Hamstring muscle strain treated by mobilizing the sacroiliac joint

The purpose of this study was to compare the effectiveness of two types of treatment of hamstring muscle strains. Twenty patients with hamstring muscle strains were assigned randomly to an Experimental Group (n = 10) or a Control Group (n = 10). Peak torque production of the quadriceps femoris and hamstring muscles and hamstring muscle length were measured before and after treatment. The hamstring muscles of the Experimental and Control groups were treated with moist heat followed by passive stretching. The Experimental Group also received manipulation of the sacroiliac joint. The change in hamstring muscle peak torque was significantly greater for the Experimental Group than for the Control Group (p less than .005). No significant differences existed between the two groups in either quadriceps femoris muscle peak torque or hamstring muscle length. The results of this study suggest a relationship between sacroiliac joint dysfunction and hamstring muscle strain.     

Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory

Abstract

Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.     

Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain

BackgroundThe Active Straight Leg Raise is a functional test used in the assessment of pelvic girdle pain, and has shown to have good validity, reliability and responsiveness. The Active Straight Leg Raise is considered to examine the patients' ability to transfer load through the pelvis. It has been hypothesized that patients with pelvic girdle pain lack the ability to stabilize the pelvic girdle, probably due to instability or increased movement of the sacroiliac joint. This study examines the movement of the sacroiliac joints during the Active Straight Leg Raise in patients with pelvic girdle pain.MethodsTantalum markers were inserted in the dorsal sacrum and ilium of 12 patients with long-lasting pelvic girdle pain scheduled for sacroiliac joint fusion surgery. Two to three weeks later movement of the sacroiliac joints during the Active Straight Leg Raise was measured with radiostereometric analysis.FindingsSmall movements were detected. There was larger movement of the sacroiliac joint of the rested leg's sacroiliac joint compared to the lifted leg's side. A mean backward rotation of 0.8° and inward tilt of 0.3° were seen in the rested leg's sacroiliac joint.InterpretationThe movements of the sacroiliac joints during the Active Straight Leg Raise are small. There was a small backward rotation of the innominate bone relative to sacrum on the rested leg's side. Our findings contradict an earlier understanding that a forward rotation of the lifted leg's innominate occur while performing the Active Straight Leg Raise.     

Abstracts: AAOMPT Conference, 2002

Abstract

Background/Purpose: The purpose of this case report is to describe the clinical management of a patient with sacroiliac joint dysfunction (SIJD) and a concomitant asymmetrical hip-joint rotation range of motion. The patient was a 53-year-old male whose chief complaint was right low back pain (LBP) that interfered with work and leisure activities. Physical therapy consisted of manual therapy, stretching, and postural education to address SIJ and hip motion abnormalities. At the conclusion of 6 visits, the hip-joint rotation range of motion was more symmetrical. The patient reported self-correction of unilateral standing and sitting postures. He returned to full-time work and to playing golf, and he rated pain at 0-1/10. This patient's asymmetrical hip-joint rotation range of motion may have been associated with SIJD, either as a result of trauma or subsequent habitual postural adjustments. Clinician awareness of the possible relationship between SIJD and asymmetrical hip joint rotation range of motion is recommended.     

Shifts in pelvic inclination angle and parasympathetic tone produced by Rolfing soft tissue manipulation

The effects of soft tissue manipulation (Rolfing method) were evaluated on young healthy men using two dependent variables: 1) angle of pelvic inclination and 2) parasympathetic activity. Pelvic inclination was assessed by determining the angle of standing pelvic tilt (SPT) with an inclinometer. Autonomic tone was assessed by a measure of cardiac vagal tone (amplitude of respiratory sinus arrhythmia) derived from monitoring heart rate. Thirty-two subjects, preselected for exhibiting an anteriorly tilted pelvis, were randomly assigned to either an Experimental Group (n = 16) that received a 45-minute Rolfing pelvic mobilization session or a Control Group (n = 16) that received a 45-minute control session without manipulation. Dependent variables were assessed before the 45-minute session, immediately after the session, and 24 hours later. Comparing pretest to posttest assessments, the Experimental Group demonstrated a significant decrease in SPT angle and a significant increase in vagal tone. The Control Group did not show significant pretest or posttest differences. The results provide theoretical support for the reported clinical uses of soft tissue pelvic manipulation for 1) certain types of low back dysfunction and 2) musculoskeletal disorders associated with autonomic stress.     

