiliac (SI) joint, S1 and S2 nerve root pathology are well documented in literature as common etiologies for low back pain. Evidence demonstrating starting angle of needle insertion during S1/S2 transforaminal and SI joint injections are lacking. Using computerized tomography (CT) radiography of the lumbosacral spine, this retrospective observational study seeks to characterize a starting angle of needle insertion at the sacral spine. MethodsThis was a single-centered, retrospective observational study performed on adult cancer patients who had CT radiography of their lumbosacral spine, without significant sacral pathology, at our hospital from January 2016 and May 2021. For each patient, we determined the anatomical location of where the S1/S2 neural foramen and SI joint widens up. Using the annotation tools available in EIM image viewer, a maximum level and minimum level of insertion was recorded in order to calculate the average angle of insertion needed for procedural performance. ResultsThrough the analysis of 64 patients, average angle of insertion was 25° ​± ​1.36 for S1, 34° ​± ​1.93 for S2, and 33° ​± ​1.95 for SI injections. There were no statistically significant differences in angles when stratified based on laterality, gender, age, and BMI. ConclusionAverage angle of insertion to target the S1, S2 neural foramen and SI joint are 25° ipsilateral oblique, 34° ipsilateral oblique, and 33° contralateral oblique respectively starting with a squared sacral endplate. To our knowledge, there are no studies in the current literature that have attempted to identify an entry angle to target these anatomical structures. Six key wordsChronic Pain, SI Joint Pain, Steroid Injection, S1 Transforaminal, S2 Transforaminal, Needle Placement.

Clinical Outcomes Following Minimally Invasive Sacroiliac Joint Fusion With Decortication: The EVoluSIon Clinical Study.

This report documents 1-year results of 250 patients enrolled in a prospective, multicenter study of a minimally invasive (MI) sacroiliac joint fusion (SIJF) system that uses decortication, graft placement, and joint fixation. The cohort includes all patients enrolled in the EVoluSIon (EVSI) clinical study who had MI SIJF surgery and completed 1-year follow-up. Average age at baseline was 60.5 years, and 70.8% were female. Sacroiliac (SI) joint-related pain duration was ≥2 years in 56% of patients. Visual analog scale (VAS) SI joint pain, Oswestry Disability Index (ODI), quality of life, and opioid use were assessed preoperatively and at 1 year. At 1 year, the mean VAS pain demonstrated a significant reduction of more than 43 points, from 76.4 at baseline to 33.0 (P < 0.0001), with 72.2% of patients attaining the minimal clinically important difference (MCID, ≥20-point improvement). Mean ODI scores also significantly improved from 54.4 at baseline to 30.5 at 1 year (P < 0.0001), with 62.5% of patients achieving the MCID (≥15-point improvement). Prior to surgery, 62.7% (126/201) of patients were taking opioids or other narcotics, but by 1 year postsurgery, only 26.9% (54/201) of patients reported using these medications, representing a significant 57.1% decrease in narcotic/opioid use (P < 0.0001). Fusion of the SI joint was seen in 68.7% of patients. Few procedural complications were reported. In all, there were 8 (8/250) serious procedure-related events, including 1 device malposition observed on the day of surgery that required replacing the superior screw with a shorter screw. Analysis of patients treated with MI SIJF in the EVSI study demonstrated that the procedure can be performed safely and results in significant improvements in pain, quality of life, and opioid use at 1 year as well as causing fusion in the majority of patients. MI SIJF differs from most procedures currently being performed in that it applies true orthopedic principles with decorticating, bone grafting, fusion, and placement of implants perpendicular to the joint for greatest stability. The 12-month data show improvement in functionality, reduction in pain, and, most notably, a reduction in narcotic usage, which is important considering the ongoing opioid epidemic.

The degenerative changes of the sacroiliac joint after S2 alar-iliac screw placement.

