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Pain Physician May 2021Manual therapy, exercise therapy, and the combination of these 2 are common treatments for sacroiliac joint dysfunction syndrome. The effects of these treatments have... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Manual therapy, exercise therapy, and the combination of these 2 are common treatments for sacroiliac joint dysfunction syndrome. The effects of these treatments have been discussed in several studies; the superiority of one over the other for patients with sacroiliac joint dysfunction syndrome is still the subject of discussion.
OBJECTIVE
This study aims to assess the effects of manual therapy for sacroiliac joints, sacroiliac joints home-based exercises, and home-based lumbar exercises.
STUDY DESIGN
A comparative, prospective, single-blind, randomized, controlled trial.
SETTING
This trial was conducted at a single center at the Istanbul University, Istanbul Medical Faculty, Department of Physical Medicine and Rehabilitation.
METHODS
Within the scope of this study, 69 women diagnosed with sacroiliac joint dysfunction syndrome through specific sacroiliac joints clinical diagnostic tests were randomized into 3 groups. The first group was assigned manual therapy and a sacroiliac joints home-based exercise program (n = 23), the second group was assigned sacroiliac joints manual therapy and a home-based lumbar exercise program (n = 23), and the third group was assigned a home-based lumbar exercise program (n = 23). All patients who participated in the study were evaluated at the beginning of the study and on the twenty-eighth and ninetieth day.
RESULTS
All 3 groups showed a significant decrease in the sacroiliac joints -related pain parameter, which is checked with the visual analogue scale (P < 0.05) after the treatment. The Gillet test, Vorlauf test, Posterior Shear test, Compression test, and irritation Point tests after the treatment yielded a significant (P < 0.05) negative trend in all groups. Short Form-36 health survey for screening form, Modified Oswestry Pain Questionnaire, and Douleur Neuropathique 4 questions patient interview questionnaire for the assessment of neuropathic pain forms revealed a significant (P < 0.05) improvement in patients' complaints after the treatment in all 3 groups. Significant improvement in patients with sacroiliac joint dysfunction syndrome in all 3 groups was identified after the treatment.
LIMITATION
The absence of a healthy control group is one of the important limitations of the study.
CONCLUSIONS
Manual therapy is effective in the long term in sacroiliac joint dysfunction syndrome. Adding specific exercises for sacroiliac joints to the sacroiliac joints manipulation treatment further increases this effectiveness.
Topics: Exercise Therapy; Female; Humans; Low Back Pain; Musculoskeletal Manipulations; Prospective Studies; Sacroiliac Joint; Single-Blind Method
PubMed: 33988941
DOI: No ID Found -
Journal of Anatomy Dec 2012This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for... (Review)
Review
This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure.
Topics: Ankylosis; Biological Evolution; Female; Humans; Ligaments; Male; Models, Biological; Movement; Pelvis; Sacroiliac Joint; Sex Characteristics
PubMed: 22994881
DOI: 10.1111/j.1469-7580.2012.01564.x -
Acta Ortopedica Mexicana 2021The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain... (Review)
Review
The purpose of this review is to provide an overview of current literature on the diagnosis and treatment of sacroiliac pain. Designation as a source of lower back pain has been controversial; However, as knowledge about the joint increases, its role as a generator of chronic pain has become better elucidated. The literature states that sacroiliac joint is the cause of pain in up to 30% of patients. Clinically, diagnosing sacroiliac pain can be difficult to assess; However, pain semiology, patient posture/movement and manual testing are useful for making the presumptive diagnosis of sacroiliac dysfunction. The most effective diagnostic test is image-guided injection of anesthetic solutions into the joint, which is considered positive if there is at least 75% acute symptom relief. Treatment begins with physiotherapy and/or intra-articular infiltration of steroids. If these fails, a possible option is radiofrequency (rizotomy) denervation of the joint. If this does not provide adequate relief, surgery may be considered, in the form of fusion; various work supports favorable outcomes in selected patients.
Topics: Humans; Injections, Intra-Articular; Low Back Pain; Sacroiliac Joint
PubMed: 34480446
DOI: No ID Found -
Frontiers in Immunology 2022Ankylosing spondylitis (AS), a chronic condition that commonly influences the spine and sacroiliac joints, usually progresses to stiffness and progressive functional... (Review)
Review
Ankylosing spondylitis (AS), a chronic condition that commonly influences the spine and sacroiliac joints, usually progresses to stiffness and progressive functional limitation. Its fundamental etiology and pathogenesis are likely multifactorial and remain elusive. As environmental factors, gut microbiota performs critical functions in the pathogenesis of AS through various mechanisms, including interacting with genes, enhancing intestinal permeability, activating the gut mucosa immune system, and affecting the intestinal microbiota metabolites. This review provides an overview of recent advances in investigating gut microbiota in AS pathogenesis and discusses potential methods for future therapeutic intervention.
Topics: Humans; Spondylitis, Ankylosing; HLA-B27 Antigen; Gastrointestinal Microbiome; Sacroiliac Joint; Spine
PubMed: 36311749
DOI: 10.3389/fimmu.2022.1010572 -
Pain Physician Jan 2006The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and... (Review)
Review
The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.