Effect of sacroiliac manipulation on postural sway in quiet standing: a randomized controlled trial

Background

Sacroiliac joint manipulation can alter joint and muscle control mechanisms through local and remote effects. Postural balance is controlled by supraspinal (rambling) and spinal–peripheral (trembling) mechanisms. A manipulation may interfere with postural control in quiet standing.

Adaptive Patterns of Movement during Downward Reach and Pick-up Movements in Knee Osteoarthritis Patients with Mild Low Back Pain

[Purpose] Patients with severe bilateral knee osteoarthritis (KOA) often suffer from low back pain (LBP). However, few studies have examined the relationship between LBP and KOA in downward reach and pick-up movements. [Subjects] Eight KOA patients with LBP (LBP group), 8 KOA patients without LBP (NLBP group), and 7 healthy participants (Control group), without osteoarthritis or low back pain, were recruited for this study. [Methods] All subjects were asked to pick up a bottle with one hand, placed at the diagonal on the opposite side of the body. A 3D motion analysis system was used to record trunk and lower limb movements. [Results] The knee flexion angle on the side ipsilateral to the bottle was significantly smaller in both KOA groups than in the controls in the downward reach and pick-up movements. KOA patients showed a significantly lower trunk flexion angle and greater pelvis anterior tilt angle than the controls. In addition, no significant differences were found between the LBP and NLBP group. [Conclusion] We suspect that severe knee pain due to OA determines the priority of movement in strategic planning for the execution of pick-up movements. The knee strategy was abandoned by our severe knee OA patients, even when they had mild LBP.Key words: Knee osteoarthritis, Low back pain, Pick-up movement     

The influence of hip abduction and external rotation on sacroiliac motion

Although the sacroiliac joint (SIJ) is conventionally accepted as a sagittal joint with little mobility in other planes, recent research has shown evidence for reduced hip abduction and axial rotation in patients with sacroiliac pain. A sample of healthy individuals was investigated to determine whether innominate motion about the sacroiliac joint can be predicted from abduction and external rotation displacement of the femur. The motion of the innominate and femur were tracked as the hip was passively rotated by standardized increments of 10° into (1) abduction; (2) external rotation; and (3) a combination of external rotation and abduction. Although sagittal and transverse plane innominate motion both increased significantly as the hip was rotated further into either abduction or external rotation, external rotation was the strongest predictor of change in innominate angle. A combination of external rotation and abduction led to greater increases in these innominate angles at a smaller degree of hip rotation. The results support the use of abduction and external rotation hip displacements (both singularly and in combination) for assessing SIJ mobility at least in the axes investigated. Further research that investigates the use of these tests in people with SIJ disorders is warranted.     

A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain

The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without manipulation. One hundred and thirty-one consecutive patients with LBP were randomly assigned to receive manipulation and an exercise intervention (n = 70) or an exercise intervention without manipulation (n = 61). Patients were classified as to whether they had experienced a worsening in disability upon follow-up. Relative risk and number needed to treat (NNT) statistics and associated 95% confidence intervals (CI) were calculated. Patients who completed the exercise intervention without manipulation were eight (95% CI: 1.1, 63.5) times more likely to experience a worsening in disability than patients who received manipulation. The NNT with manipulation to prevent one additional patient from experiencing a worsening in disability was 9.9 (95% CI: 4.9, 65.3) and 4 weeks with manipulation was 11.6 (95% CI: 5.2, 219.2). The results of this study offer an additional perspective for considering the risks and benefits of spinal manipulation and help to inform the integration of current evidence for spinal manipulation into healthcare policy.     

妇科腹腔镜手术患者术前访视与护理干预效果观察

目的探讨专科术前访视与术前护理干预在妇科腹腔镜手术患者中的应用效果。方法 120例拟行妇科腹腔镜手术的患者分为试验组和对照组。试验组由手术室护士对患者进行专科术前访视并进行护理干预,对照组由手术室护士对其进行常规访视。测量两组患者访视前后的焦虑值及麻醉前、术中心率、血压,术后进行护理满意度调查。结果干预后试验组患者的焦虑值,入手术室后的血压、心率均低于对照组,且护理满意度优于对照组,差异均有统计学意义(P<0.01)。结论专科术前访视与护理干预用于妇科腹腔镜手术患者术前访视效果明显,可以使患者具备更好的心理、生理条件配合手术,确保手术顺利进行。     