The goal of this study was to investigate clinical outcomes and risk factors for the progression of sacroiliac joint (SIJ) degeneration and bone formation after S2 alar-iliac screw (S2AIS) insertion. Using preoperative and follow-up CT scan findings (median follow-up 26 months, range 16-43 months), the authors retrospectively studied 100 SIJs in 50 patients who underwent S2AIS placement. The authors measured the progression of SIJ degeneration and bone formation after S2AIS insertion, postoperative new-onset SIJ pain, S2AIS-related reoperation, and instrumentation failures. Stepwise multivariate logistic regression modeling was performed to clarify the risk factors associated with the progression of SIJ degeneration. Significant progression of SIJ degeneration was observed in 10% of the group with preoperative SIJ degeneration (p = 0.01). Bone formation was observed in 6.9% of joints. None of the patients with these radiographic changes had new-onset SIJ pain or underwent reoperation related to instrumentation failures. Multivariate logistic regression analysis revealed that preoperative SIJ degeneration (p < 0.01) and a young age at surgery (p = 0.03) significantly affected the progression of SIJ degeneration. The progression of SIJ degeneration and bone formation neither led to major screw-related complications nor affected the postoperative clinical course during the median follow-up period of 26 months. Although S2AIS insertion is a safe procedure for most patients, the results of this study suggested that preoperative degeneration and younger age at surgery affected SIJ degeneration after S2AIS insertion. Further long-term observation may reveal other effects of S2AIS insertion on SIJ degeneration.

Are the nerves supplying the anterior sacroiliac joint nociceptive?

Sacroiliac joint (SIJ) pain is often difficult to diagnose. Moreover, while its anatomical characteristics have been well studied, its innervation and the contributions of particular nerves remain controversial, especially in relation to posterior joint innervation. To our knowledge, previous studies have not investigated the presence of nociceptive fibres in the nerves innervating the anterior SIJ. Eight adult cadaveric sides underwent dissection of the anterior SIJ. Adjacent anterior rami were examined for branches to the anterior SIJ. Any branches contributing to the anterior SIJ were measured and then resected. These samples were fixed in formalin and substance P was identified immunohistologically. On all sides, 1-2 small branches (mean diameter of 0.33 mm) arose from the posterior aspect of the L4 anterior ramus (12.5%), the L5 anterior ramus (62.5%), or simultaneously from both the L4 and L5 anterior rami (25%). These branches had a mean length of 13.5 mm. All histological samples contained nerve tissue. All samples of nerve fibres traveling to the anterior SIJ were positive for diffuse substance P reactivity. There were no histological differences between sides or sex. Each of the branches identified as travelling to the SIJ exhibited similar positivity for substance P. This cadaveric study demonstrates that the anterior SIJ nerve fibres carry pain fibres. This new knowledge has application to patients with SIJ syndrome and to its various treatments including interventional approaches to SIJ pain.

Intra-articular pulsed radiofrequency with methyl prednisolone injection in chronic sacroiliac joint arthritis: A randomized clinical trial

ABSTRACT Background Sacroiliac joint pain (SIJP) is an important cause of low back pain and seriously affects the patients’ quality of life. Therefore, it is urgent to find effective treatment methods. The goal of our research was to assess the effectiveness of radiofrequency ablation combined with steroid injection versus steroid injection alone in the treatment of chronic sacroiliac joint arthritis (SIJ) pain. Methods Sixty patients with chronic SIJ pain were divided into two groups randomly: Group RF (n = 30) received intraarticular RF + methylprednisolone, while Group C (n = 30) received intraarticular methylprednisolone alone. The Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Patient Global Impression of Change Scale (PGIC) were followed up at each observation time (before the intervention, 1 month, 3 months, 6 months, 9 months, and 12 months). Results The NRS and ODI reduced following treatment compared to pretreatment values; however, the PGIC increased in both groups. The NRS in the RF group reduced significantly than in the control group after treatment at nearly all time intervals after the third month with p = 0.015*, 0.004*, 0.049*, and 0.025*, respectively. After the first month, the difference in PGIC score between the two groups becomes statistically significant at nearly all time intervals with p < 0.05. At nearly all time intervals, the RF group had higher PGIC scores. Conclusion PRF ablation with methylprednisolone injection is a safe and efficient treatment for sacroiliac pain. It has the potential to considerably reduce sacroiliac pain, lower ODI, raise PGIG, and improve physical and mental quality of life.