Topics: Biomechanical Phenomena; Humans; Low Back Pain; Sacroiliac Joint
PubMed: 16700283
DOI: No ID Found -
Frontiers in Immunology 2022Spondyloarthritis (SpA) refers to a group of diseases with inflammation in joints and spines. In this family, ankylosing spondylitis (AS) is a rare but classic form that... (Review)
Review
Spondyloarthritis (SpA) refers to a group of diseases with inflammation in joints and spines. In this family, ankylosing spondylitis (AS) is a rare but classic form that mainly involves the spine and sacroiliac joint, leading to the loss of flexibility and fusion of the spine. Compared to other diseases in SpA, AS has a very distinct hereditary disposition and pattern of involvement, and several hypotheses about its etiopathogenesis have been proposed. In spite of significant advances made in Th17 dynamics and AS treatment, the underlying mechanism remains concealed. To this end, we covered several topics, including the nature of the immune response, the microenvironment in the articulation that is behind the disease's progression, and the split between the hypotheses and the evidence on how the intestine affects arthritis. In this review, we describe the current findings of AS and SpA, with the aim of providing an integrated view of the initiation of inflammation and the development of the disease.
Topics: Humans; Spondylitis, Ankylosing; Spondylarthritis; Sacroiliac Joint; Inflammation; Th17 Cells
PubMed: 36325352
DOI: 10.3389/fimmu.2022.996103 -
Journal of Clinical Rheumatology :... Dec 2021Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis... (Review)
Review
BACKGROUND
Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care-related costs, imposing a high burden on patients, their caregivers, and society.
SUMMARY OF WORK
Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA.
MAJOR CONCLUSIONS
A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA.
FUTURE RESEARCH DIRECTIONS
The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
Topics: Adult; Humans; Quality of Life; Rheumatologists; Sacroiliac Joint; Spine; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33105312
DOI: 10.1097/RHU.0000000000001575 -
Revista Da Associacao Medica Brasileira... Jul 2021This study aims to reveal the short-term effects of exercise therapy and manual therapy plus exercise therapy on pain, quality of life, and physical examination results...
OBJECTIVE
This study aims to reveal the short-term effects of exercise therapy and manual therapy plus exercise therapy on pain, quality of life, and physical examination results in the treatment of sacroiliac joint dysfunction syndrome (SIJDS).
METHODS
In this study, 64 patients who were participated were divided into two groups. The first group (exercise group) was assigned with the sacroiliac joint (SIJ) home exercise program and the second group (mobilization group) with the combined SIJ manual therapy and home exercise program. Physical examination tests, visual analog scale, and SF-36 evaluation were performed at the beginning of the study, at 24 h, at 1 week, and 1 month after the treatment.
RESULTS
Both groups showed that the rate of pain in the posttreatment, after the first week, and the first month; the presence of pain in the sacroiliac region; and VAS values of the patients with SIJDS compared to pretreatment values were clearly decreased (p<0.05). All tests performed in the SIJ physical examination showed significant improvement within both groups (p<0.05). However, there was no statistical difference between the two groups in 1-month period (p>0.05).
CONCLUSIONS
We found that the home exercise program and the manual therapy plus exercise program significantly improved pain intensity, quality of life, and the findings of specific tests in patients with SIJDS. In addition, superiority between the two groups in terms of pain intensity, quality of life, and specific tests was not determined.
Topics: Exercise Therapy; Humans; Musculoskeletal Manipulations; Pain Measurement; Quality of Life; Sacroiliac Joint; Treatment Outcome
PubMed: 34817514
DOI: 10.1590/1806-9282.20210436 -
Clinical and Experimental Rheumatology 2018Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The... (Review)
Review
Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The 2009 ASAS classification criteria differentiate between the classical ankylosing spondylitis or radiographic axSpA and non-radiographic axSpA based on the presence or absence of definite radiographic changes in the sacroiliac joints. Importantly, back pain in patients with axSpA may well have reasons other than axial inflammation or new bone formation. There are several important differential diagnoses such as diffuse idiopathic skeletal hyperostosis and osteitis condensans. This review summarises recent publications concerning the performance of imaging modalities in the field, such as conventional radiography, magnetic resonance imaging, computed tomography and dual energy x-ray absorptiometry including the trabecular bone score.
Topics: Back Pain; Diagnosis, Differential; Diagnostic Imaging; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results; Rheumatology; Sacroiliac Joint; Severity of Illness Index; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 30296971
DOI: No ID Found -
Pain Physician Jul 2018Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard'...
BACKGROUND
Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard' lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis.
OBJECTIVES
The purpose of this study was to examine the reliability of clinical examination and provocation tests used in the diagnosis of SIJD.
STUDY DESIGN
Retrospective analysis of prospectively collected data.
SETTING
Outpatient physical medicine and rehabilitation clinic.
METHODS
One hundred and seventeen patients presenting with lumbar and/or leg pain and diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated. Positivity in 3 out of 6 provocation tests was adopted as the criterion.
RESULTS
75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45 years. A higher level of females was determined in ender distribution. SIJD was determined on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen test. The same patients were assessed by the same clinician at 2 different times. In these data, the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of 0.92.
LIMITATION
Agreement between different observers was not evaluated, and also no comparison was performed with SI joint injection, regarded as a widely used diagnostic technique.
CONCLUSION
The anatomical position of the SI joint and the lack of a diagnostic 'gold standard' make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain provocation tests is a reliable method, and these tests can be used instead of unnecessary invasive diagnostic SI joint procedures.
KEY WORDS
Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain pattern.
Topics: Adult; Diagnosis, Differential; Female; Humans; Low Back Pain; Male; Middle Aged; Neurologic Examination; Pain Measurement; Palpation; Reproducibility of Results; Retrospective Studies; Sacroiliac Joint
PubMed: 30045603
DOI: No ID Found