放松训练改善门诊慢性病患者的焦虑情绪和睡眠质量

目的 探讨减轻门诊慢性病患者焦虑情绪、改善睡眠质量的简单有效的护理方法.方法 将60例在门诊接受输液治疗并存在焦虑情绪和睡眠障碍的慢性病患者随机分为实验组和对照组各30例,对照组患者单纯按医嘱实施常规输液治疗,实验组在常规输液治疗的基础上给予放松训练干预,疗程4周,采用焦虑自评量表(SAS)和睡眠自测量表(AIS)分别于干预前后对患者进行测评.结果 干预后两组患者焦虑评分和睡眠评分比较,实验组明显低于对照组,差异有统计学意义(P＜0. 01),实验组的焦虑程度和睡眠障碍较对照组明显减轻.结论 放松训练可以改善门诊慢性病患者的焦虑情绪和睡眠质量.     

放松训练改善门诊慢性病患者的焦虑情绪和睡眠质量

目的探讨减轻门诊慢性病患者焦虑情绪、改善睡眠质量的简单有效的护理方法。方法将60例在门诊接受输液治疗并存在焦摩隋绪和睡眠障碍的慢性病患者随机分为实验组和对照组各30例,对照组患者单纯按医嘱实施常规输液治疗,实验组在常规输液治疗的基础上给予放松训练干预,疗程4周,采用焦虑自评量表（SAS）和睡眠自测量表（AIS）分别于干预前后对患者进行测评。结果干预后两组患者焦虑评分和睡眠评分比较,实验组明显低于对照组,差异有统计学意义（P〈0.01）,实验组的焦虑程度和睡眠障碍较对照组明显减轻。结论放松训练可以改善门诊慢性病患者的焦虑情绪和睡眠质量。     

放松训练改善门诊慢性病患者的焦虑情绪和睡眠质量

目的 探讨减轻门诊慢性病患者焦虑情绪、改善睡眠质量的简单有效的护理方法.方法 将60例在门诊接受输液治疗并存在焦虑情绪和睡眠障碍的慢性病患者随机分为实验组和对照组各30例,对照组患者单纯按医嘱实施常规输液治疗,实验组在常规输液治疗的基础上给予放松训练干预,疗程4周,采用焦虑自评量表(SAS)和睡眠自测量表(AIS)分别于干预前后对患者进行测评.结果 干预后两组患者焦虑评分和睡眠评分比较,实验组明显低于对照组,差异有统计学意义(P＜0. 01),实验组的焦虑程度和睡眠障碍较对照组明显减轻.结论 放松训练可以改善门诊慢性病患者的焦虑情绪和睡眠质量.     

Side-to-side weight-bearing asymmetry in subjects with low back pain

The purpose of this project was to determine if subjects with low back pain (LBP) exhibit greater side-to-side weight-bearing (WB) asymmetry compared to healthy control subjects without LBP. This study utilized an observational double cohort design and consisted of 35 subjects with LBP and 31 healthy control subjects. Side-to-side WB asymmetry was calculated as the average of the absolute value of the difference between the right and left lower extremity from three trials. The percentage of the average side-to-side WB asymmetry relative to the total body weight was calculated to normalize expected differences in magnitude of asymmetry based on a subject's total body weight. An 11-point numeric pain rating scale was used to represent the subject's current level of pain. Patients with LBP demonstrated significantly greater normalized side-to-side WB asymmetry than healthy control subjects (8.8% vs. 3.6%, respectively, P<0.001). In patients with LBP, higher magnitudes of side-to-side WB asymmetry were significantly associated with increased pain (r=0.39, P=0.021). In conclusion patients with LBP exhibited increased side-to-side WB asymmetry compared to healthy control subjects without LBP. This asymmetry was associated with increased levels of pain. This finding is relevant for planning future studies that will attempt to provide evidence for the construct validity of manipulation by determining if side-to-side WB asymmetry normalizes after a manipulation intervention and if this improvement is associated with improvements in pain and function.     

Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia

The pressure effects of Salter innominate osteotomy (SIO), a surgical treatment for developmental hip dysplasia (DHD), on the sacroiliac joint were investigated in a retrospective study. Pre- and post-operative direct anteroposterior pelvic radiographs of 60 cases with unilateral DHD treated by SIO were examined. The mean age at surgery was 27.7 months (range 18-48 months). The distance from the posterior inferior iliac spine to the midline (from the middle of the first sacral vertebra to the symphysis pubis) was measured. No difference was found between pre- and post-operative distances on the normal, non-operated side. On the operated side, no change was observed in 10 cases (16.7%), but the distance increased by 2 mm or 3 mm in 50 cases (83.3%) post-operatively. This increase was statistically significant, but not related to age at surgery. These findings indicate that SIO creates pressure on the inferior part of the sacroiliac joint, resulting in some displacement. Such irreversible changes may eventually lead to joint degeneration and pain.     

Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study

Orakifar N, Kamali F, Pirouzi S, Jamshidi F. Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study.ObjectiveTo determine whether sacroiliac joint (SIJ) manipulation decreases α-motoneuron activity and increases the pressure pain threshold (PPT) over the posterior superior iliac spine (PSIS) in healthy women.DesignQuasi-experimental study.SettingA university medical center.ParticipantsHealthy young women (N=20) aged 18 to 30 years were recruited from among the students of a university medical center after a request for volunteers.InterventionsJoint manipulation consisted of the supine rotational glide manipulation for the sacroiliac region. PPT measurements from the PSIS and Hoffman-reflex (H-reflex) amplitudes from the tibial nerve on the same side were recorded before and after joint manipulation. PPT was monitored for 15 minutes and H-reflex for 20 minutes after the procedure.Main Outcome MeasuresChanges in tibial nerve H-reflex amplitude and PPT values after SIJ manipulation.ResultsSIJ manipulation attenuated α-motoneuronal activity significantly (P<.05) but transiently, since the decrease was seen only for 20 seconds after the intervention. There was no positive significant difference in the PPT after SIJ manipulation at any time during postintervention follow-up.ConclusionsSIJ manipulation produced a transient attenuation of α-motoneuron excitability in healthy women. These findings demonstrate that our manipulation technique can lead to a short-term reduction in muscle tone as a result of changes in sensory discharge, predominantly in la afferents. SIJ manipulation did not significantly affect the PPT in healthy women.     

Short-term effect of muscle energy technique and mechanical diagnosis and therapy in sacroiliac joint dysfunction: A pilot randomized clinical trial

IntroductionSacroiliac joint dysfunction (SIJD) is a prominent source of pain in low back pain (LBP) patients. Tenderness inferior to the posterior superior iliac spine (PSIS) is an important sign presented in SIJD. Techniques including muscle energy technique (MET) and mechanical diagnosis and therapy (MDT) have shown benefits in SIJD. However, the effects of these treatments on tenderness and pain around the PSIS are yet to be determined.AimCompare and examine the preliminary short-term effect of MET and MDT on tenderness and pain around the PSIS in SIJD.MethodsTwenty patients, aged between 20 and 65 years and diagnosed with unilateral, sub-acute, or chronic SIJD, were screened for the inclusion criteria and were randomly allocated to the MET or the MDT group. Both the groups received treatment for four sessions over one week. Pain pressure threshold (PPT) and visual analogue scale (VAS) were determined by a blinded assessor on pre- and post-treatment basis.ResultsAlthough no significant differences were observed following the treatment between the groups, some statistically significant (p < 0.05) improvements were observed within each of the groups. No drop-outs and no adverse events were reported.ConclusionThe findings of the study suggest that both interventions may be equally effective in reducing symptoms around the PSIS. However, due to the small sample size, the results need to be interpreted cautiously. Future studies on larger sample size and long-term follow up are warranted.     

Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint

The biomechanics of the sacroiliac joint makes the pelvic segment responsible for proper weight distribution between lower extremities; however, it is known to be susceptible to altered mobility. The objective of this study was to analyze baropodometric responses following thrust manipulation on subjects with sacroiliac joint restrictions. Twenty asymptomatic subjects were submitted to computerized baropodometric analysis before, after, and seven days following sacroiliac manipulation. The variables peak pressure and contact area were obtained at each of these periods as the average of absolute values of the difference between the right and left foot based on three trials. Data revealed significant reduction only in peak pressure immediately after manipulation and at follow-up when compared to pre-manipulative values (p < 0.05). Strong correlation was found between the dominant foot and the foot with greater contact area (r = 0.978), as well as between the side of joint restriction and the foot with greater contact area (r = 0.884). Weak correlation was observed between the dominant foot and the foot with greater peak pressure (r = 0.501), as well as between the side of joint restriction and the foot with greater peak pressure (r = 0.694). The results suggest that sacroiliac joint manipulation can influence peak pressure distribution between feet, but contact area does not seem to be related to the biomechanical aspects addressed in this study.     

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Background

Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.