Improved Outcomes with Concurrent Instrumentation and Fusion of the Sacroiliac Joint in Patients with Long Lumbosacral Constructs.

Retrospective Cohort Study. Spinal fusion, specifically constructs connected to pelvic bones, has been consistently reported as a predisposing factor to sacroiliac joint (SIJ) pain. The aim of this study is to compare SIJ outcomes in patients with constructs to the pelvis following instrumentation vs instrumentation plus fusion of the SIJ. Data of study subjects was extracted from a prospectively maintained database as well as retrospectively collected from records at a tertiary academic medical center in the United States between 2018 and 2020. A cohort of 103 patients was divided into 2 groups: 65 in Group 1 [S2AI screw without fusion device] and 38 in Group 2 [S2AI screw with fusion device]. None of the patients in Group 2 developed postoperative SIJ pain compared to 44.6% in Group 1. Sacroiliac joint fusion occurred in all Group 2 but none of Group 1 patients. The postoperative Visual Analogue Scale (VAS) for lower extremity (LE) pain (.8 vs .5; P = .03) and postoperative Oswestry Disability Index (ODI) (18.7 vs 14.2; P < .01) were significantly higher in Group 1. The rate of distal junctional break, failure, and/or kyphosis (DJBFK) and time to DJBFK were not significantly different between the two groups, and the rate of DJBFK did not change in the presence of multiple covariates. The SIJs carry the heavy load of long lumbosacral fusion constructs extending to the pelvis. Simultaneous SIJ instrumentation and fusion decreases the risk of disability, prevents the development of postoperative SIJ pain, and may also protect the S2AI screw from loosening and failure.

Running gait biomechanics in female runners with sacroiliac joint pain.

[Purpose] To identify running gait biomechanics associated with sacroiliac (SI) joint pain in female runners compared to healthy controls. [Participants and Methods] In this case-control study, treadmill running gait biomechanics of female runners diagnosed SI joint pain, (by ultrasound-guided diagnostic SI joint injection and/or ≥2 positive SI physical exam maneuvers) were compared with age, height, mass, and BMI matched healthy female runners. Sagittal and coronal plane treadmill running video angles were measured and compared. [Results] Eighteen female runners with SI pain, and 63 matched controls, were analyzed. There was no difference in age, height, mass, or BMI between groups. At the point of initial contact, runners with SI joint pain demonstrated less knee flexion, greater tibial overstride, and greater ankle dorsiflexion, compared to controls. In midstance, runners with SI pain had greater contralateral pelvic drop compared to controls. For unilateral SI joint pain cases (N=15), greater contralateral pelvic drop was observed when loading their affected side compared to the unaffected side. [Conclusion] Female runners with SI joint pain demonstrated greater contralateral pelvic drop during midstance phase; along with less knee flexion, greater “tibial overstride”, and greater ankle dorsiflexion at initial contact compared to controls.

A Narrative Review of Anatomy and Clinical Biopsychosocial Assessment of Sacroiliac Joint Pain

Sacroiliac Joint (SIJ) pain is a severe disorder that affects 15% to 25% of individuals having axially low back pain. The most common causes of depressive symptoms are fear of movement, pain catastrophising, stress, and nervous system sensitisation. Recent research has shown that radiological imaging, are inadequate for diagnosing SIJ pain. For immersive and patient centred experiences, a comprehensive professional Biopsychosocial (BPS) physiotherapy evaluation is suggested. A new biopsychosocial model has been proposed that acknowledges all critical health and disease factors and promotes the interaction of biological, psychological, and social influences, but moves further than a narrow perspective. Psychosocial influences on well-being have generated an interest in physician services, physiotherapy evaluation, and implementation in a more systematic approach to a patient. This method is used to determine the current pain mechanism (predominant nociceptive, neuropathic, or non neuropathic central sensitisation pain) as well as the underlying pain mechanism. Patient’s biopsychosocial variables can establish and maintain SI discomfort. For a better plan of therapy to manage SIJ dysfunction, the biopsychosocial clinical assessment takes precedence over the examination of sacroiliac joint discomfort alone.

