Low back pain of SI origin, what do the kinematics say?
Due to its complexity, the diagnosis and effective treatment of low back pain (LBP) is often difficult due to the lack of knowledge regarding its contributing factors. Therapists often treat the sacroilliac joint (SI) as a possible source or catastrophizing factor in patients with non-specific low back pain. Despite this, little is known regarding the kinematic differences in patients with LBP of SI origin versus those without SI involvement. The present study was undertaken to accurately determine the innominate movement patterns between these two populations. The authors concluded that SIJ-positive participants had differing trends of rotation and movement but not gross range of motion when compared to their SIJ-negative counterparts.
Participants between the ages of 18 and 50 years old were evaluated by a physiotherapist blinded to the study. Patients were classified into either SIJ-positive or negative groups if they tested positive for 3 SI joint provocation tests. Kinematics were then evaluated using an electromyographic palpation-digitization technique during a prone hip abduction-external rotation test.
The current single-blinded case-control study sought to shed new light into the movement patterns of the innominate bone and how it varies between those patients with LBP of SI-origin and those without.
It was shown that SIJ-negative individuals demonstrate movement trending linearly in the sagittal plane whereas SIJ-positive trends less in the sagittal plane and more in the transverse plane. Furthermore, SIJ-positive individuals demonstrated these movements primarily unilaterally where as SIJ-negative demonstrated them unilaterally and non-unilaterally equally. Taken together, the current study has further solidified our knowledge base into the mechanics of LBP and how we can begin focusing our treatment in patients with confirmed SI joint involvement.
How do you determine involvement of the SIJ in low back pain in your daily practice? What specific tests (test clusters) do you use?
> From: Adhia et al., Man Ther 3 (2015) 9. All rights reserved to Elsevier Ltd.. Click here for the Pubmed summary.