Manual Therapy Followed by Dynamic Strengthening Exercise Along With Conventional Physiotherapy Versus Manual Therapy Along With Conventional Physiotherapy on The Improvement of Pain and Functional Disability In Patients With Chronic Non-Specific Low Back Pain: A Randomized-Controlled Pilot Study

Chronic low back pain (LBP), defined as back pain persisting for more than 12 weeks, affects over 50% of the general population.[1] It is the second most common factor for patients in search of primary care services.[2]According to the US National Center for Health Statistics, 14% of new patients admitted to a hospital for treatment had low back pain, representing 13 million people.[3] Also, it is estimated that over 70% of adults have had at least one episode of LBP in their lifetime.[4]In 2007, another study revealed that lower back region pain is caused by disc degeneration, spondylolisthesis, lumbar stenosis, epidural hematoma, and other causes, and 3% of all patients discharged from hospitals have symptomatic low back pain.[5] Because the causes of LBP are variable, different exercise regimens have been used to treat patients, including lumbar flexion, extension, isometric flexion, passive extension, and intensive dynamic back exercise regimens, and many of these exercise regimens have not yielded satisfactory results.[6]Recently, some studies have focused on exercises that aim to maintain or improve lumbar spine stability, such as lumbar stabilization exercises, which are aimed at improving the neuromuscular control, strength, and endurance of the muscles that are fundamental to maintaining spinal and trunk stability through several groups of muscles, particularly transverse abdominis and lumbar multifidi, but also other paraspinal, abdominal, diaphragmatic, and pelvic muscles.[7] Unsubstantiated suggestions that stabilization training may be useful in reducing pain and disability for all patients with nonspecific LBP, have appeared in the literature,[8] but these assertions have not been definitively demonstrated. Weakness of the abdominal muscles among the trunk muscles of low back pain patients is generally prevalent, and the strengthening of the abdominal muscles is essential in the recovery of the spinal neutral position.[9] When imbalance between the abdominal muscles of the trunk and extensor muscles occurs, it triggers slow back pain and reduces stabilization of the lumbar.[10]The ability to actively control the muscles of the hip plays an important part in lumbar segmental stability. If the sacroiliac joint moves excessively, it results in pressure on the joints and disks between the L5–S1 vertebral body, sacroiliac joint, and pubic symphysis, which leads to functional failure of the sacroiliac joint and low back pain. This causes the gluteus maximus muscle to contract, creating a self-locking mechanism, thereby providing stability to the sacroiliac joint.[11]There are various forms of exercise that can be prescribed based on different schools of thought, which include intensive dynamic back extensor exercises (motor control exercises), yoga and aerobic exercises.[12]Graded strengthening exercises are aimed at improving the neuromuscular control, strength, and endurance of the muscles that are central to maintaining dynamic spinal and trunk stability. The effect of graded lumbar stabilization exercises has been studied in subjects with recurrent LBP (8). Dynamic strengthening exercises can strengthen the spinal column and supporting structures.[13] An electromyography study to compare recruitment of the rectus abdominis and erector spinae muscles during dynamic strengthening exercise revealed higher muscle activity in these muscles.[14]Therefore, the aim of this study is to compare the effects of graded lumbar strengthening exercises and lumbar dynamic strengthening exercises on the maximal isometric contraction strength of the lumbar extensors, pain severity, and functional disability in patients with nonspecific chronic LBP. According to many studies, the first step of the physiotherapy treatment pyramid is education of the patient.[15] In another study, researchers explored several research studies that included evidence on conservative treatments,[16] which included manual therapy or conservative physiotherapy, which included exercises, mobilization, McKenzie approach treatment, manipulation, strengthening programs, advice, and other manual therapy techniques, which have strong evidence of effectiveness for chronic low back pain patients.[17] According to a study,[18] rest and exercise are effective for low back pain patients.